van Rooden Cornelis J, Schippers Emile F, Barge Renée M Y, Rosendaal Frits R, Guiot Henri F L, van der Meer Felix J M, Meinders A Edo, Huisman Menno V
Department of General Internal Medicine, Room C1 R-43, Leiden University Medical Center, 2300 RC Leiden, Netherlands.
J Clin Oncol. 2005 Apr 20;23(12):2655-60. doi: 10.1200/JCO.2005.05.002.
We studied whether the risk of central venous catheter (CVC) -related thrombosis increased after an episode of CVC-related infection in patients undergoing intensive chemotherapy. Secondly, we determined whether thrombosis can be predicted or excluded by CVC lock fluid surveillance cultures.
In a prospective setting, 105 consecutive patients were carefully examined for CVC-related infection and thrombosis. In all patients, microbial surveillance cultures of CVC lock fluid were taken every other day. All patients with clinical suspicion of CVC-related thrombosis underwent Doppler ultrasound or additional venography.
The cumulative incidence of CVC-related infection was 24% (25 of 105 patients). Clinically manifest thrombosis occurred in 13 (12%) of 105 patients. In patients with CVC-related infection, the risk of thrombosis increased markedly in comparison to those without infection (relative risk, 17.6; 95% CI, 4.1 to 74.1). In patients having two or more positive subsequent CVC lock fluid cultures with identical micro-organisms, 71.4% developed thrombosis, as compared with 3.3% in patients with negative or a single positive culture.
The risk of clinically manifest thrombosis is increased after an episode of CVC-related infection in patients undergoing intensive chemotherapy. Surveillance culturing of CVC lock fluid may be clinically useful in estimating the risk for thrombosis and the instigation of focused early intervention.
我们研究了接受强化化疗的患者发生中心静脉导管（CVC）相关感染后，CVC相关血栓形成的风险是否增加。其次，我们确定了CVC封管液监测培养能否预测或排除血栓形成。
在一项前瞻性研究中，对105例连续患者进行了CVC相关感染和血栓形成的仔细检查。所有患者每隔一天进行一次CVC封管液的微生物监测培养。所有临床怀疑CVC相关血栓形成的患者均接受了多普勒超声检查或额外的静脉造影检查。
CVC相关感染的累积发生率为24%（105例患者中的25例）。105例患者中有13例（12%）发生了临床表现为血栓形成。与未发生感染的患者相比，发生CVC相关感染的患者血栓形成风险显著增加（相对风险，17.6；95%可信区间，4.1至74.1）。后续CVC封管液培养有两次或更多次相同微生物阳性的患者中，71.4%发生了血栓形成，而培养阴性或仅有一次阳性的患者中这一比例为3.3%。
接受强化化疗的患者发生CVC相关感染后，临床表现为血栓形成的风险增加。CVC封管液监测培养在估计血栓形成风险和启动有针对性的早期干预方面可能具有临床应用价值。
