维持性血液透析患者医院感染的病原学特点及影响因素研究
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摘要
目的探讨维持性血液透析(MHD)患者医院感染的病原学特点及相关影响因素。方法选取2014年1月-2017年1月医院收治的行MHD治疗的慢性肾衰竭患者98例,将出现医院感染的30例患者纳入感染组,未出现医院感染的68例患者纳入对照组,记录感染组患者的感染情况及病原菌类型,回顾性分析两组患者的相关资料,筛选出相关因素进行影响因素分析,包括患者的性别、年龄、透析时间、贫血情况、糖尿病情况、低蛋白血症情况、C-反应蛋白(CRP)水平、晚期氧化蛋白产物(AOPP)水平、经外周静脉穿刺中心静脉置管(PICC)情况等。结果 98例患者在MHD治疗过程中共有30例患者出现不同程度医院感染,感染率为30.6%,医院感染以呼吸道为主,占40.0%;30例感染患者的送检标本中共分离培养出49株病原菌,其中革兰阴性菌30株占61.2%、革兰阳性菌14株占28.6%、真菌5株占10.2%;多因素Logistic回归分析结果显示,高龄、AOPP水平高、透析时间长、合并糖尿病、低蛋白血症是影响MHD患者医院感染的影响因素(P<0.05)。结论 MHD患者医院感染较严重,且患者医院感染的影响因素多,根据感染的病原学特点给予合理的预防性治疗,同时做好患者的病情评估,积极改善患者营养状态,重视糖尿病、长期透析、高龄等易感人群的监控,对MHD患者医院感染的预防具有重要意义。
OBJECTIVE To investigate the pathogenic characteristics and related risk factors of nosocomial infections in maintenance hemodialysis(MHD)patients.METHODS A total of 98 cases of patients with chronic renal failure treated by continuous hemodialysis in our hospital from Jan.2014 to Jan.2017 were selected.The 30 patients with nosocomial infections were included in the infection group,and 68 patients without nosocomial infections were included in the control group.The distribution of infection and the types of pathogens of the infection group were recorded.A retrospective analysis was used to collect data from two groups of patients,screening related factors for risk factors,including gender,age,time of dialysis,anemia,diabetes,hypoproteinemia,C-reactive protein(CRP),advanced oxidation protein product(AOPP),and peripheral inserted central venous catheterization(PICC)and so on.RESULTSIn the 98 patients,30 patients were infected with different degrees of nosocomial infections in the MHD treatment,and the infection rate was 30.6%.The nosocomial infections mainly occurred in the respiratory tract(40.0%).Totally 49 pathogenic bacteria were isolated from specimens of 30 cases of infected pateints,including 30 strains of gram-negative bacteria accounting for 61.2%,14 strains of gram-positive bacteria accounting for 28.6%,and 5 strains of fungi accounting for 10.2%.Multi-variable logistic regression analysis showed that advanced age,high AOPP level,long dialysis time,diabetes and hypoproteinemia were independent risk factors of nosocomial infections in MHD patients(P<0.05).CONCLUSIONThe severity of nosocomial infections in MHD patients is higher,and there are many risk factors of nosocomial infections.Reasonable preventive treatment should be given according to the etiological characteristics of the infections.At the same time,we should assess the patient's conditions,improve the nutritional status of the patients,and monitor the susceptible people,such as diabetes,long-term dialysis and older age,which have great significances for the prevention of nosocomial infections of the patients.
OBJECTIVE To investigate the pathogenic characteristics and related risk factors of nosocomial infections in maintenance hemodialysis(MHD)patients.METHODS A total of 98 cases of patients with chronic renal failure treated by continuous hemodialysis in our hospital from Jan.2014 to Jan.2017 were selected.The 30 patients with nosocomial infections were included in the infection group,and 68 patients without nosocomial infections were included in the control group.The distribution of infection and the types of pathogens of the infection group were recorded.A retrospective analysis was used to collect data from two groups of patients,screening related factors for risk factors,including gender,age,time of dialysis,anemia,diabetes,hypoproteinemia,C-reactive protein(CRP),advanced oxidation protein product(AOPP),and peripheral inserted central venous catheterization(PICC)and so on.RESULTSIn the 98 patients,30 patients were infected with different degrees of nosocomial infections in the MHD treatment,and the infection rate was 30.6%.The nosocomial infections mainly occurred in the respiratory tract(40.0%).Totally 49 pathogenic bacteria were isolated from specimens of 30 cases of infected pateints,including 30 strains of gram-negative bacteria accounting for 61.2%,14 strains of gram-positive bacteria accounting for 28.6%,and 5 strains of fungi accounting for 10.2%.Multi-variable logistic regression analysis showed that advanced age,high AOPP level,long dialysis time,diabetes and hypoproteinemia were independent risk factors of nosocomial infections in MHD patients(P<0.05).CONCLUSIONThe severity of nosocomial infections in MHD patients is higher,and there are many risk factors of nosocomial infections.Reasonable preventive treatment should be given according to the etiological characteristics of the infections.At the same time,we should assess the patient's conditions,improve the nutritional status of the patients,and monitor the susceptible people,such as diabetes,long-term dialysis and older age,which have great significances for the prevention of nosocomial infections of the patients.
