Huang Yimin,Xu Weijue,Wu Yibo,et al.Diagnosis and treatment of catheter-related bloodstream infection of totally implantable venous access ports in children: a report of four cases[J].Journal of Clinical Pediatric Surgery,,19():939-942,956.[doi:10.3969/j.issn.1671-6353.2020.10.015]
Diagnosis and treatment of catheter-related bloodstream infection of totally implantable venous access ports in children: a report of four cases
- Keywords:
- Totally Implantable Venous Access Ports; Catheterization; Catheter-Related Bloodstream Infection; Child
- CLC:
- R453.2;R63;R619
- Abstract:
- Objective To summarize the clinical characteristics of catheter-related bloodstream infections(CRBSI)of totally implantable venous access ports(TIVAPs)in children.Methods A total of 99 patients successfully underwent TIVAPs implantation from March 2014 to December 2017.Four cases of CRBSI were retrospectively analyzed.The ages were 3,10,10 and 23 months respectively.The primary diseases were bowel syndrome(n=1),leukemia(n=2)and elevated Langerhans cell(n=1).Recurrent fever occurred at 3,4,7 and 9 months after TIVAPs implantation.Body temperature fluctuated between 38.7-39.5℃.The count of peripheral white blood cell was 1.8-14.9×109/L,The range of C-reactive protein(CRP)was 125-165 mg/L.The same species of bacteria(Staphylococcus aureus,Bacillus cereus,Agrobacterium tumefaciens & Achromobacter xylosoxidans)were detected in both TIVAPs and peripheral venous blood.According to the bacterial drug susceptibility test,systemic antibiotics were prescribed with an "antibacterial lock".A high concentration of sensitive antibiotic was injected into TIVAPs for 8-10 days.Results After upper treatment,the temperature of 3 cases stabilized and blood culture turned into negative.TIVAPs were removed in one child with recurrent fever and repeated positivity of blood culture.Conclusion CRBSI is one of the most serious complications of TIVAPs in children.Systemic antibiotics and "antibacterial lock" may control CRBSI and avoid a removal of TIVAPs.
References:
1 Shankar G,Jadhav V,Ravindra S,et al.Totally implantable venous access devices in children requiring long-term chemotherapy:analysis of outcome in 122 children from a single institution[J].Indian J Surg Oncol,2016,7(3):326-331.DOI 10.1007/s13193-015-0485-x.
2 Zhou J,Qian SK,He WX,et al.Implanting totally implantable venous access port via the internal jugular vein guided by ultrasonography is feasible and safe in patients with breast cancer[J].World J Surg Oncol,2014,12:378.DOI:10.1186/1477-7819-12-378.
3 Young SJ,Young LJ,Vogel J,et al.Accessing totally implantable venous assess systems on the day of placement does not significantly increase the risk of infection[J].J Vasc,2016,17(3):261-264.DOI:10.5301/jva.5000505.
4 Maristela B,Gustavo U,Franklin C,et al.Hemodialysis catheter-related infection:prophylaxis,diagnosis and treatment[J].J Vasc Access,2015,16(5):347-355.DOI:10.5301/jva.5000368.
5 Caterina G,Maria A,Alessandro C.Totally implantable venous access devices in children with medical complexity:preliminary data from a tertiary care hospital[J].J Vasc Access,2017,18(5):426-429.DOI:10.5301/jva.5000727.
6 Michelle RV,Luciana SL,Lauded CA.Risk factors for central line-associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port:A cohort study[J].Pediatr Blood Cancer,2017,64(2):336-342.DOI:10.1002/pbc.26225.
7 Yoshida J,Harada Y,Kikuchi T,et al.Does antimicrobial use density at the ward level influence monthly central line-associated bloodstream infection rates?[J].Infect Drug Resist,2014,7:331-335.DOI:10.2147/IDR.S74347.
8 Giorgio SS,Kátia C,Lenzi AV,et al.Biofilm formation in catheter-related infections by Panton-Valentine leukocidin-producing Staphylococcus aureus[J].Int Microbiol,2016,19(4):199-207.DOI:10.2436/20.1501.01.278.
9 Nuria FH,Benito A.Antibiotic-lock therapy:a clinical viewpoint[J].Expert Rev Anti Infect Ther,2014,12(1):117-129.DOI:10.1586/14787210.2014.863148.
10 Messing B,Peitra-Cohen S,Debure A,et al.Antibiotic-lock technique:a new approach to optimal therapy for catheter-related sepsis in home-parenteral nutrition patients[J].JPEN J Parenteral Enteral Nutr,1988,12(2):185-189.DOI:10.1177/0148607188012002185.
11 Corbella M,Brandolini M,Cambieri P,et al.A catheter-related bloodstream infection caused by Chryseobacterium indologenes successfully treated with antibiotic-lock rescue therapy[J].New Microbiol,2017,40(3):223-225.
12 Soman R,Gupta N,Suthar M,et al.Antibiotic lock therapy in the era of Gram-negative resistance[J].J Assoc Physicians India,2016,64(2):32-37.
13 Fernandez HN,Almirante B.Antibiotic-lock therapy:a clinical viewpoint[J].Expert Rev Anti Infect Ther,2014,12(1):117-129.DOI:10.1586/14787210.2014.863148.
14 Issam R,Hend H.Intravascular catheter-related infections:advances in diagnosis,prevention and management[J].Lancet Infect Dis,2007,7(10):645-657.DOI:10.1016/S1473-3099(07)70235-9.
15 Viana T,Lima LS,Araújo CC,et al.Risk factors for central line-associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port:A cohort study[J].Pediatr Blood Cancer,2017,64(2):336-342.DOI:10.1002/pbc.26225.
16 Walz JM,Memtsoudis SG,Heard SO.Prevention of central venous catheter bloodstream infections[J].J Intensive Care Med,2010,25(3):131-138.DOI:10.1177/0885066609358952.
Memo
收稿日期:2018-08-19。
通讯作者:刘江斌,Email:ljbin888@163.com