维持性血液透析患者感染的临床特点、病原菌分布及相关危险因素分析
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摘要
目的分析维持性血液透析(MHD)患者感染的临床特点、病原菌分布及危险因素。方法选取本院2014年1月-2017年6月收治的MHD患者170例,分为感染组和非感染组,收集信息并分析。结果 170例MHD患者中发生医院感染71例,感染率为41. 76%;以呼吸道感染(35例,49. 30%)为主。低血红蛋白、低血清白蛋白、年龄≥60岁、贫血、血透透析时间长、透析次数多、糖尿病肾病(DN)、高血压肾病、PICC应用是MHD患者感染的危险因素。共分离出116株病原菌,以革兰阴性菌为主,共69株(占59. 48%),主要为大肠埃希菌(16. 38%)、克雷伯菌属(12. 07%)、假单胞菌属(11. 21%)、不动杆菌属(8. 62%);革兰阳性菌共44株(占37. 93%),以金黄色葡萄菌(12. 93%)、表皮葡萄球菌(12. 07%)为主;真菌3株(占2. 59%)。结论 MHD患者感染主要以呼吸道感染、革兰阴性菌为主,感染危险因素较多。
Objective To analyze the clinical features and pathogen distributions in patients with maintenance hemodialysis( MHD) and explore the related risk factors. Methods A total of 170 patients with maintenance hemodialysis who were admitted to our hospital from January 2014 to June 2017 were selected as the research objects and divided into infection group and non-infection group,and then relevant data was collected and analyzed. Results Among 170 MHD patients,71 cases were nosocomial infection( 41. 76%). The main infection area was respiratory tract( 35 cases,49. 30%). Low hemoglobin,low serum albumin,age ≥ 60,anemia,long time of hemodialysis,dialysis times,diabetic nephropathy( DN),hypertensive nephropathy,PICC were risk factors for MHD infection. 116 pathogenic bacteria were isolated,of which 69 strains of Gram-negative bacteria were dominant,accounting for 59. 48%,mainly including Escherichia coli( 16. 38%),Klebsiella pneumonia( 12. 07%),Pseudomonas( 11. 21%),Acinetobacter( 8. 62%); there were 44 strains of Gram-positive bacteria( 37. 93%),mainly including Staphylococcus aureus( 12. 93%),Staphylococcus epidermidis( 12. 07%); 3 strains were Fungi( 2. 59%).Conclusion There are many risk factors for MHD infection,but respiratory tract infection and Gram-negative bacteria infection are two major ones.
Objective To analyze the clinical features and pathogen distributions in patients with maintenance hemodialysis( MHD) and explore the related risk factors. Methods A total of 170 patients with maintenance hemodialysis who were admitted to our hospital from January 2014 to June 2017 were selected as the research objects and divided into infection group and non-infection group,and then relevant data was collected and analyzed. Results Among 170 MHD patients,71 cases were nosocomial infection( 41. 76%). The main infection area was respiratory tract( 35 cases,49. 30%). Low hemoglobin,low serum albumin,age ≥ 60,anemia,long time of hemodialysis,dialysis times,diabetic nephropathy( DN),hypertensive nephropathy,PICC were risk factors for MHD infection. 116 pathogenic bacteria were isolated,of which 69 strains of Gram-negative bacteria were dominant,accounting for 59. 48%,mainly including Escherichia coli( 16. 38%),Klebsiella pneumonia( 12. 07%),Pseudomonas( 11. 21%),Acinetobacter( 8. 62%); there were 44 strains of Gram-positive bacteria( 37. 93%),mainly including Staphylococcus aureus( 12. 93%),Staphylococcus epidermidis( 12. 07%); 3 strains were Fungi( 2. 59%).Conclusion There are many risk factors for MHD infection,but respiratory tract infection and Gram-negative bacteria infection are two major ones.
引文
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[14]周东池,潘丽华,乔青燕,等.维持性血液透析患者贫血相关因素临床分析[J].中外医学研究,2016,14(10):1-3.
[15]邱金英,李璐.维持性血液透析患者透析中低血压相关因素的分析[J].赣南医学院学报,2016,36(1):104-105.
