National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Am J Kidney Dis. 2010 Sep;56(3):566-77. doi: 10.1053/j.ajkd.2010.02.352. Epub 2010 Jun 15.
Infections cause significant morbidity and mortality in patients undergoing hemodialysis. Bloodstream infections (BSIs) are particularly problematic, accounting for a substantial number of hospitalizations in these patients. Hospitalizations for BSI and other vascular access infections appear to have increased dramatically in hemodialysis patients since 1993. These infections frequently are related to central venous catheter (CVC) use for dialysis access. Regional initiatives that have shown successful decreases in catheter-related BSIs in hospitalized patients have generated interest in replicating this success in outpatient hemodialysis populations. Several interventions have been effective in preventing BSIs in the hemodialysis setting. Avoiding the use of CVCs in favor of access types with lower associated BSI risk is among the most important. When CVCs are used, adherence to evidence-based catheter insertion and maintenance practices can positively influence BSI rates. In addition, facility-level surveillance to detect BSIs and stimulate examination of vascular access use and care practices is essential to a comprehensive approach to prevention. This article describes the current epidemiology of BSIs in hemodialysis patients and effective prevention strategies to decrease the incidence of these devastating infections.
在接受血液透析的患者中，感染会导致严重的发病率和死亡率。血流感染（BSI）尤其成问题，占这些患者大量住院的原因。自 1993 年以来，BSI 和其他血管通路感染的住院治疗似乎在血液透析患者中急剧增加。这些感染通常与用于透析通路的中心静脉导管（CVC）使用有关。已经显示出在住院患者中成功降低与导管相关的 BSI 的区域举措引起了人们对在门诊血液透析人群中复制这一成功的兴趣。在血液透析环境中，有几种干预措施已被证明可以有效预防 BSI。避免使用 CVC，转而采用与较低 BSI 风险相关的其他类型的通路，是最重要的措施之一。当使用 CVC 时，坚持基于证据的导管插入和维护实践可以积极影响 BSI 率。此外，为了预防这些破坏性感染，还需要进行设施层面的监测以检测 BSI，并刺激对血管通路使用和护理实践的检查。本文描述了血液透析患者中 BSI 的当前流行病学以及降低这些严重感染发生率的有效预防策略。
