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中华实验和临床感染病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 192 -197. doi: 10.3877/cma.j.issn.1674-1358.2022.03.008

短篇论著

维持性血液透析合并菌血症患者病原菌分布及耐药性分析
刘鑫1, 闻萍1, 周阳1, 徐玲玲1,()   
  1. 1. 210003 南京市,南京医科大学第二附属医院肾脏病中心
  • 收稿日期:2021-08-16 出版日期:2022-06-15
  • 通信作者: 徐玲玲
  • 基金资助:
    江苏省自然科学基金面上项目(No. BK20201497)

Distribution and drug resistance analysis of pathogenic bacteria in maintenance hemodialysis patients complicated with bacteraemia

Xin Liu1, Ping Wen1, Yang Zhou1, Lingling Xu1,()   

  1. 1. Center for Kidney Diseases, 2nd Affiliated Hospital, Nanjing Medical University, Nanjing 210003, China
  • Received:2021-08-16 Published:2022-06-15
  • Corresponding author: Lingling Xu
引用本文:

刘鑫, 闻萍, 周阳, 徐玲玲. 维持性血液透析合并菌血症患者病原菌分布及耐药性分析[J/OL]. 中华实验和临床感染病杂志(电子版), 2022, 16(03): 192-197.

Xin Liu, Ping Wen, Yang Zhou, Lingling Xu. Distribution and drug resistance analysis of pathogenic bacteria in maintenance hemodialysis patients complicated with bacteraemia[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(03): 192-197.

目的

探讨维持性血液透析(MHD)合并菌血症患者病原菌分布和细菌耐药情况。

方法

回顾性分析2016年6月至2021年5月于南京医科大学第二附属医院肾脏病中心就诊的254例维持性血液透析合并菌血症患者的基本信息、病原菌种类以及药敏试验结果,使用SPSS 19.0软件进行分析,并对病原菌菌群变化采用Mann-Kendall趋势检验分析。

结果

入组MHD合并菌血症患者中男性130例、女性124例,平均年龄为(64.0 ± 13.0)岁,合并糖尿病患者107例(42.1%);肾脏基础疾病、血管通路类型和感染原发病灶分别以慢性肾小球肾炎[126例(49.6%)]、中心静脉导管[159例(62.6%)]和导管所致血流感染[121例(47.6%)]为主。入组患者累计分离出革兰阳性球菌175株(68.9%)、革兰阴性杆菌60株(23.6%)、真菌6株(2.4%)以及其他菌属13株(5.1%)。革兰阳性球菌群为本院MHD合并菌血症患者2016至2020年主要致病菌群,患病例数呈现显著的上升趋势(Z = 2.20、P = 0.03);其中居前3位的依次为金黄色葡萄球菌[96株(54.9%)]、表皮葡萄球菌[32株(18.3%)]和人葡萄球菌[12株(6.9%)],对青霉素耐药率分别为90.6%(87/96)、100.0%(32/32)和100.0%(12/12);而对万古霉素和利奈唑胺均无耐药。革兰阴性杆菌中检出前3位分别为肺炎克雷伯菌肺炎亚种[19株(31.7%)]、大肠埃希菌[13株(21.7%)]和铜绿假单胞菌[8株(13.3%)],对氨苄西林耐药率分别为94.7%(18/19)、84.6%(11/13)和75.0%(6/8);肺炎克雷伯菌肺炎亚种对庆大霉素和妥布霉素耐药率较低,均为10.5%(2/19),大肠埃希菌和铜绿假单胞菌对哌拉西林/他唑巴坦和亚胺培南均未见耐药。

结论

维持性血液透析患者菌血症以革兰阳性球菌感染为主,部分临床经验用抗菌药物出现不同程度的耐药性,应加强对该人群的细菌耐药性监测。

Objective

To investigate the bacterial distribution and drug resistance in maintenance hemodialysis (MHD) patients with bacteraemia.

Methods

The clinical basic information, pathogen types and drug sensitivity of 254 patients undergoing MHD complicated with bacteraemia in the Kidney Disease Center, 2nd Affiliated Hospital, Nanjing Medical University from June 2016 to May 2021 were analyzed, retrospectively. Statistical analysis was carried out by SPSS 19.0, and the changes of pathogenic bacteria was analyzed by Mann-Kendall trend test.

