文献类型：期刊文献

中文题名：维持性血液透析患者合并导管相关性血流感染预后的危险因素分析

英文题名：Prognostic risk factors of catheter-related bloodstream infection in patients with maintenance hemodialysis

作者：陈彩合[1];马淑燕[1];黄文辉[2]

第一作者：陈彩合

机构：[1]甘肃中医药大学第一临床医学院,兰州730000;[2]甘肃省人民医院肾病科,兰州730000

第一机构：甘肃中医药大学临床医学院

年份：2024

卷号：36

期号：2

起止页码：183

中文期刊名：中华危重病急救医学

外文期刊名：Chinese Critical Care Medicine

收录：CSTPCD;;Scopus;北大核心:【北大核心2023】；CSCD:【CSCD2023_2024】；PubMed;

基金：甘肃省自然科学基金(20JR10RA398);甘肃省人民医院科研基金(22GSSYD-35)。

语种：中文

中文关键词：维持性血液透析;导管相关性血流感染;预后;危险因素

外文关键词：Maintenance hemodialysis;Catheter-related bloodstream infections;Prognosis;Risk factor

摘要：目的分析维持性血液透析(MHD)患者非住院期间发生导管相关性血流感染(CRBSI)的病原菌分布特征及影响预后的危险因素。方法采用回顾性对照研究,选择2020年1月至2023年5月在甘肃省人民医院肾病科因非住院期间发生CRBSI收治的34例以半永久导管为通路进行MHD的病例为研究对象。分析MHD患者非住院期间发生CRBSI的病原菌分布特点;所有患者入院后积极给予抗感染治疗,通过电子病历系统收集患者的一般资料、实验室检查指标及住院期间预后情况。根据住院期间的治疗结果将患者分为预后不良组(14例)和预后良好组(20例),采用单因素和多因素Logistic回归分析影响患者预后的危险因素,并绘制受试者工作特征曲线(ROC曲线)评估其对预后的预测价值。结果34例患者中共分离出28株病原菌,其中革兰阳性菌25株,葡萄球菌属为最多见病原菌,占总数的82.15%,金黄色葡萄球菌16株(57.15%),包括耐甲氧西林金黄色葡萄球菌(MRSA)6株(21.43%),表皮葡萄球菌7株(25.00%),包括耐甲氧西林表皮葡萄球菌(MRSE)3株(10.71%);革兰阴性菌3株,铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌各1株。单因素分析显示,MHD合并CRBSI患者预后不良组发热时间比预后良好组明显延长〔d:8.50(3.75,45.00)比2.50(1.00,4.75),P<0.01〕,血清红细胞沉降率(ESR)、C-反应蛋白(CRP)、随机血糖(GLU)均明显高于预后良好组〔ESR(mm/1 h):82.36±24.98比56.95±35.65,CRP(mg/L):123.45±74.10比67.35±55.22,GLU(mmol/L):8.74±3.66比6.42±1.95,均P<0.05〕。多因素Logistic回归分析显示,血清CRP为MHD合并CRBSI患者预后不良的独立危险因素〔优势比(OR)=1.020,95%可信区间(95%CI)为1.002~1.038,P=0.025〕。ROC曲线分析显示,血清CRP预测MHD合并CRBSI患者预后不良的曲线下面积(AUC)为0.711;最佳截断值为104.65 mg/L时,敏感度64.3%,特异度为85.0%,说明其具有较好的预测价值。结论MHD患者非住院期间发生CRBSI时,主要以革兰阳性菌感染为主;且其预后不良主要与较高的血清CRP水平有关;血清CRP水平能有效筛选MHD合并CRBSI患者预后不良的高危人群。
Objective To analyze the pathogen distribution and prognostic risk factors of catheter-related bloodstream infection(CRBSI)in patients with maintenance hemodialysis(MHD)during non-hospitalization.Methods A retrospective comparative study was conducted.Thirty-four patients of MHD with semi-permanent catheter admitted to the department of nephrology of Gansu Provincial Hospital from January 2020 to May 2023 due to CRBSI during non-hospitalization were enrolled.The distribution characteristics of pathogens causing CRBSI in MHD patients during non-hospital period were analyzed.All patients were actively given anti-infection treatment after admission.The general data,laboratory indicators and prognosis during hospitalization were collected through the electronic medical record system.Patients were divided into poor prognosis group(14 cases)and good prognosis group(20 cases)according to the treatment results during hospitalization.Univariate and binary Logistic regression were used to analyze the risk factors affecting the prognosis of patients,and receiver operator characteristic curve(ROC curve)was drawn to evaluate its predictive value for prognosis.Results A total of 28 pathogenic bacteria were isolated from 34 patients,of which 25 were Gram-positive,Staphylococcus was the most common pathogen,accounting for 82.15%of the total,and 16 strains of Staphylococcus aureus(57.15%),including 6 methicillin-resistant Staphylococcus aureus(MRSA,21.43%).There were 7 strains of Staphylococcus epidermidis(25.00%),including 3 strains of methicillin-resistant Staphylococcus epidermidis(MRSE,10.71%).There were 3 strains of Gram-negative bacteria,1 strain each of Pseudomonas aeruginosa,Escherichia coli and Acinetobacter baumannii.Univariate analysis showed that the fever duration of MHD patients with CRBSI in the poor prognosis group was significantly longer than that in the good prognosis group[days:8.50(3.75,45.00)vs.2.50(1.00,4.75),P<0.01],serum erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and random blood glucose(GLU)were significantly higher than those in the good prognosis group[ESR(mm/1 h):82.36±24.98 vs.56.95±35.65,CRP(mg/L):123.45±74.10 vs.67.35±55.22,GLU(mmol/L):8.74±3.66 vs.6.42±1.95,all P<0.05].Binary Logistic regression analysis showed that serum CRP was an independent risk factor for poor prognosis in MHD patients with CRBSI[odds ratio(OR)=1.020,95%confidence interval(95%CI)was 1.002-1.038,P=0.025].ROC curve analysis showed that the area under the curve(AUC)of serum CRP in predicting poor prognosis of MHD patients with CRBSI was 0.711;when the optimal cut-off value was 104.65 mg/L,the sensitivity was 64.3%and the specificity was 85.0%,indicating that it has good predictive value.Conclusions Gram-positive bacteria are the main pathogens of CRBSI in MHD patients during non-hospital period.The poor prognosis is mainly related to the high level of serum CRP.Serum CRP level can effectively screen the high-risk group of MHD patients with CRBSI with poor prognosis.