Rodríguez Guardado A, Carton J A, López Ponga B, Casado L, Pérez F, Aguado S
Servicio de Medicina Interna (Infecciones), Hospital Central de Asturias, (Nuestra Señora de Covadonga), Universidad de Oviedo, Asturias.
Rev Clin Esp. 1997 Jul;197(7):484-9.
To determine the incidence of bacteremia among patients on hemodialysis, the responsible microorganisms and to describe the predisposing and prognostic factors.
A retrospective analysis was conducted of 85 episodes of bacteremia occurred from 1979-1994; the episodes involved 71 patients (male/female ratio: 27/44) with a mean age of 58 years (29-80).
Eighty-seven microorganisms were recovered, which included 61 grampositive cocci (67% Staphylococcus aureus), 25 gramnegative bacilli (52% Escherichia coli) and 1 anaerobe. The mean incidence was 3.1/100 patients on hemodialysis/year (range: 1.1-8.3), higher in patients with interstitial and cystic renal disease. In 52% of cases an intravascular source was detected, associated with vein access for hemodialysis (in 91% there were inflammatory signs at the fistula). In 16 cases (19%) no portal of entry was detected and in the remaining patients the portal of entry had an extravascular origin. Eighty patients received antibiotic therapy and 35 patients required the substitution of the vein access. Thirteen patients died (15%) as a result of bacteremia. The mortality rate was higher among patients developing shock (50%), endocarditis (75%) and in those who had remained for longer than 1,000 days on hemodialysis (45%). Bacteremia accounted for the third known cause of death on dialysis, and was responsible for 11% of deaths occurred during the time of the study.
Bacteremia among hemodialysed patients was mainly associated with Staphylococcus aureus infections at the vascular access. Bacteremia was the direct responsible for 11% of deaths occurred on dialysis.
确定血液透析患者菌血症的发生率、致病微生物，并描述易感因素和预后因素。
对1979年至1994年发生的85例菌血症进行回顾性分析；这些病例涉及71例患者（男女比例为27/44），平均年龄58岁（29 - 80岁）。
共分离出87种微生物，其中包括61种革兰氏阳性球菌（67%为金黄色葡萄球菌）、25种革兰氏阴性杆菌（52%为大肠杆菌）和1种厌氧菌。平均发生率为3.1/100血液透析患者/年（范围：1.1 - 8.3），在间质性和囊性肾病患者中发生率更高。52%的病例检测到血管内感染源，与血液透析的静脉通路有关（91%的病例在瘘管处有炎症迹象）。16例（19%）未检测到感染入口，其余患者的感染入口起源于血管外。80例患者接受了抗生素治疗，35例患者需要更换静脉通路。13例患者（15%）死于菌血症。休克患者（50%）、心内膜炎患者（75%）以及血液透析时间超过1000天的患者（45%）死亡率更高。菌血症是透析患者已知的第三大致死原因，在研究期间占死亡病例的11%。
血液透析患者的菌血症主要与血管通路处的金黄色葡萄球菌感染有关。菌血症是透析患者11%死亡的直接原因。
