中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (01): 41-44.doi: 10.3969/j.issn.1671-4091.2020.01.011

• 血管通路 • 上一篇    下一篇

血液透析用带隧道带涤纶套导管相关血流感染55 例病原学及临床特点分析#br#

郑茜子1,秦爱博1,刘钟缘1,刘刚2,金其庄1   

  1. 1北京大学第一医院肾脏内科北京大学肾脏病研究所卫生部肾脏疾病重点实验室慢性肾脏病防治教育部重点实验室 2北京中医医院怀柔医院内分泌肾病科
  • 收稿日期:2019-08-30 修回日期:2019-09-27 出版日期:2020-01-20 发布日期:2019-12-30
  • 通讯作者: 金其庄 jinqizhuang@bjmu.edu.cn E-mail:jinqizhuang@bjmu.edu.cn

Microbiological and clinical characteristics of tunnelled and cuffed hemodialysis catheter-related bloodstream infections: analyses of 55 cases #br#

  1. 1Department of Nephrology, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing 100034, China;  2Department of Endocrinology & Nephrology, Beijing Huairou Hospital of Traditional Chinese Medicine, Beijing 101400, China
  • Received:2019-08-30 Revised:2019-09-27 Online:2020-01-20 Published:2019-12-30
  • Contact: Qi-zhuang JIN E-mail:jinqizhuang@bjmu.edu.cn

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摘要： 【摘要】目的探讨血液透析用带隧道带涤纶套导管相关血流感染的病原学分布及临床特点。方法回顾性分析55 例2008 年8 月～2018 年8 月于北京大学第一医院确诊为血液透析用带隧道带涤纶套导管相关血流感染者的临床资料。结果发热、外出口感染、隧道感染及新发导管功能不良的发生率依次为100%、21.8%、7.3%及20.0%。抗生素使用前外周血培养(100% 比81.5%，P=0.047)及导管血培养阳性率(93.3%比61.5%，P=0.028)均高于抗生素使用后组。77 份阳性标本中，革兰阳性菌、革兰阴性菌和真菌分
别占45.5%、53.2%及1.3%，耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus，MRSA)为最常见病原菌(19.5%)。结论规范化留取病原学标本对于导管相关血流感染诊断至关重要，笔者所在中心革兰阴性菌感染率较高，经验性治疗时除针对MRSA 外，还需考虑覆盖革兰阴性菌。

关键词: 血液透析, 感染, 带隧道导管

Abstract: 【Abstract】Objective To investigate microbiological and clinical characteristics of tunnelled and cuffed hemodialysis catheter- related bloodstream infections (CRBSIs). Methods The medical records of all patients with confirmed CRBSIs diagnosed in Peking University First Hospital from August 2008 to August 2018 were retrospectively reviewed, and 55 cases with CRBSIs were enrolled. Clinical and microbiological data were collected and analyzed. Results Fever, exit-site infection, tunnel infection and catheter dysfunction were observed in 100%, 21.8%, 7.3% and 20.0% respectively of the cases. The positive rates of blood cultures from peripheral blood (100% vs. 81.5% , P=0.047) and blood within catheters (93.3% vs. 81.5% , P=0.028) before antimicrobial therapy were significantly higher than those after antimicrobial therapy. There were 77 positive cultures that yielded 45.5% Gram-positive, 53.2% Gram-negative and 1.3% fungal isolates. The most common organism isolated was methicillin-resistant staphylococcus aureus (MRSA,19.5%). Conclusion Standardized collection of specimens is essential for the diagnosis of CRBSIs. Gram-negative isolates accounted for most tunnelled CRBSIs in our center. For patients with suspected CRBSIs, the empirical antibiotic regimen should include agents actively against both MRSA and Gram-negative bacteria.

Key words: Hemodialysis, Infection, Tunnelled catheter

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