Risk Factors And Pathogens Of CRBSI In Uremia Patients

Objective:To explore the risk factors of CRBSI in ESRD,and to see the distribution and antibiotic susceptibility of pathogens which caused CRBSI. so as to provide some references for prevention and therapeutic of CRBSI.Methods:We collected age,sex, the type of CVC,serum albumin,serum total protein,hemoglobin,diabetes mellitus,co-infection of 343 patients who dialyzed with CVC during January 1 2013 to December 312014,including 50 cases with CRBSI and 293 cases for control.the clinical material of patients were analyzed by SPSS21.0,and P<0.05 was defined as statistical significance.Results:We analyzed the clinical materials of patients in infection-group and control-group,and we found that femoral vein catheter,temporary catheter and co-infection were risk factors of CRBSI.Also,age and serum album of infection-group were lower than that of control-group. The differences of sex,diabetes mellitus,serum totalprotein,hemoglobin were not significant. On blood culture,50 stains of pathogens were isolated, including 32 strains of gram-positive bacteria,accounting for 64% of the 50 stains of pathogens,13 strains of gram-negative bacteria and 5 strains of fungus, accounting for 26%、10%respectively. The ranking first 3 pathogens were staphylococcus aureus,staphylococcus epidermidis,enterobacter cloacae and candida parapsilosis.Most of 32 strains of gram-positive bacteria were sensitive to vancomycin(100.00%), tigecycline(100.00%), linezolid(100.00%),macrodantin(96.88%) and quinupristin/dalfopristin(96.88%). And then,gram-negative bacteria were sensitive to ceftizoxime(92.31%),imipenem(92.31%), ciprofloxacin(84.62%), levofloxacin(84.62%) and amikacin(83.33%). according to this study, voriconazole, fluconazole,itraconazole,amphotericin and 5-fluorouracil were all effective for fungus infection. For these patients which were suspected with CRBSI, we applied vancomycin or broad-spectrum antibiotics to fight with infection.Finally,42 patients were cured, 7 patients gave up their treatment,and 1patient died of septic shock.Conclusions: The morbidity of CRBSI in hemodialysis patients may be affected by the type of CVC,serum albumin,co-infection.Most of these hemodialysis patients who suffered from CRBSI in the hospital were infected by gram-positive coccus. For the patient who is suspected with CRBSI, vancomycin is the first choice according to empirical research,whether we should change the antibiotic depends on the result of his pathogen and drug sensitivity. It is necessary to pull the catheter out from the vein if the infection caused by staphylococcus aureus,pseudomonas aeruginosa and fungus.