Renal Unit, Presidio Ospedaliero di Lodi, Lodi, Italy.
Unit of Microbiology, Ospedale Maggiore Lodi, Lodi, Italy.
J Vasc Access. 2022 Mar;23(2):328-329. doi: 10.1177/1129729821990222. Epub 2021 Jan 26.
Recent reports have shown an increase in the rate of Gram-negative bacteremia in several settings, including catheter-related bloodstream infections (CRBSI). To analyze if the epidemiology of CRBSI is also changing in hemodialysis patients, we revisited the etiology of CRBSIs in our renal unit over 8 years. During the observed periods, 149 episodes of CRBSIs were reported and the CRBSI incidence rate, ranged between 0.67 and 0.82 episodes/1000 tCVC days. Of these 149 episodes, 84 (56.3%) were due to Gram-positive bacteria, 62 (41.6%) to Gram-negative bacteria, and 3 (2.1%) to polymicrobial flora, no episodes of fungi were found. There was a trend, but not statistically significative, increase over time in the number of Gram-negative CRBSIs among the total CRBSIs, rising from 37.8% in the first period to 41.2% in the second period and to 44.3% in the last period, with a parallel decrease in the percentage of Gram-positive CRBSIs (from 59.5% to 56.9% and subsequently to 54.1%). Between Gram-negative, we reported an intensification of CRBSI due to Enterobacterales, particularly Escherichia coli. Among the Gram-negative, we have isolated germs rarely reported in the literature, such as Burkholderia cepacia, Pantoea agglomerans, and Rhizobium radiobacter. Regarding Gram-positive bacteria, a triplicate incidence of Staphylococcus aureus was reported with MRSA accounting for 42% in the third period. Among the Gram-positive bacteria, we reported two episodes of Kocuria kristinae and two of Bacillus spp.Our data demonstrated that the epidemiology of CRBSI in the same center, will change over time and Gram-negative strains are an increasing cause of CRBSI. The limitation of the present report is that statistical significance has not been reached, probably due to the limited number of CRBSI. New bacteria, both Gram-negative and Gram-positive, are emerging. Collaboration with the Microbiology Department appears essential to an appropriate diagnosis.
最近的报告显示，在多个环境中，包括导管相关血流感染（CRBSI）在内，革兰氏阴性菌血症的发生率有所增加。为了分析 CRBSI 的流行病学是否也在血液透析患者中发生变化，我们重新分析了 8 年来我院肾内科 CRBSI 的病因。在观察期间，报告了 149 例 CRBSI 病例，CRBSI 的发病率在 0.67 至 0.82 例/1000 次中心静脉导管（tCVC）天之间。在这 149 例病例中，84 例（56.3%）由革兰氏阳性菌引起，62 例（41.6%）由革兰氏阴性菌引起，3 例（2.1%）由混合菌群引起，未发现真菌引起的病例。尽管没有统计学意义，但 CRBSI 中革兰氏阴性菌的数量呈上升趋势，从第 1 期的 37.8%上升至第 2 期的 41.2%和第 3 期的 44.3%，而革兰氏阳性菌的比例则呈下降趋势（从 59.5%降至 56.9%，随后降至 54.1%）。在革兰氏阴性菌中，我们报告了由于肠杆菌科导致的 CRBSI 加重，特别是大肠杆菌。在革兰氏阴性菌中，我们分离到了文献中很少报道的细菌，如洋葱伯克霍尔德菌、成团泛菌和放射形土壤杆菌。在革兰氏阳性菌中，我们报告了三例金黄色葡萄球菌感染，耐甲氧西林金黄色葡萄球菌（MRSA）在第 3 期占 42%。在革兰氏阳性菌中，我们报告了两例科氏葡萄球菌和两例芽孢杆菌。我们的数据表明，同一中心的 CRBSI 流行病学会随时间而变化，革兰氏阴性菌是 CRBSI 不断增加的原因。本报告的局限性在于，可能由于 CRBSI 的数量有限，尚未达到统计学意义。新的细菌，包括革兰氏阴性菌和革兰氏阳性菌，正在出现。与微生物科合作对于适当的诊断至关重要。
