坦桑尼亚北部血液透析患者的导管相关血流感染：一项单中心回顾性研究的见解

Catheter-Related Bloodstream Infections Among Hemodialysis Patients in Northern Tanzania: Insights From a Single-Centre Retrospective Study.

作者信息

Costantine Andrea R, Urasa Sarah J, Sadiq Abid M, Shao Elichilia R, Lyamuya Furaha S, Niccodem Elieishiupendo M, Kamabu Eugénie M, Maro Venance P, Mkwizu Elifuraha W, Chamba Nyasatu G, Furia Francis F, Mirai Tumaini E, Nziku Eliada B, Eliah Doreen T, Muhina Ibrahim Ali Ibrahim, Raza Faryal M, Mitao Modesta P, Kilonzo Kajiru G

机构信息

Department of Internal Medicine Kilimanjaro Christian Medical University College Moshi Tanzania.

Department of Internal Medicine Kilimanjaro Christian Medical Centre Moshi Tanzania.

出版信息

Health Sci Rep. 2025 Jan 13;8(1):e70338. doi: 10.1002/hsr2.70338. eCollection 2025 Jan.

DOI:10.1002/hsr2.70338

PMID:39807485

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11725762/

Abstract

BACKGROUND AND AIMS

A catheter-related bloodstream infection (CRBSI) is a life-threatening complication of hemodialysis. It is responsible for significant morbidity and mortality and a costly long hospital stay. Despite its burden, little is known about the factors associated with it and the antibiogram of its responsible causative bacteria. This study aimed to evaluate the determinants of hemodialysis CRBSI and the appropriate antibiogram for the isolated bacterial pathogens among patients attending the KCMC hemodialysis unit.

METHODS

A hospital-based retrospective analytical cross-sectional study involved adult patients with CKD or AKI undergoing hemodialysis at KCMC with tunneled or non-tunneled central venous catheters who attended from January 1, 2021 to December 31, 2022. Data were collected from the hospital's electronic medical record system. Statistical analysis was performed using SPSS version 27. Multivariate logistic regression was used to determine the factors associated with CRBSI. A -value of < 0.05 was considered statistically significant.

RESULTS

A total of 286 patients were analyzed. The patients were predominantly males (70.6%), and more than half were above 55 years old (56%), with a mean age of 58 (SD ± 14.8) years. 56.6% developed CRBSI and were predominantly gram-positive (69.7%). Major associated factors were hypoalbuminemia of < 35 g/dL, diabetes mellitus, anemia of hemoglobin < 10 g/dL, and having a femoral central venous catheter. For gram-positive bacteria, the most efficient antibiotic was vancomycin, with an overall average efficacy of 99% for all isolates. For gram-negative bacteria, the most efficient antibiotic was meropenem, with an overall average efficacy of 82.1% for all isolates.

CONCLUSION

Over 50% of patients developed CRBSI and gram-positive bacteria were the major causative bacteria. Associated factors were multifactorial and preventive care would be ideal to reduce the number of CRBSI based on these findings.

摘要

背景与目的

导管相关血流感染（CRBSI）是血液透析的一种危及生命的并发症。它会导致严重的发病率和死亡率以及高昂的长期住院费用。尽管其负担沉重，但关于与之相关的因素及其致病细菌的抗菌谱却知之甚少。本研究旨在评估基奎特中央医院血液透析科患者中血液透析CRBSI的决定因素以及分离出的细菌病原体的合适抗菌谱。

方法

一项基于医院的回顾性分析横断面研究，纳入了2021年1月1日至2022年12月31日期间在基奎特中央医院接受血液透析且使用带隧道或不带隧道的中心静脉导管的成年慢性肾脏病（CKD）或急性肾损伤（AKI）患者。数据从医院的电子病历系统收集。使用SPSS 27版进行统计分析。采用多因素逻辑回归确定与CRBSI相关的因素。P值<0.05被认为具有统计学意义。

结果

共分析了286例患者。患者以男性为主（70.6%），超过一半的患者年龄在55岁以上（56%），平均年龄为58（标准差±14.8）岁。56.6%的患者发生了CRBSI，主要为革兰氏阳性菌（69.7%）。主要相关因素包括白蛋白水平<35g/dL的低白蛋白血症（hypoalbuminemia）、糖尿病、血红蛋白<10g/dL的贫血以及使用股静脉中心静脉导管。对于革兰氏阳性菌，最有效的抗生素是万古霉素，所有分离株的总体平均有效率为99%。对于革兰氏阴性菌，最有效的抗生素是美罗培南，所有分离株的总体平均有效率为82.1%。