免疫功能低下患者局部镇痛导管相关感染和抗生素预防的有效性：一项回顾性多中心登记分析

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-04-01 DOI:10.1016/j.jclinane.2025.111826

Lukas M. Müller-Wirtz MD , William M. Patterson MPH , Sascha Ott MD MPHA , Kurt Ruetzler MD , Alparslan Turan MD , Daniel I. Sessler MD , Thomas Volk MD , Christine Kubulus MD

{"title":"免疫功能低下患者局部镇痛导管相关感染和抗生素预防的有效性：一项回顾性多中心登记分析","authors":"Lukas M. Müller-Wirtz MD , William M. Patterson MPH , Sascha Ott MD MPHA , Kurt Ruetzler MD , Alparslan Turan MD , Daniel I. Sessler MD , Thomas Volk MD , Christine Kubulus MD","doi":"10.1016/j.jclinane.2025.111826","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The risk of regional analgesia catheter-related infections in immunocompromised patients remains uncertain. We therefore tested the hypotheses that catheter-related infections appear earlier and are more severe, and that antibiotic prophylaxis is more effective in immunocompromised than immunocompetent patients.</div></div><div><h3>Methods</h3><div>Data were extracted from the Network for Safety in Regional Anesthesia and Acute Pain Therapy (net-ra) registry from 2007 to 2022. We used multivariable cox and ordinal regression to assess the effect of immune function and antibiotic prophylaxis indicated by surgery on infection onset and severity.</div></div><div><h3>Results</h3><div>We analyzed data from 196,711 catheters, including 1347 in immunocompromised patients. Infection severities in immunocompetent patients were none (190,220 (97.4 %)), mild (4517 (2.3 %)), and moderate/severe (627 (0.3 %)). In immunocompromised patients, infection severities were none (1285 (95.4 %)), mild (58 (4.3 %)), and moderate/severe (4 (0.3 %)). Immunocompromised patients who were not given antibiotics had a 29 % greater infection hazard (HR 1.29 [95 %CI: 0.95, 1.76], <em>p</em> = 0.1) and 91 % greater odds of higher infection severities (OR 1.91 [95 %CI: 1.39, 2.63], <em>p</em> < 0.001). Antibiotics were more effective in delaying infection onset (HR 0.65 [95 %CI: 0.38, 1.12], <em>p</em> = 0.12) and preventing infection (OR 0.54 [95 %CI: 0.31, 0.94], <em>p</em> = 0.029) in immunocompromised than immunocompetent patients. The number of patients needed-to-treat to prevent an infection with antibiotics was 55 in immunocompromised patients versus 83 in immunocompetent patients.</div></div><div><h3>Conclusions</h3><div>Regional analgesia catheter-related infections occur slightly earlier and are more frequent in immunocompromised patients. Antibiotics are marginally effective for catheter infection prophylaxis and should be restricted to patients who are severely immunocompromised with and at special risks.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111826"},"PeriodicalIF":5.0000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Regional analgesia catheter-related infections and the effectiveness of antibiotic prophylaxis in immunocompromised patients: A retrospective multicenter registry analysis\",\"authors\":\"Lukas M. Müller-Wirtz MD , William M. Patterson MPH , Sascha Ott MD MPHA , Kurt Ruetzler MD , Alparslan Turan MD , Daniel I. Sessler MD , Thomas Volk MD , Christine Kubulus MD\",\"doi\":\"10.1016/j.jclinane.2025.111826\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The risk of regional analgesia catheter-related infections in immunocompromised patients remains uncertain. We therefore tested the hypotheses that catheter-related infections appear earlier and are more severe, and that antibiotic prophylaxis is more effective in immunocompromised than immunocompetent patients.</div></div><div><h3>Methods</h3><div>Data were extracted from the Network for Safety in Regional Anesthesia and Acute Pain Therapy (net-ra) registry from 2007 to 2022. We used multivariable cox and ordinal regression to assess the effect of immune function and antibiotic prophylaxis indicated by surgery on infection onset and severity.</div></div><div><h3>Results</h3><div>We analyzed data from 196,711 catheters, including 1347 in immunocompromised patients. Infection severities in immunocompetent patients were none (190,220 (97.4 %)), mild (4517 (2.3 %)), and moderate/severe (627 (0.3 %)). In immunocompromised patients, infection severities were none (1285 (95.4 %)), mild (58 (4.3 %)), and moderate/severe (4 (0.3 %)). Immunocompromised patients who were not given antibiotics had a 29 % greater infection hazard (HR 1.29 [95 %CI: 0.95, 1.76], <em>p</em> = 0.1) and 91 % greater odds of higher infection severities (OR 1.91 [95 %CI: 1.39, 2.63], <em>p</em> < 0.001). Antibiotics were more effective in delaying infection onset (HR 0.65 [95 %CI: 0.38, 1.12], <em>p</em> = 0.12) and preventing infection (OR 0.54 [95 %CI: 0.31, 0.94], <em>p</em> = 0.029) in immunocompromised than immunocompetent patients. The number of patients needed-to-treat to prevent an infection with antibiotics was 55 in immunocompromised patients versus 83 in immunocompetent patients.</div></div><div><h3>Conclusions</h3><div>Regional analgesia catheter-related infections occur slightly earlier and are more frequent in immunocompromised patients. Antibiotics are marginally effective for catheter infection prophylaxis and should be restricted to patients who are severely immunocompromised with and at special risks.</div></div>\",\"PeriodicalId\":15506,\"journal\":{\"name\":\"Journal of Clinical Anesthesia\",\"volume\":\"103 \",\"pages\":\"Article 111826\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0952818025000868\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818025000868","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

