Raad Issam, Hanna Hend, Maki Dennis
Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Lancet Infect Dis. 2007 Oct;7(10):645-57. doi: 10.1016/S1473-3099(07)70235-9.
Indwelling vascular catheters are a leading source of bloodstream infections in critically ill patients and cancer patients. Because clinical diagnostic criteria are either insensitive or non-specific, such infections are often overdiagnosed, resulting in unnecessary and wasteful removal of the catheter. Catheter-sparing diagnostic methods, such as differential quantitative blood cultures and time to positivity have emerged as reliable diagnostic techniques. Novel preventive strategies include cutaneous antisepsis, maximum sterile barrier, use of antimicrobial catheters, and antimicrobial catheter lock solution. Management of catheter-related bloodstream infections involves deciding on catheter removal, antimicrobial catheter lock solution, and the type and duration of systemic antimicrobial therapy. Such decisions depend on the identity of the organism causing the bloodstream infection, the clinical and radiographical manifestations suggesting a complicated course, the underlying condition of the host (neutropenia, thrombocytopenia), and the availability of other vascular access sites.
留置血管导管是重症患者和癌症患者血流感染的主要来源。由于临床诊断标准要么不敏感，要么不具有特异性，此类感染常常被过度诊断，导致不必要且浪费的导管拔除。诸如差异定量血培养和阳性时间等保留导管的诊断方法已成为可靠的诊断技术。新型预防策略包括皮肤消毒、最大无菌屏障、使用抗菌导管以及抗菌导管封管液。导管相关血流感染的管理涉及决定是否拔除导管、使用抗菌导管封管液以及全身抗菌治疗的类型和持续时间。此类决策取决于引起血流感染的病原体种类、提示病情复杂的临床和影像学表现、宿主的基础状况（中性粒细胞减少、血小板减少）以及其他血管通路部位的可及性。
