在接受连续置换疗法和体外膜氧化治疗的患者中存在感染风险
Antoine Gaillet1, Jean-François Timsit1,2,3
1APHP Bichat University Hospital Medical and Infectious Diseases ICU Paris.
Current opinion in critical care
|August 6, 2025
概括
在接受体外膜氧化 (ECMO) 和连续置换疗法 (CRRT) 的患者中,鼻腔感染很常见,增加了死亡率. 改善监测和抗微生物药物管理对于预防和管理至关重要.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 鼻腔感染是重症患者经常出现的并发症,需要体外膜氧化 (ECMO) 和连续置换疗法 (CRRT).
- 现有的指导方针不足以解决这些高风险人群的感染相关并发症.
- 与设备相关的免疫性衰竭有助于ECMO/CRRT患者的感染风险.
研究的目的:
- 审查目前对接受ECMO和/或CRRT的患者内科感染的理解.
- 突出与这些感染相关的诊断挑战和不良结果.
- 强调迫切需要标准化诊断和预防策略.
主要方法:
- 关于ECMO/CRRT患者医院感染的最近研究的文献综述.
- 分析感染发病率,常见病原体和危险因素.
- 综合发现,为预防和管理策略提供信息.
主要成果:
- 鼻腔感染,包括呼吸器相关的肺炎 (VAP),血流感染 (BSI) 和管相关的感染 (CRI),在ECMO患者中经常发生 (9%-64%的发病率).
- VAP和BSI的比率分别可以达到每1000个ECMO-day的61,38个.
- 肠杆菌,阴性菌根,菌种和真菌是主要的病原体;与菌相关的BSI是未被认可的. ECMO支持的持续时间是关键的风险因素,感染会使死亡率增加32%.
结论:
- 在ECMO/CRRT患者中,鼻腔感染很普遍,难以诊断,并与不良结果相关.
- 预防和管理需要综合,量身定制的战略.
- 标准化定义,加强监测和有针对性的抗菌药物管理是必不可少的.
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