文章摘要
吴素娟,郑淑英,周 燕,申玲君,黄秋霞.血液透析患者导管相关性血流感染的病原菌、耐药性以及影响因素分析[J].,2020,(12):2284-2288
血液透析患者导管相关性血流感染的病原菌、耐药性以及影响因素分析
Analysis of Pathogenic Bacteria, Drug Resistance and Influencing Factors of Catheter-related Bloodstream Infection in Hemodialysis Patients
投稿时间:2010-01-23  修订日期:2020-02-17
DOI:10.13241/j.cnki.pmb.2020.12.017
中文关键词: 血液透析  导管相关性血流感染  病原菌分布  耐药性
英文关键词: Hemodialysis  Catheter related bloodstream infection  Distribution of pathogenic bacteria  Drug resistance
基金项目:广东省医学科研基金项目(B20161460)
作者单位E-mail
吴素娟 暨南大学附属第一医院血液透析中心 广东 广州 510630 wsj8421@163.com 
郑淑英 暨南大学附属第一医院血液透析中心 广东 广州 510630  
周 燕 暨南大学附属第一医院血液透析中心 广东 广州 510630  
申玲君 暨南大学附属第一医院血液透析中心 广东 广州 510630  
黄秋霞 暨南大学附属第一医院血液透析中心 广东 广州 510630  
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中文摘要:
      摘要 目的:研究血液透析患者导管相关性血流感染(CRBSI)的病原菌、耐药性以及影响因素。方法:将我院从2018年1月~2019年1月收治的100例CRBSI血液透析患者纳入研究,记作感染组。通过细菌培养分析病原菌分布情况,以药敏试验观察主要病原菌对常见抗菌药物的耐药性。另取同期于我院接受血液透析未发生CRBSI的患者100例作为无感染组,比较两组临床病理资料,并对血液透析患者CRBSI发生的影响因素进行多因素Logistic回归分析。结果:100例CRBSI患者共分离获取病原菌118株,按照占比从高到低的顺序依次是金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌、粪肠球菌、鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、其它病原菌,占比依次为25.42%、16.95%、15.25%、12.71%、9.32%、8.47%、7.63%、4.24%。金黄色葡萄球菌以及表皮葡萄球菌对万古霉素、替加环素的耐药率均为0.00%,且金黄色葡萄球菌对莫西沙星、庆大霉素的耐药率亦为0.00%。感染组合并基础疾病、导管留置时间≥2周以及股静脉插管人数占比高于无感染组(P<0.05)。经多因素Logistic回归分析可得:合并基础疾病以及插管部位为股静脉均是血液透析患者CRBSI的独立危险因素(OR=2.006、1.390,P<0.05)。结论:血液透析患者CRBSI病原菌主要为金黄色葡萄球菌、表皮葡萄球菌,上述两种病原菌对万古霉素、替加环素较为敏感,其中金黄色葡萄球菌对莫西沙星以及庆大霉素亦较为敏感。合并基础疾病,股静脉插管均会增加CRBSI发生的风险,值得临床重点关注。
英文摘要:
      ABSTRACT Objective: To study the pathogenic bacteria, drug resistance and influencing factors of catheter-related bloodstream infection (CRBSI) in hemodialysis patients. Methods: 100 patients with CRBSI hemodialysis who were admitted to our hospital from January 2018 to January 2019 were included in the study, which was referred to as the infection group. Bacterial culture was used to analyze the distribution of pathogenic bacteria, and drug sensitivity test was used to observe the resistance of main pathogenic bacteria to common antimicrobial drugs. In addition, 100 patients without CRBSI who received hemodialysis in our hospital during the same period were selected as the non-infection group. The clinical medical records of the two groups were compared, and the relationship between CRBSI occurrence and related factors in hemodialysis patients was analyzed by multivariate Logistic regression. Results: A total of 118 strains of pathogenic bacteria were isolated from 100 patients with CRBSI. In the order of proportion from high to low, staphylococcus aureus, staphylococcus epidermidis, escherichia coli, enterococcus faecalis, acinetobacter baumannii, pseudomonas aeruginosa, klebsiella pneumoniae, other pathogens, the proportions were 25.42%, 16.95%, 15.25%, 12.71%, 9.32%, 8.47%, 7.63% and 4.24% respectively. The drug resistance rate of staphylococcus aureus and staphylococcus epidermidis to vancomycin and tegacycline was 0.00%, and the drug resistance rate of staphylococcus aureus to moxifloxacin and gentamicin was also 0.00%. Infection group combination and basic diseases, catheter indwelling time ≥2 weeks, and the proportion of the number of patients intubated in femoral vein was higher than that in the non-infection group (P < 0.05). According to the multivariate Logistic regression analysis, the combination of basic diseases and femoral vein at the intubation site were independent risk factors for CRBSI in hemodialysis patients (OR=2.006, 1.390; P < 0.05). Conclusion: The main pathogens of CRBSI in hemodialysis patients are staphylococcus aureus and staphylococcus epidermidis, and the above two pathogens are more sensitive to vancomycin and tegacycline, staphylococcus aureus are also sensitive to moxifloxacin and gentamicin. In addition, combined with basic diseases, prolonged femoral venous intubation and catheter indwelling time all increase the risk of CRBSI, which are worthy of clinical attention.
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