中国药物警戒 ›› 2026, Vol. 23 ›› Issue (3): 328-333.
DOI: 10.19803/j.1672-8629.20250793

• 安全与合理用药 • 上一篇    下一篇

血液透析导管相关性血流感染用药分析

张蔚1, 卢联合2, 张瑞华2, 谭雅楠3, 李凤宏4, 田国保1, 李珺1, 董建平1#, 陈志海2,*   

  1. 1北京市海淀医院感染性疾病科,北京 100080;
    2传染病溯源预警与智能决策全国重点实验室,首都医科大学附属北京地坛医院,北京 100015;
    3北京市海淀医院检验医学科,北京 100080;
    4北京市海淀医院感染管理和疾病控制科,北京 100080
  • 收稿日期:2025-11-10 出版日期:2026-03-15 发布日期:2026-03-17
  • 通讯作者: *陈志海,男,主任医师,教授·博导,感染性疾病。E-mail: chenzhihai0001@126.com。#为共同通信作者。
  • 作者简介:张蔚,女,硕士,主治医师,感染性疾病。
  • 基金资助:
    国家重点研发计划（2022YFF1203201、2023YFC2308800）

Medications for Hemodialysis Catheter-Related Bloodstream Infections

ZHANG Wei1, LU Lianhe2, ZHANG Ruihua2, TAN Yanan3, LI Fenghong4, TIAN Guobao1, LI Jun1, DONG Jianping1#, CHEN Zhihai2,*   

  1. 1Department of Infectious Diseases, Beijing Haidian Hospital, Beijing 100080, China;
    2National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
    3Department of Medical Laboratory, Beijing Haidian Hospital, Beijing 100080, China;
    4Department of Hospital Infection Control and Disease Prevention, Beijing Haidian Hospital, Beijing 100080, China
  • Received:2025-11-10 Online:2026-03-15 Published:2026-03-17

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摘要： 目的 对比分析维持性血液透析（MHD）与非MHD患者中心静脉导管相关性血流感染（CRBSI）的病原菌分布、耐药性及临床用药情况,为临床合理应用抗菌药物提供参考。方法 回顾性分析某院2023年1月1日至2024年12月31日收治CRBSI患者的临床资料、病原菌、药敏试验结果、抗菌药物使用情况等,按照是否为MHD患者进行分组,比较2组之间的差异。结果 共纳入CRBSI患者44例,MHD组25例,非MHD组19例。MHD组患者年龄及恶性肿瘤比例低于非MHD组,且导管类型以隧道式中心静脉导管为主,非MHD组以非隧道式中心静脉导管为主,差异具有统计学意义（P<0.01）。共分离出病原菌52株,革兰阳性菌28株（53.85%）、革兰阴性菌19株（36.54%）及真菌5株（9.62%）,2组间病原学整体分布差异无统计学意义（P=0.225）。MHD组以金黄色葡萄球菌（7,24.14%）检出率最高,非MHD组以表皮葡萄球菌（5,21.74%）检出率最高。耐甲氧西林葡萄球菌在两组间比例相当（P=0.157）,多重耐药革兰阴性菌主要集中在非MHD组。抗菌药物使用方面,MHD组以单药治疗为主,而非MHD组更倾向于联合及广谱抗菌药物方案。结论 非MHD患者CRBSI病原菌谱和耐药性更复杂,面临更严峻的革兰阴性菌多重耐药挑战,临床工作中应区分不同人群,制定差异化的经验性抗感染用药方案。

关键词: 血液透析, 导管相关性血流感染, 病原菌, 葡萄球菌, 革兰阳性菌, 革兰阴性菌, 真菌, 耐药性

Abstract: Objective To analyze the distribution of pathogens, drug resistance, and clinical drug use associated with catheter-related bloodstream infections (CRBSI) among patients undergoing maintenance hemodialysis (MHD) and non-MHD pain in order to provide a reference for rational use of antibiotics in clinical practice. Methods A retrospective analysis was conducted of the clinical data, pathogens, results of drug sensitivity tests, and antibiotic use of CRBSI patients admitted to Beijing Haidian Hospital in 2023-2024. These patients were divided into MHD and non-MHD groups, and differences between the two groups were studied. Results A total of 44 CRBSI patients were enrolled, including 25 in the MHD group and 19 in the non-MHD group. Patients in the MHD group were younger and the percentage of malignancy was lower than in the non-MHD group. Tunneled central venous catheters (TCVCs) were dominating in the MHD group while non-tunneled central venous catheters (NTCVCs) were more common in the non-MHD group, and the differences between the two groups were statistically significant (P<0.01). A total of 52 pathogen strains were isolated, with Gram-positive bacteria as the dominating pathogens (28, 53.85%), followed by Gram-negative bacteria (19, 36.54%) and fungi (5, 9.62%). There was no statistically significant difference in the distribution of pathogens between the two groups (P=0.225). The most common pathogens were Staphylococcus aureus (7, 24.14%) in the MHD group and Staphylococcus epidermidis in the non-MHD group (5, 21.74%), respectively. The proportion of methicillin-resistant staphylococcus was similar across the two groups (P=0.157). Multidrug-resistant Gram-negative bacteria were prevalent in the non-MHD group. As for antimicrobial therapy, monotherapy was mostly used in the MHD group, whereas combination and broad-spectrum antimicrobial regimens were more commonly used in the non-MHD group. Conclusion The spectrum of pathogens and drug resistance related to CRBSI in non-MHD patients are more complicated, aggravated by multidrug-resistant Gram-negative bacteria. In clinical practice, differentiated empirical antibiotic regimens should be formulated based on patient populations.

Key words: Hemodialysis, Catheter-Related Bloodstream Infection, Pathogens, Staphylococcus, Gram-Positive Bacteria, Gram-Negative Bacteria, Fungi, Drug Resistance

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