Treatment of dialysis catheter-related Enterococcus bacteremia with an antibiotic lock: a quality improvement report.
Treatment of dialysis catheter-related Enterococcus bacteremia with an antibiotic lock: a quality improvement report.
复制标题
DOI：
10.1053/j.ajkd.2008.06.033
复制
发表时间：
2009-01
期刊：
影响因子：
--
通讯作者：
Allon M
中科院分区：
文献类型：
--
作者：
Peterson WJ;Maya ID;Carlton D;Estrada E;Allon M
导管相关性菌血症(CRB)是隧道式透析导管的常见并发症，肠球菌是常见的感染性微生物。CRB可以通过向导管管腔内注入抗生素锁，结合全身抗生素来治疗。这种方法对肠球菌菌血症的疗效尚不清楚。质量改进报告。采用统一抗生素锁定方案治疗门诊维持性血液透析患者对万古霉素敏感的肠球菌菌血症。前瞻性跟踪临床结果。患者在每次透析后静脉注射万古霉素，同时在两个导管管腔内注入万古霉素锁，为期3周。治疗失败被定义为抗生素开始使用后48小时内持续发热或90天内反复出现肠球菌菌血症。临床治愈定义为发热消退，无菌血症复发。记录6个月内与感染相关的主要并发症。治疗失败25例(39%)，因持续发热10例，菌血症复发15例。治疗成功39例(61%)。组严重并发症4例(6%)，心内膜炎1例，骨髓炎3例。治疗失败组严重并发症发生率为16%(4/25)，治疗成功组为0%(0/39)(P=0.01)。这是一项单中心研究。我们没有测量血清中万古霉素的水平。抗生素锁定方案允许61%患有肠球菌CRB的血液透析患者挽救导管。6%的患者会出现严重的并发症，治疗失败的患者更常见。
Catheter-related bacteremia (CRB) is a frequent complication of tunneled dialysis catheters, and Enterococcus is a common infecting organism. CRB may be treated by instilling an antibiotic lock into the catheter lumen, in conjunction with systemic antibiotics. The efficacy of this approach in Enterococcus bacteremia is unknown. Quality improvement report. 64 catheter-dependent hemodialysis outpatients with vancomycin-sensitive Enterococcus bacteremia treated with a uniform antibiotic lock protocol. Clinical outcomes were tracked prospectively. Patients received intravenous vancomycin for 3 weeks, in conjunction with a vancomycin lock instilled into both catheter lumens after each dialysis session. Treatment failure was defined as persistent fever 48 hours after initiation of antibiotics or recurrent Enterococcus bacteremia within 90 days. A clinical cure was defined as fever resolution without recurrent bacteremia. Major infection-related complications within 6 months were documented. Treatment failure occurred in 25 patients (39%), due to persistent fever in 10, and recurrent bacteremia in 15. Treatment success occurred in 39 patients (61%). A serious complication of Enterococcus CRB occurred in 4 of 64 patients (6%), endocarditis in 1 and osteomyelitis in 3. The frequency of serious complications was 16% (4/25) in patients with treatment failure, as compared with 0% (0/39) in those with treatment success (P=0.01). This was a single-center study. We did not measure serum vancomycin levels. An antibiotic lock protocol permits catheter salvage in 61% of hemodialysis patients with Enterococcus CRB. Serious complications occur in 6% of patients, and are more common in those with treatment failure.
登录
查看更多内容
影响因子：
19.6
作者：
Allon, M;Bailey, R;Zeigler, ST
通讯作者：
Zeigler, ST
影响因子：
19.6
作者：
Tanriover, B;Carlton, D;Allon, M
通讯作者：
Allon, M
影响因子：
6.1
作者：
Poole, CV;Carlton, D;Allon, M
通讯作者：
Allon, M
影响因子：
19.6
作者：
Barth, RH;DeVincenzo, N
通讯作者：
DeVincenzo, N
影响因子：
5.2
作者：
Fernandez-Hidalgo, Nuria;Almirante, Benito;Pahissa, Albert
通讯作者：
Pahissa, Albert