Oudiz Ronald J, Widlitz Allison, Beckmann X Joy, Camanga Daisy, Alfie Jose, Brundage Bruce H, Barst Robyn J
Division of Cardiology, Research & Education Institute, Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
Chest. 2004 Jul;126(1):90-4. doi: 10.1378/chest.126.1.90.
To determine the incidence of catheter-related infection in patients with pulmonary arterial hypertension (PAH) receiving epoprostenol (EPO), and to note an etiologic role for Micrococcus spp, which is rarely reported as a pathogen in the medical literature.
Observational study.
Two PAH specialty treatment centers, Harbor-UCLA Medical Center (Torrance, CA), and the College of Physicians and Surgeons, Columbia University (New York, NY).
A total of 192 patients with PAH receiving continuous therapy with IV EPO.
From 1987 to 2000, 192 patients with PAH received infusions of EPO via central venous catheter. Catheter care included regular dressing changes with dry gauze using a sterile procedure, without the use of flushes. Patients were asked to report on known infections and treatments, and symptoms. All infections were verified by a telephone call to the patient, care provider, and microbiology laboratory whenever possible.
There were 335,285 catheter days (mean +/- SD, 1,325 +/- 974 catheter days). There were 88 clinical catheter infections with 51 blood culture-positive infections, necessitating catheter removal in 38 instances. The following pathogens were isolated: Staphylococcus aureus (25); Micrococcus spp (14); mixed flora (3); coagulase-negative Staphylococcus spp (2); Corynebacterium spp (2); Serratia marcessens (1); Enterobacter spp (1); Pseudomonas aeruginosa (1); enterococci (1); and unidentified Gram-positive cocci (1). The catheter infection rate was 0.26 per 1,000 catheter days.
The use of long-term therapy with continuous EPO appears to be associated with a low incidence of catheter-related infections. Micrococcus spp were the second most common etiologic agent. Caregivers managing patients with PAH must be aware of the risk of catheter infection, as it may contribute to the morbidity and mortality associated with the use of EPO. When isolated, Micrococcus spp should not be viewed as a contaminant, but rather as a true pathogen that may require therapeutic intervention.
确定接受依前列醇（EPO）治疗的肺动脉高压（PAH）患者导管相关感染的发生率，并关注微球菌属的病因学作用，该菌在医学文献中很少被报道为病原体。
观察性研究。
两个PAH专科治疗中心，加州大学洛杉矶分校港湾医学中心（加利福尼亚州托伦斯）和哥伦比亚大学医师与外科医生学院（纽约州纽约）。
共有192例接受静脉注射EPO持续治疗的PAH患者。
1987年至2000年，192例PAH患者通过中心静脉导管输注EPO。导管护理包括采用无菌操作定期用干纱布更换敷料，不使用冲洗液。要求患者报告已知的感染、治疗情况及症状。只要有可能，所有感染都通过电话向患者、护理人员和微生物实验室进行核实。
共有335,285个导管日（平均±标准差，1,325±974个导管日）。发生88例临床导管感染，其中51例血培养阳性感染，38例需要拔除导管。分离出以下病原体：金黄色葡萄球菌（25例）；微球菌属（14例）；混合菌群（3例）；凝固酶阴性葡萄球菌属（2例）；棒状杆菌属（2例）；粘质沙雷氏菌（1例）；肠杆菌属（1例）；铜绿假单胞菌（1例）；肠球菌（1例）；未鉴定的革兰氏阳性球菌（1例）。导管感染率为每1000个导管日0.26例。
长期持续使用EPO治疗似乎与较低的导管相关感染发生率相关。微球菌属是第二常见的病原体。管理PAH患者的护理人员必须意识到导管感染的风险，因为它可能导致与使用EPO相关的发病率和死亡率。当分离出微球菌属时，不应将其视为污染物，而应视为可能需要治疗干预的真正病原体。
