Renard E, Rostane T, Carriere C, Marchandin H, Jacques-Apostol D, Lauton D, Gibert-Boulet F, Bringer J
Department of Endocrinology, Lapeyronie Hospital, Montpellier, France.
Diabetes Metab. 2001 Feb;27(1):62-5.
Complications at implantation site of implantable insulin pumps may lead to premature removal. To elucidate the origins and the outcomes of these local adverse events. We investigated seromas of the 'pump-pocket' that have been detected for an eight month-period during the follow-up of such-treated forty type 1 diabetic patients. At the start of study period, skin bacterial flora was sampled at umbilicus and groin, and isolated strains of Staphylococcus epidermidis were preserved in specific vials at -20 degrees C. Each time a seroma was detected at transcutaneous 45 days-refill of pump reservoir, it was sampled for bacterial cultures. Isolated strains of S. epidermidis from seroma were genetically compared to preserved strains of corresponding patients using Pulsed-Field Gel Electrophoresis (PFGE) after genomic restriction by SmaI. Among the ten seromas that occurred after a mean time of 9.9 months since implantation, S. epidermidis were isolated in five cases. Genetic comparison of isolated strains could be performed in three cases. Compared strains showed identical (in 2 cases) or closely related (in one case) PFGE profiles. While the five aseptic seromas resolved with rest, four infected cases required explantations after one to nineteen months in spite of antibiotic therapy and the fifth one persisted without impairment under long-term antibiotics. Our results suggest that seeding from the skin flora is a key-factor determining the severity of pump-pocket complications. We recommend that bacterial investigations of pump-pocket seromas should be systematically performed, while prophylactic measures might include antibiotic cover for each puncture of the pump-pocket.
可植入胰岛素泵植入部位的并发症可能导致过早移除。为了阐明这些局部不良事件的起源和结果，我们调查了40例接受此类治疗的1型糖尿病患者随访期间8个月内检测到的“泵袋”血清肿。在研究开始时，在脐部和腹股沟采集皮肤细菌菌群，并将分离出的表皮葡萄球菌菌株保存在-20℃的特定小瓶中。每次在经皮45天补充泵储液器时检测到血清肿，都对其进行细菌培养采样。在通过SmaI进行基因组限制后，使用脉冲场凝胶电泳（PFGE）将血清肿中分离出的表皮葡萄球菌菌株与相应患者保存的菌株进行基因比较。在植入后平均9.9个月出现的10例血清肿中，5例分离出表皮葡萄球菌。在3例中可以进行分离菌株的基因比较。比较的菌株显示出相同（2例）或密切相关（1例）的PFGE图谱。虽然5例无菌血清肿通过休息得以消退，但4例感染病例尽管接受了抗生素治疗，仍在1至19个月后需要取出泵，第5例在长期使用抗生素的情况下持续存在且无损害。我们的结果表明，皮肤菌群的接种是决定泵袋并发症严重程度的关键因素。我们建议应系统地对泵袋血清肿进行细菌学调查，而预防措施可能包括对泵袋的每次穿刺进行抗生素覆盖。