引文
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[15]成栋,周华虹,郎旭军,等.慢性肾衰竭血液透析患者泌尿系感染相关因素分析[J].中华医院感染学杂志,2017,27(5):1007-1010.
[16]李莉红,邓孝陵,陈以莲,等.尿毒症维持性血液透析患者肺部感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(17):3875-3877.
[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]Qin HY,Jia P,Liu H.Nursing strategies for patients with chronic renal failure undergoing maintenance hemodialysis treatment by arteriovenous fistula[J].Iran J Public Health,2016,45(10):1270-1275.
[19]陈碧玲,姚平,谭庆玲,等.糖尿病肾病等肾衰竭血液透析患者泌尿系感染临床分析[J].中华医院感染学杂志,2015,25(2):382-384.
[2]Talebi SS,Amini M,Qorbani M.Assessment of the causes and risk factors associated with end stage renal disease(ESRD)in hemodialysis patients from 2000to 2009in Iran[J].Scient J Kurdistan Univ Med Scien,2015,25(12):116-118.
[3]Laux TS,Barnoya J,Guerrero DR,et al.Dialysis enrollment patterns in Guatemala:evidence of the chronic kidney disease of non-traditional causes epidemic in Mesoamerica[J].BMC Nephrol,2015(16):54.
[4]张令霞,侯磊,戴衡,等.血液透析患者健康素养的研究进展[J].中国健康教育,2017,33(2):162-164.
[5]侯爱珍,陈囿元,肖观清,等.尿毒症维持性血液透析患者的死亡原因[J].实用医学杂志,2016,32(2):283-285.
[6]中华中医药学会肾病分会.慢性肾衰竭的诊断、辨证分型及疗效评定(试行方案)[J].上海中医药杂志,2006,40(8):8-9.
[7]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[8]中华人民共和国卫生部医政司.全国临床检验操作规程(第3版)(精)[M].东南大学出版社,2006.
[9]李小鹏,王治国.美国临床实验室标准化委员会标准与指南[J].中华检验医学杂志,2001,24(4):251-252.
[10]Valson AT,Sundaram M,David VG,et al.Profile of incident chronic kidney disease related-mineral bone disorders in chronic kidney disease stage 4and 5:a hospital based crosssectional survey[J].Indian J Nephrol,2014,24(2):97-107.
[11]边晓慧,刘大军,郑华,等.维持性血液透析患者预后的五年随访研究[J].中国全科医学,2014,17(7):777-780.
[12]刘婷,包蓓艳,李国富,等.维持性血液透析患者易发感染的危险因素分析[J].中华医院感染学杂志,2015,25(17):3992-3994.
[13]Wali SO,Alkhouli A,Howladar M,et al.Risk of obstructive sleep apnea among Saudis with chronic renal failure on hemodialysis[J].Ann Thorac Med,2015,10(4):263-268.
[14]吴歌,高丹,贾晓媛,等.尿毒症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,2014,24(2):393-395.
[15]成栋,周华虹,郎旭军,等.慢性肾衰竭血液透析患者泌尿系感染相关因素分析[J].中华医院感染学杂志,2017,27(5):1007-1010.
[16]李莉红,邓孝陵,陈以莲,等.尿毒症维持性血液透析患者肺部感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(17):3875-3877.
[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]Qin HY,Jia P,Liu H.Nursing strategies for patients with chronic renal failure undergoing maintenance hemodialysis treatment by arteriovenous fistula[J].Iran J Public Health,2016,45(10):1270-1275.
[19]陈碧玲,姚平,谭庆玲,等.糖尿病肾病等肾衰竭血液透析患者泌尿系感染临床分析[J].中华医院感染学杂志,2015,25(2):382-384.