贵州省124所医疗机构维持性血液透析相关感染现况调查

Current status of maintenance hemodialysis-related infection in 124 medical institutions in Guizhou Province

摘要:

目的 了解贵州省维持性血液透析(MHD)患者感染现状, 为血液透析相关感染的防控提供依据。 方法 调查2022年7—12月贵州省124所二级及以上医疗机构血液透析中心MHD患者。调查内容包括患者一般情况、血液透析相关情况、经血传播病原体感染情况及其他感染相关情况。 结果 共调查MHD患者15 114例, 年龄以36~＜60岁年龄段为主(55.83%)。血液透析龄以1~＜5年为主(59.37%), 血液透析频率主要是3次/周(73.91%)。透析血管通路以自体动静脉内瘘(AVF)为主, 共12 948例(85.77%)。原发疾病以慢性肾衰竭为主(99.89%)。血液透析患者乙型肝炎病毒(HBV)感染率5.29%, 丙型肝炎病毒(HCV)感染率0.64%, 人类免疫缺陷病毒(HIV)感染率0.24%, 梅毒螺旋体(TP)感染率1.70%。不同年龄、透析医院数、透析机构规模的MHD患者HBV感染率比较, 差异均有统计学意义(均P＜0.05)。不同年龄、不同透析时间、透析机构规模的MHD患者HCV感染率比较, 差异均有统计学意义(均P＜0.05)。不同年龄、不同透析医院数MHD患者TP感染率比较, 差异均有统计学意义(均P＜0.05)。年龄为36~＜60岁MHD患者HBV、HCV感染率较高, 分别为6.10%、0.84%。透析时间≥10年的患者HCV感染率(1.64%)较高。透析床位数≥90张的医疗机构患者HCV、HIV和TP感染率均较高, 分别为0.74%、0.28%、1.94%。HBV感染率最高的是透析床位数＜30张的医疗机构, 为18.64%。发生血管穿刺部位感染9例(0.06%), 血流感染12例(0.08%), 血管通路相关血流感染7例(0.05%), 肺部感染30例(0.20%)。不同血管通路类型MHD患者的血管通路相关血流感染发病率、肺部感染发病率比较, 差异均有统计学意义(均P＜0.05)。血管通路类型为无隧道无涤纶套导管患者的血管通路相关血流感染发病率(0.37%)和肺部感染发病率(1.10%)均较其他类型高。 结论 贵州省MHD患者以中青年为主, 男性多于女性, 透析频率多为3次/周, 以AVF为主要血管通路。MHD患者容易合并HBV、HCV、HIV、TP、血流感染和肺部感染。

Abstract:

Objective To understand the infection status of patients with maintenance hemodialysis (MHD) in Guizhou Province, and provide basis for the prevention and control of hemodialysis-related infection. Methods MHD patients in hemodialysis centers of 124 secondary and or higher grade medical institutions in Guizhou Province from July to December 2022 were surveyed. Survey content included the general conditions of patients, hemodialysis-related conditions, infection of pathogens of blood-borne diseases, and other infection-related conditions. Results A total of 15 114 MHD patients were surveyed, with age mainly ranging from 36 to < 60 years old (55.83%). Hemodialysis history ranged mainly from 1 year to < 5 years (59.37%), and the frequency of hemodialysis was mainly 3 times per week (73.91%). Autologous arteriovenous fistula (AVF) was the major vascular access for dialysis, with a total of 12 948 cases (85.77%). The main primary disease was chronic renal failure (99.89%). The infection rates of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Treponema pallidum in MHD patients were 5.29%, 0.64%, 0.24%, and 1.70%, respectively. HBV infection rates among MHD patients of different ages, different numbers of dialysis hospitals, and dialysis institutions of different scales showed statistically significant differences (all P < 0.05). HCV infection rates among MHD patients of different ages, with different dialysis times and from institutions of different scales were significantly different (all P < 0.05). TP infection rates among MHD patients of different ages and different numbers of dialysis hospitals were all significantly different (all P < 0.05). Infection rates of HBV and HCV in MHD patients aged from 36 to 60 years old (not included) were relatively higher (6.10% and 0.84%, respectively). Patients with dialysis time ≥10 years had a higher HCV infection rate (1.64%). Infection rates of HCV, HIV, and TP in patients dialyzed in medical institutions with ≥90 dialysis beds were relatively higher (0.74%, 0.28%, and 1.94%, respectively). Medical institutions with < 30 dialysis beds had the highest HBV infection rate (18.64%). There were 9 cases (0.06%) of vascular puncture infection, 12 cases (0.08%) of bloodstream infection, 7 cases (0.05%) of vascular access-related bloodstream infection, and 30 cases (0.20%) of pulmonary infection. Vascular access-related bloodstream infection rate and pulmonary infection rate among MHD patients with different types of vascular access showed statistically significant difference (all P < 0.05). Vascular access-related bloodstream infection rate (0.37%) and pulmonary infection rate (1.10%) of patients with non-cuffed catheters vascular access were higher than those of other types. Conclusion MHD patients in Guizhou Province are mainly middle-aged and young people, with more males than females. The dialysis frequency is mostly 3 times per week, and AVF is the major vascular access. MHD patients are prone to complications such as infections of HBV, HCV, HIV, and TP, as well as bloodstream infection and pulmonary infection.