Agrawal Varun, Valson Anna T, Bakthavatchalam Yamuna Devi, Kakde Shailesh, Mohapatra Anjali, David Vinoi George, Alexander Suceena, Jacob Shibu, Jude Prakash John Antony, Veeraraghavan Balaji, Varughese Santosh
Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Nephrol. 2022 Jan-Feb;32(1):34-41. doi: 10.4103/ijn.IJN_400_20. Epub 2021 Apr 8.
Skin colonization is a risk factor for multi-drug resistant (MDR) catheter-associated bloodstream infections (CABSI). This study aimed to determine the prevalence and spectrum of skin colonizing MDR organisms in incident HD patients and their correlation with CABSI.
This single-center prospective cohort study included consecutive adult incident HD patients who underwent tunneled or non-tunneled internal jugular vein HD catheter insertion between June 1, 2017 and October 31, 2017. Nasal, axillary, and exit site swabs were obtained prior to catheter insertion, at 14-21 days, and 28-35 days after catheter insertion.
Forty-three patients (69.7% male, 32.5% diabetic) were included and provided baseline swabs, while 29 and 10 patients respectively were available for follow-up swabs. MDR bacterial colonization, MRSA colonization, and MDR gram-negative colonization on the baseline set of swabs were seen in 76.7%, 69.7%, and 9.3% patients respectively. Of the 29 patients with at least two consecutive sets of swabs, 79.3% showed persistent colonization by MDR gram-positive organisms, most commonly by MRSA. Six patients developed a CABSI during the follow-up period (incidence rate 3.7 per 1000 patient days), 83.4% were gram negative, and in only one instance (16.6%) was the bacterial strain identical to that which had previously colonized the skin.
Three-fourths of HD patients were colonized by MDR bacteria prior to HD initiation. Despite the majority being persistently colonized by MDR gram-positive organisms, CABSIs were predominantly gram negative.
皮肤定植是耐多药（MDR）导管相关血流感染（CABSI）的一个危险因素。本研究旨在确定新发血液透析（HD）患者皮肤定植的耐多药微生物的患病率和谱型，以及它们与CABSI的相关性。
这项单中心前瞻性队列研究纳入了2017年6月1日至2017年10月31日期间连续接受带隧道或不带隧道的颈内静脉HD导管插入术的成年新发HD患者。在导管插入前、插入后14 - 21天以及插入后28 - 35天采集鼻腔、腋窝和出口部位拭子。
纳入43例患者（男性占69.7%，糖尿病患者占32.5%）并采集了基线拭子，同时分别有29例和10例患者可用于随访拭子采集。在基线拭子组中，耐多药细菌定植、耐甲氧西林金黄色葡萄球菌（MRSA）定植和耐多药革兰阴性菌定植分别见于76.7%、69.7%和9.3%的患者。在29例至少有两组连续拭子的患者中，79.3%显示耐多药革兰阳性菌持续定植，最常见的是MRSA。6例患者在随访期间发生了CABSI（发病率为每1000患者日3.7例），83.4%为革兰阴性菌，且仅1例（16.6%）的菌株与先前皮肤定植的菌株相同。
四分之三的HD患者在开始HD之前就被耐多药细菌定植。尽管大多数患者被耐多药革兰阳性菌持续定植，但CABSI主要是革兰阴性菌。
