Infectious complications of the hemodialysis access
Infectious complications of the hemodialysis access
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DOI：
10.1046/j.1523-1755.2001.00765.x
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发表时间：
2001-07-01
影响因子：
19.6
通讯作者：
Ayus, JC
中科院分区：
文献类型：
--
作者：
Nassar, GM;Ayus, JC
血液透析通路的感染并发症。血管通路的感染并发症是血液透析（HD）患者发病率和死亡率的主要来源。大量报告表明，血液透析患者中高达48%至73%的细菌感染涉及血管通路。当使用中心静脉透析导管时，血管通路相关感染的发生率最高。自体动静脉瘘感染的风险最低。不幸的是，人工动静脉移植物是美国最常见的血液透析通路类型，已多次被证明是菌血症和非菌血症感染的风险因素。陈旧性非功能性凝血人工动静脉移植物的隐性感染最近被认为是HD患者菌血症和发病的常见原因。与血管通路相关的高比例感染是由葡萄球菌引起的。其具有高死亡率、复发率和转移并发症。血管通路相关感染的管理有两个方面：第一个涉及选择。抗生素治疗的持续时间和给药方式。当致病微生物未知时，应根据人口统计学数据和疾病严重程度进行经验性抗生素治疗。延长特定肠外抗生素的给药时间对于减少感染并发症至关重要，特别是在葡萄球菌菌血症的情况下。第二方面涉及血管通路的管理。尽可能在进行细菌学治愈的同时，应努力保护自体静脉穿刺部位。预防血管通路相关感染的努力应侧重于增加动静脉内瘘的放置和尽量减少中心静脉透析导管的插入。仔细检查和监测血管通路对于早期发现血管通路部位相关感染至关重要。一些新的方法，旨在防止导管和假体移植物相关的感染正在探索。
Infectious complications of the hemodialysis access. Infectious complications of the vascular access are a major source of morbidity and mortality among hemodialysis (HD) patients. Numerous reports implicate the vascular access in up to 48 to 73 % of all bacteremias in HD patients. The incidence of vascular access-related infection is highest when central venous dialysis catheters are employed. Native arteriovenous fistulas carry the lowest risk of infection. Unfortunately, prosthetic arteriovenous grafts, which represent the most common type of HD access in the United States, have been repeatedly shown to be a risk factor for bacteremic and nonbacteremic infections. Silent infection in old nonfunctional clotted prosthetic arteriovenous grafts has recently been recognized as a frequent cause of bacteremia and morbidity among HD patients. High proportions of infections related to the vascular access are caused by staphylococcal organisms. which carry high rates of mortality, recurrence, and metastatic complications. Management of vascular access-related infection has two aspects: The first relates to the choice. duration, and mode of administration of antibiotic therapy. Empiric antibiotic therapy, guided hy demographic data and severity of illness, should be employed when the causative organisms are unknown. Prolonged administration of specific parenteral antibiotics is crucial in decreasing complications of infection, especially in cases of staphylococcal bacteremia. The second aspect relates to management of the vascular access. Efforts directed toward bacteriological cure should be concurrent with efforts to preserve native venous access sites whenever possible. Efforts to prevent vascular access-related infection should focus on increasing placement of arteriovenous fistulas and minimizing insertion of central venous dialysis catheters. Careful inspection and monitoring of the vascular access is of paramount importance in early detection of vascular access site-related infections. Several new approaches aimed at preventing catheter and prosthetic graft-related infection are being explored.