透析导管相关血流感染危险因素及预防措施

doi:10.3969/j.issn.1006-6233.2018.03.022

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Abstract Objective: To explore the risk factors and preventive measures of dialysis catheter related blood stream infection (CRBSI). Methods: 63 CRBSI patients who had received central venous indwelling catheter for treatment in the Nephrology of our hospital from February 2013 to March 2017 were selected as the CRBSI group, and another 63 cases without infection given central venous indwelling catheter as control group. The related risk factors and pathogenic characteristics of CRBSI were analyzed. Results: The occurrence of CRBSI was related with catheterization outside of the hospital, internal jugular vein catheterization, length of hospital stay in ICU, body mass index (BMI), mean artery pressure (MAP), acute physiology and chronic health evaluation (APACHE) Ⅱscores, catheter dwelling time, and CD4+, with statistically significant difference between the two groups (P<0.05). Femoral vein catheterization, the use of immunosuppressor, plasma catheterization or double plasma filtration, the increase of fasting plasma glucose, albumin and immunoglobulin G (IgG) levels were not related with the occurrence of CRBSI, with statistically significant difference (P>0.05); the multiple-factor analysis showed that: Catheterization outside of the hospital, internal jugular vein catheterization, MAP, APACHE) Ⅱscore, catheter dwelling time, and CD4+ were important risk factors of the occurrence of CRBSI (P<0.05). The length of hospital stay in ICU and BMI showed no definite correlation (P>0.05); the gram positive bacteria was the major microorganism detected, which accounted for 50.78%, followed by gram negative bacteria, which accounted for 36.51%; the common pathogenic bacteria were staphylococcus epidermidis, staphylococcus aureus and enterobacter cloacae. Conclusion: MAP, APACHE) Ⅱscore, catheter dwelling time, and CD4+ were important risk factors of the occurrence of CRBSI, gram positive cocci is the main pathogen for CRBSI; therefore, in clinical practice, susceptibility testing should be performed according to the pathogen, and antibacterial agents should be selected according to antimicrobial susceptibility results; aseptic operation should be strictly implemented, and catheterization time shortened to strengthen the prevention for critical illness and immune hypofunction and reduce the incidence rate of CRBSI.

Key words： Infection Risk factors Tube

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2018.03.022 OR http://www.hbyxzzs.cn/EN/Y2018/V24/I3/433

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