血液透析患者中心静脉置管相关血流感染的病原学特点和影响因素  

Etiological characteristics and influencing factors for central venous catheter-related bloodstream infection in hemodialysis patients

作　　者：周建平[1] 黄文[1] 郑淑瑛[1] 胡瑜[1] 陈海燕[1] 胡艳艳 ZHOU Jian-ping;HUANG Wen;ZHENG Shu-ying;HU Yu;CHEN Hai-yan;HU Yan-yan(Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第二医院肾内科,浙江温州325000

出　　处：《中华医院感染学杂志》2023年第9期1338-1341,共4页Chinese Journal of Nosocomiology

基　　金：浙江省科技计划项目(20191142376)。

摘　　要：目的分析血液透析(HD)患者中心静脉置管相关血流感染的病原学特点和影响因素。方法选取2020年1月-2021年4月温州医科大学附属第二医院198例中心静脉置管HD患者为研究对象,根据患者是否发生血流感染分为感染组15例和未感染组183例。分析血流感染病原菌分布,采用Logistic回归分析中心静脉置管HD患者发生血流感染的影响因素。结果15例感染患者血培养共分离出23株病原菌,分离菌株以革兰阳性菌为主,其中金黄色葡萄球菌占比43.48%、表皮葡萄球菌占比8.69%;中心静脉置管HD患者发生血流感染与年龄、体质量指数、合并糖尿病、实验室指标水平、抗菌药物使用及中心静脉置管时间有关(P<0.05);多因素Logistic回归分析显示,年龄≥65岁、合并糖尿病、ALB<35g/L、置管时间≥7d均为中心静脉置管HD患者发生血流感染的独立影响因素。结论中心静脉置管HD患者血流感染的病原菌主要为革兰阳性菌,中心静脉置管HD患者发生血流感染与年龄、合并糖尿病、ALB水平、置管时间紧密相关。OBJECTIVE To explore the etiological characteristics and influencing factors for central venous catheter-related bloodstream infection in hemodialysis(HD)patients.METHODS A total of 198 HD patients who were treated with central venous catheterization in the Second Affiliated Hospital of Wenzhou Medical University from Jan 2020 to Apr 2021 were recruited as the research subjects and were divided into the infection group with 15 cases and the no infection group with 183 cases according to the status of bloodstream infection.The distribution of pathogens causing the bloodstream infection was observed,and logistic regression analysis was performed for the influencing factors for the bloodstream infection in the HD patients.RESULTS Totally 23 strains of pathogens were isolated from blood specimens of the 15 patients with the infection.Gram-positive bacteria were dominant among the isolated pathogens,among which Staphylococcus aureus accounted for 43.48%,Staphylococcus epidermidis accounted for 8.69%.The incidence of bloodstream infection in the central venous catheterization HD patients was associated with the age,body mass index,complication with diabetes mellitus,laboratory test indexes,use of antibiotics and central venous catheter indwelling time(P<0.05).Multivariate logistic regression analysis showed that the no less than 65 years of age,complication with diabetes mellitus,ALB less than 35 g/L and catheter indwelling time no less than 7 days were the independent influencing factors for the bloodstream infection in the HD patients.CONCLUSION The gram-positive bacteria are dominant among the pathogens isolated from the central venous catheterization HD patients with bloodstream infection.The incidence of bloodstream infection in the HD patients is closely associated with the age,complication with diabetes mellitus,ALB level and catheter indwelling time.

关 键 词：血液透析 中心静脉置管 血流感染 病原菌 影响因素 

分 类 号：R459.5[医药卫生—治疗学]