Joshi Amit J, Hart Peter D
Division of Nephrology, Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA.
Semin Dial. 2013 Mar-Apr;26(2):223-6. doi: 10.1111/j.1525-139X.2012.01115.x. Epub 2012 Aug 1.
We prospectively examined the efficacy of systemic antibiotics and antibiotic catheter locks for the treatment of tunneled hemodialysis catheter related blood stream infections (CRBSI). Patients with clinical signs of tunnel or metastatic infection were excluded. All patients with suspected CRBSI were treated empirically with systemic antibiotics at the onset of symptoms before final culture and susceptibility results were available. Once the organism was identified, antibiotics treatment was tailored and antibiotic catheter locks were instilled after each dialysis treatment. Clearance of infection was documented by negative surveillance cultures after completion of antibiotic course. Out of 46 episodes of CRBSI; 16 were due to gram positive organisms, 22 were due to gram negative organisms, and 8 were polymicrobial (≥2 organisms) infections. 19 cases required removal of dialysis catheter. Antibiotic lock protocol was successful for eradicating infection in 27 of 46 episodes (59%). The likelihood of a clinical cure was identical in both gram-positive and gram-negative infections (63% and 62% respectively). Antibiotic lock protocol remains an option in the treatment of clinically stable patients with CRBSI; however, success rate of this protocol in eradicating the infection is modest.
我们前瞻性地研究了全身使用抗生素和抗生素封管治疗隧道式血液透析导管相关血流感染（CRBSI）的疗效。排除有隧道或转移性感染临床体征的患者。所有疑似CRBSI的患者在症状出现时，在最终培养和药敏结果出来之前，经验性地接受全身抗生素治疗。一旦确定病原体，就调整抗生素治疗方案，并在每次透析治疗后注入抗生素封管液。抗生素疗程结束后，通过监测培养阴性记录感染清除情况。在46例CRBSI病例中，16例由革兰氏阳性菌引起，22例由革兰氏阴性菌引起，8例为多微生物（≥2种微生物）感染。19例需要拔除透析导管。抗生素封管方案在46例中的27例（59%）成功根除感染。革兰氏阳性菌和革兰氏阴性菌感染的临床治愈率相同（分别为63%和62%）。抗生素封管方案仍然是治疗临床稳定的CRBSI患者的一种选择；然而，该方案根除感染的成功率一般。