[16]郭亚光,陈于蓝,何永春.维持性血液透析患者中心静脉导管感染危险因素分析[J].现代实用医学,2016,28(5):80-82.
[17]娄爱菊,吴炜戎,谢启新,等.维持性血液透析患者感染的相关因素临床分析[J].现代医院,2015,15(12):47-49.
[18] Bech LF,Drustrup L,Nygaard L,et al. Environmental risk factors for developing catheter-related bloodstream infection in home parenteral nutrition patients:a 6-year follow-up study[J]. JPEN J Parenter Enteral Nutr,2016,40(7):989-994.
[19]庾凤娟,司徒瑞儒,张晓媚,等.维持性血液透析患者感染的病原菌及其药敏分析[J].中国现代药物应用,2017,11(14):71-72.
[20]刘秀芳,胡白瑛.维持血透患者导管相关性血流感染的病原菌分布及临床特点分析[J].右江民族医学院学报,2017,39(5):374-376,380.
[2]景颖颖,唐丽春,汪瑶.维持性血液透析患者生活质量及影响因素研究[J].护理管理杂志,2015,15(4):248-250.
[3]董文鹏,王扬威,王瑞霞,等.维持性血液透析患者死亡的相关因素[J].中国老年学杂志,2017,37(5):1207-1209.
[4] Sugawara A,Sato H,Ito S. Diabetes and hepatitis C infection in dialysis patients:the present situation in Japan[J]. Nephro,2011,4(1):391-392.
[5]郝艳华,姜亚芳.维持性血液透析患者症状经历的调查研究[J].中华护理杂志,2016,51(3):299-303.
[6]张婉词,李寒,于玲,等.维持性血液透析患者丙型肝炎病毒感染的血清学变化及危险因素分析:附三年随访资料[J].中华临床医师杂志,2013,7(1):83-85.
[7]张晓华,李静,王利华.近5年维持性血液透析患者的流行病学调查分析[J].中国血液净化,2015,14(11):698-702.
[8]金素萍,王如.血液透析患者医院感染分析与护理措施[J].实用临床医药杂志,2011,15(20):65-67.
[9]唐春苑,王饶萍,叶晓青,等.维持性血液透析患者家庭负担与生活质量的关系[J].解放军护理杂志,2015,32(16):1-5.
[10]李松,孙希彩,潘晓静.维持性血液透析患者医院感染危险因素分析[J].中华医院感染学杂志,2015,25(2):386-387.
[11]叶白如,谷禾,杨午红,等.老年慢性肾衰竭维持性血液透析患者医院感染相关因素分析[J].中华医院感染学杂志,2015,25(10):2247-2249.
[12]吕威.维持性血液透析患者感染的临床特点与相关因素探究[J].实用临床护理学杂志,2017,2(1):12-13.
[13]刘丹.维持性血液透析患者感染的临床特点与相关因素分析[J].中华临床医师杂志:电子版,2016,10(11):45-46.
[14]周东池,潘丽华,乔青燕,等.维持性血液透析患者贫血相关因素临床分析[J].中外医学研究,2016,14(10):1-3.
[15]邱金英,李璐.维持性血液透析患者透析中低血压相关因素的分析[J].赣南医学院学报,2016,36(1):104-105.
[16]郭亚光,陈于蓝,何永春.维持性血液透析患者中心静脉导管感染危险因素分析[J].现代实用医学,2016,28(5):80-82.
[17]娄爱菊,吴炜戎,谢启新,等.维持性血液透析患者感染的相关因素临床分析[J].现代医院,2015,15(12):47-49.
[18] Bech LF,Drustrup L,Nygaard L,et al. Environmental risk factors for developing catheter-related bloodstream infection in home parenteral nutrition patients:a 6-year follow-up study[J]. JPEN J Parenter Enteral Nutr,2016,40(7):989-994.
[19]庾凤娟,司徒瑞儒,张晓媚,等.维持性血液透析患者感染的病原菌及其药敏分析[J].中国现代药物应用,2017,11(14):71-72.
[20]刘秀芳,胡白瑛.维持血透患者导管相关性血流感染的病原菌分布及临床特点分析[J].右江民族医学院学报,2017,39(5):374-376,380.