Annual Investigation Of Infection In Single Center Maintenance Hemodialysis Patients In Chengde Area

Objective:By conducting an annual survey on the occurrence of infection in patients on maintenance hemodialysis(MHD)in Chengde Central Hospital we initially grasped the current situation of infection in MHD patients in this hemodialysis center and provided an epidemiological investigation basis for the development of infection prevention and control measures for the MHD patient population.Methods:An annual continuous follow-up survey was conducted on 158 patients who performed MHD in the hemodialysis unit of Chengde Central Hospital from January 2019 to December 2019 and a questionnaire was used to register basic information of MHD patients:name sex age dialysis age etiology vascular access hemodialysis modality etc;infection occurrence:time site type degree and prognosis of infection;laboratory data:white blood cell(WBC)count hemoglobin(Hb)neutrophil percentage(NEUT%)C-reactive protein(CRP)plasma albumin(ALB)pre-dialysis serum creatinine(Scr)pre-dialysis urea nitrogen(BUN)etc.The collected data were statistically analyzed for the disease in which the infection occurred time of infection site of infection type of infection and regression of infection etc.Theχ2 test t-test and Mann-Whitney U test were used to compare the statistical significance of the differences of each index between groups and binary logistic regression was used to analyze the influencing factors of co-infection in MHD patients.Results:A total of 145 MHD patients were investigated continuously and effectively among which 81 patients were infected accounting for 55.86%.A total of 105 cases of infection occurred with an average incidence of 0.73 infections per patient year.The infection sites were as follows:respiratory tract infection(47.62%)digestive tract infection(23.81%)urinary tract infection(14.29%)cathetery-related infection(4.76%)skin infection(4.76%)secondary infection of diabetic foot(2.86%)and other infections(1.90%).The incidence of infection in those with diabetic nephropathy(DN)etiology was75.61%(31/41)which was the highest followed by hypertensive nephropathy at 53.85%(14/26)chronic glomerulonephritis at 53.06%(26/49)lupus nephritis at 50%(2/4)polycystic kidney at 50.00%(1/2)drug-related kidney damage was 37.50%(3/8)and other etiologies accounted for 26.67%(4/15).There is a statistical difference in the overall mean of infection among patients with different etiologies of MHD(χ~2=13.522 P<0.05).The infection of MHD patients can occur in all seasons but the highest incidence is in winter 26.21%(38/145)followed by summer 19.31%(28/145)spring 13.79%(20/145),and autumn 13.10%(19/145).Compared with uninfected patients the average age of infected patients with MHD was older[(60.53±13.61)years vs(56.16±12.49)years t=1.992 P=0.048]the etiology of MHD patients is DN(38.27%vs 15.63%χ~2=9.048 P=0.003)and placement of temporary central venous catheter(13.58%vs 3.13%χ~2=4.788 P=0.029)were higher proportion the average Hb level[(96.40±18.15)g/L vs(104.75±18.72)g/L t=-2.715 P=0.007]and mean ALB levels[(38.36±5.44)g/L vs(41.59±5.39)g/L t=-3.571 P<0.001]and Mean KT/V levels[(1.17±0.10)g/L compared to(1.30±0.15)g/L t=-6.263p<0.001]were lower.Further multivariate logistic regression analysis revealed that age DN Hb level and ALB level were the relevant influencing factors for the occurrence of infections in MHD patients.The risk of infection in MHD patients increased approximately 1.7-fold(95%CI 1.106-2.481)for every13.26 years of age increase;the risk of infection in MHD patients with DN as the cause increased approximately 3.7-fold(95%CI 1.469-9.377)compared with other non-diabetic nephropathy patients(N-DN);The risk of infection increased approximately 0.6-fold(95%CI 0.429-0.955)for every 18.80g/L decrease in Hb level and approximately 0.6-fold(95%CI 0.395-0.909)for every 5.63 g/L decrease in ALB level,Patients with MHD on inadequate dialysis(0.14 per reduction in KT/V)have an approximately 0.3-fold increased risk of infection compared to those on adequate dialysis(95%CI 0.145 to0.452).Conclusion:1.The annual incidence of infection in the population of MHD patients in our hemodialysis center is 55.86%with a high incidence of infection.2.The incidence of MHD infection can occur in all seasons,but the incidence is high in winter.3.The main sites of infection in patients with MHD are the respiratory tract,followed by the gastrointestinal and urinary tracts respectively.4.The occurrence of infections in patients with MHD is mainly associated with increasing age,DN in the etiology,low Hb levels,low ALB levels,and inadequate dialysis.