de Frutos Porras Elena, Cobo-Vázquez Elvira, Hernanz Lobo Alicia, Santos Sebastián María Del Mar, Pérez Fernández Elia, Garrido Colino Carmen, Cela Elena, Navarro Gómez María Luisa
Hospital Fundación de Alcorcón, C/Budapest 1, 28922 Madrid, Spain.
Hospital Maternoinfantil Gregorio Marañón, c/O'Donnell 46, 28009 Madrid, Spain.
Children (Basel). 2024 Aug 14;11(8):983. doi: 10.3390/children11080983.
One of the main drawbacks of tunneled central venous catheters (CVCs) is catheter-related bloodstream infections (CRBSIs). Antibiotic lock therapy (ALT) can be combined with systemic antibiotics to achieve catheter salvage. Our objectives are to describe cases of CRBSI and our experience with ALT in a pediatric oncology-hematology ward.
a retrospective descriptive study of pediatric CRBSI cases in a Spanish oncology-hematology unit from 2007 to 2017 was conducted. We collected demographic, clinical, and microbiological data from all patients.
fifty-eight CRBSIs were diagnosed in thirty-nine patients; 72.9% of these patients were male, with a median age of 42.1 months. The main underlying diseases were leukemia/lymphoma (51.7%) and solid tumors (32.7%). Thirty-five (60.3%) CRBSIs were caused by Gram-positive cocci, of which 70.6% were coagulase-negative , and sixteen (27.6%) were caused by Gram-negative bacilli. We treated 41/58 (71%) cases with ALT. A total of 12/17 (71%) CVCs that were not treated with adjunctive ALT were removed, compared with 13/41 (32%) that were treated with ALT (relative risk (RR), 0.449; confidence interval (CI), 95%: 0.259-0.778, = 0.004). Major reasons to remove the CVC in the CRBSI-ALT group were local insertion/pocket site infection (23%), persistent symptoms (23%), and infectious' relapses (15%).
ALT was shown to be an effective approach to keeping the CVC in place, with no added adverse effects.
隧道式中心静脉导管（CVC）的主要缺点之一是导管相关血流感染（CRBSI）。抗生素封管疗法（ALT）可与全身抗生素联合使用以挽救导管。我们的目的是描述CRBSI病例以及我们在儿科肿瘤血液科病房使用ALT的经验。
对2007年至2017年西班牙一家肿瘤血液科的儿科CRBSI病例进行回顾性描述性研究。我们收集了所有患者的人口统计学、临床和微生物学数据。
39例患者中诊断出58例CRBSI；这些患者中72.9%为男性，中位年龄为42.1个月。主要基础疾病为白血病/淋巴瘤（51.7%）和实体瘤（32.7%）。35例（60.3%）CRBSI由革兰氏阳性球菌引起，其中70.6%为凝固酶阴性，16例（27.6%）由革兰氏阴性杆菌引起。我们对41/58（71%）例患者采用ALT治疗。未接受辅助ALT治疗的17根CVC中有12/17（71%）被拔除，而接受ALT治疗的41根CVC中有13/41（32%）被拔除（相对风险（RR），0.449；置信区间（CI），95%：0.259 - 0.778，P = 0.004）。CRBSI-ALT组拔除CVC的主要原因是局部插入/置管部位感染（23%）、症状持续（23%）和感染复发（15%）。
ALT被证明是一种有效保留CVC的方法，且无额外不良反应。
