FAKTORI RIZIKA ZA KATETER-VEZANE INFEKCIJE KOD BOLESNIKA NA HEMODIJALIZI
Sažetak
Uvod/Cilj. Infekcije povezane sa kateterom i dalje predstavljaju značajan uzrok morbiditeta i mortaliteta kod bolesnika na hemodijalizi. Cilj ovog ispitivanja je bio da se utvrdi incidencija, analiziraju faktori rizika i identifikuju etiološki uzročnici kateter infekcija kod ovih bolesnika. Metode. Ispitivanje je sprovedeno na Klinici za nefrologiju i kliničku imunologiju Kliničkog centra Vojvodine u periodu od avgusta 2012. do maja 2015. godine. Ispitivanjem je bilo obuhvaćeno 113 bolesnika lečenih hroničnim hemodijalizama. Upoređivani su faktori rizika od infekcija povezanih sa kateterom kod bolesnika sa dokazanom infekcijom u odnosu na kontrolnu grupu. Analizirani su demografski i laboratorijski parametri, komorbiditeti i upotreba imunosupresivne terapije, dužina dijaliziranja, urgentno plasiranje, pozicija i otežano plasiranje katetera, broj mesta insercije i manipulacija kateterom, postojanje trajnog vaskularnog pristupa u maturaciji ili bez vaskularnog pristupa tokom plasiranja katetera, dužina trajanja katetera, hiruške intervencije (≤ 30 dana od plasiranog katetera), dužina hospitalizacije i izolovani uzročnici infekcija. Rezultati. Kod 113 bolesnika plasirano je 197 katetera, od kojih su 182 bila privremena. Ukupni broj dana katetera iznosio je 17,842, a incidencija infekcija je bila 3.53 slučajeva na 1,000 kateter dana. Tokom perioda praćenja potvrđene su 63 kateter-povezane infekcije, 54 (85.7%) privremenih i 9 (14.3%) trajnih katetera. Multivarijantnom logistističkom regresionom analizom (granične vrednosti određene receiver operating curve – ROC analizom), kao nezavisni prediktori kateter-povezanih infekcija dobijeni su: vrednost hemoglobina < 95 g/l (p < 0.001) i albumina < 33g/l (p = 0.041), trajanje katetera > 90 dana (p = 0.004), > 2/dan manipulacije kateterom (p = 0.011) i trajanje hospitalizacije > 15 dana (p = 0.003). Najčešći uzročnik je bio Staphylococcus spp. koagulaza negativan. Zaključak. Intenziviranje mera prevencije i kontrole infekcija bi znatno smanjilo učestalost kateter-povezanih infekcija i broj hospitalizacija. Pravovremeno kreiranje nativne arteriovenske fistule smanjilo bi upotrebu dijaliznih katetera.
Reference
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