Author: Leo
Keywords: dialysis infection
Dialysis patients' infection remains an important health care problem. Studies have reported that although the hospitalization rate of dialysis patients in the recent overall decline, but the infection-related hospitalization rate has not declined. Because of the increased number of new antibiotics and new antibiotics, the current infection is more difficult to treat, therefore, preventive measures should be the key.
First, the reasons for dialysis patients infected
Over the years, hemodialysis (HD) and peritoneal dialysis (PD) patients have been considered to be less responsive to vaccination, as evidenced by the production of seroprotective antibodies such as hepatitis B, pneumococcal, tetanus toxoid vaccines. Pulmonary infection in chronic dialysis patients with mortality is 14 to 16 times the general population, of which more than half of the lower respiratory tract infection is caused by Streptococcus pneumoniae.
Compared with patients with PD, HD patients have a higher risk of developing lung infections, which may be related to increased lung volume during dialysis. In addition, HD patients often travel to and from the dialysis center and wait together during dialysis, which increases the risk of respiratory tract infections, and PD is a "home" treatment.
Second, reduce the rate of hemodialysis patients measures
The choice of central venous dialysis catheter may also affect the risk of infection, not only whether there are tunnels and with polyester sets, different design effects will be different. Thus, the care of the catheter varies from one center to another, and is reflected in whether or not the sterile operation is performed when the catheter is connected and disconnected.
The clinical cost of reducing the risk of infection requires economic costs, and it is important for patients and health care providers to determine which operations are effective in reducing the risk of infection and which are most ineffective. Although the implementation of clinical care in HD patients with infection prevention guidelines reduces the incidence of catheter-related bacteremia, but similar care methods did not significantly reduce the risk of PD patients with peritonitis.
Although there are differences in climate, but the pathogen of peritonitis is similar, which indicates that the difference between skin microbes is not obvious. Increased intestinal mucosal permeability and bacterial translocation are the most common causes of intestinal carcinogenic peritonitis.
The risk of developing diverticulitis in both elderly HD and PD patients has increased due to restrictions on fluid intake and the development of diets to reduce the intake of phosphorus and potassium. Intestinal microbial changes will be immune and adaptive immunity, which has an impact on the distal part of the bowel. The combination of these effects may also increase the risk of dermatological metastatic peritonitis.
Third, summary
To sum up, dialysis patients' infection remains an important health care problem. Studies have reported that although the hospitalization rate of dialysis patients in the recent overall decline, but the infection-related hospitalization rate has not declined. Because of the increased number of new antibiotics and new antibiotics, the current infection is more difficult to treat, therefore, preventive measures should be the key.
The dialysis center should actively vaccinate against respiratory tract pathogens to reduce the risk of pulmonary infection and should also pay attention to limiting hemodialysis in fluid overload, especially during dialysis. To reduce catheter-related infections, dialysis centers should focus on increasing the number of patients with hemodialysis with arteriovenous fistula, limiting CVC.
Prevention of infection in clinical care guidelines can reduce catheter-related bacteremia, but failed to effectively prevent the occurrence of PD patients with peritonitis, and therefore need more research to reduce the risk of peritonitis in patients with dialysis.
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