中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (12): 943-946.doi: 10.3969/j.issn.1671-4091.2024.12.013

• 血管通路 • 上一篇    下一篇

维持性血液透析患者导管相关性血流感染发生季节、病原菌特点及药敏分析

张 炎    高志伟    廉秀花    王尊松   

  1. 250014 济南，山东第一医科大学第一附属医院(山东省千佛山医院) 1血液净化室2肾病学科，山东省肾病研究所
  • 收稿日期:2024-04-07 修回日期:2024-09-18 出版日期:2024-12-12 发布日期:2024-12-12
  • 通讯作者: 王尊松 E-mail:wzsong3@163.com
  • 基金资助:
    山东省自然科学基金(ZR2023MH255)；齐鲁卫生与健康领军人才项目；中国医师协会循证医学专业委员会肾科学组“PRO•润”基金(KYJ202206-0003-10)

Analysis of catheter-related bloodstream infections on seasonal prevalence, pathogen characteristics, and drug sensitivity in maintenance hemodialysis patients

ZHANG Yan, GAO Zhi-wei, LIAN Xiu-hua, WANG Zun-song   

  1. Hemodialysis Division and 2Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
  • Received:2024-04-07 Revised:2024-09-18 Online:2024-12-12 Published:2024-12-12
  • Contact: 250014 济南，山东第一医科大学第一附属医院(山东省千佛山医院) 2肾病学科，山东省肾病研究所 E-mail:wzsong3@163.com

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摘要： 目的  分析维持性血液透析(maintenance hemodialysis,MHD)患者导管相关性血流感染(catheter related blood stream infection,CRBSI)发病季节、病原菌特点及药敏性。 方法  回顾性分析2012年8月─2021年6月在山东第一医科大学第一附属医院肾病学科行带隧道和涤纶套导管(tunnel-cuffed catheter,TCC)置入手术患者的导管使用情况，共纳入因导管相关性血流感染住院患者62例，其中血培养有明确病原菌患者48例，分析其感染发生季节、病原菌特点及药敏性。 结果  导管血流感染在春夏季高于秋冬季(χ2=6.323,P =0.012)。导管血流感染的病原菌中革兰氏阳性菌占52.9%，革兰氏阴性菌占45.1%，革兰氏阳性菌一半以上是金黄色葡萄球菌(63.0%)，其次是表皮葡萄球菌(22.2%)；革兰氏阴性菌种类较多，感染比例最高的是大肠埃希菌(21.7%)。对革兰氏阳性菌较敏感的抗生素有万古霉素、替考拉宁、替加环素，耐药率较高的抗生素有青霉素G、红霉素、克林霉素。对革兰氏阴性菌较敏感的抗生素有厄他培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦，耐药率较高的抗生素有氨苄西林、头孢唑啉。 结论  导管血流感染在春、夏季发病率较高。导管血流感染的革兰氏阳性菌中金黄色葡萄球菌和表皮葡萄球菌占绝大部分，革兰氏阴性菌种类较多，最常见的是大肠埃希菌。特殊使用级抗生素使用受到限制时，可考虑莫西沙星加用哌拉西林/他唑巴坦或头孢哌酮/舒巴坦作为CRBSI经验性抗生素治疗的选择。

关键词: 血液透析, 导管相关性血流感染, 病原菌, 药敏分析

Abstract: Objective  To analyze the seasonal prevalence, pathogen characteristics, and drug sensitivity of catheter-related blood stream infection (CRBSI) in maintenance hemodialysis (MHD) patients.  Method  A retrospective analysis was conducted on the patients treated with tunnel-cuffed catheter (TCC) insertion surgery for MHD at the Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University from August 2012 to June 2021. CRBSI happened in a total of 62 hospitalized patients, including 48 patients with defined pathogenic bacteria from blood cultures. Their infection season, pathogenic bacterial characteristics and drug sensitivity were analyzed.  Results  CRBSI occurred higher in spring and summer (38 cases, 61.3%) than in autumn and winter (24 cases, 38.7%) (c2=6.323, P=0.012). Gram positive bacteria accounted for 52.9%, and Gram negative bacteria for 45.1%. More than half of the Gram positive bacteria were staphylococcus aureus (63.0%), followed by staphylococcus epidermidis (22.2%). Many types of Gram negative bacteria caused the CRBSI, and Escherichia coli accounted for 21.7% of Gram negative bacteria. Antibiotics sensitive to Gram positive bacteria included vancomycin, teicoplanin, tigecycline, antibiotics with higher resistance rates included penicillin G, erythromycin, and clindamycin. Antibiotics sensitive to gram-negative bacteria included ertapenem, piperacillin/tazobactam, cefoperazone/sulbactam, antibiotics with higher resistance rates included ampicillin and cefazolin.  Conclusion  The incidence of CRBSI is higher in spring and summer. Staphylococcus aureus and staphylococcus epidermidis account for the vast majority of Gram positive bacteria. Many types of Gram negative bacteria are involved in CRBSI, with Escherichia coli being the most common bacterium. When the use of special grade antibiotics is restricted, moxifloxacin combined with piperacillin/tazobactam or cefoperazone/sulbactam can be considered as an empirical antibiotic treatment option for CRBSI.

Key words: Hemodialysis, Catheter related blood stream infection, Pathogenic bacteria, Drug sensitivity analysis

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