维持性血液透析患者非住院期导管相关性血流感染的病原菌特征与预后风险因子研究  

Pathogen characteristics and prognostic risk factors for non-hospitalcatheter-related bloodstream infections in maintenance hemodialysis patients

作　　者：郁颜旭 时智敏 李萍[2] 苏长敏[1] YU Yanxu;SHI Zhimin;LI Ping;SU Changmin(l.Blood Purification Centre,Lianyungang First People's Hospital,Lianyungang 222002,Jiangsu,China;Infection Management Department,Lianyungang First People's Hospital)

机构地区：[1]连云港市第一人民医院血液净化中心,江苏连云港222002 [2]连云港市第一人民医院感染管理科

出　　处：《中国病原生物学杂志》2025年第3期287-291,共5页Journal of Pathogen Biology

基　　金：连云港市科协软课题研究项目(No.Lkxyx2317)。

摘　　要：目的探索维持性血液透析患者非住院期导管相关性血流感染(CRBSI)的病原菌特征和药敏结果,同时利用列线图模型分析影响预后风险因子。方法回顾性分析的305例维持性血液透析患者均在2021年1月至2023年12月期间收集,根据有无感染分为两组,即感染组(n=42,发生CRBSI),未感染组(n=263,未发生CRBSI),比较两组基本资料后,经二元Logistic回归分析影响感染的独立因素,且针对感染患者,需重点分析病原菌分布情况以及药敏结果。结果305例维持性血液透析患者,42例(13.77%)发生导管相关性血流感染,以革兰阳性菌最为常见,所占比61.90%。金黄色葡萄球菌和表皮葡萄球菌对利奈唑胺、万古霉素表现出高度敏感,可作为首选抗菌药。同时,经二元Logistic回归分析,年龄>60岁、存在贫血是影响维持性血液透析患者发生CRBSI的危险因素,导管留置时间、空腹血糖是保护因素,且利于预测模型和列线图分析,C-index为0.95,决策曲线显示,该模型的阈值概率范围为70%~95%,其净收益率>0,真实值和预测值吻合度绝对误差为0.015,AUC为0.850,95%CI0.785~0.915,结果均说明该模型预测能力较好。结论革兰阳性菌是维持性血液透析患者非住院期CRBSI主要病菌,同时,CRBSI易受到年龄、导管留置时间、血糖、贫血等因素影响,因此需重视感染相关防控措施,合理选择抗菌药物。Objective To explore the pathogen characteristics and drug susceptibility results of catheter-related bloodstream infection(CRBSI)in maintenance hemodialysis patients,and to analyze the outcome risk factors using nomogram model.Methods The 305 maintenance hemodialysis patients were collected from January 2021 to December 2023 and were divided into two groups according to the presence of infection,namely infected group(n=42,CRBSI)and uninfected group(n=263,no CRBSI).After comparing the basic data of the two groups,the independent factors affecting infection,and the distribution of pathogen and drug susceptibility results should be analyzed.ResultsIn305 maintenance hemodialysis patients,42 patients(13.77%)had catheter-related bloodstream infection,and gram-positive bacteria were the most common,accounting for 61.9o%.Staphylococcus aureus and Staphylococcus epidermidis are highly susceptible to linezolid and vancomycin and can be used as preferred antimicrobials.Meanwhile,according to binary Logistic regression analysis,age>60 years and anemia were the risk factors affecting CRBSI in maintenance hemodialysis patients,catheter retention time and fasting blood glucose were protective factors,conducive to the prediction model and nomogram analysis,C-index was 0.95,the decision curve showed that the threshold probability range was 70%to 95%,its net yield was>0,the absolute error between true and predicted value was 0.015,AUC was 0.850,95%CI 0.785-0.915,which showed that the model has good predictive ability.Conclusion Gram-positive bacteria are the main bacteria of CRBSI in non-hospitalized maintenance hemodialysis patients.Meanwhile,CRBSI is susceptible to age,catheter retention time,blood glucose,anemia and other factors,so we should pay attention to infection prevention and control measures and rationally choose antimicrobial drugs.

关 键 词：维持性血液透析 导管相关性血流感染 病原菌 特征 预后 风险因子 

分 类 号：R47[医药卫生—护理学]