Staszewski S, Dimas K, Stille W
Dtsch Med Wochenschr. 1985 Jan 11;110(2):43-7. doi: 10.1055/s-2008-1068771.
Microbiological investigations showed a positive culture in 430 out of 1540 venous catheters and shunts for dialysis. In 21 cases, a mixed culture with two different specific organisms was present. Of the total of 451 isolated organisms, 362 were gram-positive cocci and only 56 gram-negative bacillaceae. Staphylococcus epidermidis was by far the most frequent pathogen (n = 228), staphylococcus aureus in second place (n = 94). Among the gram-negative organisms, germs of the Klebsiella-Enterobacter group and Pseudomonas aeruginosa dominated. Staphylococcus aureus represented 31% of all germs isolated from Scribner shunts and Brescia fistulas. On the other hand the causative organism could be isolated in only 18% of the infected venous catheters. Staphylococcus aureus was the most frequent pathogen in septicemia due to catheters; in 16 out of 24 patients this microorganism was found in both cultures drawn from the blood and from the catheter. In 16 cases, a venous catheter led to septicemia, a shunt for chronical dialysis in 2 cases only. The frequency of infections caused by catheters can be significantly lowered by prudent care of the site of insertion, sterile handling and short indwelling time.
微生物学调查显示,在1540根用于透析的静脉导管和分流管中,有430根培养结果呈阳性。21例存在两种不同特定微生物的混合培养。在总共451株分离出的微生物中,362株为革兰氏阳性球菌,仅56株为革兰氏阴性杆菌科。表皮葡萄球菌是迄今为止最常见的病原体(n = 228),金黄色葡萄球菌位居第二(n = 94)。在革兰氏阴性菌中,克雷伯菌属-肠杆菌属菌群和铜绿假单胞菌占主导。金黄色葡萄球菌占从斯克里布纳分流管和布雷西亚瘘管分离出的所有细菌的31%。另一方面,在仅18%的受感染静脉导管中可分离出致病生物体。金黄色葡萄球菌是导管相关败血症中最常见的病原体;在24例患者中的16例中,从血液和导管采集的两种培养物中均发现了这种微生物。16例中,静脉导管导致败血症,仅2例是慢性透析分流管导致的。通过谨慎护理插入部位、无菌操作和缩短留置时间,可显著降低导管引起的感染频率。