Larsen Line Nordahl, Malchau Emma, Kristensen Brian, Schroeder Henrik
Department of Paediatrics, Aarhus University Hospital, Skejby, Denmark.
J Pediatr Hematol Oncol. 2011 Mar;33(2):e64-8. doi: 10.1097/MPH.0b013e3181f6933d.
Long-term tunneled central venous catheters (CVCs) are often the source of catheter-associated bloodstream infections (CABSIs), which may be difficult to eradicate and may lead to premature catheter removal.
This prospective controlled study used instillation of 2 M hydrochloric acid (HCl) as an adjuvant to the intravenous antibiotic treatment of children with bacteremia and compared the results with those from the immediate preceding period. The primary outcome variable was infection-related CVC removal within 100 days of bacteremia. Only patients with double lumen Hickman CVC with external tubings were included.
During a period of 36 months, 109 episodes of bacteremia were treated, 51 during the period where HCl was not used and 58 during the period where HCl was used. Forty-two out of 58 bacteremias were treated with HCl during the "HCl period." An intention-to-treat analysis showed that the median time to infection-related CVC removal was significantly longer during the HCl period compared with the non-HCl period (94 d vs. 12.5 d). At day 100 significantly more CVCs remained in place compared with the non-HCl period. Of the 42 CVCs treated with HCl, 2 had to be removed because of infection before day 30 and further 7 CVCs were removed before day 100. There was no difference in the occurrence of new bacteremias within the first 30 days of bacteremia in the 2 groups.
HCl may successfully supplement intravenous antibiotics in the treatment of CABSI and contribute to CVC salvage.
长期隧道式中心静脉导管（CVC）常常是导管相关血流感染（CABSI）的源头，这类感染可能难以根除，并可能导致导管过早拔除。
这项前瞻性对照研究采用向患有菌血症的儿童静脉内抗生素治疗中滴注2 M盐酸（HCl）作为辅助手段，并将结果与紧接的前一时期进行比较。主要结局变量是菌血症发生后100天内与感染相关的CVC拔除情况。仅纳入带有外部管路的双腔希克曼CVC患者。
在36个月期间，共治疗了109例菌血症发作，其中未使用HCl的时期有51例，使用HCl的时期有58例。在“HCl时期”，58例菌血症中有42例接受了HCl治疗。意向性分析显示，与非HCl时期相比，HCl时期与感染相关的CVC拔除的中位时间显著更长（94天对12.5天）。在第100天时，与非HCl时期相比，留置的CVC显著更多。在接受HCl治疗的42根CVC中，有2根因感染在第30天前必须拔除，另有7根CVC在第100天前被拔除。两组在菌血症发生后的前30天内新菌血症的发生率没有差异。
HCl在治疗CABSI时可能成功补充静脉内抗生素，并有助于挽救CVC。
