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Zhu Q, Yue Y, Zhu L, Cui J, Zhu M, Chen L, Yang Z, Liang Z. Epidemiology and microbiology of Gram-positive bloodstream infections in a tertiary-care hospital in Beijing, China: a 6-year retrospective study. Antimicrob Resist Infect Control 2018; 7:107. [PMID: 30202520 PMCID: PMC6122739 DOI: 10.1186/s13756-018-0398-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/21/2018] [Indexed: 01/23/2023] Open
Abstract
Background Gram-positive bacterial bloodstream infections (BSIs) are serious diseases associated with high morbidity and mortality. The following study examines the incidence, clinical characteristics and microbiological features, drug resistance situations and mortality associated with Gram-positive BSIs at a large Chinese tertiary-care hospital in Beijing, China. Methods A retrospective cohort study of patients with Gram-positive BSIs was performed between January 1, 2011, and June 31, 2017, at the Chinese People’s Liberation Army General Hospital. The patients’ data were collected and included in the reviewing electronic medical records. Results A total of 6887 episodes of Gram-positive BSIs occurred among 4275 patients over 6 years, and there were 3438 significant BSI episodes 69% of these cases were healthcare-associated, while 31% were community-associated. The overall incidence of Gram-positive BSIs fluctuated from 7.26 to 4.63 episodes per 1000 admissions over 6 years. Malignancy was the most common comorbidity and indwelling central intravenous catheter was the most common predisposing factor for BSI. Staphylococci were the major pathogen (65.5%), followed by Enterococcus spp:(17.5%), Streptococcus spp.(7.1%) and other bacterial pathogens (9.9%). The resistance rates of Staphylococci and E.faecium to penicillins were more than 90%. the vancomycin-resistant isolates were E. faecium (4.1%) and staphylococcus epidermidis (0.13%); and only E.faecalis and E.faecium showed resistance to linezolid (3.8% and 3.1%). Between 2011 and 2017, the overall mortality of Gram-positive BSIs decreased from 6.27 to 4.75% (X2 = 0.912, p = 0.892). Neverthess, the mortality in the ICU decreased from 60.46 to 47.82%, while in the general ward it increased from 39.54 to 52.18%. Conclusions The morbidity and mortality of Gram-positive BSIs have showed downward trends. Vancomycin and linezolid are still consider the best treatment for patients with Gram-positive BSIs.
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Affiliation(s)
- Qiang Zhu
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Yan Yue
- 3The postgraduate department, Chinese PLA General Hospital, Beijing, 100853 China
| | - Lichen Zhu
- Department of Respiratory Medicine, Affiliated Hospital of Nantong Third People's Hospital, Qingnian Central Street No. 99, Jiangsu Province, 226000 China
| | - Jiewei Cui
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Minghui Zhu
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Liangan Chen
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Zhen Yang
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Zhixin Liang
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
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Tanır Basaranoglu S, Karadag-Oncel E, Aykac K, Ozsurekci Y, Aycan AE, Cengiz AB, Kara A, Ceyhan M. Presepsin: A new marker of catheter related blood stream infections in pediatric patients: Reply to Rivera-Moran Javier et al. J Infect Chemother 2018; 24:687. [DOI: 10.1016/j.jiac.2018.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
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Jahanbakhsh S, Singh NB, Yim J, Rose WE, Rybak MJ. Evaluation of Telavancin Alone and Combined with Ceftaroline or Rifampin against Methicillin-Resistant Staphylococcus aureus in an In Vitro Biofilm Model. Antimicrob Agents Chemother 2018; 62:e00567-18. [PMID: 29784849 PMCID: PMC6105779 DOI: 10.1128/aac.00567-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/15/2018] [Indexed: 12/11/2022] Open
Abstract
Infections caused by biofilm-producing methicillin-resistant Staphylococcus aureus (MRSA) bacteria are challenging due to increasing antibiotic resistance. Synergistic activities of lipopeptides and lipoglycopeptides with β-lactams have been demonstrated for MRSA, but little is known about biofilm-embedded organisms. Our objective was to evaluate two telavancin (TLV) dosage regimens (7.5 mg/kg of body weight and 10 mg/kg every 24 h [q24h]) alone and in combination with ceftaroline (CPT) (600 mg every 8 h [q8h]) or rifampin (RIF) (450 mg every 12 h [q12h]) against two biofilm-producing MRSA strains (494 and N315). Pharmacokinetic/pharmacodynamic CDC biofilm reactor models with polyurethane coupons were used to evaluate the efficacies of the antibiotic combinations over 72 h. Overall, there were no significant differences observed between the two TLV dosing regimens either alone or in combination with RIF or CPT against these strains. Both TLV dosing regimens and CPT alone demonstrated killing but did not reach bactericidal reduction at 72 h. However, both TLV regimens in combination with RIF demonstrated enhanced activity against both strains, with a rapid decrease in CFU/ml at 4 h that was bactericidal and maintained over the 72-h experiment (-Δ3.75 log10 CFU/ml from baseline; P < 0.0001). Of interest, no enhanced activity was observed for TLV combined with CPT. No development of resistance was observed in any of the combination models. However, resistance to RIF developed as early as 24 h, with MIC values exceeding 32 mg/liter. Our results show that TLV plus RIF displayed therapeutic improvement against biofilm-producing MRSA. These results suggest that TLV at 7.5 and 10 mg/kg q24h are equally effective in eradicating biofilm-associated MRSA strains in vitro.
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Affiliation(s)
- Seyedehameneh Jahanbakhsh
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Nivedita B Singh
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Juwon Yim
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Warren E Rose
- School of Pharmacy and Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- School of Medicine, Wayne State University, Detroit, Michigan, USA
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154
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Javier RM, Diego MM, Jorge L M. Presepsin: A new marker of catheter related blood stream infections in pediatric patients. J Infect Chemother 2018; 24:686. [DOI: 10.1016/j.jiac.2018.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/27/2018] [Accepted: 04/11/2018] [Indexed: 11/30/2022]
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155
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Aloush SM, Al-Sayaghi K, Tubaishat A, Dolansky M, Abdelkader FA, Suliman M, Al Bashtawy M, Alzaidi A, Twalbeh L, Sumaqa YA, Halabi M. Compliance of Middle Eastern hospitals with the central line associated bloodstream infection prevention guidelines. Appl Nurs Res 2018; 43:56-60. [PMID: 30220364 DOI: 10.1016/j.apnr.2018.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 05/05/2018] [Accepted: 06/23/2018] [Indexed: 12/27/2022]
Abstract
AIMS The purposes of this study were to (1) assess compliance with the CLABSI prevention guidelines, (2) assess the predictors of compliance, and (3) investigate the effect of compliance on the rate of CLABSI and related mortality. BACKGROUND Implementation of the Central Line Associated Bloodstream Infection (CLABSI) prevention guidelines from the Centers for Disease Control and Prevention (CDC) helps to reduce the rate of CLABSI and related mortality, although the extent to which hospitals implement these guidelines is questionable. METHODS A prospective design was used in this study. Observations were conducted over three months in the intensive care units of 58 hospitals in three Middle Eastern countries. An observational checklist, based on the CDC guidelines, was used to assess compliance. The rate of CLABSI and related mortality were obtained from patients' records. RESULTS The degree of compliance, rate of CLABSI and mortality were highly variable. The multiple regression model showed that the hospitals' characteristics explained 82.0% of the variance of compliance (R2Adj= 0.820, F=29.82, p<0.05). The number of beds in the intensive care unit and patient-nurse ratio were significant predictors of compliance. A lower number of beds and a lower patient-to-nurse ratio were related to higher compliance. Moreover, higher compliance with CLABSI prevention guidelines was associated with lower rate of CLABSI and related mortality. CONCLUSIONS Improvement in the patients' outcome can be achieved through compliance with the CLABSI prevention guidelines. lowering patient-nurse ratio and the number of beds in the ICUs would help to improve compliance.
