Analysis Of Clinical Characteristics And Risk Factors Of Infection In Maintenance Hemodialysis Patients

Objective:To investigate the clinical characteristics and risk factors of infection in maintenance hemodialysis patients,and to provide the basis for clinical diagnosis and prevention.Methods:The clinical data and laboratory results of maintenance hemodialysis patients from January 2018 to December 2020 in the Nephrology Department of our hospital were collected,and divided into infection group and non infection group according to whether infected or not.Data collection included general data(gender,age,days of hospitalization,and hospitalization cost),clinical data(primary kidney disease,complications and comorbidities,number of previous nephrology hospitalizations,previous infection or not,previous antibiotic use,dialysis age,dialysis frequency,dialysis access type,infection site),laboratory tests(white blood cell count,hemoglobin,serum albumin,serum creatinine,serum uric acid,serum calcium,serum phosphorus,serum iron,C-reactive protein,parathyroid hormone,brain natriuretic peptide,bacterial culture results,and susceptibility test results).SPSS software was used to describe the statistical results and compare the difference between infection group and non infection group,and P < 0.05 was considered statistically significant.Independent variables with statistically significant differences were selected by referring to the relevant literature and actual clinical situation for binary logistic regression to analyze the risk factors of infection in maintenance hemodialysis patients.Results:1.Of the 234 patients,131(56%)were male and 103(44%)were female,the male to female ratio was 1.3:1,and the average age was(60.61 ± 13.22).Of the primary disease composition,108(46.2%)were chronic glomerulonephritis,48(20.5%)were hypertensive nephropathy,38(16.2%)were diabetic nephropathy,30(12.8%)were obstructive nephropathy,6(2.6%)were lupus nephritis,2(0.9%)were Ig A nephropathy,1(0.4%)was ANCA associated nephropathy,and 1(0.4%)was polycystic kidney disease.2.Of the 234 patients,73(31.2%)were in the infected group and 46 were male,161(68.8%)were in the non-infected group and 85 were male.Pulmonary infection was the most common site of infection in 36 cases,followed by 15 cases of catheter-related infection,12 cases of skin and mucosal infection,2 cases of upper respiratory tract infection,1case of peritonitis,and a total of 7 cases of composite site infection,included 5 cases of pulmonary infection with other sites and 2 cases of catheter-related infection with other sites.Pathogen culture was performed in 37(50.7%)patients and the positive culture rate was 81.8%(30 patients).The infected bacterial species were dominated by Gram negative bacterias of 22 cases which Klebsiella pneumoniae accounted for the first 7 cases and was more common in pulmonary infections.The second common bacterias was Enterobacter cloacae in 4 cases,all of which were catheter-related infections.Staphylococcus epidermidis were more frequent in Gram-positive bacterias accounting for 3 cases and most of them were common in skin and soft tissue infections.Fungal infection in 1 case.There were 18 cases(60%)of multidrug-resistant bacteria,included 12 cases of Gram-negative bacteria and 6 cases of Gram-positive bacteria.3.In univariate analysis,there were significant differences in patients with diabetes mellitus,previous infection,previous combination of more than 2antibiotics,vascular access as central venous catheter,white blood cells,CRP,albumin,serum creatinine,serum iron and BNP.Logistic regression analysis suggested serum iron were protective factors for infected maintenance hemodialysis patients.Previous infection,diabetes mellitus,central venous catheter for vascular access,and BNP are risk factors for infected maintenance hemodialysis patients.Conclusions:1.The lung is the most common site of infection in maintenance hemodialysis patients,followed by catheter-related infection.2.Previous infection,diabetes mellitus,and central venous catheter for vascular access are the risk factors of infection in maintenance hemodialysis patients.3.The increase of BNP may increase the risk of infection in maintenance hemodialysis patients,and the increase of serum iron may reduce the risk of infection in maintenance hemodialysis patients.