摘要
目的分析经中心静脉导管(CVC)血液透析患者导管相关性血流感染(CRBSI)的病原菌分布、耐药性及相关因素,为医院感染预防和控制工作提供客观依据。方法选取2012年1月-2016年12月经CVC血液透析治疗的患者146例作为研究对象,对其CRBSI的发生率、临床资料、血液指标及发生CRBSI患者CVC血液样本中的病原菌分布、耐药性进行观察和比较。结果有61例患者发生CRBSI,感染率为41.8%;logistic多元回归分析显示,合并糖尿病、NE≥70%、sCr≥750μmol/L、RBC<3×1012/L、Alb<35g/L、Hb<90g/L是CVC血液透析患者发生CRBSI的独立危险因素(P<0.05);分离出67株病原菌,其中,革兰阳性菌40株占59.70%、革兰阴性菌25株占37.31%、真菌2株占2.99%;革兰阳性菌对青霉素G等药物的耐药率较高,革兰阴性菌对头孢曲松等药物的耐药率较高。结论 CVC血液透析合并CRBSI的病原菌分布、耐药性和相关危险因素具有一定的特征性,临床医务人员应对其进行准确的识别和有效的干预,选用敏感抗菌药物进行抗感染治疗,从而降低血液透析患者导管相关性血流感染的发生率。
OBJECTIVE To investigate the distribution and drug resistance of pathogens causing catheter-related bloodstream infection（CRBSI）in central venous catheter（CVC）hemodialysis patients and analyze the related factors,so as to provide guidance for prevention and control of nosocomial infections.METHODS A total of 146 patients who received the CVC hemodialysis from Jan.2012 to Dec.2016 were recruited as the study objects.The incidence of CRBSI,clinical data,blood indexes and distribution and drug resistance of pathogens isolated from blood specimens were observed and compared.RESULTS Totally 61 cases of patients had CRBSI,with the infection rate of 41.8%.Multivariate logisticregression analysis indicated that complication with diabetes mellitus,NE no less than 70%,sCr no less than 750μmol/L,RBC less than 3×1012/L,Alb less than 35 g/L and Hb less than90 g/L were independent risk factors for CRBSI in CVC hemodialysis patients（P〈0.05）.Totally 67 strains of pathogens were isolated,of which 40 strains（59.70%）were gram-positive bacteria,25 strains（37.31%）were gram-negative bacteria,and 2 strains（2.99%）were fungi.The gram-positive bacteria were highly resistant to penicillin G,and the gram-negative bacteria were highly resistant to ceftriaxone.CONCLUSION The distribution and drug resistance of the pathogens and the related risk factors show certain characteristics in the CVC hemodialysis patients complicated with CRBSI.It is necessary for clinicians to carry out accurate identification,take effective interventions and use sensitive antibiotics for treatment of the infections,so as to reduce the incidence of CRBSI in the hemodialysis patients.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第21期4891-4894,共4页
Chinese Journal of Nosocomiology
基金
安徽省卫生厅基金资助项目(2014ZY30)
关键词
中心静脉导管
血液透析
导管相关性血流感染
病原菌分布
耐药性分析
相关因素分析
Central venous catheter
Hemodialysis
Catheter-related bloodstream infection
Distribution of pathogen
Analysis of drug resistance
Analysis of related factors