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Affiliation(s)
- Sami M Aloush
- Al al bayt University, School of Nursing, Mafraq, Jordan.
| | - Khaled Al-Sayaghi
- Taibah University, School of Nursing, Madinah, Saudi Arabia; Sana'a University, Faculty of Medicine and Health Sciences, Sana'a, Republic of Yemen
| | | | - Mary Dolansky
- Case Western Reserve University, School of Nursing, Cleveland, OH, United States of America
| | | | | | | | | | - Loai Twalbeh
- Al al bayt University, School of Nursing, Mafraq, Jordan
| | | | - Marwa Halabi
- Al al bayt University, School of Nursing, Mafraq, Jordan
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156
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Toxic epidermal necrolysis data from the CELESTE multinational registry. Part II: Specific systemic and local risk factors for the development of infectious complications. Burns 2018; 44:1561-1572. [PMID: 29903602 DOI: 10.1016/j.burns.2018.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 12/20/2022]
Abstract
The aim of the study was to identify the most important systemic and local risk factors for the development of infectious complications in patients with toxic epidermal necrolysis (TEN). MATERIAL AND METHODOLOGY This is a multicentric study that included all patients with TEN who were hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area included a population of over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation) registry, wherein specific parameters related to epidemiological indicators and infectious complications in patients with TEN were evaluated as a retrospective analysis. RESULTS A total of 38 patients (97%) of the group were treated with corticosteroids. The comparison of patients with different doses of corticosteroids did not exhibit a statistically significant effect of corticosteroid administration on the development of infectious complications (p=0.421). There was no effect of the extent of the exfoliated area on the development of infectious complications in this area. The average extent of the exfoliated area was 66% TBSA (total body surface area) in patients with reported infectious complications and 71% TBSA (p=0.675) in patients without infectious complications. In the case of the development of an infectious complication in the bloodstream (BSI), the increasing effect of the SCORTEN (SCORe of Toxic Epidermal Necrosis) value was monitored during hospitalization. Within 5days from the beginning of the hospitalization, the average SCORTEN value was 2.7 in 6 patients with BSI and 3.0 in 32 patients without BSI (p=0.588). In the period after the 15th day of hospitalization, 7 patients with BSI had an average SCORTEN value of 3.4, and 16 patients without BSI had an average SCORTEN value of 2.5 (p=0.079). In the case of low respiratory tract infection (LRTI), the effects of the necessity for artificial pulmonary ventilation and the presence of tracheostomy were monitored. The statistically significant effect of mechanical ventilation on the development of LRTI occurred only during the period of 11-15days from the beginning of the hospitalization (p=0.016). The effect of the tracheostomy on the development of LRTI was proven to be more significant. CONCLUSION We did not find any statistically significant correlation between the nature of immunosuppressive therapy and the risk of developing infectious complications. We failed to identify statistically significant risk factors for the development of BSI. Mechanical ventilation and tracheostomy increase the likelihood of developing LRTIs in patients with TEN.
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157
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Lipový B, Holoubek J, Hanslianová M, Cvanová M, Klein L, Grossová I, Zajíček R, Bukovčan P, Koller J, Baran M, Lengyel P, Eimer L, Jandová M, Košťál M, Brychta P. Toxic epidermal necrolysis data from the CELESTE multinational registry. Part I: Epidemiology and general microbiological characteristics. Burns 2018; 44:1551-1560. [PMID: 29886114 DOI: 10.1016/j.burns.2018.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/28/2017] [Accepted: 01/27/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Toxic epidermal necrolysis (TEN) is a rare, life-threatening autoimmune disease predominantly manifested in the skin and mucous membranes. Today, infectious complications have the dominant share in mortality of TEN patients. Due to the nature of the therapy and administration of immunosuppressive medications, a wide range of potentially pathogenic microorganisms, which cause infectious complications in different compartments in these patients, is not surprising. MATERIAL AND METHODOLOGY This is a multicentric study, which included all patients with TEN hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area was over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the registry CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation), when specific parameters relating to epidemiological indicators and infectious complications in patients with TEN were evaluated in the form of a retrospective analysis. RESULTS In total, 39 patients with TEN were included in the study (12 patients died, mortality was 31%), who were hospitalized in the monitored period. The median age of patients in the group was 63 years (the range was 4-83 years, the mean was 51 years), the median of the exfoliated area was 70% TBSA (total body surface area) (range 30-100%, mean 67%). SCORTEN was calculated for 38 patients on the day of admission. Its median in all patients was 3 (range 1-6; mean 3). Any kind of infectious complication in the study group was recorded in 33 patients in total (85%). In total, 30 patients (77%) were infected with gram-positive cocci, 27 patients (69%) with gram-negative rods, and yeast cells or fibrous sponge were cultivated in 12 patients (31%). A total of 32 patients (82%) were found to have infectious complications in the exfoliated area, 15 patients (39%) had lower respiratory tract infections, 18 patients (46%) urinary tract infections and 15 patients (39%) an infection in the bloodstream. The most common potentially pathogenic microorganism isolated in our study group was coagulase neg. Staphylococcus, which caused infectious complications in 24 patients. Enterococcus faecalis/faecium (19 patients), Pseudomonas aeruginosa (17 patients), Staphylococcus aureus (11 patients) and Escherichia coli (11 patients) were other most frequently isolated micro-organisms. CONCLUSION The published data were obtained from the unique registry of TEN patients in Central Europe. In the first part, we have succeeded in defining the basic epidemiological indicators in the group of patients anonymously included in this registry. The study clearly confirms that infectious complications currently play an essential role in TEN patients, often limiting the chances of survival. The study also shows a high prevalence of these complications in the period after 15days from the start of hospitalization, when most patients already have completely regenerated skin cover.
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Affiliation(s)
- B Lipový
- Department of Burns and Reconstructive Surgery, Teaching Hospital Brno, Czech Republic; Faculty of Medicine, Masaryk University Brno, Czech Republic.
