Garaventa A, Castagnola E, Dallorso S, Dini G, Trucco D, Vianello O, Carrega G, Cuneo P, Buffa P, Magillo P
Divisione di Ematologia ed Oncologia Pediatrica, Istituto G. Gaslini di Genova, Italia.
Pediatr Med Chir. 1995 Mar-Apr;17(2):147-50.
Indwelling central venous catheters obviate many problems in the care of children with malignancies, but they also are a well-known source of infection. We are reviewed the history of 584 Broviac catheters inserted from January 1984 to December 1991, in 475 children with cancer in order to assess the etiology of bacteremias, their association with neutropenia and their relationship with the presence of the catheters. The overall duration-time of the catheters, employed for blood tests, drug and blood infusions and parenteral nutrition, was 1-835 days (median 263, mean 186). Total catheter courses was 108.678 days. In this period 226 episodes of sepsis were observed in 180 patients: 157 in neutropenic patients and 69 in non neutropenic. Catheter related bacteremias were diagnosed in 65/226 episodes (29%): 23 (35%) were observed in neutropenic patients and 42 (65%) in non neutropenic (P < 0.005). Gram-positive pathogens were isolated in 28/65 (43%) episodes, Gram-negatives in 15/65 (23%), fungi in 9/65 (14%), and the remaining 13 (20%) were polymicrobial. In the last years we observed an increase of catheter related bacteremias due to Gram-negative rods no change was observed in pathogens causing catheters unrelated bacteremias. The high incidence of catheters related bacteremias in non neutropenic, non hospitalized patients, stress on the home-care of the catheters; a high level of suspicion of Gram-negative infections should be maintained in cancer patients with an indwelling central venous catheters.
留置中心静脉导管可避免恶性肿瘤患儿护理中的许多问题，但它们也是众所周知的感染源。我们回顾了1984年1月至1991年12月期间为475例癌症患儿插入的584根Broviac导管的使用情况，以评估菌血症的病因、其与中性粒细胞减少的关联以及与导管存在的关系。导管用于血液检测、药物和血液输注以及肠外营养的总时长为1 - 835天（中位数263天，平均数186天）。导管总使用疗程为108678天。在此期间，180例患者出现了226次败血症发作：中性粒细胞减少患者157次，非中性粒细胞减少患者69次。65/226次发作（29%）被诊断为导管相关菌血症：中性粒细胞减少患者中观察到23次（35%），非中性粒细胞减少患者中观察到42次（65%）（P < 0.005）。28/65次发作（43%）分离出革兰氏阳性病原体，15/65次（23%）为革兰氏阴性菌，9/65次（14%）为真菌，其余13次（20%）为多微生物感染情况。在过去几年中，我们观察到革兰氏阴性杆菌导致的导管相关菌血症有所增加，而导致与导管无关菌血症的病原体未发生变化。非中性粒细胞减少、非住院患者中导管相关菌血症的高发生率，强调了导管的家庭护理；对于留置中心静脉导管的癌症患者，应高度怀疑革兰氏阴性感染。
