Domingo P, Fontanet A, Sánchez F, Allende L, Vazquez G
Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain.
Clin Infect Dis. 1999 Aug;29(2):346-51. doi: 10.1086/520213.
To determine the morbidity associated with long-term use of a totally implantable central venous access device (Port-A-Cath [PAC]) in patients with AIDS, we studied 68 consecutive patients with AIDS requiring 79 such devices for long-term use, inserted over a period of 5 years. The total number of PAC-days was 20,159. At least one PAC-related complication occurred with 40 of 79 PACs (50.6% [95% confidence interval (CI): 39.6%-61.6%]), and 16 devices (20.2% [95% CI, 11.4%-29.0%]) had to be removed because of complications. Device-related infection occurred with 33 of 79 PACs (41.7% [95 CI, 30.8%-52.6%]). The predominant infection occurring with PACs was chamber infection, with an incidence of 0.16 per 100 PAC-days. The predominant organisms isolated from patients with chamber infections but also from those with device-related bacteremia were gram-positive cocci (79.4%). The presence of neutropenia (odds ratio [OR] = 9.72; 95% CI, 3.0-31.3; P < .001) and a CD4 cell count lower than 0.025 x 10(9)/L (OR = 6.14; 95% CI, 1.9-19.2; P = .002) were independent predictors of infection. The antibiotic lock technique was associated with decreased device loss when compared with isolated systemic antibiotic therapy (OR = 0.05; 95% CI, 0.0-0.59; P = .008). This technique may be useful to treat PAC infection in patients with AIDS, for whom the risk of PAC-related complications is very high.
为确定艾滋病患者长期使用全植入式中心静脉通路装置（Port - A - Cath [PAC]）的发病率，我们研究了连续68例艾滋病患者，这些患者在5年期间共需要长期使用79个此类装置。PAC使用天数总计为20,159天。79个PAC中有40个（50.6% [95%置信区间（CI）：39.6% - 61.6%]）发生了至少1例与PAC相关的并发症，16个装置（20.2% [95% CI，11.4% - 29.0%]）因并发症而不得不移除。79个PAC中有33个（41.7% [95% CI，30.8% - 52.6%]）发生了与装置相关的感染。PAC发生的主要感染是腔室感染，发病率为每100个PAC使用日0.16例。从腔室感染患者以及与装置相关菌血症患者中分离出的主要病原体是革兰氏阳性球菌（79.4%）。中性粒细胞减少（优势比[OR] = 9.72；95% CI，3.0 - 31.3；P <.001）和CD4细胞计数低于0.025×10⁹/L（OR = 6.14；95% CI，1.9 - 19.2；P =.002）是感染的独立预测因素。与单独的全身抗生素治疗相比，抗生素封管技术与装置丢失减少相关（OR = 0.05；95% CI，0.0 - 0.59；P =.008）。对于艾滋病患者，其发生与PAC相关并发症的风险非常高，该技术可能有助于治疗PAC感染。
