Schäffler H, Daraban A M, Roggenbrod S, Schumacher U, Königsrainer A, Gregor M, Lamprecht G
1st Medical Department, University of Tübingen, Germany.
Z Gastroenterol. 2011 Mar;49(3):335-9. doi: 10.1055/s-0029-1245980. Epub 2011 Mar 9.
Parenteral nutrition is life-saving for patients with severe intestinal failure. Line-related blood stream infection is the most frequent complication and strategies have been developed to sterilize central lines. Nevertheless, failures of attempted sterilization are not well understood.
19 ports were explanted from 19 patients receiving parenteral nutrition because of port-related blood stream infection and failed sterilization, defined as a) recurrence of the same organism after a recent sterilization attempt <90 days), b) recovery of the causative organism after 10 days of proper antibiotic therapy or c) insufficient clinical improvement. Port chambers were opened and swabs were examined by culture.
Pathogens resembled those typically found in successfully treated line-related blood stream infection. Despite proper therapy for a median of 6.5 days the same pathogen was recovered from 18/19 chambers. In 9/19 chambers visible debris were found, from which the pathogen could be cultured.
Infected debris or infected biofilms in the chamber are the reason for failure to sterilize a port. Lock techniques, single lumen tunneled catheters or in certain settings the exchange of only the port chamber may be approaches to prevent, circumvent or treat failures of attempted sterilization of an infected port system.
肠外营养对严重肠衰竭患者具有挽救生命的作用。与导管相关的血流感染是最常见的并发症，并且已经制定了使中心静脉导管无菌的策略。然而，尝试无菌处理失败的原因尚未完全明确。
从19例接受肠外营养的患者身上取出19个端口，这些患者因与端口相关的血流感染以及无菌处理失败而接受治疗，无菌处理失败定义为：a）最近一次无菌处理尝试后<90天内相同病原体复发，b）经过10天适当抗生素治疗后仍分离出致病病原体，或c）临床改善不充分。打开端口腔室，通过培养检查拭子。
病原体与成功治疗的与导管相关的血流感染中常见的病原体相似。尽管进行了中位时间为6.5天的适当治疗，但仍从19个腔室中的18个分离出相同病原体。在19个腔室中的9个发现了可见的碎屑，从中可培养出病原体。
腔室内的感染性碎屑或感染性生物膜是端口无菌处理失败的原因。封管技术、单腔隧道式导管或在某些情况下仅更换端口腔室可能是预防、规避或治疗感染端口系统无菌处理失败的方法。
