癌症合并念珠菌血症患者中心静脉导管的管理

Management of central venous catheters in patients with cancer and candidemia.

作者信息

Raad Issam, Hanna Hend, Boktour Maha, Girgawy Essam, Danawi Hadi, Mardani Masoud, Kontoyiannis Dimitrios, Darouiche Rabih, Hachem Ray, Bodey Gerald P

机构信息

Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.

出版信息

Clin Infect Dis. 2004 Apr 15;38(8):1119-27. doi: 10.1086/382874. Epub 2004 Mar 26.

DOI:10.1086/382874

PMID:15095217

Abstract

To determine the need and appropriate timing of catheter removal in patients with candidemia, the records for 404 patients with cancer and central venous catheters (CVCs) who developed candidemia during the period of 1993-1998 were retrospectively reviewed. Of the total 404 cases of candidemia, 241 (60%) were due to a primary source, 111 (27%) were catheter related, and 52 (13%) were secondary cases of candidemia caused by a source other than the catheter. Multivariate analysis showed that catheter removal < or =72 h after onset improved response to antifungal therapy exclusively in patients with catheter-related candidemia (P=.04). Clinical characteristics that suggested a noncatheter source for the candidemia were disseminated infection (P<.01), previous chemotherapy (P<.01), previous corticosteroid therapy (P=.02), and poor response to antifungal therapy (P<.03). CVC removal < or =72 h after onset should be considered in patients with suspected catheter-related candidemia who have no evidence of dissemination, recent corticosteroid therapy, or chemotherapy.

摘要

为确定念珠菌血症患者拔除导管的必要性及合适时机，我们回顾性分析了1993年至1998年间404例患癌症且置有中心静脉导管（CVC）并发生念珠菌血症患者的记录。在404例念珠菌血症病例中，241例（60%）为原发性感染，111例（27%）与导管相关，52例（13%）是由导管以外的其他来源引起的继发性念珠菌血症。多因素分析显示，仅在导管相关念珠菌血症患者中，发病后≤72小时拔除导管可改善抗真菌治疗反应（P = 0.04）。提示念珠菌血症非导管来源的临床特征包括播散性感染（P < 0.01）、既往化疗史（P < 0.01）、既往使用皮质类固醇治疗史（P = 0.02）以及对抗真菌治疗反应不佳（P < 0.03）。对于疑似导管相关念珠菌血症且无播散、近期使用皮质类固醇治疗或化疗证据的患者，应考虑在发病后≤72小时拔除CVC。