永久性透析导管患者导管相关感染的危险因素。
Risk factors for catheter-related infections in patients receiving permanent dialysis catheter.
机构信息
Department of Nephrology and Rheumatology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Str.40, 37099, Göttingen, Germany.
Department of Nephrology and Hypertension, Academic Teaching Hospital Bamberg, Bugerstrasse 80, 96049, Bamberg, Germany.
出版信息
BMC Nephrol. 2019 May 31;20(1):199. doi: 10.1186/s12882-019-1392-0.
BACKGROUND
Due to rising vascular comorbidities of patients undergoing dialysis, the prevalence of permanent hemodialysis catheters as hemodialysis access is increasing. However, infection is a major complication of these catheters. Therefore, identification of potential predicting risk factors leading to early infection related complications is valuable, in particular the significance the CRP (C-reactive protein)-value is of interest.
METHODS
In this retrospective study 151 permanent hemodialysis catheters implanted in 130 patients were examined. The following data were collected at the time of catheter implantation: CRP-value, history of catheter-related infection, microbiological status, immunosuppression and diabetes mellitus. The primary outcomes were recorded over the 3 months following the implantation: catheter-related infection, days of hospital stay and death. Catheter removal or revision, rehospitalization and use of antibiotics were identified as secondary outcomes.
RESULTS
We identified a total of 27 (17.9%) infections (systemic infection: 2.26 episodes/ 1000 catheter days, local infection: 0.6 episodes/ 1000 catheter days). The development of an infection was independent of the CRP-value (p = 0.66) as well as the presence of diabetes mellitus (p = 0.64) or immunosuppression (p = 0.71). Univariate analysis revealed that infection was more frequent in patients with MRSA-carriage (p < 0.001), in case of previous catheter-related infection (p < 0.05) and of bacteremia or bacteriuria in the period of 3 months before catheter implantation (p < 0.001). Catheter removal or revision (p = 0.002), rehospitalization (p = 0.001) and use of antibiotics (p = 0.02) were also more often observed in patients with MRSA-carriage.
CONCLUSIONS
The CRP-value at the time of implantation of a permanent hemodialysis catheter is not associated with the development of early catheter related infections, but an individual history of catheter-related infection, MRSA-carriage and bacteremia or bacteriuria in the period of 3 months prior to catheter implantation are significant risk factors.
背景
由于接受透析治疗的患者血管合并症的增加，永久性血液透析导管作为血液透析通路的患病率正在增加。然而，感染是这些导管的主要并发症。因此，确定导致早期感染相关并发症的潜在预测风险因素是有价值的，特别是 CRP（C 反应蛋白）值的意义。
方法
在这项回顾性研究中，检查了 130 名患者的 151 个永久性血液透析导管。在导管植入时收集了以下数据：CRP 值、导管相关感染史、微生物状态、免疫抑制和糖尿病。主要结果记录在导管植入后 3 个月内：导管相关感染、住院天数和死亡。导管移除或修改、再次住院和使用抗生素被确定为次要结果。
结果
我们共发现 27 例（17.9%）感染（全身感染：每 1000 个导管日 2.26 例，局部感染：每 1000 个导管日 0.6 例）。感染的发生与 CRP 值无关（p=0.66），也与糖尿病（p=0.64）或免疫抑制（p=0.71）无关。单因素分析显示，在 MRSA 携带患者中感染更常见（p<0.001），在有导管相关感染史的患者中（p<0.05），以及在导管植入前 3 个月内有菌血症或菌尿的患者中（p<0.001）。在 MRSA 携带患者中，更常观察到导管移除或修改（p=0.002）、再次住院（p=0.001）和使用抗生素（p=0.02）。
结论
永久性血液透析导管植入时的 CRP 值与早期导管相关感染的发生无关，但导管相关感染史、MRSA 携带以及导管植入前 3 个月内的菌血症或菌尿是显著的危险因素。
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