Pathogens and risk factors for pulmonary infection during hemodialysis in patients with chronic kidney disease
OBJECTIVE To explore the distribution characteristics of pathogenic bacteria and related risk factors of pulmonary infection(PI)in patients with chronic kidney disease(CKD)during hemodialysis.METHODS Patients with CKD who received treatment at Affiliated Hospital of Jiangnan University from May 2018 to Nov 2022 were enrolled.A total of 106 cases were included and their clinical data were retrospectively analyzed.The patients were divided into the infected group(27 cases)and the non-infected group(79 cases)according to whether PI occurred during hemodialysis.The characteristics of pathogenic distribution in patients of the infection group were analyzed and the clinical data between the two groups were compared.The risk factors of PI in patients with CKD during hemodialysis were analyzed by multivariate logistic regression analysis.RESULTS A total of 13 strains of patho-genic bacteria were detected in 27 patients of the infection group,with a detection rate of 48.15％.There were two strains of gram-positive bacteria,seven strains of gram-negative bacteria and 4 strains of fungal.The proportion of patients with grade Ⅳ heart function,diabetes and heart failure in the infected group was 44.44％,48.15％and 51.85％,respectively,which were higher than 22.78％,26.58％and 30.38％in the uninfected group(P＜0.05).The proportion of infected patients with the level of peripheral blood hemoglobinx＜110 g/L was 62.96％,which were higher than 40.51％in the non-infected group.The levels of peripheral blood leukocyte and red blood cell distribution width were higher than those in the non-infected group.The serum phosphorus level was lower than that in the non-infected group(P＜0.05).Multifactor logistic regression analysis showed that the risk factors for PI in CKD patients during hemodialysis included diabetes and heart failure(OR=3.658,2.680,P＜0.05).CONCLUSION The risk factors of PI in CKD patients during hemodialysis include combination of diabetes and heart failure.And gram-negative bacteria account for a high proportion of infection pathogens,mainly Klebsiella pneumoniae.Therefore,targeted preventive measures and antibacterial treatment could be given clinically.
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