抗生素封存療法用在預防與治療管路引起的血流感染簡介

Antibiotic Lock Therapy for Prophylaxis and Treatment of Catheter-related Bloodstream Infection

林明燊(Ming-Shen Lin) ； 王春玉(Yu Wang)

《感染控制雜誌》 23卷2期 (2013/04) Pp. 88-94

https://doi.org/10.6526/ICJ.201304_23(2).0004

摘要

Patients receiving chemotherapy, hemodialysis, or total parenteral nutrition, or those who are critically ill often suffer from catheter-related bloodstream infections (CRBI). Among them, immunocompromised conditions and a long duration of catheterization (＞ 14 days) in crease the risk of CRBI, which may subseguently result in prolonged hospitalizations and increased mortality rates.According to the guidelines of the Infectious Diseases Society of America (IDSA) and Centers for Disease Control, patients can be treated for CRBI with systemic antibiotics combined with antibiotic lock therapy (ALT) when catheter removal is not a feasible option. This article reviewed the current literature on the empiric use of ALT for common pathogens, the concentrations of the ALT solutions administered, and the dwell time of the ALT solution.Many small-scale studies have shown that standard therapy combined with ALT is more beneficial than standard therapy alone. It may decrease the rate of infection and relapse as well as delay catheter removal. The efficacy, however, is still inferior to either removing the catheters or replacing them. The IDSA recommends that CRBI be managed according to each patient's clinical condition and situation.

關鍵字

抗生素 ； 抗微生物製劑 ； 封存療法 ； 導管相關血液感染

並列摘要

Patients receiving chemotherapy, hemodialysis, or total parenteral nutrition, or those who are critically ill often suffer from catheter-related bloodstream infections (CRBI). Among them, immunocompromised conditions and a long duration of catheterization (＞ 14 days) in crease the risk of CRBI, which may subseguently result in prolonged hospitalizations and increased mortality rates.According to the guidelines of the Infectious Diseases Society of America (IDSA) and Centers for Disease Control, patients can be treated for CRBI with systemic antibiotics combined with antibiotic lock therapy (ALT) when catheter removal is not a feasible option. This article reviewed the current literature on the empiric use of ALT for common pathogens, the concentrations of the ALT solutions administered, and the dwell time of the ALT solution.Many small-scale studies have shown that standard therapy combined with ALT is more beneficial than standard therapy alone. It may decrease the rate of infection and relapse as well as delay catheter removal. The efficacy, however, is still inferior to either removing the catheters or replacing them. The IDSA recommends that CRBI be managed according to each patient's clinical condition and situation.

並列關鍵字

Antibiotics ； antimicrobial agents ； lock therapy ； catheter-related bloodstream infection