Sedlacek Martin, Gemery John M, Cheung Ambrose L, Bayer Arnold S, Remillard Brian D
Division of Nephrology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756-0001, USA.
Am J Kidney Dis. 2007 Mar;49(3):401-8. doi: 10.1053/j.ajkd.2006.12.014.
Hemodialysis patients with tunneled catheters are at increased risk of bacteremic Staphylococcus aureus infections. In vitro and in vivo studies showed that aspirin has direct antistaphylococcal effects by inhibiting expression of alpha-toxin and matrix adhesion genes through activation of sigma factor B stress-induced operon. We hypothesized that long-term treatment with aspirin may decrease the frequency of S aureus bacteremia in such patients.
We retrospectively analyzed electronic medical records for a variety of clinical parameters, including catheter dwell times, blood culture results, and aspirin use in our dialysis population.
A total of 4,722 blood cultures were performed in 872 patients during more than 476 patient-catheter-years. There was a lower rate of catheter-associated S aureus bacteremia in patients treated with aspirin versus those not treated with aspirin (0.17 versus 0.34 events/patient-catheter-year, P = 0.003), whereas no such difference was observed for other bacteria. This association was dose dependent, seen mostly with the 325-mg aspirin dose. Using the Cox proportional hazard method, risk to develop a first episode of S aureus bacteremia decreased by 54% in patients using aspirin (confidence interval, 24 to 72; P = 0.002). Aspirin was associated with decreased risk of: (1) a first episode of methicillin-resistant S aureus bacteremia and (2) metastatic complications during the first episode of catheter-related S aureus bacteremia.
These data are consistent with our clinical hypothesis that aspirin has a clinically useful antistaphylococcal effect in the dialysis population.
使用带隧道式导管的血液透析患者发生金黄色葡萄球菌菌血症感染的风险增加。体外和体内研究表明，阿司匹林通过激活B因子应激诱导操纵子抑制α毒素和基质粘附基因的表达，从而具有直接的抗葡萄球菌作用。我们假设，长期使用阿司匹林可能会降低此类患者金黄色葡萄球菌菌血症的发生率。
我们回顾性分析了电子病历中的各种临床参数，包括导管留置时间、血培养结果以及我们透析人群中阿司匹林的使用情况。
在超过476患者-导管年期间，对872例患者共进行了4722次血培养。与未使用阿司匹林的患者相比，使用阿司匹林的患者导管相关金黄色葡萄球菌菌血症的发生率较低（0.17比0.34事件/患者-导管年，P = 0.003），而其他细菌则未观察到这种差异。这种关联是剂量依赖性的，主要见于325毫克阿司匹林剂量。使用Cox比例风险法，使用阿司匹林的患者发生首次金黄色葡萄球菌菌血症的风险降低了54%（置信区间，24至72；P = 0.002）。阿司匹林与以下风险降低相关：（1）首次耐甲氧西林金黄色葡萄球菌菌血症，以及（2）导管相关金黄色葡萄球菌菌血症首次发作期间的转移性并发症。
这些数据与我们的临床假设一致，即阿司匹林在透析人群中具有临床上有用的抗葡萄球菌作用。
