Gordon S M, Tipple M, Bland L A, Jarvis W R
Hospital Infections Program, Centers for Disease Control, Atlanta, GA 30333.
JAMA. 1988 Oct 14;260(14):2077-81.
We investigated 18 pyrogenic reactions (PRs) that occurred between July 1 and 13, 1987, in 16 patients receiving long-term hemodialysis at one dialysis center in Illinois. We defined a case of PR as the onset of chills or fever (oral temperature, greater than or equal to 37.8 degrees C) in a patient who was afebrile and had no signs or symptoms of infection before a dialysis treatment. Pyrogenic reactions to dialysis sessions during the epidemic period (July 1 through 14) were associated with the use of a reused dialyzer (risk ratio, 6.2; 95% confidence interval, 0.8 to 45). The water used to rinse the dialyzers after use and to dilute the germicide for disinfecting the dialyzers contained high concentrations of endotoxins (greater than 6 ng/mL) and bacteria (greater than 10(4) colony forming units/mL). After reuse of dialyzers was discontinued at the center, the PR rate fell to pre-epidemic levels. We concluded that PRs were associated with reuse of dialyzers, probably contaminated with endotoxins. Active surveillance for PRs among patients undergoing long-term hemodialysis should be routine at all dialysis centers; an increase in PRs should prompt timely review of water treatment and dialyzer reprocessing systems.
我们调查了1987年7月1日至13日期间，在伊利诺伊州一家透析中心接受长期血液透析的16名患者发生的18起热原反应（PRs）。我们将PR病例定义为在透析治疗前体温正常且无感染体征或症状的患者出现寒战或发热（口腔温度大于或等于37.8摄氏度）。流行期间（7月1日至14日）透析过程中的热原反应与复用透析器的使用有关（风险比，6.2；95%置信区间，0.8至45）。用于透析器使用后冲洗以及稀释用于透析器消毒的杀菌剂的水含有高浓度的内毒素（大于6 ng/mL）和细菌（大于10⁴菌落形成单位/mL）。该中心停止复用透析器后，PR发生率降至流行前水平。我们得出结论，PRs与复用可能被内毒素污染的透析器有关。所有透析中心应对接受长期血液透析的患者进行PRs的主动监测；PRs的增加应促使及时审查水处理和透析器再处理系统。
