关键词: 血液透析, 导管相关感染, 相关因素, 病原菌, 耐药性

Abstract: 【Abstract】Objective To study the risk factors and clinical characteristics of catheter- related blood stream infection (CRBSI) in hemodialysis patients, so as to provide strategies for the prevention and treatment of CRBSI in these patients. Methods A total of 320 patients undergoing hemodialysis using central venous catheters and treated in the Blood Purification Center, Xuzhou Medical University Affiliated Hospital in the period from January 2015 to May 202 were retrospectively analyzed. According to the infection status, they were divided into infected group and non-infected group. Their clinical data and laboratory indicators were recruited
to explore the relevant factors for the infections and to analyze the pathogenic bacteria and their drug sensitivities. Results There were 60 cases of CRBSI among 320 patients, the incidence rate was 18.75%. Compared with the non- infected group, femoral vein catheterization in the infected group (χ2=5.585, P=0.016), long- term catheterization (χ2=17.903, P<0.001), and catheterization days ≥28 days (χ2=18.526, P<0.001) ), dialysis time ≥1 year (χ2=35.688, P<0.001), the proportion of people suffering from hypertension (χ2=4.571, P=0.033) were significantly higher than those in the non- infected group, and sodium in the infected group (t=2.635) , P=0.009), chlorine (t=2.978,P=0.003) levels were significantly lower than those in the noninfected
group, and the white blood cell count (Z=-4.812, P<0.001), neutrophil to lymphocyte ratio (Neutrophil to lymphocyte ratio, NLR) (Z=-4.953, P<0.001), C-reactive protein (CRP) (Z=-6.399, P<0.001), procalcitonin (PCT) (Z=-9.716, P<0.001), parathyroid hormone (PTH) (Z=-3.002, P=0.003) levels were significantly higher than those of the non-infected group, and the differences were statistically significant (P<0.05 ), Logistic regression showed that femoral vein catheterization [OR=4.483, 95% CI (1.814~11.079), P=0.001], longterm catheterization [OR=4.039, 95% CI(1.636~9.972),P=0.002], The number of days of catheterization ≥28 days [OR=6.636, 95% CI (2.605~16.905), P=0.000] dialysis time ≥1 year [OR=3.016, 95% CI (1.268~ 7.175), P=0.013], NLR [OR=1.065, 95% CI (1.020~1.111), P=0.004], PCT [OR=1.044, 95% CI (1.028~1.061), P= 0.000], PTH [OR=1.003, 95% CI (1.001~1.006), P=0.002] is an independent risk factor for catheter-related infection in hemodialysis patients. The main pathogenic bacteria of infection are Gram-negative bacteria, and the single bacterial species are mainly Staphylococcus aureus and Pseudomonas aeruginosa. During the course of anti-infection treatment, the medication should be adjusted in time according to the results of drug sensitivity. Conclusion Femoral vein catheterization, long-term catheterization, catheterization days≥28 days, dialysis period more than one year, NLR, PCT, and PTH were the risk factors for CRBSI in hemodialysis patients.
The main pathogenic bacteria of the infection were Gram- negative bacteria, and the main bacterial species were Staphylococcus aureus and Pseudomonas aeruginosa. The anti-infection medications should be adjusted in time according to the results of drug sensitivity tests.

Key words: Hemodialysis, Catheter-related infection, Related factor, Pathogenic bacterium, Drug resistance