背景免疫功能低下患者发生局部镇痛导管相关感染的风险尚不确定。因此，我们测试了导管相关感染出现得更早、更严重的假设，以及免疫功能低下患者的抗生素预防比免疫功能正常患者更有效的假设。方法数据取自2007 - 2022年区域麻醉和急性疼痛治疗安全网络（net-ra）注册表。我们使用多变量cox和有序回归来评估免疫功能和手术指示的抗生素预防对感染发生和严重程度的影响。结果我们分析了196,711根导管的数据，其中1347根是免疫功能低下的患者。免疫功能正常患者感染严重程度为无感染（190,220(97.4%)），轻度感染（4517(2.3%)），中/重度感染（627(0.3%)）。在免疫功能低下的患者中，感染严重程度为无感染（1285例（95.4%）），轻度感染（58例（4.3%）），中/重度感染（4例（0.3%））。未给予抗生素的免疫功能受损患者感染风险增加29% (HR 1.29 [95% CI: 0.95, 1.76], p = 0.1)，感染严重程度增加的几率增加91% (OR 1.91 [95% CI: 1.39, 2.63], p <；0.001)。在免疫功能低下患者中，抗生素在延缓感染发生（HR 0.65 [95% CI: 0.38, 1.12], p = 0.12）和预防感染（OR 0.54 [95% CI: 0.31, 0.94], p = 0.029）方面比免疫功能正常患者更有效。免疫功能低下患者需要治疗以预防抗生素感染的人数为55人，而免疫功能正常患者为83人。结论局部镇痛导管相关感染在免疫功能低下患者中发生时间稍早，发生率较高。抗生素对预防导管感染的作用微乎其微，应仅限于免疫功能严重低下和有特殊风险的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Regional analgesia catheter-related infections and the effectiveness of antibiotic prophylaxis in immunocompromised patients: A retrospective multicenter registry analysis

Background

The risk of regional analgesia catheter-related infections in immunocompromised patients remains uncertain. We therefore tested the hypotheses that catheter-related infections appear earlier and are more severe, and that antibiotic prophylaxis is more effective in immunocompromised than immunocompetent patients.

Methods

Data were extracted from the Network for Safety in Regional Anesthesia and Acute Pain Therapy (net-ra) registry from 2007 to 2022. We used multivariable cox and ordinal regression to assess the effect of immune function and antibiotic prophylaxis indicated by surgery on infection onset and severity.

Results

We analyzed data from 196,711 catheters, including 1347 in immunocompromised patients. Infection severities in immunocompetent patients were none (190,220 (97.4 %)), mild (4517 (2.3 %)), and moderate/severe (627 (0.3 %)). In immunocompromised patients, infection severities were none (1285 (95.4 %)), mild (58 (4.3 %)), and moderate/severe (4 (0.3 %)). Immunocompromised patients who were not given antibiotics had a 29 % greater infection hazard (HR 1.29 [95 %CI: 0.95, 1.76], p = 0.1) and 91 % greater odds of higher infection severities (OR 1.91 [95 %CI: 1.39, 2.63], p < 0.001). Antibiotics were more effective in delaying infection onset (HR 0.65 [95 %CI: 0.38, 1.12], p = 0.12) and preventing infection (OR 0.54 [95 %CI: 0.31, 0.94], p = 0.029) in immunocompromised than immunocompetent patients. The number of patients needed-to-treat to prevent an infection with antibiotics was 55 in immunocompromised patients versus 83 in immunocompetent patients.

Conclusions

Regional analgesia catheter-related infections occur slightly earlier and are more frequent in immunocompromised patients. Antibiotics are marginally effective for catheter infection prophylaxis and should be restricted to patients who are severely immunocompromised with and at special risks.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.