强制性感染管控措施对维持性血液透析患者血管导管相关感染的影响  

The impact of mandatory infection control measures on catheter-related infections in maintenance hemodialysis patients

作　　者：曾艳[1] 陈友明[1] 田洁[1] 郑晓艳[1] ZENG Yan;CHEN Youming;TIAN Jie;ZHENG Xiaoyan(Blood Purification department,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院血液净化科,福州市350001

出　　处：《临床合理用药杂志》2024年第1期22-26,30,共6页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的 分析强制性感染管控措施对维持性血液透析患者发生血管导管相关感染(VCAI)的群体特征、感染率、病原菌及药敏的影响,为临床治疗提供指导。方法 选取2019年3月—2021年2月福建省立医院收治的维持性血液透析患者567例,其中施行强制性管控前(2019年3月—2020年2月)患者295例,施行强制性管控后(2020年3月—2021年2月)患者272例。收集管控前后2组患者的基本信息(包括年龄、性别、置管部位)以及病原学检查结果,对管控前后VCAI群体特征变化、感染率、病原学结果及药敏结果进行比较分析。结果 管控后感染率为10.29%(28/272),低于管控前的16.27%(48/295),差异有统计学意义(χ^(2)=4.356,P=0.037)。管控后患者平均年龄较管控前更高(Z=-6.889,P<0.01)。管控前分离出病原菌58株,以革兰阳性菌为主,占63.79%,管控后分离出病原菌33株,革兰阴性菌为主,占54.55%,管控后革兰阳性菌感染较前有明显下降(χ^(2)=3.899,P=0.048)。管控前检出多重耐药菌28株(48.28%),管控后检出多重耐药菌23株(69.70%)。革兰阳性菌对利奈唑胺、万古霉素敏感;对环丙沙星、克林霉素、红霉素、左氧氟沙星、莫西沙星、苯唑西林耐药率均>50%;青霉素、庆大霉素耐药严重,但分别对粪肠球菌及金黄色葡萄球菌效果突出。革兰阴性菌对厄他培南、亚胺培南、头孢吡肟耐药率较低;青霉素、阿莫西林、头孢唑林、头孢西丁、复方磺胺甲口恶唑耐药率>50%;替加环素对阴性、阳性菌均覆盖良好,且未发现耐药菌。结论 强制性感染管控是行之有效的VCAI防控措施,在目前已形成习惯的基础上可常态化保持。管控后感染人群年龄增大,革兰阳性致病菌检出率下降,多重耐药菌检出率上升,故应加强老年患者的管理,优选颈内静脉作为置管部位并注意抗生素的合理使用。临床推荐利奈唑胺、万古霉素、替加环素作为经验性全身用药,抗�Objective To analyze the impact of mandatory infection control measures on the demographic characteristics,infection rates,causative pathogens,and antimicrobial susceptibility of the population at risk for vascular catheter-associated infection(VCAI)in maintenance hemodialysis patients,aiming to provide guidance for clinical treatment.Methods A total of 567 maintenance hemodialysis patients admitted to Fujian Provincial Hospital,from March 2019 to February 2021 were selected.Among them,295 patients were treated before implementing mandatory control measures(March 2019—February 2020),and 272 patients were treated after implementing mandatory control measures(March 2020—February 2021).The basic information(age,gender,catheter placement site)and microbiological examination results of the two groups before and after the control measures were collected.A comparison and analysis were conducted on the changes in demographic characteristics,infection rates,microbiology findings,and drug susceptibility test results between the pre-control and post-control VCAI population.Results The post-control infection rate was 10.29%(28/272),which was lower than the pre-control rate of 16.27%(48/295)with a statistically significant difference(χ^(2)=4.356,P=0.037).The average age of patients after control measures was higher compared to before(Z=-6.889,P<0.01).Prior to control measures,58 strains of pathogens were isolated,primarily Gram-positive bacteria accounting for 63.79%.After control measures,33 strains of pathogens were isolated,predominantly Gram-negative bacteria accounting for 54.55%.There was a significant decrease in Gram-positive bacterial infections after control measures(χ^(2)=3.899,P=0.048).Before control measures,28 strains of multidrug-resistant bacteria were detected(48.28%),whereas after control measures,23 strains of multidrug-resistant bacteria were detected(69.70%).Gram-positive bacteria showed sensitivity to linezolid and vancomycin,while resistance rates were over 50%for ciprofloxacin,clindamycin,erythro

关 键 词：导管相关性感染 维持性血液透析 病原菌 耐药性 

分 类 号：R692.5[医药卫生—泌尿科学]