Bullard K M, Dunn D L
Department of Surgery, University of California, San Francisco, USA.
Am J Surg. 1996 Dec;172(6A):13S-19S. doi: 10.1016/s0002-9610(96)00345-5.
The past decade has witnessed an explosive rise in the rate of bacteremia and intravascular catheter infection. Although gram-negative organisms continue to account for up to one third of these infections, gram-positive organisms have become increasingly prevalent pathogens. Virulent antibiotic-resistant bacterial strains have emerged and present a formidable treatment challenge. Simultaneously, management of catheter infection has evolved. Although patients who develop fungemia, gram-negative bacteremia, or sepsis syndrome are best treated by catheter removal in addition to antimicrobial therapy, an increasing body of evidence suggests that many gram-positive bacterial catheter infections can be treated by use of antimicrobial agents without catheter removal. Advances in catheter design and immunotherapy for sepsis syndrome also hold promise. Despite these innovations, determining the initial need for catheter placement, adherence to meticulous sterile surgical technique during insertion, and subsequent fastidious catheter maintenance remain the mainstays of preventing these potentially disastrous infections.
在过去十年中，菌血症和血管内导管感染的发生率呈爆发性上升。尽管革兰氏阴性菌仍占这些感染的三分之一，但革兰氏阳性菌已成为越来越普遍的病原体。具有高毒力的耐药菌株不断出现，给治疗带来了巨大挑战。与此同时，导管感染的管理也在不断发展。虽然发生真菌血症、革兰氏阴性菌血症或脓毒症综合征的患者除抗菌治疗外，最好通过拔除导管进行治疗，但越来越多的证据表明，许多革兰氏阳性菌导管感染可以在不拔除导管的情况下使用抗菌药物进行治疗。导管设计的进步和脓毒症综合征的免疫治疗也带来了希望。尽管有这些创新，但确定最初放置导管的必要性、在插入过程中严格遵守无菌手术技术以及随后精心维护导管，仍然是预防这些潜在灾难性感染的主要手段。