| | - J Holoubek
- Department of Burns and Reconstructive Surgery, Teaching Hospital Brno, Czech Republic
| | - M Hanslianová
- Department of Clinical Microbiology, Teaching Hospital Brno, Czech Republic
| | - M Cvanová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - L Klein
- Division of Plastic Surgery and Burns Treatment, Department of Surgery, Charles University, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic; Department of Military Surgery, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - I Grossová
- Prague Burn Center, Charles University, 3rd Faculty of Medicine and Teaching Hospital Královské Vinohrady, Prague, Czech Republic
| | - R Zajíček
- Prague Burn Center, Charles University, 3rd Faculty of Medicine and Teaching Hospital Královské Vinohrady, Prague, Czech Republic
| | - P Bukovčan
- Department of Burns and Reconstructive Surgery, Faculty of Medicine, Comenius University in Bratislava, Slovakia
| | - J Koller
- Department of Burns and Reconstructive Surgery, Faculty of Medicine, Comenius University in Bratislava, Slovakia
| | - M Baran
- Department of Burns and Reconstructive Surgery, 1st Private Hospital Košice-Šaca, Slovakia
| | - P Lengyel
- Department of Burns and Reconstructive Surgery, 1st Private Hospital Košice-Šaca, Slovakia
| | - L Eimer
- Department of Paediatrics, Charles University, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic
| | - M Jandová
- Department of Dermatovenerology, Charles University, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic
| | - M Košťál
- IV. Internal Haematology Department, Charles University, Faculty of Medicine and Teaching Hospital, Hradec Králové, Czech Republic
| | - P Brychta
- Department of Burns and Reconstructive Surgery, Teaching Hospital Brno, Czech Republic; Faculty of Medicine, Masaryk University Brno, Czech Republic
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158
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Gupta R, Sharma S, Saxena S. Changing panorama for surveillance of device-associated healthcare infections: Challenges faced in implementation of current guidelines. Indian J Med Microbiol 2018; 36:18-25. [PMID: 29735821 DOI: 10.4103/ijmm.ijmm_18_50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Healthcare-associated infections (HAI) are preventable in up to 30% of patients with evidence-based infection prevention and control (IPC) activities. IPC activities require effective surveillance to generate data for the HAI rates, defining priority areas, identifying processes amenable for improvement and institute interventions to improve patient's safety. However, uniform, accurate and standardised surveillance methodology using objective definitions can only generate meaningful data for effective execution of IPC activities. The highly exhaustive, complex and ever-evolving infection surveillance methodology pose a challenge for effective data capture, analysis and interpretation by ground level personnel. The present review addresses the gaps in knowledge and day-to-day challenges in surveillance faced by infection control team for effective implementation of IPC activities.
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Affiliation(s)
- Renu Gupta
- Department of Microbiology, Institute of Human Behavior and Allied Sciences, New Delhi, India
| | - Sangeeta Sharma
- Department of Neuro Psychopharmacology, Institute of Human Behavior and Allied Sciences, New Delhi, India
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- Department of Microbiology, Institute of Human Behavior and Allied Sciences, New Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Lady Hardinge Medical College, New Delhi, India
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159
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Aloush S. Educating intensive care unit nurses to use central venous catheter infection prevention guidelines: effectiveness of an educational course. J Res Nurs 2018; 23:406-413. [PMID: 34394451 DOI: 10.1177/1744987118762992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Nurses' knowledge of central venous catheter-related infection (CVC-RI) prevention guidelines is poor, indicating that nurses do not receive proper education about these guidelines. Aim The aim of this study was to evaluate the effectiveness of an educational course that aimed to improve nurses' knowledge about CVC-RI prevention guidelines. Method A sample of 131 nurses were randomly assigned to the experimental group (received an educational course) or control group (received no education). Pre-Post data were collected using a structured questionnaire that included a 23-item knowledge assessment. Results In the pre-test, all participants demonstrated poor knowledge, with mean scores of 8.2 (standard deviation = 3.6). After completion of the course, knowledge was significantly improved in the experimental group, whereas the control group showed no change (t(106,3) = 25.1, p = 0.00). Conclusions An educational course on CVC-RI prevention guidelines had an encouraging effect. Decision makers are recommended to implement such courses in their settings to improve nurses' competency.
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Affiliation(s)
- Sami Aloush
- Assistant Professor, Adult Health Nursing Department, Al Albayt University, Jordan
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160
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Lara HH, Guisbiers G, Mendoza J, Mimun LC, Vincent BA, Lopez-Ribot JL, Nash KL. Synergistic antifungal effect of chitosan-stabilized selenium nanoparticles synthesized by pulsed laser ablation in liquids against Candida albicans biofilms. Int J Nanomedicine 2018; 13:2697-2708. [PMID: 29760550 PMCID: PMC5937483 DOI: 10.2147/ijn.s151285] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Candida albicans is a major opportunistic fungal pathogen. One of the most important virulence factors that contribute to the pathogenesis of candidiasis is its ability to form biofilms. A key characteristic of Candida biofilms is their resistance to antifungal agents. Due to significant morbidity and mortality rates related to biofilm-associated drug resistance, there is an urgency to develop novel nanotechnology-based approaches preventing biofilm-related infections. METHODS In this study, we report, for the first time, the synthesis of selenium nanoparticles by irradiating selenium pellets by nanosecond pulsed laser ablation in liquid chitosan as a capping agent. Synergy of the fungicidal effect of selenium nanoparticles and chitosan was quantified by the combination index theorem of Chou-Talalay. RESULTS This drug combination resulted in a potent fungicidal effect against a preformed C. albicans biofilm in a dose-response manner. By advanced electron microscopy techniques, we documented the adhesive and permeabilizing properties of chitosan, therefore allowing selenium nanoparticles to enter as the cell wall of the yeast became disrupted and distorted. Most importantly, we demonstrated a potent quantitative synergistic effect when compounds such as selenium and chitosan are combined. CONCLUSION These chitosan-stabilized selenium nanoparticles could be used for ex vivo applications such as sterilizers for surfaces and biomedical devices.
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Affiliation(s)
- Humberto H Lara
- Department of Biology and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Gregory Guisbiers
- Department of Physics and Astronomy, University of Arkansas at Little Rock, Little Rock, AR, USA
| | - Jonathan Mendoza
- Department of Physics and Astronomy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Lawrence C Mimun
- US Army Engineer Research & Development Center, Vicksburg, MS, USA
| | - Brandy A Vincent
- Department of Physics and Astronomy, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Jose L Lopez-Ribot
- Department of Biology and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Kelly L Nash
- Department of Physics and Astronomy, The University of Texas at San Antonio, San Antonio, TX, USA
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El Nekidy WS, Soong D, Kadri A, Tabbara O, Ibrahim A, Ghazi IM. Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist. Case Rep Nephrol Dial 2018; 8:121-129. [PMID: 30140677 PMCID: PMC6103365 DOI: 10.1159/000489923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022] Open
Abstract
Catheter-related blood stream infections comprise a major concern in hemodialysis patients, leading to increased mortality, morbidity, and cost of treatment. Prompt appropriate systemic antibiotics treatment, which includes administration of appropriate systemic antibiotics and, frequently, catheter removal and replacement, is warranted. However, in hemodialysis patients, repeated catheter insertions may cause central vein stenosis and thrombosis which limits the future availability of hemodialysis access. Lock solutions containing antibiotics and anticoagulants, instilled directly into the catheter lumen after each dialysis, have been successfully utilized for catheter salvage but higher rates of recurrence and complications were observed in infections resulting from staphylococcal species. We report several cases of catheter salvage using antibiotic lock solution in staphylococcal bacteremia with the purpose of stimulating the interest in randomized clinical trials. Evaluating the risk and benefits of catheter salvage in this patient subset in light of optimized systemic antibiotic dosing, improved lock solution use, and multidisciplinary involvement, balanced with the critical need to prevent unnecessary vascular trauma, is of great importance.
