Zhang Qin, Huo Yujia, Li Chengfei, Sun Qinggang, Xi Xi, Sun Rui, Sun Qingju, Jiang Meijuan, Li Guang
Department of Hematology, No.971 Hospital of People's Liberation Army Navy, No.22 Minjiang Road, Qingdao, Shandong, 266000, China.
Department of Traditional Chinese Medicine, Qingdao Special Service Sanatorium of People's Liberation Army Navy, No.1 Taipingjiao Sixth Road, Qingdao, Shandong, 266000, China.
Ann Hematol. 2025 Mar;104(3):1975-1984. doi: 10.1007/s00277-025-06263-8. Epub 2025 Feb 25.
Catheter-related bloodstream infections represent one of the most prevalent complications in patients with peripherally inserted central venous catheters (PICCs). The application of antibiotic lock therapy (ALT), particularly in patients with hematological malignancies, has not been well documented. We aim to share our experience on ALT for these patients and to evaluate its effectiveness and safety. All cases of patients with hematological malignancies who had PICC from January 2018 to October 2024 were retrospectively reviewed. Microbiologic data of PICC-related bloodstream infections (PRBSIs) were collected. A comparison was made between patients managed with ALT and those without it. Factors affecting PICC removal were also explored. A total of 45 patients experienced 67 episodes of PRBSIs, yielding an incidence rate of 2.98 per 1,000 PICC days. The median time of PRBSI onset was 42 days. Predominant pathogens included Gram-negative bacilli (49.3%) and Gram-positive cocci (35.8%). The catheter salvage rate was significantly higher at 76.5% when ALT was combined with systemic antibiotic therapy (SAT), compared to 51.5% for SAT alone (p = 0.033). 3 death events (3/34) compared with 4 death events (4/33) occurred in each therapeutic regimen (p = 0.709). Elevated procalcitonin levels (> 2ng/ml) and inadequate empirical therapy were risk factors for PICC removal; conversely, ALT served as a protective factor against it. ALT in combination with systemic antibiotics is a safe and effective approach for managing PRBSIs in patients with hematological malignancies, helping to avoid unnecessary catheter removal and could be considered in clinical practice when catheter retention is desired.
导管相关血流感染是外周静脉中心静脉导管（PICC）患者中最常见的并发症之一。抗生素封管疗法（ALT）的应用，尤其是在血液系统恶性肿瘤患者中的应用，尚未得到充分的文献记载。我们旨在分享我们对这些患者进行ALT治疗的经验，并评估其有效性和安全性。回顾性分析了2018年1月至2024年10月期间接受PICC治疗的所有血液系统恶性肿瘤患者的病例。收集了PICC相关血流感染（PRBSI）的微生物学数据。对接受ALT治疗的患者和未接受ALT治疗的患者进行了比较。还探讨了影响PICC拔除的因素。共有45例患者发生了67次PRBSI发作，发病率为每1000个PICC日2.98次。PRBSI发病的中位时间为42天。主要病原体包括革兰氏阴性杆菌（49.3%）和革兰氏阳性球菌（35.8%）。与单独使用全身抗生素治疗（SAT）时的51.5%相比，ALT联合SAT时导管挽救率显著更高，为76.5%（p = 0.033）。每种治疗方案中发生3例死亡事件（3/34），而另一种治疗方案发生4例死亡事件（4/33）（p = 0.709）。降钙素原水平升高（>2ng/ml）和经验性治疗不足是PICC拔除的危险因素；相反，ALT是预防PICC拔除的保护因素。ALT联合全身抗生素是治疗血液系统恶性肿瘤患者PRBSI的一种安全有效的方法，有助于避免不必要的导管拔除，在希望保留导管时可在临床实践中考虑。
