EVALUATION OF STRATEGIES FOR CENTRAL VENOUS CATHETER REPLACEMENT
EVALUATION OF STRATEGIES FOR CENTRAL VENOUS CATHETER REPLACEMENT
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DOI：
10.1097/00003246-199206000-00017
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发表时间：
1992-06-01
影响因子：
8.8
通讯作者：
COSTERTON, JW
中科院分区：
文献类型：
--
作者：
OLSON, ME;LAM, K;COSTERTON, JW
目的：评估将细菌定植的中心静脉导管留在原位的后果，并比较三种导管更换策略在动物模型中用于导管修复控制的效果。设计：前瞻性研究。设置：大型大学的实验室和动物设施。受试者：18只健康的雌性成年绵羊。干预措施：将不透射线硅化弹性体中心静脉导管插入颈静脉，并用大肠杆菌或表皮葡萄球菌定植。 感染7天后，使用导丝更换导管; B）在48小时间隔后取出并在新的颈静脉部位更换新导管;或c）使用导丝更换并将抗生素（妥布霉素、头孢菌素）注射到导管中。 在插入新导管后7天对动物实施安乐死。 定量微生物学进行血液样本收集每天从导管和外周静脉，以及从导管和组织回收的羊在时间的尸体解剖。测量和主要结果：当导管被改变使用导丝，他们成为殖民地的细菌在48小时内，和羊有栓塞性肺炎和植物性心内膜炎尸检。 将抗生素注入导管腔时，观察到类似的结果。 如果在48小时间隔后取出定植的导管并插入新的导管，则未观察到肺炎、肺炎和心内膜炎。在导丝上更换生物膜定殖的中心静脉导管与更换导管的快速定殖和产生分离的、粘液封闭的，耐药聚集体，定植于其他导管或通过在血流中传播引发心内膜炎或肺炎。
Objectives: To assess the consequences of leaving a bacterially colonized central venous catheter in place and to compare the effects of three catheter replacement strategies for catheter repair control in an animal model.Design: Prospective study.Setting: Laboratory and animal facility of a large university.Subjects: Eighteen healthy, female, adult sheep.Interventions: Radiopaque-siliconized elastomer central venous catheters were inserted into the jugular veins and colonized with either Escherichia coli or Staphylococcus epidermidis. After 7 days of infection, the catheters were either: a) exchanged using a guidewire; b) removed and replaced with a new catheter in a new jugular vein site after a 48-hr interval; or c) exchanged using a guidewire and antibiotics (tobramycin, cephaloridine) injected into the catheter. Animals were euthanized 7 days after insertion of the new catheter. Quantitative microbiology was performed on blood samples collected daily from the catheters and a peripheral vein, as well as from catheters and tissue recovered from the sheep at the time of autopsy.Measurements and Main Result: When catheters were changed using a guidewire, they became colonized by bacteria within 48 hrs, and the sheep had embolic pneumonia and vegetative endocarditis at autopsy. Similar consequences were observed when antibiotics were administered into the catheter lumen. If colonized catheters were removed and a new catheter was inserted after a 48-hr interval, recolonization, pneumonia, and endocarditis were not observed.Conclusions: Replacement of a biofilm-colonized central venous catheter over a guide-wire is associated with rapid colonization of the replacement catheter and production of detached, slime-enclosed, antibiotic-resistant aggregates that colonize other catheters or initiate endocarditis or pneumonia by dissemination in the bloodstream.