Taylor G D, McKenzie M, Buchanan-Chell M, Caballo L, Chui L, Kowalewska-Grochowska K
University of Alberta, University of Alberta Hospital, Edmonton, Canada.
Infect Control Hosp Epidemiol. 1998 Sep;19(9):643-6. doi: 10.1086/647891.
To describe investigations into an increase in hemodialysis-related bacteremia that occurred in our hospital in the first 6 months of 1996.
Hemodialysis unit in a tertiary-care medical center.
Prospective surveillance for hemodialysis bacteremia has been performed for several years. Cases that occurred in 1995 were compared to cases in the first 6 months of 1996. Unit data on dialysis runs and method of dialysis access were used to calculate rates. Nested polymerase chain reaction (PCR) was used to type 18 Staphylococcus aureus isolates from 1996. A case-control study comparing 80 randomly selected hemodialysis patients from 1995 and 1996 was performed to examine infection risk factors.
The hemodialysis bacteremia rate was 1.2 per 1,000 runs in 1995 and 2.8 per 1,000 in the first 6 months of 1996 (P=.0009). The 25 cases in 1995 and 32 in the first half of 1996 were similar in age, gender, means of vascular access, and microbial etiology. Central venous catheter (CVC) access accounted for >90% of cases in both time periods. S aureus was the most common microbial etiology (53% of the 1996 cases). PCR typing of S aureus isolates from 1996 demonstrated five different strains, the most common having six isolates. The use of CVCs as a means of vascular access abruptly increased in the unit in January 1996, from <30% of dialysis runs in 1995 to >40% in 1996 (P<.001), associated with structural changes in healthcare delivery in the region resulting in delays in performing surgical procedures, such as creation of vascular grafts and fistulae.
A marked increase in hemodialysis bacteremia occurred in 1996, associated with increased reliance on CVCs for vascular access in hemodialysis patients during a period of healthcare restructuring.
描述对我院1996年头6个月发生的血液透析相关菌血症增加情况的调查。
一家三级医疗中心的血液透析科。
对血液透析菌血症进行前瞻性监测已开展数年。将1995年发生的病例与1996年头6个月的病例进行比较。利用透析运行的科室数据和透析通路方法来计算发生率。采用巢式聚合酶链反应（PCR）对1996年分离出的18株金黄色葡萄球菌进行分型。进行了一项病例对照研究，比较了1995年和1996年随机选取的80例血液透析患者，以检查感染危险因素。
1995年血液透析菌血症发生率为每1000次透析运行1.2例，1996年头6个月为每1000次透析运行2.8例（P = 0.0009）。1995年的25例病例和1996年上半年的32例病例在年龄、性别、血管通路方式和微生物病因方面相似。两个时间段中，中心静脉导管（CVC）通路占病例的比例均超过90%。金黄色葡萄球菌是最常见的微生物病因（1996年病例的53%）。对1996年分离出的金黄色葡萄球菌进行PCR分型显示有5种不同菌株，最常见的菌株有6株分离菌。1996年1月，该科室使用CVC作为血管通路的比例突然增加，从1995年透析运行的不到30%增至1996年的超过40%（P < 0.001），这与该地区医疗服务结构变化导致诸如血管移植物和动静脉内瘘手术延迟有关。
1996年血液透析菌血症显著增加，与医疗结构调整期间血液透析患者血管通路对CVC的依赖增加有关。