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Affiliation(s)
| | - Derrick Soong
- Department of Pharmacy, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Albert Kadri
- Department of Nephrology, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Osama Tabbara
- Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Amina Ibrahim
- Faculty of Biological Sciences, University of Windsor, Windsor, Ontario, Canada
| | - Islam M. Ghazi
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA
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Hamada SR, Fromentin M, Ronot M, Gauss T, Harrois A, Duranteau J, Paugam-Burtz C. Femoral arterial and central venous catheters in the trauma resuscitation room. Injury 2018; 49:927-932. [PMID: 29602488 DOI: 10.1016/j.injury.2018.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 02/11/2018] [Accepted: 03/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arterial and central venous femoral catheters (fAC-CVC) use during the initial management of severe trauma patients is not a standard technique in most trauma centers. Arguments in favor of their use are: continuous monitoring of blood pressure, safe drug administration, easy blood sampling and potentially large bore venous access. The lack of evidence makes the practice heterogeneous. The aim of the present study was to describe the use and complications of fAC-CVC in the trauma bay in two centers where they are routinely used. METHODS This was a retrospective analysis of routine fAC-CVC use from two French trauma centers. All patients admitted directly to the trauma resuscitation room were included. Demographic, clinical and biological data were collected from the scene to discharge to describe the use of catheters during initial trauma management including infectious, mechanical and thrombotic complications. RESULTS 243 pairs of femoral catheters were inserted among 692 patients admitted in both trauma centers. Femoral AC-CVC use was more frequent in critically ill patients with higher ISS 26 [17; 41] vs 13 [8; 24], p < 0.001(median [quartile 1-3]), severe traumatic brain injury (AIS head 1[0-4] vs 0[0-3], p < 0.001), lower systolic blood pressure, 92 (37) vs 113 (28) mmHg, p < 0.001 mean (standard deviation), lower haemoglobin on arrival, 10.9 (3) vs 13.3 (2.1) g/dL (p < 0.001), and higher blood lactate concentration, 4.0 (3.9) vs 2.1 (1.8) mmol/L (p < 0.001). In patients with fAC-CVC use time in the trauma room was longer, 46 [40;60] vs 30 [20;40] minutes (p < 0.05). In total 52 colonizations and 3 bloodstream infections were noted in 1000 catheter days. An incidence of 12% of mechanical complications and of 42% deep venous thromboses were observed. Of the latter none was associated with confirmed pulmonary embolism. CONCLUSION Femoral AC-CVC appeared to be deployed more often in critically ill patients, presenting with shock and/or traumatic brain injury in particular. The observed rate of complications in this sample seems to be low compared to reported rates.
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Affiliation(s)
- S R Hamada
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Université Paris Sud, 78 rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France.
| | - M Fromentin
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, 27 Rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - M Ronot
- Radiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Université Paris Diderot, 100 rue du Général Leclerc, Clichy, Paris 7, 92110, France
| | - T Gauss
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Université Paris Diderot, 100 rue du Général Leclerc, Clichy, Paris 7, 92110, France
| | - A Harrois
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Université Paris Sud, 78 rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
| | - J Duranteau
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Université Paris Sud, 78 rue du Général Leclerc, Le Kremlin Bicêtre, 94275, France
| | - C Paugam-Burtz
- Anaesthesia and Critical Care Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Université Paris Diderot, 100 rue du Général Leclerc, Clichy, Paris 7, 92110, France
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Guzmán Ramos PJ, Fernández Pérez C, Ayllón Santiago T, Baquero Artigao MR, Ortiz‐Díez G. Incidence of and associated factors for bacterial colonization of intravenous catheters removed from dogs in response to clinical complications. J Vet Intern Med 2018; 32:1084-1091. [PMID: 29602241 PMCID: PMC5980313 DOI: 10.1111/jvim.15118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 12/21/2017] [Accepted: 02/14/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Infection rate associated with intravenous (IV) catheter placement is emerging as an important issue in small animal veterinary medicine, mostly because of the economic costs associated with these infections. Identification of possible associated factors may provide useful information for the surveillance and prevention of such infections. OBJECTIVES To determine the incidence of positive bacterial cultures obtained from IV catheters used in dogs hospitalized for at least 48 hours and removed because of clinical complication. To identify the bacteria involved and factors associated with bacterial colonization. ANIMALS One-hundred eighty-two dogs that underwent IV catheterization from January 2015 to July 2015 at the Veterinary Teaching Hospital of Alfonso X el Sabio University of Madrid were enrolled in the study. RESULTS The bacterial colonization rate of all IV catheters removed in response to clinical complications was 39.6%, the cumulative proportion of catheters that remained in place at 24, 48, and 72 hours after placement was 89.5, 78, and 59.4%, respectively. Multivariable Cox proportional hazards regression indicated significant associations for staff who performed catheterization (junior, P = .002; student, P = .034) and use of steroidal anti-inflammatory drugs (P = .036). The most frequently isolated bacterium was Acinetobacter spp. (21.7%). CONCLUSIONS AND CLINICAL IMPORTANCE The bacterial colonization incidence related to IV catheter placement was slightly higher than the incidence described in other veterinary studies. Associated factors not previously described in veterinary medicine were found. The most frequently isolated organism was Acinetobacter spp., indicating its importance as an emerging pathogen in catheter colonization.
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Affiliation(s)
- Pedro Jose Guzmán Ramos
- Hospital Clínico Veterinario de la Universidad Alfonso X el Sabio, Universidad Alfonso X el SabioMadridSpain
| | - Cristina Fernández Pérez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Hospital Universitario Clínico San Carlos (Servicio de Medicina Preventiva), Universidad Complutense de MadridMadridSpain
| | - Tania Ayllón Santiago
- Instituto Nacional de Infectología Evandro Chagas, Núcleo Operacional Centinela de Mosquitos Vetores FiocruzRío de JaneiroBrazil
- Departamento de Microbiología de la Universidad Alfonso X el SabioMadridSpain
| | | | - Gustavo Ortiz‐Díez
- Hospital Clínico Veterinario de la Universidad Alfonso X el Sabio, Universidad Alfonso X el SabioMadridSpain
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164
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Alonso B, Pérez-Granda MJ, Rodríguez-Huerta A, Rodríguez C, Bouza E, Guembe M. The optimal ethanol lock therapy regimen for treatment of biofilm-associated catheter infections: an in-vitro study. J Hosp Infect 2018; 100:e187-e195. [PMID: 29653134 DOI: 10.1016/j.jhin.2018.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/04/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Ethanol-based lock therapy (LT) solutions are used as an alternative to antibiotics for the conservative management of catheter-related bloodstream infection. However, no clear consensus on regimen or dose has been reached. AIM To find the ethanol-based lock solution containing a sufficiently low concentration of ethanol for reduction of the metabolic activity of bacterial and fungal biofilms. METHODS Using an in-vitro model, three concentrations of ethanol (25%, 40%, 70%) were tested, with and without 60 IU of heparin, at six different time-points and against 24 h preformed biofilms of Staphylococcus aureus ATCC29213, Staphylococcus epidermidis (clinical isolate), Enterococcus faecalis ATCC33186, Candida albicans ATCC14058, and Escherichia coli ATCC25922. The reduction in the metabolic activity of the biofilm was measured using the tetrazolium salt assay and LT was considered to be successful when metabolic activity fell by >90%. Regrowth inhibition was then tested within 24 h and seven days after each LT regimen only at the ethanol concentration of the most successful LT regimen. FINDINGS The most successful LT was achieved with 40% ethanol + 60 IU of heparin only at 24, 72, and 24 h for seven-day regimens (P < 0.05). However, none of the regimens reached 45% RI within seven days of therapy. CONCLUSION According to our in-vitro data, an ethanol-based lock solution with 40% ethanol + 60 IU heparin administered daily for 72 h is sufficient to almost eradicate the metabolic activity of bacterial and fungal biofilms. Future studies are needed to study cell regrowth after LT.
