Antibiotic-lock therapy for long-term intravascular catheter-related bacteraemia: results of an open, non-comparative study
Antibiotic-lock therapy for long-term intravascular catheter-related bacteraemia: results of an open, non-comparative study
复制标题
DOI：
10.1093/jac/dkl103
复制
发表时间：
2006-06-01
影响因子：
5.2
通讯作者：
Pahissa, Albert
中科院分区：
文献类型：
--
作者：
Fernandez-Hidalgo, Nuria;Almirante, Benito;Pahissa, Albert
背景：感染是与长期中心静脉导管相关的主要问题之一。本研究评估的有效性，封管治疗（ALT）治疗导管相关菌血症（CRB）。方法：CRB被定义为定量血培养计数通过任何导管内腔5倍以上并行外周血培养，定性血培养阳性的同一种微生物在所有样本。同时开始全身治疗和ALT，使用万古霉素（2000 mg/L）治疗革兰氏阳性菌，使用环丙沙星或阿米卡星（2000 mg/L）治疗革兰氏阴性杆菌。肝素加至ALT。通过临床和微生物学标准评估有效性。治愈被定义为阴性血培养在两个网站没有导管取出后1个月完成therapy.Results：共115次CRB在98例患者进行了分析。导管用于化疗（50次）、血液透析（37次）、全肠外营养（24次）和联合化疗和营养（4次）。从导管放置到CRB发作的中位时间为105天（10例，范围26-210）。病因包括81例（70%）中的革兰氏阳性菌[56例凝固酶阴性葡萄球菌（CoNS），20例金黄色葡萄球菌和5例其他微生物]，26例（23%）中的革兰氏阴性杆菌（11例大肠埃希菌，5例铜绿假单胞菌和10例其他微生物）和8例（7%）中的多种微生物。共治愈94例（82%）。治疗失败21例，S.金黄色葡萄球菌（1例相关死亡）、9例CoNS、1例铜绿假单胞菌、1例普通变形杆菌和1例多种微生物。治疗成功的中位导管随访时间为168天（范围7-2740）。结论：ALT联合全身抗生素治疗CRB似乎是有效的，特别是在革兰氏阴性和CoNS发作。S.金黄色葡萄球菌CRB的治疗失败率升高。
Background: Infection is one of the main problems associated with long-term central venous catheters. This study assesses the effectiveness of antibiotic-lock therapy (ALT) for treating catheter-related bacteraemia (CRB).Methods: CRB was defined as quantitative blood culture counts through any catheter lumen 5-fold greater than concurrent peripheral blood culture, and qualitative blood culture positive for the same microorganism in all samples. Systemic treatment and ALT were started simultaneously using vancomycin (2000 mg/L) for Gram-positive organisms, and ciprofloxacin or amikacin (2000 mg/L) for Gram-negative bacilli. Heparin was added to ALT. Effectiveness was assessed by clinical and microbiological criteria. Cure was defined as negative blood cultures at both sites without catheter removal at 1 month after the completion of therapy.Results: A total of 115 episodes of CRB in 98 patients were analysed. Catheters were used for chemotherapy (50 episodes), haemodialysis (37), total parenteral nutrition (24) and combined chemotherapy and nutrition (4). Median time from catheter placement to CRB onset was 105 days (10 range 26-210). Aetiologies included Gram-positive organisms [56 coagulase-negative staphylococci (CoNS), 20 Staphylococcus aureus and 5 other organisms] in 81 episodes (70%), Gram-negative bacilli (11 Escherichia coli, 5 Pseudomonas aeruginosa and 10 other organisms) in 26 (23%) and polymicrobial in 8 (7%). A total of 94 episodes were cured (82%). There were 21 therapeutic failures: 9 S. aureus (1 related death), 9 CoNS, 1 P. aeruginosa, 1 Proteus vulgaris and 1 polymicrobial. Median catheter follow-up in therapeutic success was 168 days (range 7-2740).Conclusions: ALT combined with systemic antibiotics seems to be effective for treating CRB, especially in Gram-negative and CoNS episodes. S. aureus CRB had an elevated rate of therapeutic failure.