无隧道和涤纶套的透析导管相关性血流感染临床特点及危险因素分析

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摘要目的：探讨采用无隧道和涤纶套的透析导管(noncuffed catheter,NCC)行血液透析患者发生导管相关性血流感染(catheter-related bloodstream infection，CRBSI)的临床特点及危险因素。方法：选择2019年1月至2021年12月在江苏大学附属医院血液净化中心通过超声引导下经皮中心静脉置入NCC行血液透析治疗的患者169例进行回顾性分析，统计不同置管部位的CRBSI发生率，分析CRBSI患者的感染特点及病原菌分布。依据是否发生CRBSI分为感染组(n=22)和非感染组(n=147)，比较两组临床病理参数；进一步采用二元Logistic回归分析NCC患者发生CRBSI的影响因素，绘制受试者工作特征(ROC)曲线，评估预测效果。结果：颈内静脉置管和股静脉置管CRBSI发生率比较，差异无统计学意义(χ2=0.221，P=0.638)；22例CRBSI患者共检出病原菌21株，其中革兰阳性球菌16株，以金黄色葡萄球菌为主(10株)，革兰阴性杆菌5株。感染组血清白蛋白、高密度脂蛋白和血清铁水平明显低于非感染组(P均<0.05)；Logistic回归分析显示，血清白蛋白、高密度脂蛋白是血液透析患者发生CRBSI的影响因素(P=0.006，0.007)。ROC曲线显示，白蛋白AUC为0.726，高密度脂蛋白AUC为0.704。结论： NCC透析患者发生CRBSI的病原菌以革兰阳性球菌为主，多见于金黄色葡萄球菌；低水平血清白蛋白、高密度脂蛋白是CRBSI的危险因素。

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	徐丽华
	何建强

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Abstract： Objective： To explore the clinical characteristics and risk factors of catheterrelated bloodstream infection (CRBSI) in patients undergoing hemodialysis with non-cuffed catheter (NCC). Methods： A retrospective analysis was performed on 169 patients who underwent hemodialysis treatment with ultrasound-guided percutaneous central venous insertion of non-cuffed catheter at the Blood Purification Center, Affiliated Hospital of Jiangsu University from January 2019 to December 2021. The incidence of CRBSI at different catheterization sites was analyzed, and the infection characteristics and pathogenic bacteria distribution of CRBSI patients were analyzed. The patients were divided into infected group (n=22) and noninfected group (n=147) according to whether CRBSI occurred, and the clinicopathological parameters of the two groups were compared. Further, Logistic regression was used to analyze the influencing factors of CRBSI in NCC patients,and receiver operating characteristic (ROC) curve was used to evaluate the prediction effect. Results： There was no significant difference in incidence of CRBSI between internal jugular vein catheterization and femoral vein catheterization (χ2=0.221, P=0.638). A total of 21 strains of pathogenic bacteria were detected in 22 patients with CRBSI, including 16 strains of Gram-positive coccus, mainly Staphylococcus aureus (10 strains) and 5 strains of Gram-negative bacillus. The levels of serum albumin, high-density lipoprotein and serum iron in infected group were significantly lower than those in non-infected group (all P<0.05). Logistic regression analysis showed that serum albumin and high-density lipoprotein were influencing factors for CRBSI in hemodialysis patients (P=0.006, 0.007). ROC curve showed that the AUC of albumin and high-density lipoprotein was 0.726 and 0.704, respectively. Conclusion： Gram-positive bacteria, especially staphylococcus aureus, were the main pathogens causing CRBSI in non-cuffed catheter hemodialysis patients. The low levels of serum albumin and high-density lipoprotein are risk factors for CRBSI.

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收稿日期: 2023-08-21

基金资助: 镇江市社会发展项目(SH2022036)

通讯作者: 何建强(通讯作者)，副主任医师，E-mail： hejq0305@163.com

作者简介: 徐丽华(1987—)，女，硕士，主治医师，主要从事慢性肾脏病研究；

引用本文:

徐丽华，何建强. 无隧道和涤纶套的透析导管相关性血流感染临床特点及危险因素分析[J]. 江苏大学学报:医学版, 2024, 34(02): 176-179,184. XU Lihua, HE Jianqiang. Clinical characteristics and risk factors of non-cuffed

catheter-related bloodstream infection in hemodialysis patients

. Journal of Jiangsu University(Medicine Edition), 2024, 34(02): 176-179,184.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2024/V34/I02/176

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