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Affiliation(s)
- B Alonso
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M J Pérez-Granda
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain
| | - A Rodríguez-Huerta
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Microbiology Department, Faculty of Medicine, Universidad Complutense de Madrid, Spain
| | - M Guembe
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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165
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Yap HY, Pang SC, Tan CS, Tan YL, Goh N, Achudan S, Lee KG, Tan RY, Choong LHL, Chong TT. Catheter-related complications and survival among incident hemodialysis patients in Singapore. J Vasc Access 2018; 19:602-608. [DOI: 10.1177/1129729818765055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Hemodialysis is the main modality of renal replacement therapy in Singapore. However, a majority of the patients in Singapore are initiated on hemodialysis via a catheter. This study examines the complication rates and factors predicting catheter-related bloodstream infections and mortality rates in patients who were initiated on hemodialysis at our institution. Methods: This is a single-center retrospective analysis of incident hemodialysis patients who were initiated on renal replacement therapy between 1 January 2010 and 31 December 2012. Catheter-related bloodstream infection risk factors, organisms, and associated mortality were analyzed. Results: The catheter-related bloodstream infection and exit site infection incidence rates were 0.75 and 0.50 per 1000 catheter days, respectively. The mean duration to first catheter-related bloodstream infection episode was 182.47 ± 144.04 catheter days. Prolonged catheter duration was found to be a risk factor for catheter-related bloodstream infection. Compared to patients initiated on dialysis via arteriovenous fistula, initiation of dialysis via catheter is strongly associated with increased mortality (6.0% vs 14.5%; p = 0.02). In particular, the presence of diabetes mellitus and development of catheter-related bloodstream infection was associated with increased mortality ( p = 0.04 and 0.05, respectively). In addition, patients who began hemodialysis before being seen by a nephrologist were associated with decreased mortality (3.4% vs 13.0%; p = 0.03). Conclusion: In conclusion, prolonged duration of catheter insertion is found to be a risk factor for catheter-related bloodstream infection in hemodialysis patients, and its development is associated with increased mortality. Early referral to a nephrologist and creation of arteriovenous fistula in pre-end-stage renal disease patients are pivotal in improving the outcomes of patients.
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Affiliation(s)
- Hao-Yun Yap
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Suh-Chien Pang
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Chieh-Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yi-Liang Tan
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Nicholette Goh
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Shaam Achudan
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Kian-Guan Lee
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Ru-Yu Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | | - Tze-Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
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166
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Oliveira W, Silva P, Silva R, Silva G, Machado G, Coelho L, Correia M. Staphylococcus aureus and Staphylococcus epidermidis infections on implants. J Hosp Infect 2018; 98:111-117. [DOI: 10.1016/j.jhin.2017.11.008] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/15/2017] [Indexed: 01/11/2023]
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167
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Xu LC, Li Z, Tian Z, Chen C, Allcock HR, Siedlecki CA. A new textured polyphosphazene biomaterial with improved blood coagulation and microbial infection responses. Acta Biomater 2018; 67:87-98. [PMID: 29229544 DOI: 10.1016/j.actbio.2017.11.056] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 12/16/2022]
Abstract
A new poly[bis(octafluoropentoxy) phosphazene] (OFP) was synthesized for the purpose of blood contacting medical devices. OFP was further either developed into crosslinkable polyphosphazene (X-OFP) or blended with polyurethane (PU) as the mixture (OFP/PU) for improvement of mechanical property of polyphosphazene polymers. All the materials were fabricated as smooth films or further textured with submicron pillars for the assay of antimicrobial and antithrombotic properties. Results showed that crosslinkable OFP (X-OFP) and blends of OFP/PU successfully improved the mechanical strength of OFP and fewer defects of pillars were found on the textured polyphosphazene surfaces. The antithrombotic experiments showed that polyphosphazene OFP materials reduced human Factor XII activation and platelet adhesion, thereby being resistant to plasma coagulation and thrombosis. The bacterial adhesion and biofilm experiments demonstrated that OFP materials inhibited staphylococcal bacterial adhesion and biofilm formation. The surface texturing further reduced the platelet adhesion and bacterial adhesion, and inhibited biofilm formation up to 23 days. The data suggested that textured OFP materials may provide a practical approach to improve the biocompatibility of current biomaterials in the application of blood contacting medical devices with significant reduction in risk of pathogenic infection and thrombosis. STATEMENT OF SIGNIFICANCE The thromboembolic events and microbial infection have been the significant barriers for the long term use of biomaterials in blood-contacting medical devices. The development of new materials with multiple functions including anti-thrombosis and antibacterial surfaces is a high research priority. This study synthesized new biostable and biocompatible polyphosphazene polymers, poly[bis(octafluoropentoxy)phosphazene] (OFP) and crosslinkable OFP, and successfully improved the mechanical strength of polyphosphazenes. Polymers were fabricated into textured films with submicron pillars on the surfaces. The antimicrobial and antithrombotic assays demonstrated that new materials combined with surface physical modification have significant reduction in risk of pathogenic infection and thrombosis, and improve the biocompatibility of current biomaterials in the application of blood-contacting medical devices. It would be interest to biomaterials and bioengineering related communities.
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Affiliation(s)
- Li-Chong Xu
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, United States.
| | - Zhongjing Li
- Department of Chemistry, The Pennsylvania State University, University Park, PA 16802, United States
| | - Zhicheng Tian
- Department of Chemistry, The Pennsylvania State University, University Park, PA 16802, United States
| | - Chen Chen
- Department of Chemistry, The Pennsylvania State University, University Park, PA 16802, United States
| | - Harry R Allcock
- Department of Chemistry, The Pennsylvania State University, University Park, PA 16802, United States
| | - Christopher A Siedlecki
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, United States; Department of Bioengineering, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, United States
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168
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Omotani S, Tani K, Aoe M, Esaki S, Nagai K, Hatsuda Y, Mukai J, Teramachi H, Myotoku M. Bactericidal effects of deep ultraviolet light-emitting diode for solutions during intravenous infusion. Int J Med Sci 2018; 15:101-107. [PMID: 29333093 PMCID: PMC5765722 DOI: 10.7150/ijms.22206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/13/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Ultraviolet irradiation is effectively used as a disinfection method for inactivating microorganisms. Methods: We investigated the bactericidal effects by irradiation with a deep-ultraviolet light-emitting diode (DUV-LED) on the causative microorganisms of catheter related blood stream infection contaminating the solution for intravenous infusion. For irradiation, prototype modules for water disinfection with a DUV-LED were used. Experiments were conducted on five kinds of microorganisms. We examined the dependence of bactericidal action on eleven solutions. Administration sets were carried out three types. Results: When the administration set JY-PB343L containing the infusion tube made of polybutadiene was used, the bactericidal action of the DUV-LED against all tested microorganisms in the physiological saline solutions was considered to be effective. We confirmed that the number of viable bacteria decreased in 5% glucose solution and electrolyte infusions with DUV-LED irradiation. Conclusions: These results indicate that the DUV-LED irradiation has bactericidal effects in glucose infusion and electrolyte infusions by irradiating via a plasticizer-free polybutadiene administration set. We consider DUV-LED irradiation to be clinically applicable.
