Crabtree John H, Burchette Raoul J, Siddiqi Rukhsana A, Huen Isan T, Hadnott Linda L, Fishman Arnold
Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower, California 90706, USA.
Perit Dial Int. 2003 Jul-Aug;23(4):368-74.
Dialysis-related infections are the commonest cause of catheter loss and transfer to hemodialysis. Surface modifications of the catheter that reduce infections are of major importance.
The efficacy of silver-ion treated catheters in reducing dialysis-related infections was tested.
The study design was a prospective, randomized controlled trial. Patients were implanted with either a silver-treated study catheter or a control catheter. Prospective collection of data included infectious complications and catheter survival.
The subject groups were comprised of 67 silver-treated catheters and 72 control catheters. Demographic characteristics of the study and control groups were equal. Exit-site infection rates for the study group and control group (0.52 and 0.45 episodes/patient-year of dialysis respectively) were not different by Poisson regression analysis (p > 0.4). Peritonitis rates were identical for the two groups (0.37 episodes/patient-year) and were not different by Poisson analysis (p > 0.9). Antibiotic-free intervals between infections for the study and control groups were not significantly different for exit-site infections (p = 0.58), peritonitis (p = 0.44), or both infections combined (p = 0.47). Actuarial analyses showed no differences between the groups in the probability of remaining free of exit-site infection (p > 0.2) or peritonitis (p > 0.7). Similarly, catheter survival was not significantly different between the groups (p > 0.6).
Surface modification of catheters with ion beam implantation of silver produced no clinical effect with respect to reducing dialysis-related infections.
透析相关感染是导管丢失和转为血液透析的最常见原因。减少感染的导管表面改性至关重要。
测试银离子处理导管在减少透析相关感染方面的疗效。
研究设计为前瞻性随机对照试验。患者植入银处理的研究导管或对照导管。前瞻性收集的数据包括感染并发症和导管存活情况。
研究组由67根银处理导管和72根对照导管组成。研究组和对照组的人口统计学特征相同。通过泊松回归分析，研究组和对照组的出口部位感染率（分别为0.52和0.45次/患者透析年）无差异（p>0.4）。两组的腹膜炎发生率相同（0.37次/患者透析年），泊松分析无差异（p>0.9）。研究组和对照组在出口部位感染（p=0.58）、腹膜炎（p=0.44）或两种感染合并（p=0.47）时，感染之间的无抗生素间隔时间无显著差异。精算分析显示，两组在无出口部位感染（p>0.2）或腹膜炎（p>0.7）的概率上无差异。同样，两组之间的导管存活率无显著差异（p>0.6）。
通过离子束植入银对导管进行表面改性在减少透析相关感染方面没有临床效果。
