Infection Associated with Temporary Central Venous Catheter for Hemodialysis: A Review of 5 Years Experience

暫時性血液透析中央靜脈導管感染的探討：五年的回溯研究報告

張子爰(Tsu-Yuan Chang) ； 方華章(Hua-Chang Fang) ； 曾惠明(Huey Ming Tzeng) ； 周康茹(Kang-Ju Chou) ； 吳明瑞(Ming-Jei Wu) ； 蔡晉銓(Chin-Chuan Tsai) ； 陳盈凱(Ying-Kai Chen) ； 蔡明凱(Ming-Kai Tsai) ； 鍾孝民(Hsiao-Min Chung)

《Acta Nephrologica》 16卷1期 (2002/01) Pp. 12-18

摘要

背景：中央靜脈導管暫時用於血液透析的血管通路已行之有年。血管管路感染是造成透析患者的罹病率的重要原因，而中央靜脈導管又為各種血管管路中最容易感染的。已有許多研究指出暫時性血液透析中央靜脈導管的感染率及其感染的危險因子，在此，我們將本院五年回溯性的經驗報告出來。
方法：我們回溯探討由1997年1月到2001年11月共700個案例，討論的危險因子包括年齡、性別、糖尿病、急慢性腎衰竭、血比容、白蛋白、一個療程導管留置的時間及插管次數。
結果：共有85個案例發生感染，感染率為12.14%，發生率為8.46/1000 cathter days。最多的致病菌為Oxacillin-resistant Staphylococcus aureus。在單變異分析中，有意義的危險因子為白蛋白、糖尿病、一個療程導管留置的時間及插管次數。在多變異分析中，只有白蛋白及一個療程插管的次數才具有統計學上的意義。
結論：在我們的研究中，導管感染的危險因子以白蛋白及一個療程插管的次數最重要。所以，我們建議減少療程中插管的次數，改善病患的營養狀況，並對低白蛋白症的病患保持高度警覺，並考慮施予一些已經證實的方法來預防感染。

關鍵字

危險因子 ； 導管感染 ； 血液透析

並列摘要

Background. To investigate the risk factors of the infection of temporary central venous catheterization and compare these results to that of previous studies, we collected 700 events of catheter insertion for hemodialysis patients who needed a temporary vascular access.
Methods. We performed a retrospective study of 700 events (1350 catheter insertions) which recorded temporary central venous catheter insertions from January 1997 to November 2001. The demographic parameters and data of possible contributing factors, such as age, sex, duration and frequency of one treatment course, diabetes mellitus, acute or chronic renal failure, serum albumin and hematocrit level, of central venous catheter-related infections were collected. The above data were analyzed by using student’s t test or chi-square test for univariate analysis. To discover the independent risk factors, variables with probability less than 0.05 were put into binary logistic regression analysis.
Results. A total of 85 episodes of catheter-related infection occurred, representing an infection rate of 12.14% of events and incidence of 8.46/1000 catheter-days. The most common isolated pathogen responsible for infection was oxacillin-resistant Staphylococcus aureus. In univariate analysis, there were significant differences demonstrated in the variables of duration of an event, frequency of insertion in one event, serum albumin level and diabetes mellitus between infection and non-infection patients. However, both the frequency of an event and serum albumin level were the independent risk factors in multivariate analysis.
Conclusion. Based on our findings, we suggest that decreasing frequency of catheter change and improving the nutritional condition of patients with hypoalbuminemia might reduce the catheter-related infection in hemodialysis patients.

並列關鍵字

risk factors ； catheter infection ； hemodialysis