Infection Control Service, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Infection Control Service, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Antimicrob Agents Chemother. 2018 Aug 27;62(9). doi: 10.1128/AAC.00569-18. Print 2018 Sep.
The management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.
癌症患者耐多药（MDR）细菌所致长期中心静脉导管（LTCVC）感染的管理是一项挑战。本研究旨在分析癌症患者 LTCVC 相关性感染的结局，确定不良结局的风险因素，并确定 MDR 细菌和抗生素锁治疗（ALT）在管理此类感染中的作用。我们评估了 2009 年 1 月至 2016 年 12 月期间所有 LTCVC 相关性感染的治疗情况。感染按照国际导管相关性感染指南报告。结局指标为 30 天死亡率和治疗失败率。我们通过 Cox 逐步正向回归分析了风险因素。我们确定了 296 例 LTCVC 相关性感染；212 例（71.6%）为血流感染（BSI）。最常见的病原体是革兰氏阴性 MDR 细菌。62 例（29.2%）患者使用了 ALT，成功率为 75.9%。初始治疗失败的危险因素为感染时序器官衰竭评估（SOFA）评分高和姑息治疗；治疗开始时使用 ALT 被确定为保护因素。LTCVC 相关性感染后 30 天死亡率的危险因素为感染时 SOFA 评分高、感染 MDR 细菌和姑息治疗；治疗开始时使用 ALT、血液恶性肿瘤和遵循 LTCVC 相关性感染管理的机构方案被确定为保护因素。尽管 MDR 细菌感染的发生率较高，但 ALT 可改善癌症患者 LTCVC 相关性感染的结局。
