Usefulness of Anti-Infective Lock Solutions for Catheter-Related Bloodstream Infections
Usefulness of Anti-Infective Lock Solutions for Catheter-Related Bloodstream Infections
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DOI：
10.1002/msj.20213
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发表时间：
2010-09-01
影响因子：
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通讯作者：
Yousefzadeh, Nina
中科院分区：
文献类型：
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作者：
Kim, Esther Y.;Saunders, Patricia;Yousefzadeh, Nina
中心静脉导管通常用于住院和门诊患者的给药，但其使用具有发生导管相关血流感染的风险，增加发病率和死亡率。美国传染病学会的指南包括使用抗生素封管液作为腔内感染的治疗选择，当器械难以取出时，但这些封管液并不常规用于预防导管相关血流感染。由于在需要长期导管插入术或有多根导管的患者中并不总是能够取出导管，因此可以使用抗生素封管治疗，目的是在对管腔进行灭菌的同时避免取出导管。抗生素封管液的使用是局部感染的一个有吸引力的选择，因为它易于使用，成本低，并且如果导管保持封闭，通常没有全身副作用。对于长期或短期留置导管且无出口部位或隧道感染体征的患者，当使用全身抗生素治疗时，以挽救为目标的患者可能受益于该技术，仅在无并发症的感染中考虑抗生素锁定治疗，通常为凝固酶阴性葡萄球菌或革兰氏阴性杆菌引起的非隧道导管或输液港感染。一般来说，建议7至14天的短期方案。一些研究支持万古霉素、庆大霉素、头孢唑林或乙醇的抗菌锁定疗法。抗生素锁有可能对死亡率和成本节约产生积极影响。西奈山医疗中心正在制定一项协议。Mt Sinai J Med 77：549-558，2010. (c)2010年西奈山医学院
Central venous catheters are commonly used For the administration of medications in both the inpatient and outpatient settings, but their use carries the risk of developing catheter-related bloodstream infections, increasing morbidity and mortality. Guidelines from the Infectious Diseases Society of America include use of antibiotic lock solutions as a therapeutic option for intraluminal infections when the device is difficult to remove, but these lock solutions are not indicated routinely for the prophylaxis of catheter-related bloodstream infections. Because catheter removal is not always possible in patients who require chronic catheterization or who have multiple catheters, antibiotic lock therapy can be utilized with the goal of sparing removal of the catheter while sterilizing the lumen. The use of an antibiotic lock solution is an appealing option for localized infections because it is easy to use, is associated with a low cost, and is usually without systemic side effects if the catheter remains closed. Patients with long-term or short-term catheters with no signs of exit-site or tunnel infection for whom salvage is the goal may benefit from this technique when treated with systemic antibiotics, Consider antibiotic lock therapy only in uncomplicated infections, typically nontunneled catheter or port infections with coagulase-negative staphylococci or gram-negative bacilli. Generally, a short-term regimen of 7 to 14 days is recommended. Several studies have supported antimicrobial lock therapy with vancomycin, gentamicin, cefazolin, or ethanol. Antibiotic locks have the potential to positively impact mortality and cost savings. A protocol at the Mount Sinai Medical Center is in development. Mt Sinai J Med 77:549-558, 2010. (c) 2010 Mount Sinai School of Medicine