Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new proph...Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.展开更多
[目的]系统评价采用乙醇封管与肝素封管预防长期静脉留置导管病人发生导管相关性感染的效果。[方法]检索PubMed、EMbase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国期刊全文数据库及数字化全文数据库等资源,纳...[目的]系统评价采用乙醇封管与肝素封管预防长期静脉留置导管病人发生导管相关性感染的效果。[方法]检索PubMed、EMbase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国期刊全文数据库及数字化全文数据库等资源,纳入对比乙醇与肝素封管预防导管相关性感染的随机对照试验(RCT)。采用Cochrane系统评价手册5.1.0版提供的偏倚风险评估工具对纳入研究进行质量评价,采用Stata12.0软件进行统计分析。[结果]共纳入5项RCT,共266例病人。Meta分析结果显示:与肝素封管相比,乙醇封管能有效预防导管相关性血流感染的发生[OR=0.25,95%CI(0.12,0.52),P=0.000 3)],且不增加血栓形成及不良反应的风险(P>0.05)。两组病人隧道感染、出口感染等指标差异无统计学意义(P>0.05)。[结论]乙醇封管相比肝素封管能有效降低长期静脉留置导管病人发生导管相关性血流感染的风险,是一种有效、安全的封管方式,且不增加血栓形成及不良反应的风险。展开更多
文摘Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.
文摘[目的]系统评价采用乙醇封管与肝素封管预防长期静脉留置导管病人发生导管相关性感染的效果。[方法]检索PubMed、EMbase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国期刊全文数据库及数字化全文数据库等资源,纳入对比乙醇与肝素封管预防导管相关性感染的随机对照试验(RCT)。采用Cochrane系统评价手册5.1.0版提供的偏倚风险评估工具对纳入研究进行质量评价,采用Stata12.0软件进行统计分析。[结果]共纳入5项RCT,共266例病人。Meta分析结果显示:与肝素封管相比,乙醇封管能有效预防导管相关性血流感染的发生[OR=0.25,95%CI(0.12,0.52),P=0.000 3)],且不增加血栓形成及不良反应的风险(P>0.05)。两组病人隧道感染、出口感染等指标差异无统计学意义(P>0.05)。[结论]乙醇封管相比肝素封管能有效降低长期静脉留置导管病人发生导管相关性血流感染的风险,是一种有效、安全的封管方式,且不增加血栓形成及不良反应的风险。
