Clinical management of dialysis catheter-related bacteremia with concurrent exit-site infection.
Clinical management of dialysis catheter-related bacteremia with concurrent exit-site infection.
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DOI：
10.1111/j.1525-139x.2011.00869.x
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发表时间：
2011-03
影响因子：
1.6
通讯作者：
Allon M
中科院分区：
文献类型：
--
作者：
Sychev D;Maya ID;Allon M
透析导管相关菌血症（CRB）通常可采用全身性抗生素联合抗生素封管治疗，以尝试挽救导管。目前尚不清楚是否可以用这种方法治疗与出口部位感染相关的CRB。我们回顾性查询了一个前瞻性的计算机化血管通路数据库，确定了1436例CRB发作，其中64例有并发出口部位。表皮葡萄球菌并发出口部位感染的频率为9.6%，金黄色葡萄球菌为6.1%，革兰氏阴性CRB仅为0.7%（葡萄球菌vs革兰氏阴性杆菌p<0.001）。24例金黄色葡萄球菌感染患者发生5例严重并发症（4例严重脓毒症，1例心内膜炎），而32例表皮葡萄球菌感染患者未发生严重并发症。金黄色葡萄球菌感染患者的导管存活时间显著缩短。金黄色葡萄球菌感染的中位导管生存期（无感染或功能障碍）为14天，表皮葡萄球菌感染的中位导管生存期为30天。总之，并发出口部位感染最常见于葡萄球菌CRB。当感染微生物是表皮葡萄球菌时，尝试全身性抗生素和抗生素锁定进行抢救是合理的。但是，当病原体为金黄色葡萄球菌时，应立即取出导管。
Dialysis catheter-related bacteremia (CRB) can frequently be treated with systemic antibiotics, in conjunction with an antibiotic lock, in an attempt to salvage the catheter. It is unknown whether CRB associated with an exit site infection can be treated with such an approach. We retrospectively queried a prospective, computerized vascular access database, and identified 1436 episodes of CRB, of which 64 cases had a concurrent exit site. The frequency of concurrent exit site infection was 9.6% with Staphylococcus epidermidis, 6.1% with Staphylococcus aureus, and only 0.7% with Gram negative CRB (p<0.001 for Staphylococcus vs Gram negative rods). Five serious complications (4 major sepsis, 1 endocarditis) occurred in 24 patients with Staphylococcus aureus infection, but none in 32 episodes of Staphylococcus epidermidis infection. Catheter survival was significantly shorter in patients with Staphylococcus aureus infections. The median catheter survival (without infection or dysfunction) was 14 days with Staphylococcus aureus vs 30 days with Staphylococcus epidermidis infection. In conclusion, concurrent exit site infection is seen most commonly in association with Staphylococcal CRB. When the infecting organism is Staphylococcus epidermidis, attempted salvage with systemic antibiotics and an antibiotic lock is reasonable. However, prompt catheter removal is indicated when the pathogen is Staphylococcus aureus.