Groeger J S, Lucas A B, Thaler H T, Friedlander-Klar H, Brown A E, Kiehn T E, Armstrong D
Special Care Unit, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Ann Intern Med. 1993 Dec 15;119(12):1168-74. doi: 10.7326/0003-4819-119-12-199312150-00003.
To evaluate infectious morbidity associated with long-term use of venous access devices.
Prospective, observational study.
Comprehensive cancer center at a university hospital.
1431 consecutive patients with cancer requiring 1630 venous access devices for long-term use inserted between 1 June 1987 and 31 May 1989.
Quantitative microbiologic tests to identify device-related bacteremia and fungemia, catheter tunnel infection, pocket infection in implantable port devices, and site infections; number of days the device remained in situ and time until infectious morbidity; vessel or device thrombosis and device breakage.
At least one device-related infection occurred with 341 of 788 (43% [95% CI, 39% to 47%]) catheters compared with 57 of 680 (8% [CI, 6% to 10%]) completely implanted ports (P < or = 0.001). Device-related bacteremia or fungemia is the predominant infection occurring with catheters, whereas ports have a more equal distribution of pocket, site, and device-related bacteremia. The predominant organisms isolated in catheter-related bacteremia were gram-negative bacilli (55%) compared with gram-positive cocci (65.5%) in port-related bacteremia. The number of infections per 1000 device days was 2.77 (95% CI, 2.48 to 3.06) for catheters compared with 0.21 (CI, 0.16 to 0.27) for ports (P < or = 0.001). Based on a parametric model of time to first infection, devices lasted longer in patients with solid tumors than in those with hematopoietic tumors. Ports lasted longer than catheters across all patient groups.
The incidence of infections per device-day was 12 times greater with catheters than with ports. Patients with solid tumors were the least likely to have device-related infectious morbidity compared with those with hematologic cancers. The reasons for the difference in infectious complications is uncertain but may be attributable to type of disease, intensity of therapy, frequency with which devices are accessed, or duration of neutropenia.
评估长期使用静脉通路装置相关的感染发病率。
前瞻性观察性研究。
大学医院的综合癌症中心。
1987年6月1日至1989年5月31日期间连续1431例需要长期使用1630个静脉通路装置的癌症患者。
定量微生物学检测，以确定与装置相关的菌血症和真菌血症、导管隧道感染、植入式端口装置的囊袋感染以及部位感染；装置留置原位的天数和直至发生感染性发病的时间；血管或装置血栓形成以及装置破损。
788根导管中有341根（43%[95%置信区间，39%至47%]）发生至少1次与装置相关的感染，而680个完全植入式端口中有57个（8%[置信区间，6%至10%]）发生感染（P≤0.001）。与装置相关的菌血症或真菌血症是导管发生的主要感染类型，而端口的囊袋、部位和与装置相关的菌血症分布更为均衡。导管相关菌血症中分离出的主要病原体为革兰氏阴性杆菌（55%），而端口相关菌血症中则为革兰氏阳性球菌（65.5%）。导管每1000个装置日的感染次数为2.77次（95%置信区间，2.48至3.06），端口为0.21次（置信区间，0.16至0.27）（P≤0.001）。根据首次感染时间的参数模型，实体瘤患者的装置使用时间比血液系统肿瘤患者更长。在所有患者组中，端口的使用时间比导管更长。
导管每装置日感染的发生率比端口高12倍。与血液系统癌症患者相比，实体瘤患者发生与装置相关的感染性发病的可能性最小。感染并发症差异的原因尚不确定，但可能归因于疾病类型、治疗强度以及装置使用频率或中性粒细胞减少持续时间。
