Goldmann D A, Pier G B
Hospital Epidemiology Program, Children's Hospital, Boston, Massachusetts.
Clin Microbiol Rev. 1993 Apr;6(2):176-92. doi: 10.1128/CMR.6.2.176.
Over the past few decades, there have been major technological improvements in the manufacture of intravenous solutions and the manufacture and design of catheter materials. However, the risk of infection in patients receiving infusion therapy remains substantial, in part because of host factors (for example, increased use of immunosuppressive therapy, more aggressive surgery and life support, and improved survival at the extremes of life) and in part because of the availability of catheters that can be left in place for very long periods. Microbial components of normal skin flora, particularly coagulase-negative staphylococci, have emerged as the predominant pathogens in catheter-associated infections. Therefore, efforts to prevent skin microorganisms from entering the catheter wound (such as tunnelling of catheters and use of catheter cuffs and local antimicrobial agents) are logical and relatively effective. The specific properties of microorganisms that transform normally harmless commensals such as coagulase-negative staphylococci into formidable pathogens in the presence of a plastic foreign body are being explored. For example, Staphylococcus epidermidis elaborates a polysaccharide adhesin that also functions as a capsule and is a target for opsonic killing. However, the interactions between microorganism and catheter that lead to adherence, persistence, infection, and dissemination appear to be multifactorial.
在过去几十年里，静脉输液溶液的制造以及导管材料的制造和设计都有了重大技术改进。然而，接受输液治疗的患者发生感染的风险仍然很大，部分原因是宿主因素（例如，免疫抑制治疗的使用增加、手术和生命支持更加激进以及在生命两端的生存率提高），部分原因是存在可长时间留置的导管。正常皮肤菌群的微生物成分，特别是凝固酶阴性葡萄球菌，已成为导管相关感染的主要病原体。因此，防止皮肤微生物进入导管伤口的努力（如导管隧道技术、使用导管套囊和局部抗菌剂）是合理且相对有效的。正在探索微生物的特定特性，这些特性会使凝固酶阴性葡萄球菌等通常无害的共生菌在存在塑料异物的情况下转变为强大的病原体。例如，表皮葡萄球菌会产生一种多糖黏附素，它也起到荚膜的作用，是调理吞噬杀伤的靶点。然而，微生物与导管之间导致黏附、持续存在、感染和传播的相互作用似乎是多因素的。
