门诊血液透析患者血管通路感染目标性监测

Targeted surveillance of vascular access infection in hemodialysis outpatients

摘要:

目的了解门诊血液透析患者血管通路感染发病情况及其危险因素。方法采用前瞻性监测方法，参照国内外相关指南及规范制定监测方法，对某院2014年6月1日—2016年5月31日所有门诊血液透析患者进行目标性监测。结果2014年6月1日—2016年5月31日共有门诊血液透析患者584例，血管通路总次数为64 203例次，发生感染79例，85例次，血管通路感染例次发病率为1.32‰。其中血管穿刺部位感染36例（42.35%），血管通路相关血流感染49例（57.65%）。不同血管通路类型患者中人工血管患者的血管通路感染发病率最高（19.67‰），其次为非隧道式中心静脉置管患者（4.91‰）、隧道式中心静脉置管患者（0.73‰）、动静脉内瘘患者（0.09‰）。年龄＞60岁、透析时间＞1年、伴有糖尿病、高血压是门诊血液透析患者发生血管通路感染的危险因素（均P＜0.05）。 49例血管通路相关血流感染患者送检的血标本中共分离病原菌39株。革兰阳性球菌36株（92.31%），主要为金黄色葡萄球菌（30株，其中6株为耐甲氧西林金黄色葡萄球菌）；革兰阴性杆菌3株（7.69%）。结论加强前瞻性目标监测，可以更好地了解门诊血液透析患者血管通路感染的现状、特征及其危险因素，有利于采取针对性的预防控制措施，从而减少门诊血液透析患者血管通路感染的发生。

Abstract:

ObjectiveTo investigate the occurrence and risk factors of vascular access infection(VAI) in hemodialysis outpatients. MethodsProspective surveillance method, monitoring methods was formulated and adopted by referring to the relevant guidelines and regulations at home and abroad, targeted surveillance was performed among all outpatients receiving hemodialysis in a hospital from June 1, 2014 to May 31, 2016. ResultsA total of 584 outpatients received hemodialysis from June 1, 2014 to May 31, 2016, with 64 203 times of vascular access, 79 patients developed 85 cases of infection, case incidence of VAI was 1.32‰. 36 cases（42.35%） were infection at vascular puncture sites, 49 (57.65%） were vascular accessrelated bloodstream infection. Among patients with different types of vascular access, incidence of VAI was the highest among patients with artificial vascular graft（19.67‰），followed by those with nontunneled central venous catheter（4.91‰）, with tunneled central venous catheter（0.73‰）, and with arteriovenous fistula（0.09‰）. Age＞60 years, hemodialysis time>1 year, diabetes, and hypertension were risk factors for VAI in outpatients with hemodialysis(all P<0.05). 39 strains of pathogens were isolated from 49 patients with vascular accessrelated bloodstream infection, including 36 (92.31%) grampositive bacteria, mainly Staphylococcus aureus(n=30, 6 of which were methicillinresistant Staphylococcus aureus); 3(7.69%) gramnegative bacteria. ConclusionStrengthening prospective targeted surveillance can better understand the status, characteristics, and risk factors of VAI in hemodialysis outpatients, it is conducive to taking targeted prevention and control measures, thus reduce the incidence of VAI in hemodialysis outpatients.