Nanyunja Doreen, Chothia Mogamat-Yazied, Opio Kenneth C, Ocama Ponsiano, Bwanga Freddie, Kiggundu Daniel, Byakika-Kibwika Pauline
Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
IJID Reg. 2022 Sep 14;5:72-78. doi: 10.1016/j.ijregi.2022.09.002. eCollection 2022 Dec.
The high burden of infectious complications among patients receiving haemodialysis (HD) via central venous catheters increases morbidity and mortality. This study determined the incidence of catheter-related bloodstream infections (CRBSIs), microbiological profile of causative organisms, and associated predictors in patients on chronic HD.
A prospective single-centre cohort study of 121 adult patients with end-stage kidney disease was conducted from October 2019 to March 2020. Antibiotic susceptibility was determined by the Kirby-Bauer disk diffusion method. Cox proportional hazards model was used to determine predictors of CRBSI.
The mean age was 50 (standard deviation 14.9) years and the median duration of follow-up was 69 (interquartile range 23-124) days. At least one CRBSI was recorded for 41% of patients, at a rate of 5.2 infections per 1000 patient-days. Causative organisms were predominantly Gram-negative bacteria (60.3%), and 36.5% of all isolates were multi-drug resistant. Anaemia [hazard ratio (HR) 5.44, 0.019, 95% confidence interval (CI) 1.32-22.48] and previous bloodstream infection [HR 2.47, 0.028, 95% CI 1.10-5.54] were predictors of CRBSI.
The high incidence of CRBSI in patients on chronic HD with predominance of Gram-negative bacteria means that catheter care bundles should include Gram-negative coverage.
通过中心静脉导管进行血液透析（HD）的患者感染并发症负担较重，会增加发病率和死亡率。本研究确定了慢性血液透析患者中导管相关血流感染（CRBSI）的发生率、致病微生物的微生物学特征以及相关预测因素。
2019年10月至2020年3月对121例终末期肾病成年患者进行了一项前瞻性单中心队列研究。采用 Kirby-Bauer 纸片扩散法测定抗生素敏感性。使用Cox比例风险模型确定CRBSI的预测因素。
平均年龄为50（标准差14.9）岁，中位随访时间为69（四分位间距23 - 124）天。41%的患者记录到至少一次CRBSI，发生率为每1000患者日5.2次感染。致病微生物主要为革兰氏阴性菌（60.3%），所有分离株中有36.5%对多种药物耐药。贫血[风险比（HR）5.44，P = 0.019，95%置信区间（CI）1.32 - 22.48]和既往血流感染[HR 2.47，P = 0.028，95% CI 1.10 - 5.54]是CRBSI的预测因素。
慢性血液透析患者中CRBSI的高发生率以及革兰氏阴性菌占主导地位意味着导管护理集束应包括针对革兰氏阴性菌的覆盖措施。
