Wagner Steven C, Eschelman David J, Gonsalves Carin F, Bonn Joseph, Sullivan Kevin L
Division of Cardiovascular and Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
J Vasc Interv Radiol. 2004 Apr;15(4):375-8. doi: 10.1097/01.rvi.0000121410.46920.6e.
To evaluate the incidence of implantable venous access device infection in patients with sickle cell disease.
The authors performed a retrospective search of their hospital's information system from January 1, 1996 to December 31, 2001 to identify hospital admissions with ICD-9 codes related to sickle cell anemia. This search yielded 2703 admissions in 293 patients. A search of the radiology information system identified 23 of these patients who had placement of an implantable venous access device. Excluding two patients who were lost to follow-up, the population of this study included eight men and 13 women aged 23 to 62 years old (mean, 37 years). A total of 30 implantable venous access devices (25 venous ports, five tunneled catheters) were placed by interventional radiologists. Cases of device infection were identified based on clinical data, microbiology, reports of device removal, and clinical follow-up. Infections were defined according to the Centers for Disease Control criteria for catheter-related bloodstream infection. The incidence of infection, organism, and time from device placement to infection was determined.
In 21 patients with 30 devices, 18 device infections (60%) occurred in 12 patients (57%) involving 15 venous ports and three tunneled catheters. There were a total of 12389 days of catheter use and a rate of 1.5 infections per 1000 catheter days. Infections occurred from 16 to 1542 days (mean, 349 days) after device placement. Blood, wound, and catheter tip cultures yielded solitary organisms in 13 cases and mixed organisms in four cases. Staphylococcus aureus was the most common pathogen (59%). One patient was considered infected based on clinical signs and purulent discharge from the port site, despite negative cultures after partial antibiotic treatment. One patient died of sepsis resulting from an infected port.
This study shows a high incidence of infection associated with placement of implantable venous access devices in patients with sickle cell disease. Therefore, the authors avoid placing these devices in this patient population.
评估镰状细胞病患者中植入式静脉通路装置感染的发生率。
作者对其医院信息系统进行了回顾性检索，时间跨度为1996年1月1日至2001年12月31日，以确定具有与镰状细胞贫血相关的国际疾病分类第九版（ICD - 9）编码的住院病例。此次检索共得到293例患者的2703次住院记录。通过检索放射学信息系统，确定其中23例患者植入了植入式静脉通路装置。排除2例失访患者后，本研究的人群包括8名男性和13名女性，年龄在23岁至62岁之间（平均37岁）。介入放射科医生共放置了30个植入式静脉通路装置（25个静脉端口，5个隧道式导管）。根据临床数据、微生物学、装置移除报告及临床随访确定装置感染病例。感染根据疾病控制中心关于导管相关血流感染的标准进行定义。确定感染发生率、病原体及从装置植入到感染的时间。
在21例使用30个装置的患者中，12例患者（57%）发生了18次装置感染（60%），涉及15个静脉端口和3个隧道式导管。导管使用总天数为12389天，每1000导管日感染率为1.5次。感染发生在装置植入后16天至1542天（平均349天）。血液、伤口及导管尖端培养在13例中培养出单一病原体，4例中培养出混合病原体。金黄色葡萄球菌是最常见的病原体（59%）。1例患者尽管在部分抗生素治疗后培养结果为阴性，但根据临床体征和端口部位的脓性分泌物被认为发生了感染。1例患者因感染的端口导致败血症死亡。
本研究显示镰状细胞病患者植入式静脉通路装置植入相关的感染发生率较高。因此，作者避免在该患者群体中放置这些装置。
