de Cal M, Cazzavillan S, Cruz D, Nalesso F, Brendolan A, Rassu M, Ronco C
Dipartimento di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italy.
G Ital Nefrol. 2009 Sep-Oct;26(5):616-20.
Central venous catheters (CVCs) play an important role in replacement therapy for patients with acute and chronic renal failure. Secondary infections due to central venous access are responsible for 48-73% of bacteremia in hemodialysis patients and are an important cause of morbidity and increased health costs for these patients. Episodes of unexplained fever were noted in hemodialysis patients in our center starting in October 2006. An investigation for causative microorganisms was conducted from October 2006 to April 2007. Bacterial DNA was extracted and amplified using universal primers for bacterial 16S. Amplification by multiple PCR was performed on the samples and the subsequent sequencing led to the identification of the microorganism of interest as belonging to Methylobacterium radiotolerans. We report the largest cluster of dialysis catheter-related bloodstream infections caused by M. radiotolerans, and describe the difficulties in the prompt and correct identification of these bacteria. Thirty-seven patients had positive cultures for M. radiotolerans from blood (2.7%) or CVC (29.7%) or both (67.6%). After removal and replacement of CVCs and antibiotic therapy and the strict application of an infection management protocol, there were no more fever episodes or cultures positive for M. radiotolerans.
中心静脉导管(CVCs)在急慢性肾衰竭患者的替代治疗中发挥着重要作用。中心静脉置管引起的继发感染占血液透析患者菌血症的48%-73%,是这些患者发病和医疗费用增加的重要原因。自2006年10月起,我们中心的血液透析患者出现了不明原因发热的情况。2006年10月至2007年4月对致病微生物进行了调查。使用细菌16S通用引物提取并扩增细菌DNA。对样本进行多重PCR扩增,随后的测序确定感兴趣的微生物属于耐辐射甲基杆菌。我们报告了由耐辐射甲基杆菌引起的最大规模的透析导管相关血流感染群,并描述了快速准确鉴定这些细菌的困难。37例患者血液(2.7%)或CVC(29.7%)或两者(67.6%)的培养物中耐辐射甲基杆菌呈阳性。在拔除并更换CVC、进行抗生素治疗以及严格实施感染管理方案后,不再有发热发作,耐辐射甲基杆菌培养物也不再呈阳性。