Kiehn T E, Armstrong D
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Eur J Clin Microbiol Infect Dis. 1990 Dec;9(12):869-72. doi: 10.1007/BF01967501.
A significant increase in the use of vascular access devices has changed the spectrum of organisms causing bacteremia and fungemia at Memorial Sloan-Kettering Cancer Center. This paper documents the 1988 laboratory experience with bacteremia and fungemia and contrasts some of that data with information obtained in 1984. In 1988, 439 tunnelled-catheters and 355 ports were inserted in patients; 2,778 organisms were subsequently recovered from 933 episodes of bacteremia and fungemia. Fifty-percent of the episodes of bacteremia and fungemia were vascular access device-related. Compared to 1984, the relative incidence of bacteremia due to gram-positive organisms increased from 33 to 43%, polymicrobic cultures increased from 24 to 27%, and the number of organisms with colony counts greater than 100 cfu/ml increased from 24 to 44%. In 1988, device-related sepsis was often caused by Acinetobacter spp., Bacillus spp., Corynebacterium spp., pseudomonads other than Pseudomonas aeruginosa, and coagulase-negative staphylococci. Infection was also caused by species of flavobacteria, Micrococcus, and Rhodotorula. Efforts required for identification of many of the newer pathogens have escalated material and personnel costs.
血管通路装置使用的显著增加改变了斯隆凯特琳癌症纪念中心引起菌血症和真菌血症的微生物谱。本文记录了1988年菌血症和真菌血症的实验室经验，并将其中一些数据与1984年获得的信息进行了对比。1988年，为患者插入了439根隧道式导管和355个端口；随后从933例菌血症和真菌血症中分离出2778种微生物。50%的菌血症和真菌血症发作与血管通路装置有关。与1984年相比，革兰氏阳性菌引起的菌血症相对发病率从33%增至43%，多种微生物培养从24%增至27%，菌落计数大于100 cfu/ml的微生物数量从24%增至44%。1988年，与装置相关的败血症常由不动杆菌属、芽孢杆菌属、棒状杆菌属、除铜绿假单胞菌外的假单胞菌属以及凝固酶阴性葡萄球菌引起。感染也由黄杆菌属、微球菌属和红酵母属的菌种引起。鉴定许多新病原体所需的努力增加了材料和人员成本。
