Kateter Enfeksiyonlarına Alternatif Çözüm: Kilit Tedavisi

Abstract

Uzun süreli kalıcı kateter kullanımının en önemli komplikasyonu kateter enfeksiyonlarıdır. Infectious Diseases Society of America (IDSA) koagülaz negatif stafilokok, S.aureus ve gram (-) ilişkili kateter enfeksiyonlarında kateter değişimi mümkün değilse sistemik tedavi ve kateter kilit tedavisinin birlikte verilmesini; fungal enfeksiyonlarda ise kateterin değişimini önermektedir. Ancak kısa barsak sendromu, konjenital diare bozuklukları gibi özel hasta gruplarında Candida ilişkili kateter enfeksiyonları sık görülmektedir. Bu durum sürekli kateter değişimleri ve komplikasyonlarına neden olmakta, hastanelerde büyük maliyet kaybı oluşturmaktadır. Burada NEUROG3 gen defekti, konjenital intestinal malabsorbsiyon sendromu tanılı yaşamını parenteral nutrisyon ile idame ettiren iki yıl dokuz aylık kız hastada liposomal amfoterisin B kilit ve sistemik tedavisi uygulanarak C. glabrata ilişkili kateter enfeksiyonunun tedavi edildiği başarılı bir olgu sunulmuştur.

Keywords

• liposomal amfoterisin B
• liposomal kilit tedavisi
• fungal enfeksiyonlar
• NEUROG3

Alternative Solution to Catheter Infections: Lock Therapy

Abstract

One of the main complications of long-term use of permanent catheters is infection of the catheter. Guidelines issued by the Infectious Diaseases Society of America (IDSA) recommend the additon of antibiotic lock therapy to parenteral antibiotic therapy for tunneled or implantable catheter-associated infections caused by coagulase-negative Staphylococcus, S aureus, and gram-negative rods when removal of the catheter is not an option. However, IDSA guidelines strongly recommend removal of the catheter if possible in patients with catheter-associated infections secondary to Candida. However, Candida-associated catheter infections are common in certain high-risk patient groups including those with short bowel syndrome and congenital diarrheal disorders. Such situationsmay necessitate frequent ghange of catheters along with a host of other complications, resulting in huge loss of revenue to hospitals as well as inconvenience to patients. Here, we present a case in which C. glabrata-associated catheter infection was successfully treated by applying liposomal amphotericin B lock along with systemic antifungal treatment. The patient was a young girl aged 2 years and 9 months having Neurogenin-3 (NEUROG3) gene defect associated with congenital intestinal malabsorption syndrome.

Keywords

• liposomal amphotericin B
• liposomal lock therapy
• fungal infections
• NEUROG3

References

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