Lorente Leonardo
Leonardo Lorente, Intensive Care Unit, Hospital Universitario de Canarias, 38320 La Laguna, Santa Cruz de Tenerife, Spain.
World J Crit Care Med. 2016 May 4;5(2):137-42. doi: 10.5492/wjccm.v5.i2.137.
Central venous catheters are commonly used in critically ill patients. Such catheterization may entail mechanical and infectious complications. The interest in catheter-related infection lies in the morbidity, mortality and costs that it involved. Numerous contributions have been made in the prevention of catheter-related infection and the current review focuses on the possible current role of antimicrobial impregnated catheters to reduce catheter-related bloodstream infections (CRBSI). There is evidence that the use of chlorhexidine-silver sulfadiazine (CHSS), rifampicin-minocycline, or rifampicin-miconazol impregnated catheters reduce the incidence of CRBSI and costs. In addition, there are some clinical circumstances associated with higher risk of CRBSI, such as the venous catheter access and the presence of tracheostomy. Current guidelines for the prevention of CRBSI recommended the use of a CHSS or rifampicin-minocycline impregnated catheter in patients whose catheter is expected to remain in place > 5 d and if the CRBSI rate has not decreased after implementation of a comprehensive strategy to reduce it.
中心静脉导管常用于重症患者。这种导管插入术可能会引发机械性和感染性并发症。对导管相关感染的关注在于其所涉及的发病率、死亡率和成本。在预防导管相关感染方面已经做出了许多贡献,而当前的综述聚焦于抗菌浸渍导管在降低导管相关血流感染(CRBSI)方面可能发挥的当前作用。有证据表明,使用洗必泰 - 磺胺嘧啶银(CHSS)、利福平 - 米诺环素或利福平 - 咪康唑浸渍导管可降低CRBSI的发生率和成本。此外,存在一些与CRBSI风险较高相关的临床情况,如静脉导管通路和气管切开术的存在。当前预防CRBSI的指南建议,对于预计导管留置时间>5天且在实施全面降低CRBSI策略后CRBSI发生率未降低的患者,使用CHSS或利福平 - 米诺环素浸渍导管。