血液透析患者血液感染的长期趋势:来自瑞士纵向研究的见解。

IF 4.4 2区 医学 Q1 INFECTIOUS DISEASES
Nasreen Hassoun-Kheir, Niccolò Buetti, David Jaques, Valérie Olivier, Marie-Noelle Chraiti, Monique Perez, Marlieke Ea de Kraker, Holly Jackson, Jacques Schrenzel, Patrick Saudan, Stephan Harbarth
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引用次数: 0

摘要

背景:血液透析相关血流感染(bsi)是患者的一个重要负担。了解血液透析患者bsi的趋势对于降低其发病率和改善患者预后的策略至关重要。本研究旨在评估长期趋势,确定致病生物,评估耐药模式,并确定日内瓦大学医院血液透析相关bsi的来源,这些医院自2000年以来一直实施金黄色葡萄球菌筛查和血液透析患者去菌落。方法:采用纵向队列研究,采用2006 ~ 2003年的资料。我们纳入了在我们机构接受维持性血液透析治疗的所有患者。血液透析相关的BSI定义为在积极的血液透析治疗期间发生的BSI,在住院或门诊血液透析单位诊断。结果包括血液透析相关bsi的发病率、致病病原体、来源和耐药菌的趋势。泊松回归用于对发病率比(IRR)随时间变化的趋势进行建模。结果:在11,413个月的血液透析中,218名血液透析患者共发现了313次真正的BSI发作。BSI的总发病率为2.7次/ 100例患者-血液透析-月,随着时间的推移呈持续下降趋势。与2006-08年相比,2009-11年血液透析相关BSI发生率下降了16% (IRR 0.84, 95%可信区间[CI] 0.60-1.18), 2021-23年最大降幅为44% (IRR 0.56, 95% CI 0.36-0.83)。下降趋势主要是由于金黄色葡萄球菌的bsi减少,而肠杆菌的bsi率保持稳定。导管相关bsi占感染的41.5%(130/313),2014年之后显著下降。耐药菌引起的bsi罕见,耐甲氧西林金黄色葡萄球菌呈下降趋势。结论:血液透析相关BSI发生率显著下降,主要是由于金黄色葡萄球菌BSI和导管相关感染的减少。未观察到革兰氏阴性BSI替代。预防血液透析相关的BSI是减轻血液透析患者感染负担的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Secular trends of bloodstream infections in hemodialysis patients: insights from a longitudinal Swiss study.

Secular trends of bloodstream infections in hemodialysis patients: insights from a longitudinal Swiss study.

Secular trends of bloodstream infections in hemodialysis patients: insights from a longitudinal Swiss study.

Secular trends of bloodstream infections in hemodialysis patients: insights from a longitudinal Swiss study.

Background: Hemodialysis-associated bloodstream infections (BSIs) represent a significant burden for patients. Understanding the trends in BSIs among hemodialysis patients is crucial for informing strategies to reduce their incidence and improve patient outcomes. This study aimed to evaluate secular trends, identify causative organisms, assess resistance patterns, and determine the sources of hemodialysis-associated BSIs at Geneva University Hospitals, where Staphylococcus aureus screening and decolonization of hemodialysis patients have been implemented since the year 2000.

Methods: A longitudinal cohort study was conducted using data from 2006 to 23. We included all patients receiving maintenance hemodialysis treatment at our institution. A hemodialysis-associated BSI was defined as BSI occurring during active hemodialysis treatment and diagnosed either during hospital admission or in outpatient hemodialysis unit. Outcomes included incidence rates of hemodialysis-associated BSIs, trends in causative pathogens, sources, and resistant organisms. Poisson regression was used to model trends over time of incidence rate ratios (IRR).

Results: A total of 313 true BSI episodes were identified in 218 hemodialysis patients over 11,413 patient-hemodialysis months. The overall BSI incidence rate was 2.7 episodes per 100 patient-hemodialysis-months, with a consistent decrease over time. Compared to 2006-08, hemodialysis-associated BSI rates decreased by 16% in 2009-11 (IRR 0.84, 95% confidence interval [CI] 0.60-1.18), and by a maximum of 44% in 2021-23 (IRR 0.56, 95% CI 0.36-0.83). The decreasing trend was mainly due to reduced S. aureus BSIs, while Enterobacterales BSIs rates remained stable. Catheter-related BSIs accounted for 41.5% of infections (130/313), with marked reduction following 2014. BSIs caused by resistant bacteria were rare, with decreasing trends of methicillin-resistant S. aureus.

Conclusions: Hemodialysis-associated BSI rates significantly declined, driven largely by reductions in S. aureus BSIs and catheter-related infections. No replacement by Gram-negative BSI was observed. Prevention of hemodialysis-associated BSI is key for reducing infection burden among hemodialysis patients.

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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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