Holub Matthieu, Lebeaux David, Grohs Patrick, Joseph Laure, Pellerin Olivier, Cheminet Geoffrey, Kassis Najiby, Abdellaoui Salomé, Pouchot Jacques, Ranque Brigitte, Arlet Jean Benoit, Lafont Emmanuel
Service de Médecine Interne, Hôpital Européen George Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP), Sorbonne Université, 20 Rue Leblanc, 75015, Paris, France.
Centre National de Référence Des Syndromes Drépanocytaires Majeurs de L'adulte, Hôpital Européen George Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France.
Eur J Clin Microbiol Infect Dis. 2025 Apr;44(4):877-886. doi: 10.1007/s10096-024-05035-y. Epub 2025 Feb 2.
Although catheter-related infections are the leading cause of bloodstream infections in patients with sickle cell disease (SCD), data are scarce in adult patients. The objectives of the present study were to describe central-venous-catheter-related bloodstream infections in patients with SCD and identify risk factors.
We conducted a retrospective, observational study of adult patients with SCD diagnosed with central-venous-catheter-related bloodstream infections between 2011 and 2023 in two SCD reference centres. Each patient with SCD and a bloodstream infection related to a totally implantable venous access port was matched with two control patients with SCD and an infection-free totally implantable venous access port.
Thirty-five (6.6%) of the 534 patients experienced a total of 69 central-venous-catheter-related bloodstream infections. Concomitant vaso-occlusive crises were observed for 81.2% of the infections. The 30-day mortality rate was 2.8%, and the infection recurrence rate was 45.7%. We observed 26 totally implantable venous access port-related bloodstream infections in 19 patients, with an incidence rate of 0.31 per 1000 catheter-days. After adjustment, the frequency of hospital admission for a vaso-occlusive crisis (odds ratio (OR) [95% confidence interval (CI)] = 1.6 [1.2-2.4]) and the presence of a psychiatric comorbidity (19.8 [4.0-148.1]) remained significantly associated with totally implantable venous access port-related bloodstream infections. Suboptimal antibiotic levels were observed in five (39%) of the 13 patients having undergone therapeutic drug monitoring. The treatment failed in four (80%) of the five patients, who presented with glomerular hyperfiltration.
A central-venous-catheter-related bloodstream infection is a severe complication in adult patients with SCD and is associated with psychiatric comorbidities and severe SCD.
尽管导管相关感染是镰状细胞病（SCD）患者血流感染的主要原因，但成年患者的数据却很稀少。本研究的目的是描述SCD患者中心静脉导管相关血流感染情况并确定危险因素。
我们对2011年至2023年期间在两个SCD参考中心被诊断为中心静脉导管相关血流感染的成年SCD患者进行了一项回顾性观察研究。每例患有SCD且血流感染与完全植入式静脉通路端口相关的患者与两名无感染的完全植入式静脉通路端口的SCD对照患者进行匹配。
534例患者中有35例（6.6%）共发生69次中心静脉导管相关血流感染。81.2%的感染伴有血管闭塞性危象。30天死亡率为2.8%，感染复发率为45.7%。我们在19例患者中观察到26次与完全植入式静脉通路端口相关的血流感染，发生率为每1000导管日0.31次。调整后，因血管闭塞性危象住院的频率（比值比（OR）[95%置信区间（CI）]=1.6[1.2 - 2.4]）和存在精神疾病合并症（19.8[4.0 - 148.1]）仍与完全植入式静脉通路端口相关血流感染显著相关。在接受治疗药物监测的13例患者中，有5例（39%）观察到抗生素水平未达最佳。5例患者中有4例（80%）治疗失败，这些患者出现了肾小球超滤。
中心静脉导管相关血流感染是成年SCD患者的一种严重并发症，与精神疾病合并症和严重SCD相关。
