Dalrymple Lorien S, Mu Yi, Nguyen Danh V, Romano Patrick S, Chertow Glenn M, Grimes Barbara, Kaysen George A, Johansen Kirsten L
Departments of Medicine and
Health Sciences, University of California, Davis, California;
Clin J Am Soc Nephrol. 2015 Dec 7;10(12):2170-80. doi: 10.2215/CJN.03050315. Epub 2015 Nov 13.
Infection-related hospitalizations have increased dramatically over the last 10 years in patients receiving in-center hemodialysis. Patient and dialysis facility characteristics associated with the rate of infection-related hospitalization were examined, with consideration of the region of care, rural-urban residence, and socioeconomic status.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The US Renal Data System linked to the American Community Survey and Rural-Urban Commuting Area codes was used to examine factors associated with hospitalization for infection among Medicare beneficiaries starting in-center hemodialysis between 2005 and 2008. A Poisson mixed effects model was used to examine the associations among patient and dialysis facility characteristics and the rate of infection-related hospitalization.
Among 135,545 Medicare beneficiaries, 38,475 (28%) had at least one infection-related hospitalization. The overall rate of infection-related hospitalization was 40.2 per 100 person-years. Age ≥ 85 years old, cancer, chronic obstructive pulmonary disease, inability to ambulate or transfer, drug dependence, residence in a care facility, serum albumin <3.5 g/dl at dialysis initiation, and dialysis initiation with an access other than a fistula were associated with a ≥ 20% increase in the rate of infection-related hospitalization. Patients residing in isolated small rural compared with urban areas had lower rates of hospitalization for infection (rate ratio, 0.91; 95% confidence interval, 0.86 to 0.97), and rates of hospitalization for infection varied across the ESRD networks. Measures of socioeconomic status (at the zip code level), total facility staffing, and the composition of staff (percentage of nurses) were not associated with the rate of hospitalization for infection.
Patient and facility factors associated with higher rates of infection-related hospitalization were identified. The findings from this study can be used to identify patients at higher risk for infection and inform the design of infection prevention strategies.
在过去10年中，接受中心血液透析的患者因感染导致的住院人数急剧增加。本研究考察了与感染相关住院率相关的患者及透析机构特征，并考虑了医疗区域、城乡居住情况和社会经济地位。
设计、地点、参与者及测量方法：利用与美国社区调查及城乡通勤区代码相链接的美国肾脏数据系统，研究2005年至2008年开始接受中心血液透析的医疗保险受益人中与感染相关住院的影响因素。采用泊松混合效应模型来研究患者及透析机构特征与感染相关住院率之间的关联。
在135,545名医疗保险受益人中，38,475人（28%）至少有一次与感染相关的住院治疗。感染相关住院的总体发生率为每100人年40.2次。年龄≥85岁、癌症、慢性阻塞性肺疾病、无法行走或转移、药物依赖、居住在护理机构、透析开始时血清白蛋白<3.5 g/dl以及采用除动静脉内瘘以外的通路开始透析，均与感染相关住院率增加≥20%相关。与城市地区相比，居住在偏远农村小地区的患者感染住院率较低（率比为0.91；95%置信区间为0.86至0.97），并且不同的终末期肾病网络感染住院率有所不同。社会经济地位指标（邮政编码层面）、机构总人员配备及人员构成（护士比例）与感染住院率无关。
确定了与较高感染相关住院率相关的患者及机构因素。本研究结果可用于识别感染风险较高的患者，并为感染预防策略的设计提供依据。