Results

Among the enrolled MHD patients complicated with bacteraemia, there were 130 cases of male and 124 cases of female, with the mean age of (64.0 ± 13.0) years old. And 107 (42.1%) patients with diabetes mellitus. Kidney-based disease, type of vascular pathway and primary infectious lesions were mainly chronic glomerulonephritis [126 (49.6%)], central venous catheter [159 (62.6%)] and catheter [121 (47.6%)], respectively. Total of 175 strains of Gram-positive cocci (68.9%), 60 (23.6%) strains of Gram-negative bacteria, 6 (2.4%) strains of fungi and 13 (5.1%) strains of other bacterial genera were isolated. Gram-positive coccus was the main pathogenic bacteria of MHD patients complicated with bacteraemia in our hospital from June 2016 to May 2020, the number of patients showed a significant upward trend (Z = 2.20, P = 0.03); the top three strains were Staphylococcus aureus [96 strains (54.9%)], Staphylococcus epidermidis [32 strains (18.3%)] and Staphylococcus hominis [12 strains (6.9%)]; the resistance rates to penicillin were 90.6% (87/96), 100.0% (32/32) and 100.0% (12/12), respectively; but there was no resistance to either vancomycin or linezolid. Among the Gram-negative bacilli, the top three were Klebsiella pneumoniae subspecies [19 strains (31.7%)], Escherichia coli [13 strains (21.7%)] and Pseudomonas aeruginosa [8 strains (13.3%)]; the resistance rate to ampicillin were 94.7% (18/19), 84.6% (11/13) and 75.0% (6/8). The Klebsiella pneumoniae subspecies showed lower resistance rates to gentamicin and tobramycin, both were 10.5% (2/19); Escherichia coli and Pseudomonas aeruginosa showed no resistance to piperacillin/tazobactam and imipenem.

Conclusions

Bacteraemia in maintenance hemodialysis patients were mainly Gram-positive coccus. Different degree of drug resistance was found to some commonly used antibiotics based on clinical experience. Bacterial resistances monitoring should be strengthened.

表1 MHD合并菌血症患者的一般资料
图1 2016至2020年MHD患者菌血症菌群分布
表2 MHD合并菌血症患者主要菌群
表3 所分离主要革兰阳性球菌对常见抗菌药物的耐药性[株(%)]
表4 所分离主要革兰阴性杆菌对常见抗菌药物的耐药性[株(%)]
图2 5年间不同菌群耐药性变化趋势注:A:革兰阳性球菌,B:革兰阴性菌
[1]
Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review[J]. Lancet, 2015,385(9981):1975-1982.
[2]
向健,王俊. 血液透析患者透析前感染性疾病标志物检测的临床意义[J/CD]. 中华实验和临床感染病杂志(电子版),2016,10(1):90-92.
[3]
Syed-Ahmed M, Narayanan M. Immune dysfunction and risk of infection in chronic kidney disease[J]. Adv Chronic Kidney Dis,2019,26(1):8-15.
[4]
Rteil A, Kazma JM, El Sawda J, et al. Clinical characteristics, risk factors and microbiology of infections in patients receiving chronic hemodialysis[J]. J Infect Public Health,2020,13(8):1166-1171.
[5]
蒋玲,陆鹏,侯娟, 等. 糖尿病肾病和非糖尿病肾病维持性血液透析并发感染者的病原菌分布,预后及影响因素[J/CD]. 中华实验和临床感染病杂志(电子版),2020,14(6):467-472.
[6]
Fysaraki M, Samonis G, Valachis A, et al. Incidence, clinical, microbiological features and outcome of bloodstream infections in patients undergoing hemodialysis[J]. Int J Med Sci,2013,10(12):1632-1638.
[7]
中华人民共和国卫生部. 医院感染诊断标准(试行)[EB/OL]. 2001.

