Risk Factors And Drug Resistance Analysis Of Central Venous Catheter-related Bloodstream Infection In Hemodialysis

Background and Purpose:Currently, hemodialysis is still a major method of blood purification for the endstage renal disease, and with the development of economy and technology, centralvenous catheter as hemodialysis vascular access is subject recognized from patientsand medical staff in the clinic. Infection is one of the common complicationshemdialysis patients who intubated central venous catheter, and catheter-related bloodstream infection is alao the common cause for hospitalization and catheter-extubated inhemodialysis patients. In recent years, with the increase in the type of antibiotic and alarge number of antibiotics application under long term, bacteria spectrum is changingand while resistant bacteria and fungus had increased. Therefore the studyretrospectively analyzes the clinical data of nearly2years hemodialysiscatheter-related blood stream infection patients in the First Hospital of Jilin University,which aims to probe the risk factors of long term catheter-related blood streaminfection in hemodialysis pathogenic spectrum and drug resistance change, andprovide clinical guidance for prevention and treatment of catheter-related blood streaminfection.Materials and Methods:112hemodialysis patients were selected who were hospitalizing in nephrologydepartment at the First Hospital of Jilin University during2013to2015,according towhether the occurrence of catheter-related blood stream infection, divided into theinfected group and the control group. Statistics each patient’s age, gender, maritalstatus, dialysis month, catheterization time, catheter site, primary disease, bloodroutine examination, electrolytes, renal function, albumin, pre-albumin, ferritin, parathyroid hormone, blood culture results and antibiotic susceptibility results and soon. Investigate the risk factors of catheter-related blood stream infection, clarify thedistribution of pathogenic and the change of bacteria resistance.Results：1.There is no statistical difference between the two groups’ clinical datas in age,duration of dialysis, gender, marital status, primary disease and other generalinformation.2. In comparing the blood parameters, the number of white blood cell, percentageof neutrophils, globulin, serum creatinine, blood urea nitrogen, ferritin, parathyroidhormone in infected group is significantly higher than that in the control group, whilethe number of red blood cell, hemoglobin,hematocrit, serum album invalues significa-ntly lower than the control group. These differences between the two groups arestatistically significant (P<0.05).There is no significant difference between the twogroups in platelet count, pre-albumin, potassium, sodium, chloride, calcium,phosphorus area.3. The catheter-based sites of infected patients and the control group are bothinternal jugular vein, and main right internal jugular vein.There is no significantdifference between the two groups.4. In this study, the longest catheterization time of central venous catheter inhemodialysis patients is five years, and the shortest catheterization time is threemonths.The study statistics the infection rates of the three different catheterizationtime patients. According to catheterization time, the patients were divided into A, B, Cthree groups. In group A,the catheterization time is in12months,among which thereare8infected patients and33uninfected patients, the infected rate is19.51%. Ingroup B,the catheterization time is between12months to24months,among whichthere are24infected patients and21uninfected patients, the infected rate is53.33%Ingroup C,the catheterization time is more than24months,among which there are15infected patients and11uninfected patients, the infected rate is57.69%. The infectionincidence is highest in group C, meanwhile group A of the lowest infection rates, there are significant differences among the three groups(P<0.05).Comparing between groupA and group B is statistically significant(P<0.05);while the compare between group Aand group C is statistically significant(P<0.01); but there is no statistically significantbetween group B and group C.5. The infection group patients with diabetes mellitus is by up to27cases,accounting for54%of the total number of infections, and in the control group ofpatients with diabetes mellitus by up to20cases, accounting for32.3%. There was asignificant statistical difference between the two groups(P<0.05).6. In47patients with catheter-related blood stream infection were totally culturedblood circulation96cases,64cultureswere positive, the positive rate was66.67%, atotal of training66strains pathogenic bacteria, which include Gram-positive bacteria42strains, accounting for63.64%; Gram-negative bacteria20strains, accountingfor30.30%; fungus4strains, accounting for6.06%.4patients were mixed infections,who all cultured two kinds of pathogens. Among Gram-positive bacteriastaphylococcus aureus is in the main,25strains; Among Gram-negative bacteria,serratia marcescensa ccount for the highestproportion,4strains.7.The drug resistance of main Gram-positive bacteria to linezolid, vancomycinwas0; followed by moxifloxacin, nitrofurantoin, rifampin, tetracycline, respectively5.56%,5.26%,2.38%,9.52%; the resistance rates of levofloxacin, amikacinrespectively is17.95%,16.22%,15.15%, and resistance rates forcefazolin, cefuroxime,clindamycin is up to87.5%,77.78%,61.9%; penicillin is highistly up to90.48%. Forthe main Gram-negative bacteria, cefepime, imipenem, meropenem, moxifloxacin,amikacin’s resistance was0; followed by sulfamethoxazole, levofloxacin, aztreonam,respectively,6.67%,10%,10%;the resistance rates of ceftriaxone, ceftazidime,gentamicin, tetracyclineis respectively20%,20%,25%,11.76%; cefoxitin,cefoperazone/sulbactam, cefuroximeis55.56%,75%,75%; cefazolin resistance to thehighest, at76.92%.Conclusion:1. Anemia, malnutrition, high uremic toxins, catheterization time more than12 months, combined with diabetes mellitus, high levels of ferritin and parathormone arerisk factors of catheter-related blood stream infection in hemodialysis patients.2. The pathogenic bacteria of central venous catheter-related blood streaminfection are given priority to gram-positive bacterium, the most common cases ofwhich are staphylococcus aureus. Gram-negative bacteria are given priority to serratiamarcescens.3. Empirically anti-infection treatment of central venous catheter-related bloodstream infection is given priority to the treatment of anti-gram-positive bacteria.Vancomycin can be continued to be the first choice.