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Affiliation(s)
| | | | - Mai Aoe
- Faculty of Pharmacy, Osaka Ohtani University
| | - Seiji Esaki
- Faculty of Pharmacy, Osaka Ohtani University
| | | | | | - Junji Mukai
- Faculty of Pharmacy, Osaka Ohtani University
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169
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Pérez-Granda MJ, Alonso B, Rodríguez-Huerta A, Rodríguez C, Guembe M. In vitro assessment of the anti-biofilm activity of ethanol alone and in combination with enoxaparin 60IU. Enferm Infecc Microbiol Clin 2017; 36:627-632. [PMID: 29224997 DOI: 10.1016/j.eimc.2017.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/31/2017] [Accepted: 11/05/2017] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Catheter-related bloodstream infection (C-RBSI) can sometimes be managed without catheter removal by combining systemic therapy with catheter lock therapy. Most antiseptic lock solutions are made up of ethanol combined with an anticoagulant. However, data regarding the anti-biofilm activity of ethanol combined with enoxaparin are scarce. We aimed to assess the efficacy of ethanol at different concentrations combined with enoxaparin 60IU as a lock solution for eradication of the biofilm of different microorganisms. METHODS Using a static 96-well plate in vitro model, we tested 30%, 35%, and 40% ethanol alone and combined with 60IU of enoxaparin against 24-h-old biofilm from the following microorganisms: Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Escherichia coli, and Candida albicans. Time of exposure was assessed during a 2-h and 24-h regimen. We analysed the percentage reduction in metabolic activity using the XTT assay. We considered therapy to be successful when metabolic activity was reduced by >90%. RESULTS In the 2-h regimen, the therapy was successful against all microorganisms at 35% and 40% ethanol without enoxaparin (p<0.001). In the 24-h regimen, the therapy was successful against all microorganisms at all ethanol solutions without enoxaparin (p<0.001). When ethanol was combined with enoxaparin, the therapy was only successful in the 24-h regimen in biofilms of S. epidermidis, C. albicans and E. coli at all concentrations of ethanol assessed. CONCLUSIONS Our in vitro model demonstrated that when ethanol is combined with enoxaparin in a lock solution, it negatively affects ethanol anti-biofilm activity after both short and long exposures.
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Affiliation(s)
- María Jesús Pérez-Granda
- Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES, Madrid, Spain; Department of Nursing, Faculty of Nursing, Physiotherapy and Pediatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Beatriz Alonso
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Rodríguez-Huerta
- Servicio de Hematología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carmen Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Guembe
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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170
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Reidenberg BE, Wanner C, Polsky B, Castanheira M, Shelip A, Stalleicken D, Pfaffle AE. Postmarketing experience with Neutrolin® (taurolidine, heparin, calcium citrate) catheter lock solution in hemodialysis patients. Eur J Clin Microbiol Infect Dis 2017; 37:661-663. [PMID: 29214504 PMCID: PMC5978892 DOI: 10.1007/s10096-017-3157-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/29/2017] [Indexed: 12/02/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) are major complications for patients with life-threatening conditions requiring chronic vascular catheterization. The wide range of etiologic microbes and the ongoing development of resistance to antimicrobials with specific mechanisms of action make this an appropriate target for applying a nonspecific antimicrobial therapeutic. Taurolidine hydrolyzes into two antimicrobial moieties, formaldehyde and methylene glycol, which react with microbial surfaces. Neutrolin® (taurolidine, heparin, calcium citrate) was recently introduced in Germany as an antimicrobial catheter lock solution. This postmarketing experience collected data on 201 patients at 20 centers from January 2014 through September 2016. Likely CRBSI was observed in 13 episodes in 47,118 days (0.2759 per 1000 days [0.1468, 0.4718]). Thrombosed catheter was observed in seven catheters in 47,118 days (0.1486 per 1000 days [0.0595, 0.3061]). No adverse drug reactions that led to the discontinuation of Neutrolin® use were reported. Two patients experienced occasional transient dysgeusia. Neutrolin®, when used in conjunction with guideline-based catheter care, showed reduction in the rate of both CRBSI and catheter thrombosis relative to recent historical controls.
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Affiliation(s)
- Bruce E Reidenberg
- Department of Pharmacology, Weill Cornell Medicine, 1300 York Ave., New York, NY, 10021, USA.
| | - Christoph Wanner
- Division of Nephrology, University of Wurzburg, Wurzburg, Germany
| | - Bruce Polsky
- Department of Medicine, NYU Winthrop Hospital, Mineola, NY, USA
| | | | - Alla Shelip
- CorMedix, Inc., 400 Connell Drive, Suite 5000, Berkeley Heights, NJ, 07922, USA
| | | | - Antony E Pfaffle
- CorMedix, Inc., 400 Connell Drive, Suite 5000, Berkeley Heights, NJ, 07922, USA.
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171
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Kroupa J, Knot J, Ulman J, Bednar F, Dohnalova A, Motovska Z. Clinical and laboratory predictors of Infectious Complications in patients after Out-of-Hospital Cardiac Arrest. J Crit Care 2017; 42:85-91. [DOI: 10.1016/j.jcrc.2017.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/07/2017] [Accepted: 07/03/2017] [Indexed: 01/15/2023]
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172
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Wallace A, Albadawi H, Patel N, Khademhosseini A, Zhang YS, Naidu S, Knuttinen G, Oklu R. Anti-fouling strategies for central venous catheters. Cardiovasc Diagn Ther 2017; 7:S246-S257. [PMID: 29399528 DOI: 10.21037/cdt.2017.09.18] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Central venous catheters (CVCs) are ubiquitous in the healthcare industry and carry two common complications, catheter related infections and occlusion, particularly by thrombus. Catheter-related bloodstream infections (CRBSI) are an important cause of nosocomial infections that increase patient morbidity, mortality, and hospital cost. Innovative design strategies for intravenous catheters can help reduce these preventable infections. Antimicrobial coatings can play a major role in preventing disease. These coatings can be divided into two major categories: drug eluting and non-drug eluting. Much of these catheter designs are targeted at preventing the formation of microbial biofilms that make treatment of CRBSI nearly impossible without removal of the intravenous device. Exciting developments in catheter impregnation with antibiotics as well as nanoscale surface design promise innovative changes in the way that physicians manage intravenous catheters. Occlusion of a catheter renders the catheter unusable and is often treated by tissue plasminogen activator administration or replacement of the line. Prevention of this complication requires a thorough understanding of the mechanisms of platelet aggregation, signaling and cross-linking. This article will look at the advances in biomaterial design specifically drug eluting, non-drug eluting, lubricious coatings and micropatterning as well as some of the characteristics of each as they relate to CVCs.
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Affiliation(s)
- Alex Wallace
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Nikasha Patel
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Ali Khademhosseini
- Department of Bioengineering, Department of Chemical and Biomolecular Engineering, Henry Samueli School of Engineering and Applied Sciences, University of California-Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.,Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA, USA.,California NanoSystems Institute (CNSI), University of California-Los Angeles (UCLA), Los Angeles, CA, USA
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Sailendra Naidu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Grace Knuttinen
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
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173
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Kim GH, Lee SB, Kim JH, Lee CK. Peripherally Inserted Central Catheter in Trauma Patients: Early Experience at a Single Institute. JOURNAL OF ACUTE CARE SURGERY 2017. [DOI: 10.17479/jacs.2017.7.2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Gil Hwan Kim
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Sang Bong Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Hun Kim
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Chan Kyu Lee
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
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174
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Rosa L, Cutone A, Coletti M, Lepanto MS, Scotti M, Valenti P, Raponi G, Ghezzi MC, Berlutti F. Biotimer assay: A reliable and rapid method for the evaluation of central venous catheter microbial colonization. J Microbiol Methods 2017; 143:20-25. [PMID: 28966069 DOI: 10.1016/j.mimet.2017.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 01/17/2023]
Abstract
Adherent bacteria and biofilm frequently colonize central venous catheters (CVCs). CVC colonization is correlated to infections and particularly to bloodstream ones. The classical microbiological methods to determine of CVC colonization are not fully reliable and are time-consuming. BioTimer Assay (BTA) is a biological method already used to count bacteria adherent to abiotic surfaces and biofilm without sample manipulation. BTA employs specific reagents whose color changed according to bacterial metabolism. BTA is based on the principle that a metabolic reaction will be faster when more bacteria are present in the sample. Therefore, the time required for color changes of BTA reagents determines the number of bacteria present in the sample through a correlation line. Here, for the first time, we applied BTA and a specifically developed laboratory procedure to evaluate CVC colonization in comparison with the routine microbiological method (RMM). 125 CVCs removed from patients for suspected catheter-related bloodstream infection (CRBSI) or at hospital discharge were examined. BTA was reliable in assessing sterility and CVC colonization (100% agreement with RMM) and in recognizing the presence of fermenting or non-fermenting bacteria (97.1% agreement with RMM) shortening the analytical time by between 2- and 3-fold. Moreover, the reliability of BTA as early alert of CRBSI was evaluated. The sensitivity, specificity, positive, and negative predictive values for BTA as an early alert of CRBSI were 100, 40.0, 88.8 and 100%, respectively. In conclusion, BTA and the related laboratory procedure should be incorporated into routine microbiological methods since it can be considered a reliable tool to evaluate CVC colonization in a very short time and a rapid alert for CRBSIs.
