早期超声检查发现感染性血栓性静脉炎是减少中性粒细胞减少症合并血流感染患者感染相关死亡率的主要指标，此时应考虑移除中心静脉导管。
Early ultrasonographic finding of septic thrombophlebitis is the main indicator of central venous catheter removal to reduce infection-related mortality in neutropenic patients with bloodstream infection.
机构信息
Departments of Biochemistry and Medical Biotechnology.
Cellular and Molecular Biology and Pathology, Federico II University Medical School, Naples, Italy.
出版信息
Ann Oncol. 2012 Aug;23(8):2122-2128. doi: 10.1093/annonc/mdr588. Epub 2012 Jan 6.
BACKGROUND
Septic thrombophlebitis increases patient morbidity and mortality following metastatic infections, pulmonary emboli, and/or septic shock. Central venous catheter (CVC) removal for occult septic thrombophlebitis challenges current strategy in neutropenic patients.
PATIENTS AND METHODS
We prospectively evaluated infection-related mortality in 100 acute leukemia patients, with CVC-related bloodstream infection (CRBSI) after chemotherapy, who systematically underwent ultrasonography to identify the need for catheter removal. Their infection-related mortality was compared with that of a historical cohort of 100 acute leukemia patients, with CRBSI after chemotherapy, managed with a clinically driven strategy. Appropriate antimicrobial therapy was administered in all patients analyzed.
RESULTS
In the prospective series, 30/100 patients required catheter removal for ultrasonography-detected septic thrombophlebitis after 1 median day from BSI onset; 70/100 patients without septic thrombophlebitis retained their CVC. In the historical cohort, 60/100 patients removed the catheter (persistent fever, 40 patients; persistent BSI, 10 patients; or clinically manifest septic thrombophlebitis, 10 patients) after 8 median days from BSI onset; 40/100 patients retained the CVC because they had not clinical findings of complicated infection. At 30 days median follow-up, one patient died for infection in the ultrasonography-assisted group versus 17 patients in the historical cohort (P<0.01). With the ultrasonography-driven strategy, early septic thrombophlebitis detection and prompt CVC removal decrease infection-related mortality, whereas clinically driven strategy leads to inappropriate number, reasons, and timeliness of CVC removal.
CONCLUSION
Ultrasonography is an easy imaging diagnostic tool enabling effective and safe management of patients with acute leukemia and CRBSI.
背景
转移性感染、肺栓塞和/或感染性休克会导致脓毒性血栓性静脉炎，增加患者的发病率和死亡率。对于隐匿性脓毒性血栓性静脉炎的中心静脉导管（CVC）拔除对中性粒细胞减少症患者目前的策略提出了挑战。
患者和方法
我们前瞻性评估了 100 例接受化疗后发生 CVC 相关血流感染（CRBSI）的急性白血病患者的感染相关死亡率，这些患者系统地接受了超声检查以确定是否需要拔除导管。将他们的感染相关死亡率与 100 例接受化疗后发生 CRBSI 的急性白血病患者的历史队列进行比较，该历史队列采用临床驱动的策略进行管理。所有分析的患者均接受了适当的抗菌治疗。
结果
在前瞻性系列中，30/100 例患者在 BSI 发病后 1 天内通过超声检查发现脓毒性血栓性静脉炎，需要拔除导管；70/100 例无脓毒性血栓性静脉炎的患者保留了 CVC。在历史队列中，60/100 例患者在 BSI 发病后 8 天内（持续发热 40 例；持续 BSI 10 例；或临床表现为脓毒性血栓性静脉炎 10 例）拔除了导管；40/100 例患者保留了 CVC，因为他们没有复杂感染的临床发现。在 30 天的中位随访中，超声辅助组有 1 例患者因感染死亡，而历史队列有 17 例患者（P<0.01）。采用超声驱动策略可早期发现脓毒性血栓性静脉炎并及时拔除 CVC，降低感染相关死亡率，而临床驱动策略则导致 CVC 拔除的数量、原因和及时性不当。
结论
超声是一种简单的影像学诊断工具，可有效安全地管理急性白血病和 CRBSI 患者。
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