URL    
[8]
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: 25th informational supplement. CLSI document M100-S25[M]. Wayne, PA: Clinical and Laboratory Standards Institute,2015.
[9]
Chan CT, Blankestijn PJ, Dember LM, et al. Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference[J]. Kidney Int,2019,96(1):37-47.
[10]
Chavers BM, Solid CA, Gilbertson DT, et al. Infection-related hospitalization rates in pediatric versus adult patients with end-stage renal disease in the United States[J]. J Am Soc Nephrol,2007,18(3):952-959.
[11]
Sarnak MJ, Jaber BL. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population[J]. Kidney Int,2000,58(4):1758-1764.
[12]
Alhazmi SM, Noor SO, Alshamrani MM, et al. Bloodstream infection at hemodialysis facilities in Jeddah: a medical record review[J]. Ann Saudi Med,2019,39(4):258-264.
[13]
Kumbar L, Yee J. Current concepts in hemodialysis vascular access infections[J]. Adv Chronic Kidney Dis,2019,26(1):16-22.
[14]
Crowe K, White B, Khanna N, et al. Epidemiology of bloodstream infections in a Scottish haemodialysis population with focus on vascular access method[J]. J Hosp Infect,2021,110:37-44.
[15]
Nguyen DB, Shugart A, Lines C, et al. National Healthcare Safety Network (NHSN) dialysis event surveillance report for 2014[J]. Clin J Am Soc Nephrol,2017,12(7):1139-1146.
[16]
Vandecasteele SJ, Boelaert JR, De Vriese AS. Staphylococcus aureus infections in hemodialysis: what a nephrologist should know[J]. Clin J Am Soc Nephrol,2009,4(8):1388-1400.
[17]
Chaudry MS, Gislason GH, Kamper AL, et al. Increased risk of Staphylococcus aureus bacteremia in hemodialysis-A nationwide study[J]. Hemodial Int,2019,23(2):230-238.
[18]
Centers for Disease Control and Prevention. Recommendations for preventing transmission of infections among chronic hemodialysis patients[J]. MMWR Recomm Rep,2001,50(RR-5):1-43.
[19]
Rodrigues Pires de Campos L, Farrel Cortes M, Deo B, et al. Risk factors for bloodstream infection by multidrug-resistant organisms in critically ill patients in a reference trauma hospital[J]. Am J Infect Control. 2021. [Published online ahead of print].
[20]
McCann M, Clarke M, Mellotte G, et al. Vascular access and infection prevention and control: a national survey of routine practices in Irish haemodialysis units[J]. Clin Kidney J,2013,6(2):176-182.
[21]
Vascular Access Work G. Clinical practice guidelines for vascular access[J]. Am J Kidney Dis,2006,48(Suppl 1):S176-S247.
[22]
Vascular Access Work G. Clinical practice guidelines for vascular access[J]. Am J Kidney Dis,2006,48(Suppl 1):S248-S273.
[23]
Fernandez-Hidalgo N, Almirante B, Calleja R, et al. Antibiotic-lock therapy for long-term intravascular catheter-related bacteraemia: results of an open, non-comparative study[J]. J Antimicrob Chemother,2006,57(6):1172-1180.
[24]
Mandolfo S, Anesi A, Rognoni V. The epidemiology of central venous catheter-related bloodstream infection in our renal units is changing[J]. J Vasc Access,2022,23(2):328-329.
[25]
Murray EC, Marek A, Thomson PC, et al. Gram-negative bacteraemia in haemodialysis[J]. Nephrol Dial Transplant,2015,30(7):1202-1208.
[26]
Shimon O, Green H, Eliakim-Raz N, et al. Gram-negative bloodstream infections in hemodialysis patients: A retrospective study[J]. Clin Nephrol,2018,90(2):117-124.
[27]
Snyder GM, D’Agata EM. Novel antimicrobial-resistant bacteria among patients requiring chronic hemodialysis[J]. Curr Opin Nephrol Hypertens,2012,21(2):211-215.
[28]
Vanegas JM, Salazar-Ospina L, Roncancio GA, et al. Post-antibiotic era in hemodialysis? Two case reports of simultaneous colonization and bacteremia by multidrug-resistant bacteria[J]. J Bras Nefrol,2021,43(4):597-602.
[29]
Hussein WF, Gomez N, Sun SJ, et al. Use of a gentamicin-citrate lock leads to lower catheter-related bloodstream infection rates and reduced cost of care in hemodialysis patients[J]. Hemodial Int,2021,25(1):20-28.
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