中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (05): 315-318.doi: 10.3969/j.issn.1671-4091.2016.05.015

• 血管通路 • 上一篇    下一篇

临时中心静脉导管感染的病原菌变化及危险因素分析

庞玉洪1,赵建明1,陈抗侵1,牟爱华1,毛界1,徐智会2   

  1. 1重庆市涪陵中心医院肾内科
    2重庆市綦江区人民医院重症医学科
  • 收稿日期:2015-11-23 修回日期:2016-03-05 出版日期:2016-05-12 发布日期:2016-05-19
  • 通讯作者: 赵建明 zhaojianmingfl@163.com E-mail:xiongyizy01@163.com
  • 基金资助:

    重庆市卫生计生委医学科研计划项目(20143062)

Change of pathogens and risk factors for temporary central venous catheter-related infection

  • Received:2015-11-23 Revised:2016-03-05 Online:2016-05-12 Published:2016-05-19

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摘要： 目的观察血液透析中心静脉导管相关感染的病原菌分布、药敏情况及危险因素，为导管相关感染的防治提供临床依据。方法回顾性分析2012 年05 月至2015 年05 月在本院通过中心静脉置管行血液透析治疗的450 例患者临床资料，将其分为感染组与非感染组。其中46 例患者发生导管相关感染，分析其病原菌分布、耐药性及相关危险因素。结果革兰阳性菌为导管相关感染的主要致病菌(66.7%)，其主要以金黄色葡萄球菌(19.6%)、表皮葡萄球菌(15.7%)、溶血葡萄球菌(11.8%)、粪肠球菌(9.8%)为主。药敏试验结果显示病原菌对临床常用抗菌药物普遍耐药，对青霉素、阿莫西林、克林霉素、及头孢唑林等耐药率较高(耐药率＞79.3%)；而对万古霉素和利奈唑胺较敏感(耐药率0～20.7%)。发现感染组与非感染组在年龄(χ2=5.985，P=0.045)、白蛋白水平(χ2=8.535，P=0.017)、插管前抗生素使用情况(χ2=5.865，P=0.046)、插管次数(χ2=11.074，P=0.008)、导管留置时间(χ2=11.861，P=0.004)、是否合并基础疾病(χ2=11.264，P=0.007)方面，差异具有统计学意义；logistic 回归分析显示，白蛋白水平＜35g/L(OR 1.732，95% CI 1.042～2.995，P=0.018)、插管次数≥3 次(OR 2.011，95% CI 1.084～3.123，P=0.011)、导管留置时间≥2 周(OR 1.873，95% CI 1.108～2.921，P=0.010)及有基础疾病(OR 1.793，95% CI 1.075～2.863，P=0.013)为导管相关感染发生的独立危险因素。结论中心静脉导管相关感染的发生与多种影响因素有关，其致病菌主要以革兰阳性菌为主，对常用抗生素普遍耐药，临床上应根据病原菌分布、药敏试验结果及相关危险因素，合理选用抗生素，同时积极采取综合防治措施，降低导管相关感染的发生率。

关键词: 血液透析, 静脉导管, 感染, 危险因素, 耐药性

Abstract: Objective To investigate the change of pathogens, drug sensitivity and risk factors of central venous catheter-related infection in hemodialysis patients in order to improve the prevention of catheter-related infection. Methods The main pathogens for catheter- related infection were Gram- positive bacteria (66.7% ) including Staphylococcus aureus (19.6% ), Staphylococcus epidermidis (15.7% ), S.haemolyticus (11.8%) and Enterococcus faecalis (9.8%). Drug sensitivity test showed that these pathogens developed the resistance to multiple drugs including penicillin, amoxicillin, clindamycin and cefazolin with a resistance rate
of >79.3%, and were relatively sensitive to vancomycin and linezolid (resistance rate of 0～20.7%). Results showed that albumin level (χ2=5.985, P=0.045), antibiotics before catheterization (χ2=8.535, P=0.017), intubation times (χ2=11.074, P=0.008), catheter indwelling time (χ2=11.861, P=0.004) and underlying disease (χ2=11.264, P=0.007) were significant different between infection group and non-infection group (P＜0.05). Logistic regression showed that albumin level ＜35g/L (OR 1.732, 95% CI 1.084～3.123, P=0.018), intubation times ≥3 (OR 2.011, 95% CI 1.084～3.123, P=0.011), catheter indwelling time ≥2 weeks (OR 1.873, 95% CI 1.108～2.921, P=0.010) and underlying disease (OR 1.793, 95% CI 1.075～2.863, P=0.013) were the independent risk factors for catheter-related infection in patients undergoing blood purification. Results The incidence of catheter-related infection is affected by many factors. The main pathogens for catheter-related infection are Gram-positive bacteria and have the resistance to multiple drugs. In addition to the judicious use of antibiotics and prevention measures, the information about the distribution of pathogens, drug sensitivity test and related risk factors is also useful for the prevention and treatment of catheter-related infection. Conclusions The incidence of catheter-related infection is affected by many factors. The main pathogens for catheterrelated infection are Gram-positive bacteria and have a general drug resistance, based on distribution of pathogens, drug sensitivity test results and related risk factors, which should be taken effective measures to reduce the morbidity of catheter-related infection.

Key words: Hemodialysis, venous catheter, infection, risk factor, drug resistance