Lebeaux D, Zarrouk V, Leflon-Guibout V, Lefort A, Fantin B
Service de médecine interne, hôpital Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
Rev Med Interne. 2010 Dec;31(12):819-27. doi: 10.1016/j.revmed.2010.06.014. Epub 2010 Aug 11.
Totally implanted access port-related infections are responsible for their own morbidity and mortality. Main risk factors of totally implanted access port-related infections are total parenteral nutrition, young age, difficulties during insertion, poor general status and neutropenia. Recent guidelines defined intravascular catheter-related infections. This relies on a strict clinical and microbiological work-up including simultaneous culture of blood drawn from the catheter and a peripheral vein. The search for local or general complications is mandatory: clinical and possibly echographic assessments are therefore needed. Depending on the context and the type of microorganism, this evaluation may include transoesophageal echocardiography and search for suppurative thrombosis in case of catheter-related bloodstream infection caused by Staphylococcus aureus. Indeed, intravascular complications in this setting are frequent. Catheter removal is mandatory in case of local complication (tunnel infection or port pocket abscess), septic thrombosis, infective endocarditis, osteomyelitis, septic shock or infection related to specific pathogens (S. aureus, Candida spp., Pseudomonas aeruginosa). Otherwise, retention of the catheter might be proposed given results from recent studies including antibiotic lock therapy associated with systemic antibiotic. Future studies must focus on defining more precisely the factors associated with salvage therapy failure including host, pathogens virulence factors and biofilm formation.
完全植入式输液港相关感染会导致患者发病和死亡。完全植入式输液港相关感染的主要危险因素包括全胃肠外营养、年轻、植入困难、一般状况差和中性粒细胞减少。近期指南对血管内导管相关感染进行了定义。这依赖于严格的临床和微生物学检查，包括同时对从导管和外周静脉采集的血液进行培养。必须查找局部或全身并发症：因此需要进行临床评估，可能还需要超声检查。根据具体情况和微生物类型，这种评估可能包括经食管超声心动图检查，以及在由金黄色葡萄球菌引起的导管相关血流感染时查找化脓性血栓形成。实际上，在这种情况下血管内并发症很常见。如果出现局部并发症（隧道感染或输液港囊袋脓肿）、脓毒性血栓形成、感染性心内膜炎、骨髓炎、感染性休克或与特定病原体（金黄色葡萄球菌、念珠菌属、铜绿假单胞菌）相关的感染，必须拔除导管。否则，鉴于近期研究结果，包括抗生素封管疗法联合全身使用抗生素，可能会建议保留导管。未来的研究必须专注于更精确地确定与挽救治疗失败相关的因素，包括宿主、病原体毒力因子和生物膜形成。
