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DOI: 10.1055/s-2007-963276
© Georg Thieme Verlag KG Stuttgart · New York
Periinterventionelle prophylaktische Antibiotikagabe bei der radiologischen Portkatheterimplantation
Periinterventional Prophylactic Antibiotics in Radiological Port Catheter ImplantationPublikationsverlauf
eingereicht: 4.1.2007
angenommen: 9.5.2007
Publikationsdatum:
18. Juli 2007 (online)
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Zusammenfassung
Ziel: Kann eine singuläre prophylaktische, periinterventionelle Antibiotikagabe infektassoziierte Portkatheterkomplikationen reduzieren? Material und Methoden: In der Zeit vom Januar bis September 2002 wurden 164 Patienten mit Indikation zur zentralvenösen Portimplantation konsekutiv in die Studie eingeschlossen. Bei der Implantation war es dem jeweiligen Radiologen überlassen, ob er eine periinterventionelle, prophylaktische Antibiose durchführte oder nicht. Die Antibiose erfolgte mittels einer singulären, periinterventionellen, intravenösen Applikation von Ampicillin und Sulbactam (Unacid, Pfizer), bei Penicillinallergie 100 mg Ciprofloxacin i. v. (Ciprobay, Bayer). Eine katheterassoziierte Infektion wurde definiert als lokale oder systemische Infektion, welche eine Katheterexplantation notwendig machte. Ergebnisse: Indikation zur Portimplantation war eine maligne Grunderkrankung mit notwendiger Chemotherapie in 158 Fällen. Die Portkatheterimplantation (Chemosite [Tyco Healthcare] [n = 123], LowProfile [Arrow International] [n = 35], anderes Portsystem [n = 6]) erfolgte mittels sonografisch gesteuerter Punktion der rechten V. jugularis in 139 Fällen, in 24 Fällen über die linke V. jugularis und in einem Fall über die linke V. subclavia. Die periinterventionelle, prophylaktische Antibiose erfolgte bei 75 Patienten (Unacid [n = 63], Ciprobay [n = 12]), 89 Patienten erhielten keine Antibiose. Bei einem Patienten trat eine leichte allergische Reaktion auf die Antibiose auf, welche sich unter intravenöser Applikation von Antihistaminika und Kortison besserte. Insgesamt wurden 7 Portsysteme aufgrund infektiöser Komplikationen explantiert, 6 in der Gruppe ohne Prophylaxe gegenüber einem in der Gruppe mit Prophylaxe. Schlussfolgerungen: Die einmalige, prophylaktische Antibiose während der radiologisch-interventionellen Portkatheterimplantation kann die Häufigkeit infektiöser Früh- und Spätkomplikationen senken.
Abstract
Purpose: To evaluate whether catheter-related infections after radiologically placed port catheters can be reduced by single-shot periinterventional antibiosis. Materials and Method: Between January and September 2002, 164 consecutive patients with indication for central venous port catheter implantation were included in the present study. During implantation the interventional radiologist was responsible for deciding whether to administer a prophylactic single-shot antibiosis. The prophylactic antibiosis entailed intravenous administration of ampicillin and sulbactam (3 g Unacid, Pfizer) or 100 mg ciprofloxacine (Ciprobay, Bayer) in the case of an allergy history to penicillins. Catheter-related infection was defined as a local or systemic infection necessitating port catheter extraction. Results: Indication for port catheter implantation was a malignant disease requiring chemotherapy in 158 cases. The port catheter (Chemosite [Tyco Healthcare] [n = 123], low-profile [Arrow International] [n = 35], other port system [n = 6]) was implanted via sonographically guided puncture of the right jugular vein in 139 patients, via the left jugular vein in 24 cases and via the right subclavian vein in one patient. 75 patients received periinterventional prophylactic antibiosis (Unacid [n = 63] Ciprobay [n = 12]) and 89 patients did not receive antibiosis. The prophylactic antibiosis caused a minor allergic reaction in one patient that improved with antihistamic and corticoid medication. A total of 7 ports, 6 without prophylactic antibiosis versus one with periinterventional prophylaxis, were extracted due to infectious complications. Conclusion: Single-shot periinterventional prophylactic antibiosis can reduce early and late infectious complications after radiological-interventional placement of central venous port catheters.
Key words
infection - interventional procedures - port catheter implantation - prophylaxis
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Dr. Bernhard Gebauer
Klinik für Strahlenheilkunde, Charité, Universitätsmedizin
Augustenburger Platz 1
13353 Berlin
Telefon: ++49/30/4 50 55 70 01
Fax: ++49/30/4 50 55 79 01
eMail: bernhard.gebauer@charite.de