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Affiliation(s)
- Luigi Rosa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.ale A. Moro, 5, 00185 Rome, Italy.
| | - Antimo Cutone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.ale A. Moro, 5, 00185 Rome, Italy.
| | - Monica Coletti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.ale A. Moro, 5, 00185 Rome, Italy.
| | - Maria Stefania Lepanto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.ale A. Moro, 5, 00185 Rome, Italy.
| | - Mellani Scotti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.ale A. Moro, 5, 00185 Rome, Italy.
| | - Piera Valenti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.ale A. Moro, 5, 00185 Rome, Italy.
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.ale A. Moro, 5, 00185 Rome, Italy.
| | - Maria Cristina Ghezzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.ale A. Moro, 5, 00185 Rome, Italy
| | - Francesca Berlutti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.ale A. Moro, 5, 00185 Rome, Italy.
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175
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Lucas N, Humble M, Sim D, Balm M, Carter J, Weinkove R. Temporal changes in neutropenic blood culture isolates and disease associations: a single centre series of 1139 episodes. Intern Med J 2017; 47:962-965. [PMID: 28782216 DOI: 10.1111/imj.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/26/2017] [Accepted: 02/26/2017] [Indexed: 11/29/2022]
Abstract
Neutropenic infections are life-threatening and require empiric antibiotic treatment. We examined 1139 blood culture isolates from our institution over a 36-year period from neutropenic patients to examine temporal trends and disease associations. Positive associations were found between viridans streptococci and acute myeloid leukaemia, coagulase negative staphylococci and acute lymphoblastic leukaemia and Pseudomonas aeruginosa and indolent B-cell malignancies.
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Affiliation(s)
- Nathanael Lucas
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand.,School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Michael Humble
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Dalice Sim
- Dean's Department, University of Otago, Wellington, New Zealand
| | - Michelle Balm
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand.,Wellington Southern Community Laboratories, Wellington Hospital, Wellington, New Zealand.,Infection Services, Capital and Coast District Health Board, Wellington, New Zealand
| | - John Carter
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand.,Wellington Blood and Cancer Centre, Capital and Coast District Health Board, Wellington, New Zealand
| | - Robert Weinkove
- Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand.,Malaghan Institute of Medical Research, Wellington, New Zealand.,Wellington Blood and Cancer Centre, Capital and Coast District Health Board, Wellington, New Zealand
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176
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Affiliation(s)
- Kevin Hugill
- Director of Nursing, Hamad Medical Corporation, Doha Qatar
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177
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Manuel W. A guide to vascular access in haemodialysis patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:1-7. [PMID: 28745968 DOI: 10.12968/bjon.2017.26.14.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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178
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Efficient Killing of Planktonic and Biofilm-Embedded Coagulase-Negative Staphylococci by Bactericidal Protein P128. Antimicrob Agents Chemother 2017; 61:AAC.00457-17. [PMID: 28559263 DOI: 10.1128/aac.00457-17] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/21/2017] [Indexed: 01/10/2023] Open
Abstract
Coagulase-negative staphylococci (CoNS) are the major causative agents of foreign-body-related infections, including catheter-related bloodstream infections. Because of the involvement of biofilms, foreign-body-related infections are difficult to treat. P128, a chimeric recombinant phage-derived ectolysin, has been shown to possess bactericidal activity on strains of Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA). We tested the killing potential of P128 on three clinically significant species of CoNS, S. epidermidis, S. haemolyticus, and S. lugdunensis, under a variety of physiological conditions representing growing and nongrowing states. The MIC90 and minimum bactericidal concentration at which 90% of strains tested are killed (MBC90) of P128 on 62 clinical strains of CoNS were found to be 16 and 32 μg/ml (0.58 and 1.16 μM), respectively, demonstrating the bactericidal nature of P128 on CoNS strains. Serum showed a potentiating effect on P128 inhibition, as indicated by 4- to 32-fold lower MIC values observed in serum. P128 caused a rapid loss of viability in all CoNS strains tested. Persisters of CoNS that were enriched in the presence of vancomycin or daptomycin were killed by P128 at 1× the MIC in a rapid manner. Low concentrations of P128 caused a 2- to 5-log reduction in CFU in stationary-phase or poorly metabolizing CoNS cultures. P128 at low concentrations eliminated CoNS biofilms in microtiter plates and on the surface of catheters. Combinations of P128 and standard-of-care (SoC) antibiotics were highly synergistic in inhibiting growth in preformed biofilms. Potent activity on planktonic cells, persisters, and biofilms of CoNS suggests that P128 is a promising candidate for the clinical development of treatments for foreign-body-related and other CoNS infections.
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179
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Wo Y, Li Z, Colletta A, Wu J, Xi C, Matzger AJ, Brisbois EJ, Bartlett RH, Meyerhoff ME. Study of Crystal Formation and Nitric Oxide (NO) Release Mechanism from S-Nitroso- N-acetylpenicillamine (SNAP)-Doped CarboSil Polymer Composites for Potential Antimicrobial Applications. COMPOSITES. PART B, ENGINEERING 2017; 121:23-33. [PMID: 28989300 PMCID: PMC5625630 DOI: 10.1016/j.compositesb.2017.03.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Stable and long-term nitric oxide (NO) releasing polymeric materials have many potential biomedical applications. Herein, we report the real-time observation of the crystallization process of the NO donor, S-nitroso-N-acetylpenicillamine (SNAP), within a thermoplastic silicone-polycarbonate-urethane biomedical polymer, CarboSil 20 80A. It is demonstrated that the NO release rate from this composite material is directly correlated with the surface area that the CarboSil polymer film is exposed to when in contact with aqueous solution. The decomposition of SNAP in solution (e.g. PBS, ethanol, THF, etc.) is a pseudo-first-order reaction proportional to the SNAP concentration. Further, catheters fabricated with this novel NO releasing composite material are shown to exhibit significant effects on preventing biofilm formation on catheter surface by Pseudomonas aeruginosa and Proteus mirabilis grown in CDC bioreactor over 14 days, with a 2 and 3 log-unit reduction in number of live bacteria on their surfaces, respectively. Therefore, the SNAP-CarboSil composite is a promising new material to develop antimicrobial catheters, as well as other biomedical devices.
