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

doi:10.3877/cma.j.issn.1674-1358.2022.03.008

Abstract

Abstract:

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.

Key words: Hemodialysis, Bacteraemia, Bacterial resistance

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

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References 29

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一般资料		数值
年龄（±s，岁）		64.0 ± 13.0
男性[例（%）]		130（51.2）
糖尿病[例（%）]		107（42.1）
肾脏基础病[例（%）]
	慢性肾小球肾炎	126（49.6）
	糖尿病肾病	67（26.4）
	多囊肾	13（5.1）
	高血压肾损害	18（7.1）
	肾恶性肿瘤	5（2.0）
	梗阻性肾病	7（2.8）
	不详	18（7.1）
血管通路类型[例（%）]
	中心静脉导管	159（62.6）
	自体动静脉内瘘	70（27.6）
	人工血管内瘘	25（9.8）
感染原发病灶[例（%）]
	导管	121（47.6）
	呼吸道	62（24.4）
	内瘘（自体或人工血管）	34（13.4）
	其他	22（8.7）
	原发感染灶不明	15（5.9）

一般资料		数值
年龄（±s，岁）		64.0 ± 13.0
男性[例（%）]		130（51.2）
糖尿病[例（%）]		107（42.1）
肾脏基础病[例（%）]
	慢性肾小球肾炎	126（49.6）
	糖尿病肾病	67（26.4）
	多囊肾	13（5.1）
	高血压肾损害	18（7.1）
	肾恶性肿瘤	5（2.0）
	梗阻性肾病	7（2.8）
	不详	18（7.1）
血管通路类型[例（%）]
	中心静脉导管	159（62.6）
	自体动静脉内瘘	70（27.6）
	人工血管内瘘	25（9.8）
感染原发病灶[例（%）]
	导管	121（47.6）
	呼吸道	62（24.4）
	内瘘（自体或人工血管）	34（13.4）
	其他	22（8.7）
	原发感染灶不明	15（5.9）

细菌		株（%）
革兰阳性球菌
	金黄色葡萄球菌	96（54.9）
	表皮葡萄球菌	32（18.3）
	人葡萄球菌	12（6.9）
	头状葡萄球菌	8（4.6）
	溶血葡萄球菌	5（2.9）
	粪肠球菌	2（1.1）
	屎肠球菌	6（3.4）
	其他	15（8.6）
革兰阴性杆菌
	肺炎克雷伯菌肺炎亚种	19（31.7）
	大肠埃希菌	13（21.7）
	铜绿假单胞菌	8（13.3）
	鲍曼不动杆菌	4（6.7）
	阴沟肠杆菌亚种	5（8.3）
真菌
	近平滑假丝酵母菌	1（16.7）
	白假丝酵母菌	3（50.0）
	无名假丝酵母菌	1（16.7）
	隐球菌	1（16.7）
	其他	13（5.1）

细菌		株（%）
革兰阳性球菌
	金黄色葡萄球菌	96（54.9）
	表皮葡萄球菌	32（18.3）
	人葡萄球菌	12（6.9）
	头状葡萄球菌	8（4.6）
	溶血葡萄球菌	5（2.9）
	粪肠球菌	2（1.1）
	屎肠球菌	6（3.4）
	其他	15（8.6）
革兰阴性杆菌
	肺炎克雷伯菌肺炎亚种	19（31.7）
	大肠埃希菌	13（21.7）
	铜绿假单胞菌	8（13.3）
	鲍曼不动杆菌	4（6.7）
	阴沟肠杆菌亚种	5（8.3）
真菌
	近平滑假丝酵母菌	1（16.7）
	白假丝酵母菌	3（50.0）
	无名假丝酵母菌	1（16.7）
	隐球菌	1（16.7）
	其他	13（5.1）

抗菌药物	金黄色葡萄球球菌（n = 96）	表皮葡萄球菌（n = 32）	人葡萄球菌（n = 12）
氧氟沙星	14（14.6）	25（78.1）	9（75.0）
庆大霉素	6（6.2）	14（43.7）	1（8.3）
青霉素	87（90.6）	32（100.0）	12（100.0）
苯唑西林	24（25.0）	30（93.7）	12（100.0）
万古霉素	0（0.0）	0（0.0）	0（0.0）
利奈唑胺	0（0.0）	0（0.0）	0（0.0）
替加环素	0（0.0）	1（3.1）	0（0.0）
复方新诺明	4（4.2）	16（50.0）	8（66.7）
红霉素	37（38.5）	19（59.4）	11（91.7）
克林霉素	35（36.5）	10（31.2）	9（75.0）
四环素	11（11.5）	6（18.7）	3（25.0）
莫西沙星	13（13.5）	24（75.0）	8（66.7）

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