Sahli Farida, Feidjel Razika, Laalaoui Rima
Microbiology laboratory, Setif University Hospital, Algeria; Faculty of Medicine, Setif 1 University, Algeria.
Faculty of Medicine, Setif 1 University, Algeria.
J Infect Public Health. 2017 Jul-Aug;10(4):403-408. doi: 10.1016/j.jiph.2016.06.008. Epub 2016 Aug 8.
The main complication of central venous catheter (CVC) in hemodialysis is infection. Identifying CVC related infection (CVC-RI) risk factors and causative micro-organisms is important for setting prevention policies. There were no data regarding CVC-RI in hemodialysis in Algeria. To determine rates of CVC-RI in hemodialysis in Setif university hospital, risk factors and causative microorganisms, we conducted a prospective study from November 2014 to May 2015 involving patients with CVC in hemodialysis. Micro-organisms isolated from semi quantitative culture of CVC and blood culture were identified and tested for antibiotic susceptibility using the automated MicroScan system (DADE Behring, Sacramento, CA, USA). Chi-square test was performed to compare demographic and clinical variables (age, sex, comorbidities, duration of CVC, insertion site) in the groups of patients with and without CVC-RI. P<0.05 was considered statistically significant. All analyses were performed using SPSS V17 for Windows statistical package (SPSS Inc., Chicago, IL, USA). 94 patients and 152 CVC procedures were analyzed. 34 CVC-RI were documented with an incidence of 16.6 per 1000 CVC-days. Incidence of CVC related bloodstream infection (CVC-RBI) was 10.8 per 1000 CVC-days. Independent risk factors associated with CVC-RI were diabetes (P=0.01) and duration of catheterization (P= 0.01). Causative micro-organisms were: Klebsiella pneumoniae 26.5%, coagulase-negative staphylococci 23.5% and Staphylococcus aureus 23.5%. Micro-organisms were multidrug-resistant (MDR). Mortality was statistically associated to inadequate antibiotic therapy. The duration of CVC should be reduced by creation of fistulas. More compliance to hygiene measure is needed for decreasing CVC-RI and resistance rate.
血液透析中中心静脉导管（CVC）的主要并发症是感染。识别CVC相关感染（CVC-RI）的危险因素和致病微生物对于制定预防策略很重要。阿尔及利亚尚无关于血液透析中CVC-RI的数据。为了确定塞提夫大学医院血液透析中CVC-RI的发生率、危险因素和致病微生物，我们于2014年11月至2015年5月对血液透析中使用CVC的患者进行了一项前瞻性研究。从CVC的半定量培养和血培养中分离出的微生物，使用自动化MicroScan系统（美国加利福尼亚州萨克拉门托市的DADE Behring公司）进行鉴定并检测抗生素敏感性。采用卡方检验比较有和无CVC-RI患者组的人口统计学和临床变量（年龄、性别、合并症、CVC使用时间、置管部位）。P<0.05被认为具有统计学意义。所有分析均使用适用于Windows的SPSS V17统计软件包（美国伊利诺伊州芝加哥市的SPSS公司）进行。分析了94例患者和152次CVC置管操作。记录到34例CVC-RI，发生率为每1000个CVC日16.6例。CVC相关血流感染（CVC-RBI）的发生率为每1000个CVC日10.8例。与CVC-RI相关的独立危险因素是糖尿病（P=0.01）和置管时间（P=0.01）。致病微生物为：肺炎克雷伯菌26.5%、凝固酶阴性葡萄球菌23.5%和金黄色葡萄球菌23.5%。微生物具有多重耐药性（MDR）。死亡率与抗生素治疗不充分在统计学上相关。应通过建立内瘘来缩短CVC的使用时间。为降低CVC-RI和耐药率，需要更好地遵守卫生措施。
