Analysis Of Risk Factors And Drug Resistance For Tunneled-cuffed Catheter-related Infection In Dialysis Patients

ObjectivesTo explore the risk factors,pathogenic bacteria spectrum and drug resistance of tunneled-cuffed catheter-related infections in hemodialysis patients,and to provide a theoretical basis for reducing infection rate and improving cure rate.MethodsA total of 58 patients with vascular access with tunneled-cuffed catheter were selected from the blood purification center of our hospital from January 2013 to December 2018.The general condition of all patients and the results of relevant auxiliary tests were collected.Patients were divided into infected and non-infected groups based on whether a catheter-related infection occurred.The pathogenic bacteria and drug resistance of infected patients were counted.The t test,χ~2 test,rank sum test and so on were used to compare the differences between the two groups of patients.The above meaningful indicators were used as independent variables,and the two-category Logistic regression analysis was used to analyze the risk factors of catheter-related infections in hemodialysis patients.Results1.There were 33,085 catheter days in 58 patients and 25 patients with catheter-related infections.The incidence rate was 0.756/1000 catheter days.2.There were significant differences in dialysis age,primary disease,diabetes,catheter thrombosis,neutrophil percentage,hypersensitive C-reactive protein,hemoglobin,and ferritin between the infected group and the non-infected group(P<0.05).There were no significant differences in gender,catheter indwelling time,hypertension,coronary heart disease,pericardial effusion,pleural effusion,ascites,white blood cell count,urea nitrogen before dialysis,serum creatinine before dialysis,uric acid before dialysis,Cystatin C before dialysis,total protein,albumin,total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein,serum potassium,blood sodium,blood chlorine,blood calcium,blood sugar,whole parathyroid hormone,B-type natriuretic peptide,transferrin saturation and urinary clearance index.Logistic regression analysis showed that dialysis age,diabetes,catheter thrombosis,high ferritin and low hypohemoglobin were independent risk factors for catheter-related infection with tunneled-cuffed catheters in hemodialysis patients.3.The results were positive for 20 times,and a total of 21 strains of pathogenic bacteria were cultured,including 12 strains of gram-positive bacteria,of which staphylococcus aureus was the most and methicillin-resistant staphylococcus aureus was the second.Among the 9 strains of gram-negative bacteria,pseudomonas aeruginosa was the most,followed by acinetobacter haemolyticus.4.The gram-positive bacteria cultivated had the lowest resistance rate to rifampicin,linezolid,teicoplanin,moxifloxacin and vancomycin,and the highest resistance rate to clarithromycin.The gram-negative bacteria had the lowest resistance rate to amikacin and levofloxacin,and the highest resistance rate to ceftazidime.Conclusions1.Dialysis age,diabetes,catheter thrombosis,high ferritin and low hemoglobin levels may be independent risk factors for tunneled-cuffed catheter-related infections.2.The most common pathogenic bacteria associated with tunneled-cuffed catheter-related infection is gram-positive bacteria,mainly staphylococcus aureus.Pseudomonas aeruginosa dominated gram-negative bacteria.3.Broad-spectrum antibiotics are used as the main experimental therapy for the tunneled-cuffed catheter-related bloodstream infection,combined with systemic antibiotics and antibiotic catheterization therapy,and then the therapeutic regimen need to be adjusted according to the drug sensitivity results.