血液透析患者导管相关性血流感染的危险因素及其预测模型构建  

Risk factors of catheter-related bloodstream infection in hemodialysis patients and construction of prediction model

作　　者：李道新[1] 熊飞[2] 李红兵[1] 吴爱纯[1] 李红波[1] LI Dao-xin;XIONG Fei;LI Hong-bing;WU Ai-chun;LI Hong-bo(Wuhan First Hospital,Wuhan,Hubei 430022,China)

机构地区：[1]武汉市第一医院血液透析室,湖北武汉430022 [2]武汉市第一医院肾内科,湖北武汉430022

出　　处：《中华医院感染学杂志》2023年第3期368-371,共4页Chinese Journal of Nosocomiology

基　　金：武汉市卫生健康委基金资助项目(WX21B20)。

摘　　要：目的 分析血液透析患者导管相关性血流感染(CRBSI)的危险因素及其预测模型的构建。方法 选取2019年1月-2021年1月武汉市第一医院收治的180例行血液透析的中心静脉留置导管患者为研究对象,根据有无CRBSI发生分为感染组(n=20)和非感染组(n=160),分析CRBSI病原菌和耐药性,并收集两组一般资料,采用Logistic分析影响血液透析患者CRBSI的危险因素,建立感染预测模型,并绘制受试者工作特征(ROC)曲线评估模型预测效果。结果 180例行血液透析患者中,20例发生CRBSI,发生率为11.11%;患者均表现为畏寒、发热、寒战、厌食及纳差等症状,且体温>38℃,并伴有呼吸急促及心率加快;少数患者伴有导管口红、肿及脓性分泌物渗出;20例CRBSI患者共培养分离病原菌34株,其中革兰阴性菌17株占50.00%,革兰阳性菌14株占41.18%,真菌3株占8.82%,以大肠埃希菌和金黄色葡萄球菌为主;主要革兰阳性菌对青霉素、氨苄西林耐药率较高(>70%);主要革兰阴性菌对氨苄西林、阿莫西林耐药率较高(>58%);Logistic多因素分析显示,导管留置时间、白蛋白(ALB)是血液透析患者CRBSI发生的危险因素(P<0.05);ROC曲线指标Prob的灵敏度为83.30%,特异度为65.00%,曲线下面积(AUC)为0.821,说明模型具有较好的预测价值(P<0.05)。结论 血液透析患者并发CRBSI的危险因素与导管留置时间和ALB水平有关,以此为基础构建预测模型,能有效筛选血液透析并发CRBSI的高危人群。OBJECTIVE To analyze the risk factors of catheter-related bloodstream infection(CRBSI) in hemodialysis patients,and the construction of its prediction model.METHODS A total of 180 patients with central venous indwelling catheters who underwent hemodialysis in Wuhan First Hospital from Jan.2019 to Jan.2021 were selected as the study subjects,and were divided into infection group(n=20) and non-infection group(n=160) according to the presence or absence of CRBSI.Pathogenic bacteria and drug resistance of CRBSI were analyzed,and general data of the two groups were collected.Logistic regression was used to analyze the influencing factors of CRBSI in hemodialysis patients,a prediction model of infection was established,and its predictive performance was assessed with the receiver operating characteristic(ROC) curve.RESULTS Among the 180 hemodialysis patients,there were 20 patients with CRBSI,with an incidence rate of 11.11%.All patients had symptoms such as intolerance of cold,fever,shivering,anorexia and poor appetite,and body temperature >38 ℃,accompanied by shortness of breath and rapid heart rate.A few patients had redness,swelling,pain and secretion exudation at catheter site.A total of 34 pathogen strains were isolated from the 20 patients with CRBSI,of which 17 strains of Gram-negative bacteria accounted for 50.00%,14 strains of Gram-positive bacteria accounted for 41.48%,and 3 strains of fungi accounted for 8.82%,mainly Escherichia coli and Staphylococcus aureus.The resistance rates of main Gram-positive bacteria to penicillin and ampicillin were relatively high(>70%),and the resistance rates of main Gram-negative bacteria to ampicillin and amoxicillin were relatively high(>58%).Multivariate logistic regression analysis showed that catheter indwelling time and decreased ALB were risk factors for the occurrence of CRBSI in hemodialysis patients(P<0.05).The sensitivity,specificity and area under the curve(AUC) of ROC curve indicator Prob were 83.30%,65.00% and 0.821,respectively,indicating that the model was of

关 键 词：血液透析 导管相关性血流感染 病原菌 危险因素 预测模型 

分 类 号：R459.5[医药卫生—治疗学]