在透析患者中预防感染的策略
Daniela Ponce1, Dorothea Nitsch2, Talat Alp Ikizler3
1Division of Internal Medicine, Botucatu School of Medicine, University of São Paulo State (UNESP). Botucatu, Sao paulo, Brazil.
Seminars in nephrology
|January 10, 2024
概括
感染对接受透析的患者构成重大威胁,增加死亡风险. 实施强有力的感染预防策略,特别是血管接入和腹腔透析,对于患者安全和改善结果至关重要.
科学领域:
- 腎病學與傳染病的研究
- 公共卫生和医疗保健管理
背景情况:
- 感染是末期病 (ESKD) 患者的第二大死亡原因,透析患者面临更高的风险.
- 耐多药生物,侵入性器械,抗生素暴露和免疫力受损有助于透析患者感染易感性.
- 血管通道,特别是中央静脉导管 (CVC),是细菌病,住院和血液透析 (HD) 患者死亡的主要危险因素.
研究的目的:
- 对透析患者的各种感染预防措施的有效性进行审查和评估.
- 突出导管相关感染和腹膜炎对患者发病率和死亡率的影响.
- 强调医疗主管在实施和监测感染预防计划中的作用.
主要方法:
- 对临床试验,系统性审查和对透析中感染预防的元分析的审查.
- 对血液透析和腹膜透析中感染相关的风险因素的分析.
- 评估预防和管理导管相关感染和腹膜炎的策略.
主要成果:
- 导管相关的细菌病是HD中CVC使用的严重并发症,随着导管停留时间的增加而增加.
- 腹膜炎虽然往往是可以治疗的,但可能导致严重的并发症,包括腹膜衰竭和切换到HD.
- 患者培训,早期诊断和适当的抗生素选择是成功治疗腹膜炎的关键.
结论:
- 有效的感染预防对于降低透析患者的死亡率和发病率至关重要.
- 实施血管接入和腹膜透析的综合策略是必不可少的.
- 医疗主管在透析诊所内领导和改善感染预防实践方面发挥着至关重要的作用.
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