【摘要】目的探讨研究血液透析患者发生导管相关性血流感染(catheter-related blood stream infection ,CRBSI)的危险因素及感染特点，为预防导管相关性感染的发生及指导临床治疗提供参照依据。方法对2015 年1 月～2020 年5 月徐州医科大学附属医院血液净化中心通过中心静脉置管行血液透析的患者320 例进行回顾性分析，依据是否并发感染分为感染组和未感染组，对患者一般情况及实验
室指标进行分析，探究引起感染的相关因素，并对其病原菌及药敏结果进行分析。结果320 例患者中发生CRBSI 的有60 例，发生率为18.75%。与非感染组相比，感染组股静脉置管（χ2=5.585，P=0.016）、置长期管（χ2=17.903，P＜0.001）、置管天数≥28 天（χ2=18.526，P＜0.001）、透析时间≥1 年（χ2=35.688，P＜0.001）、患高血压疾病（χ2=4.571，P=0.033）人数所占比例均明显高于非感染组，感染组患者钠（t=2.635，P=0.009）、氯（t=2.978，P=0.003）水平均明显低于非感染组，感染组患者白细胞计数（Z=- 4.812，P0.001）、中性粒细胞与淋巴细胞比（Neutrophil to lymphocyte ratio,NLR）（Z=-4.953，P＜0.001）、C-反应蛋白（C-reactive protein，CRP）（Z =-6.399，P＜0.001）、降钙素原（procalcitonin,PCT）（Z=-9.716，P＜0.001）、甲状旁腺激素（parathyroid hormone，PTH）（Z=-3.002，P=0.003）水平均明显高于非感染组，差异均具有统计学意义（P＜0.05），Logistic 回归显示, 股静脉置管[OR=4.483, 95% CI（1.814～11.079), P=0.001]、置长期管[OR=4.039, 95% CI(1.636～9.972), P=0.002]、置管天数≥28 天[OR=6.636，95% CI(2.605～16.905)，P=0.000)]、透析时间≥1 年[OR=3.016，95% CI（1.268～7.175），P= 0.013)]、NLR[OR=1.065，95% CI(1.020～1.111)，P=0.004]、PCT[OR=1.044，95% CI(1.028～1.061)，P=0.000]、PTH [OR= 1.003，95% CI（1.001～1.006），P=0.002]是血液透析患者发生导管相关性感染的独立危险因素。感染患者中共检出病原菌67株，其中革兰阳性菌25株，革兰阴性菌41株，真菌1株。革兰阳性菌中对头孢唑林、头孢噻吩、头孢泊肟、头孢西丁的耐药率分别为100%、83.3%、80.0%、80.0%；革兰阴性菌中对红霉素、头孢西丁、克林霉素、青霉素G的耐药率分别为88%、87.5%、85.7%、83.3%。结论股静脉置管、置长期管、置管天数≥28 天、透析时间≥1 年、NLR、PCT、PTH 是血液透析患者发生CRBSI 的危险因素。感染致病菌以革兰氏阴性菌为主，单菌种构成主要以金葡菌与铜绿假单胞菌为主，抗感染治疗过程中应及时根据药敏结果调整用药。

【Abstract】Objective To study the risk factors and clinical characteristics of catheter- related blood stream infection (CRBSI) in hemodialysis patients, so as to provide strategies for the prevention and treatment of CRBSI in these patients. Methods A total of 320 patients undergoing hemodialysis using central venous catheters and treated in the Blood Purification Center, Xuzhou Medical University Affiliated Hospital in the period from January 2015 to May 202 were retrospectively analyzed. According to the infection status, they were divided into infected group and non-infected group. Their clinical data and laboratory indicators were recruited
to explore the relevant factors for the infections and to analyze the pathogenic bacteria and their drug sensitivities. Results There were 60 cases of CRBSI among 320 patients, the incidence rate was 18.75%. Compared with the non- infected group, femoral vein catheterization in the infected group (χ2=5.585, P=0.016), long- term catheterization (χ2=17.903, P<0.001), and catheterization days ≥28 days (χ2=18.526, P<0.001) ), dialysis time ≥1 year (χ2=35.688, P<0.001), the proportion of people suffering from hypertension (χ2=4.571, P=0.033) were significantly higher than those in the non- infected group, and sodium in the infected group (t=2.635) , P=0.009), chlorine (t=2.978,P=0.003) levels were significantly lower than those in the noninfected
group, and the white blood cell count (Z=-4.812, P<0.001), neutrophil to lymphocyte ratio (Neutrophil to lymphocyte ratio, NLR) (Z=-4.953, P<0.001), C-reactive protein (CRP) (Z=-6.399, P<0.001), procalcitonin (PCT) (Z=-9.716, P<0.001), parathyroid hormone (PTH) (Z=-3.002, P=0.003) levels were significantly higher than those of the non-infected group, and the differences were statistically significant (P<0.05 ), Logistic regression showed that femoral vein catheterization [OR=4.483, 95% CI (1.814~11.079), P=0.001], longterm catheterization [OR=4.039, 95% CI(1.636~9.972),P=0.002], The number of days of catheterization ≥28 days [OR=6.636, 95% CI (2.605~16.905), P=0.000] dialysis time ≥1 year [OR=3.016, 95% CI (1.268~ 7.175), P=0.013], NLR [OR=1.065, 95% CI (1.020~1.111), P=0.004], PCT [OR=1.044, 95% CI (1.028~1.061), P= 0.000], PTH [OR=1.003, 95% CI (1.001~1.006), P=0.002] is an independent risk factor for catheter-related infection in hemodialysis patients. The main pathogenic bacteria of infection are Gram-negative bacteria, and the single bacterial species are mainly Staphylococcus aureus and Pseudomonas aeruginosa. During the course of anti-infection treatment, the medication should be adjusted in time according to the results of drug sensitivity. Conclusion Femoral vein catheterization, long-term catheterization, catheterization days≥28 days, dialysis period more than one year, NLR, PCT, and PTH were the risk factors for CRBSI in hemodialysis patients.
The main pathogenic bacteria of the infection were Gram- negative bacteria, and the main bacterial species were Staphylococcus aureus and Pseudomonas aeruginosa. The anti-infection medications should be adjusted in time according to the results of drug sensitivity tests.