The Analysis Of The Risk Factors And Drug Resistance Of Central Venous Catheter Related Bloodstream Infection Of Hemodialysis And Peritoneal Dialysis Related Peritonitis

Objective: To investigate the risk factors,pathogen distribution and drug resistance for the long-term hemodialysis catheter-related bloodstream infection and peritoneal dialysis-related peritonitis in the patients who underwent renal replacement therapy.It may provide evidence for prevention and treatment of those infection.Methods: We collected 134 patients with end-stage renal disease who underwent renal replacement therapy in our nephrology division from October 2015 to October 2017.Of all the patients,65 cases with tunneled central venous catheterswere regarded as MHD group,69 cases with peritoneal dialysis catheter were regarded as CAPD group.According to whether occurred the catheter-related bloodstream infection(CRBSI),MHD group was divided into CRBSI group and Non-CRBSI(N-CRBSI)group.According to whether occurred peritoneal dialysis-related peritonitis(PDRP),CAPD group was divided into PDRP group and Non-PDRP(N-PDRP)group.We collected their clinical data,such as general data,clinical experimental indexes and etiology.Univariate and multivariate logistic regression analysis was used to analyze the risk factors of CRBSI in MHD group,and the risk factors of PDRP in CAPD group.Chi square test and constituent ratio analysis was used to analyze the distribution and drug resistance of pathogens in CRBSI group and PDRP group.Result: 1、There were35 patients(55 cases)with CRBSIin MHD group,the infection rate was 0.85 person-time.There were30 patients(38 cases)withPDRP in CAPD group,the infection rate was 0.55 person-time.There were statistical difference between the two groups(P< 0.05).2、Multivariate logistic regression analysis showed that low plasma albumin(OR = 0.836,P = 0.039),long-term indwelling time(OR = 1.143,P = 0.011),and diabetes mellitus(OR = 5.903,P = 0.017)were independent risk factors for CRBSI in MHD group.3、Multivariate logistic regression analysis showed that low plasma albumin(OR = 0.853,P = 0.042),long-term indwelling time(OR = 1.077,P = 0.040),and diabetes mellitus(OR = 5.480,P = 0.022)were independent risk factors for PDRP in CAPD group.4、Pathogens were mainly gram-positive bacteria in CRBSI group and PDRP group(69.23% VS.57.89%).Staphylococs cusaureus was the main pathogenic bacteria in CRBSI group(40.00%).Epidermis staphylococcus was main pathogenic bacteria in PDRP group.And the composition ratio of Staphylococcus aureus in CRBSI group was higher than that in PDRP group(40.00% VS.10.52%)(P<0.05).The second pathogenic bacteria were gram-negative(27.82%VS.36.84%).Serratiamarcescens was the main pathogenic bacteria in the CRBSI group.Escherichia coli was the main pathogenic bacteria in PDRP group.And the composition ratio of Escherichia coli in PDRP group was higher than that in CRBSI group(21.05% VS.3.08%)(P<0.05).Fungal infections were seldom in both groups(3.08% VS.5.26%).5、All gram-positive bacteria were sensitive to teicoplanin and vancomycin and so on,but resistant to penicillin and erythromycin(>50.00%)in CRBSI group and PDRPgroup.All gram-negative bacteria were sensitive to imipenem and meropenem and so on,but resistant to ampicillin(>80.00%)in CRBSI group and PDRPgroup.Conclusion: 1、The infection rate of CRBSI in MHD patientswas higher than that of PDRP in peritoneal dialysis patients.2、Low plasma albumin,Long-term indwelling time and diabetes mellitus were independent risk factors for CRBSI and PDRP.3、The pathogens of CRBSI and PDRP were mainly gram-positive bacteria,followed by gram-negative bacteria and fungus.For gram-positive bacteria infection,we can chose teicoplanin and vancomycin to control inflammation.And for gram-negative bacteria,we can use imipenem and meropenem as antibiotics option.