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如何管理革兰氏阴性杆菌引起的中心静脉导管相关血流感染?

How to manage central venous catheter-related bloodstream infections due to Gram-negative bacilli?

机构信息

Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Universidad Complutense, Madrid, Spain.

出版信息

Curr Opin Infect Dis. 2022 Dec 1;35(6):583-588. doi: 10.1097/QCO.0000000000000855. Epub 2022 Jul 15.

Abstract

PURPOSE OF REVIEW

The aim of this study was to review recent data evaluating the management of central venous catheter-related bloodstream infection due to Gram-negative bacilli (GNB).

RECENT FINDINGS

The incidence of GNB catheter-related bloodstream infection (CRBSI) has been increasing considerably in the last years, and this has raised a concern due to the high reported rate of multidrug-resistant in these infections what poses a considerable challenge for effective treatment. However, there are no specific guidelines for the management of GNB-CRBSI and optimal treatment duration has not been clearly defined. Recent studies have shown that the risk for complications is clearly different to what is stablished for Staphylococcus aureus . Therefore, a short course of antibiotic therapy might be effective once the central venous catheter (CVC) has been removed and the monitoring complications through control blood cultures or echocardiography seem to be less helpful in GNB CRBSI.

SUMMARY

The incidence of GNB CRBSI has been increasing considerably in the last years; this has raised a concern due to the high reported rate of MDR in these infections what poses a considerable challenge for effective treatment. However, there are no specific guidelines for the management of GNB-CRBSI and optimal treatment duration has not been clearly defined. Recent studies have shown that the risk for complications is clearly different to what is stablished for S. aureus . Therefore, a short course of antibiotic therapy might be effective once the CVC has been removed and the monitoring complications through control blood cultures or echocardiography seem to be less helpful in GNB-CRBSI.

摘要

目的综述

本研究旨在回顾近年来评估革兰氏阴性菌(GNB)所致中心静脉导管相关血流感染(CRBSI)管理的最新数据。

最新发现

近年来,GNB 导管相关血流感染(CRBSI)的发病率显著增加,由于这些感染的报告耐药率较高,这引起了人们的关注,对有效治疗构成了相当大的挑战。然而,目前尚无针对 GNB-CRBSI 管理的具体指南,并且尚未明确最佳治疗持续时间。最近的研究表明,并发症的风险与金黄色葡萄球菌(S. aureus)明显不同。因此,一旦移除中央静脉导管(CVC),并通过控制血培养或超声心动图监测并发症,抗生素短疗程治疗可能是有效的,而在 GNB-CRBSI 中,这些监测似乎不太有帮助。

总结

近年来,GNB CRBSI 的发病率显著增加;由于这些感染的报告耐药率较高,这引起了人们的关注,对有效治疗构成了相当大的挑战。然而,目前尚无针对 GNB-CRBSI 管理的具体指南,并且尚未明确最佳治疗持续时间。最近的研究表明,并发症的风险与 S. aureus 明显不同。因此,一旦移除 CVC,并通过控制血培养或超声心动图监测并发症,抗生素短疗程治疗可能是有效的,而在 GNB-CRBSI 中,这些监测似乎不太有帮助。

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