Nielsen J, Kolmos H J, Rosdahl V T
Department of Clinical Microbiology, Statens Serum Institut, Hvidovre Hospital, Copenhagen, Denmark.
Scand J Infect Dis. 1998;30(6):569-72. doi: 10.1080/00365549850161115.
Surveillance cultures for the demonstration of coagulase-negative staphylococci in patients on catheter haemodialysis were performed in an attempt to predict dialysis catheter-related septicaemia. In all, 43 patients with 67 haemodialysis catheters were followed for a 1-y period. Once a week, swab specimens were obtained from the skin at the insertion site and the hub, and blood cultures were obtained from the catheter. Among coagulase-negative staphylococci, S. epidermidis was the most frequently (80%) isolated species, and two biotypes accounted for 55.7% of the 41 biotypes isolated. 11 septicaemia cases due to coagulase-negative staphylococci occurred, all caused by S. epidermidis, and the incidence of S. epidermidis septicaemia was 21% among patients and 16% among catheter periods. S. epidermidis septicaemia occurred in 17%, 31% and 33% of all catheter periods in which S. epidermidis was cultured from the skin, hub and catheter blood, respectively. In two-thirds of all catheter periods, S. epidermidis was cultured from catheter blood despite lack of clinical signs of septicaemia. In conclusion, cultures from the skin, hub or catheter blood are not useful for prediction of dialysis catheter-related septicaemia due to coagulase-negative staphylococci. When septicaemia is suspected, peripheral blood cultures are mandatory to reach a correct diagnosis and aetiology.
为了预测透析导管相关败血症，对接受导管血液透析的患者进行了凝固酶阴性葡萄球菌监测培养。总共对43例患者的67根血液透析导管进行了为期1年的随访。每周一次，从导管插入部位的皮肤和接头处获取拭子标本，并从导管采集血培养标本。在凝固酶阴性葡萄球菌中，表皮葡萄球菌是最常分离出的菌种（80%），在分离出的41种生物型中，两种生物型占55.7%。发生了11例由凝固酶阴性葡萄球菌引起的败血症病例，均由表皮葡萄球菌引起，表皮葡萄球菌败血症在患者中的发生率为21%，在导管使用期间的发生率为16%。在分别从皮肤、接头和导管血中培养出表皮葡萄球菌的所有导管使用期间，表皮葡萄球菌败血症的发生率分别为17%、31%和33%。在所有导管使用期间的三分之二，尽管没有败血症的临床症状，但仍从导管血中培养出表皮葡萄球菌。总之，来自皮肤、接头或导管血的培养对于预测凝固酶阴性葡萄球菌引起的透析导管相关败血症并无用处。当怀疑有败血症时，必须进行外周血培养以做出正确的诊断并确定病因。
