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

管路所引起的血液相關感染，常發生在接受化療、血液透析、全靜脈營養及及重症的病患等，這些病人除了本身免疫狀況不佳外，常需要長時間（＞14天）使用相關管路，使他們暴露在較高的感染風險，而引起導管相關的血液感染（Catheter Related Bloodstream Infection, CRBI），進而延長病人的住院天數甚至提高死亡的風險。根據美國感染科學會（The Infectious Diseases Society of America, IDSA）與美國疾病管制局（Centers for Disease Control, CDC）所建議的處置，如果病人的情況仍需保留現存管路，除了使用全身性的抗生素外，則可以考慮合併使用抗生素封存療法（Antibiotic Lock Therapy, ALT）。作者在查詢相關文獻後，依據管路感染常見的菌種以及經驗性抗生素的給予，整理常見的抗生素在使用封存療法時，封存溶液的建議配置與建議封存時間，以及依據管路與封存溶液的性質，所需注入封存的容量。在成效方面，根據許多小型研究顯示，使用抗生素封存療法在保留的管路上，相較於僅使用全身性抗生素來治療，在感染的預防及治療，可能可以延長管路的使用，降低感染的發生與復發。但在治療效果上，仍不比移除管路或是更換管路來的好，所以在臨床上仍需要依據病人的實際狀況，適當地決策使用時機。

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.