Venenkatheter-assoziierte Infektionen bei Patienten mit Neutropenie

Venenkatheter-assoziierte Infektionen sind ein häufiges Problem bei hospitalisierten Patienten mit beträchtlicher Morbidität und Mortalität. Für Patienten mit Neutropenie lässt sich aus den vorliegenden Daten die Inzidenz nicht sicher abschätzen. Das Risiko für Katheter-assoziierte Infektionen steigt mit zunehmender Dauer der Neutropenie. Als Erreger haben grampositive Bakterien (Koagulase-negative Staphylokokken, Staphylococcus aureus) die größte Bedeutung. Danach folgen Infektionen durch Candida spp., während gramnegative Bakterien eine geringere Rolle spielen. Basis für eine Katheter- assoziierte Infektion ist immer die Blutkultur, lokale Infektionszeichen können Hinweise geben. Die definitive Diagnose erfordert in der Regel eine Entfernung des Katheters und seine mikrobiologische Untersuchung. Als Standardverfahren hierfür gilt die Abrolltechnik nach Maki mit semiquantitativer Kultur. Therapeutisch muss bei klinischen Hinweisen auf eine Katheter-assoziierte Infektion neben einer gezielten antibiotischen Therapie immer die Notwendigkeit der Entfernung des Katheters erwogen werden. Absolute Indikationen für eine Entfernung des Katheters stellen Infektionen mit Staphylococcus aureus und Candida spp. sowie Tunnel- und Tascheninfektionen dar. Durch die Verwendung von Antibiotika- beschichteten Kathetern kann die Infektionsrate möglicherweise auch bei neutropenischen Patienten in Zukunft gesenkt werden.

Catheter-related infections in patients with neutropenia

Catheter-related infections cause considerable morbidity and mortality in hospitalized patients. For patients with neutropenia epidemiological data are scarce and the exact incidence has not yet been determined. The risk of catheter-related infections increases with the duration of neutropenia. Gram-positive bacteria (coagulase-negative staphylococci, staphylococcus aureus) are most frequently cultured, followed by candida species. In contrast, gram-negative bacteria play only a minor role in catheter-related infections. Positive blood cultures are the cornerstone in the diagnosis of catheter-related infections, and local signs of infection may add additional information. However, a definite diagnosis requires the removal of the catheter and its microbiological examination. The role plate method with semiquantitative cultures (Maki) has been established as standard in most laboratories. For therapy of catheter-related infections antibiotics are applied according to the susceptibility of the cultured organism. Removal of the catheter has to be considered in every case of suspected catheter-related infection and is mandatory in staphylococcus aureus and candida infections. Tunnel infection of long term catheters is always an indication for removal. In the future, the rate of catheter-related infections in neutropenic patients may be reduced by the use of catheters coated with antimicrobial agents.

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