Risk factors of catheter-related blood stream infection associated with chronic hemodialysis diabetics with cuffed dialysis catheter in Baoding area
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摘要: 目的 探讨维持性血液透析糖尿病患者带cuff透析导管相关性血流感染（catheter-related bloodstream infection，CRBSI）的危险因素，为防控透析导管血流感染提供临床依据。方法 对本地区2015年3月至2020年3月使用带cuff透析导管行维持性血液透析的150例糖尿病患者临床资料进行回顾性分析，根据有无CRBSI分为感染组与未感染组，对比两组患者性别、年龄、置管时间、空腹血糖、血红蛋白（hemoglobin，Hb）、白蛋白（albumin，Alb）、红细胞计数（erythrocyte count，RBC）、白细胞计数（white blood cell count，WBC）等临床指标，并将筛查出的有意义指标进行多因素logistic回归分析。结果 150例患者中发生CRBSI 26例，发生率为2.4/千导管日；检出病原菌29株，以金黄色葡萄球菌构成比最高（占34.48%），其次是表皮葡萄球菌与铜绿假单胞菌（占13.79%）；经单因素方差分析，发现年龄、导管留置时间、空腹血糖、糖化血红蛋白、Hb、Alb与血液透析糖尿病患者发生CRBSI有关（P<0.05）；经多因素回归分析发现，维持性血液透析糖尿病患者发生CRBSI的主要危险因素有年龄≥65岁（OR=2.731）、导管留置时间>90 d （OR=5.627）、空腹血糖≥12 mmol/L （OR=7.035）、糖化血红蛋白≥10%（OR=6.571）、Hb<80 g/L （OR=3.469）、Alb<35 g/L （OR=5.049）。结论 维持性血液透析糖尿病带cuff透析导管患者CRBSI的主要病原菌为金黄色葡萄球菌，其发生的危险因素有年龄大、导管留置时间长、血糖浓度高及Hb、Alb水平低，提示应对高危人群开展积极的防控工作，以降低带cuff透析导管相关血流感染的发生风险。Abstract: Objective To explore the risk factors of catheter-related bloodstream infection(CRBSI) in chronic hemodialysis diabetics with cuffed dialysis catheter and provide guidance for the prevention and control of CRBSI. Methods For this retrospective study,150 chronic hemodialysis diabetics between March 2015 and March 2020 with cuffed dialysis catheter were recruited. According to the CRBSI standard,they were classified into CRBSI and non-CRBSI(nCRBSI) groups. Chi-square test was performed for comparing demographic and clinical variables of age,gender,indwelling duration,fasting blood glucose,glycated hemoglobin,hemoglobin(Hb),Alb,RBC and WBC. P<0.05 was deemed as statistically significant and multi-factor Logistic regression analysis was performed. Results There were 26 cases of CRBSI with an incidence rate of 2.4 thousand duct day;29 strains of pathogenic bacteria were detected with predominantly Staphylococcus aureus(34.48%),followed by Staphylococcus epidermidis and Pseudomonas aeruginosa(13.79%). Single factor analysis indicated that age,indwelling duration,fasting blood glucose,glycosylated hemoglobin,Hb and Alb were correlated with CRBSI in chronic hemodialysis diabetics(P<0.05). Multi-factor Logistic regression analysis revealed that independent risk factors for CRBSI included age ≥ 65 years(OR=2.731),indwelling duration >90 days(OR=5.627),fasting blood glucose ≥ 12 mmol/L(OR=7.035),glycosylated hemoglobin ≥ 10%(OR=6.571),Hb <80 g/L(OR=3.469) and Alb<35 g/L(OR=5.049). Conclusion The predominant pathogen of CRBSI in chronic hemodialysis diabetic patients with cuffed dialysis catheter is S. aureus. The risk factors of CRBSI are advanced age,long indwelling duration,hyperglycemia and low Hb or Alb level. Therefore active prevention and control should be implemented for high-risk diabetics for reducing the risk of CRBSI in cuffed dialysis catheter.
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