Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA,
Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Am J Nephrol. 2019;50(2):126-132. doi: 10.1159/000501357. Epub 2019 Jun 26.
Catheter-related bloodstream infections -(CRBSI) are associated with a high burden of morbidity and mortality, but the impact of infecting organism on clinical outcomes has been poorly studied.
This retrospective analysis of a prospective vascular access database from a large academic dialysis center investigated whether the organism type affected the clinical presentation or complications of CRBSI.
Among 339 patients with suspected CRBSI, an alternate source of infection was identified in 50 (15%). Of 289 patients with CRBSI, 249 grew a single organism and 40 were polymicrobial. Fever and/or rigors were presenting signs in ≥90% of patients with Staphylococcus aureus or Gram-negative CRBSI, but only 61% of Staphylococcus epidermidis infections (p < 0.001). Hospitalization occurred in 67% of patients with S. aureus CRBSI versus 34% of those with S. epidermidis and 40% of those with a Gram-negative bacteria (p < 0.001). Admission to the intensive care unit was required in 14, 9, and 2% (p = 0.06); metastatic infection occurred in 10, 4, and 4% (p = 0.42); and median length of stay among patients admitted to the hospital was 4, 4, and 5.5 days (p = 0.60), respectively. Death due to CRBSI occurred in only 1% of patients with CRBSI.
CRBSI is confirmed in 85% of catheter-dependent hemodialysis patients in whom it is suspected. S. epidermidis CRBSI tends to present with atypical symptoms. S. aureus CRBSI is more likely to require hospitalization or intensive care admission. Metastatic infection is relatively uncommon, and death due to CRBSI is rare.
导管相关血流感染（CRBSI）与较高的发病率和死亡率有关，但感染病原体对临床结果的影响研究甚少。
本研究回顾性分析了一家大型学术透析中心前瞻性血管通路数据库，调查了病原体类型是否会影响 CRBSI 的临床表现或并发症。
在 339 例疑似 CRBSI 的患者中，50 例（15%）确定了感染的其他来源。在 289 例 CRBSI 患者中，249 例培养出单一病原体，40 例为多微生物病原体。金黄色葡萄球菌或革兰氏阴性菌 CRBSI 患者中≥90%有发热和/或寒战等表现症状，但表皮葡萄球菌感染患者中仅 61%（p<0.001）。金黄色葡萄球菌 CRBSI 患者中有 67%住院，而表皮葡萄球菌患者中有 34%，革兰氏阴性菌患者中有 40%（p<0.001）。14%、9%和 2%（p=0.06）需要入住重症监护病房；10%、4%和 4%（p=0.42）发生转移性感染；住院患者的中位住院时间分别为 4 天、4 天和 5.5 天（p=0.60）。仅有 1%的 CRBSI 患者因 CRBSI 死亡。
在怀疑患有导管依赖性血液透析患者中，有 85%的患者被确诊为 CRBSI。表皮葡萄球菌 CRBSI 倾向于表现出非典型症状。金黄色葡萄球菌 CRBSI 更有可能需要住院或入住重症监护病房。转移性感染相对少见，CRBSI 导致的死亡也罕见。