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Affiliation(s)
- Yaqi Wo
- Department of Chemistry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Zi Li
- Department of Chemistry, University of Michigan, Ann Arbor, MI, 48109, USA
| | | | - Jianfeng Wu
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Chuanwu Xi
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Adam J. Matzger
- Department of Chemistry, University of Michigan, Ann Arbor, MI, 48109, USA
| | | | - Robert H. Bartlett
- Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Mark E. Meyerhoff
- Department of Chemistry, University of Michigan, Ann Arbor, MI, 48109, USA
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180
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Wo Y, Xu LC, Li Z, Matzger AJ, Meyerhoff ME, Siedlecki CA. Antimicrobial nitric oxide releasing surfaces based on S-nitroso-N-acetylpenicillamine impregnated polymers combined with submicron-textured surface topography. Biomater Sci 2017; 5:1265-1278. [PMID: 28560367 PMCID: PMC6290899 DOI: 10.1039/c7bm00108h] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A novel dual functioning antimicrobial CarboSil 20 80A polymer material that combines physical topographical surface modification and nitric oxide (NO) release is prepared and evaluated for its efficacy in reducing bacterial adhesion in vitro. The new biomaterial is created via a soft lithography two-stage replication process to induce submicron textures on its surface, followed by solvent impregnation with the NO donor, S-nitroso-N-acetylpenicillamine (SNAP), to obtain long-term (up to 38 d) NO release. The NO releasing textured polymer surface is evaluated against four bacteria commonly known to cause infections in hospital settings and the results demonstrate that the combined strategy enables a synergistic effect on reducing the bacterial adhesion of Staphylococcus epidermidis and Pseudomonas aeruginosa bacteria.
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Affiliation(s)
- Yaqi Wo
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Li-Chong Xu
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, USA
| | - Zi Li
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Adam J. Matzger
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mark E. Meyerhoff
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Christopher A. Siedlecki
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, USA
- Department of Bioengineering, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, USA
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181
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Hashem AA, Abd El Fadeal NM, Shehata AS. In vitro activities of vancomycin and linezolid against biofilm-producing methicillin-resistant staphylococci species isolated from catheter-related bloodstream infections from an Egyptian tertiary hospital. J Med Microbiol 2017; 66:744-752. [DOI: 10.1099/jmm.0.000490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Asmaa A. Hashem
- Department of Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Noha M. Abd El Fadeal
- Department of Medical Biochemistry, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Atef S. Shehata
- Department of Microbiology and Immunology, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
- Department of Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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182
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Gominet M, Compain F, Beloin C, Lebeaux D. Central venous catheters and biofilms: where do we stand in 2017? APMIS 2017; 125:365-375. [PMID: 28407421 DOI: 10.1111/apm.12665] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/29/2016] [Indexed: 12/28/2022]
Abstract
The use of central venous catheters (CVC) is associated with a risk of microbial colonization and subsequent potentially severe infection. Microbial contamination of the catheter leads to the development of a microbial consortia associated with the CVC surface and embedded in an extracellular matrix, named biofilm. This biofilm provides bacterial cells the ability to survive antimicrobial agents and the host immune system and to disseminate to other sites of the body. The best preventive strategy is to avoid any unnecessary catheterization or to reduce indwelling duration when a CVC is required. Beside aseptic care and antibiotic-impregnated catheters (like minocycline/rifampin), preventive locks can be proposed in some cases, whereas non-biocidal approaches are under active research like anti-adhesive or competitive interactions strategies. When the diagnosis of catheter-related bloodstream infection (CRBSI) is suspected on clinical symptoms, it requires a microbiological confirmation by paired blood cultures in order to avoid unnecessary catheter removal. The treatment of CRBSI relies on catheter removal and systemic antimicrobials. However, antibiotic lock technique (ALT) can be used as an attempt to eradicate biofilm formed on the inside lumen of the catheter in case of uncomplicated long-term catheter-related BSI caused by coagulase-negative staphylococci (CoNS) or Enterobacteriaceae. Recently, promising strategies have been developed to improve biofilm eradication; they rely on matrix degradation or destabilization or the development of anti-persister compounds, targeting the most tolerant bacterial cells inside the biofilm. Understanding biofilm formation at the molecular level may help us to develop new approaches to prevent or treat these frequent infections.
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Affiliation(s)
- Marie Gominet
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Paris, France
| | - Fabrice Compain
- Université Paris Descartes, Paris, France.,Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Christophe Beloin
- Unité de Génétique des Biofilms, Département de Microbiologie, Institut Pasteur, Paris, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Paris, France
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183
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Wo Y, Brisbois EJ, Wu J, Li Z, Major TC, Mohammed A, Wang X, Colletta A, Bull JL, Matzger AJ, Xi C, Bartlett RH, Meyerhoff ME. Reduction of Thrombosis and Bacterial Infection via Controlled Nitric Oxide (NO) Release from S-Nitroso- N-acetylpenicillamine (SNAP) Impregnated CarboSil Intravascular Catheters. ACS Biomater Sci Eng 2017; 3:349-359. [PMID: 28317023 PMCID: PMC5351555 DOI: 10.1021/acsbiomaterials.6b00622] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/21/2017] [Indexed: 01/15/2023]
Abstract
Nitric oxide (NO) has many important physiological functions, including its ability to inhibit platelet activation and serve as potent antimicrobial agent. The multiple roles of NO in vivo have led to great interest in the development of biomaterials that can deliver NO for specific biomedical applications. Herein, we report a simple solvent impregnation technique to incorporate a nontoxic NO donor, S-nitroso-N-acetylpenicillamine (SNAP), into a more biocompatible biomedical grade polymer, CarboSil 20 80A. The resulting polymer-crystal composite material yields a very stable, long-term NO release biomaterial. The SNAP impregnation process is carefully characterized and optimized, and it is shown that SNAP crystal formation occurs in the bulk of the polymer after solvent evaporation. LC-MS results demonstrate that more than 70% of NO release from this new composite material originates from the SNAP embedded CarboSil phase, and not from the SNAP species leaching out into the soaking solution. Catheters prepared with CarboSil and then impregnated with 15 wt % SNAP provide a controlled NO release over a 14 d period at physiologically relevant fluxes and are shown to significantly reduce long-term (14 day) bacterial biofilm formation against Staphylococcus epidermidis and Pseudonomas aeruginosa in a CDC bioreactor model. After 7 h of catheter implantation in the jugular veins of rabbit, the SNAP CarboSil catheters exhibit a 96% reduction in thrombus area (0.03 ± 0.01 cm2/catheter) compared to the controls (0.84 ± 0.19 cm2/catheter) (n = 3). These results suggest that SNAP impregnated CarboSil can become an attractive new biomaterial for use in preparing intravascular catheters and other implanted medical devices.
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Affiliation(s)
- Yaqi Wo
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Elizabeth J. Brisbois
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Jianfeng Wu
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Zi Li
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Terry C. Major
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Azmath Mohammed
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Xianglong Wang
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Alessandro Colletta
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Joseph L. Bull
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Adam J. Matzger
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Chuanwu Xi
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Robert H. Bartlett
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Mark E. Meyerhoff
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
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184
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:216-230. [DOI: 10.1007/s00103-016-2485-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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185
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Aggarwal M, Vijan V, Vupputuri A, Nandakumar S, Mathew N. A Rare Case of Fatal Endocarditis and Sepsis Caused by Pseudomonas aeruginosa in a Patient with Chronic Renal Failure. J Clin Diagn Res 2016; 10:OD12-3. [PMID: 27630891 DOI: 10.7860/jcdr/2016/20220.8175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 05/10/2016] [Indexed: 11/24/2022]
Abstract
Nosocomial catheter-related and Arteriovenous fistula (AV)-related infections are significant concern in patients undergoing haemodialysis. These infections are associated with multiple complications as well as mortality and demands immediate and appropriate management. While coagulase-negative staphylococci, S.aureus, and Escherichia coli are the most common causes of catheter-related infections in haemodialysis patients, such infections caused by Pseudomonas aeruginosa are relatively rare. Here, we present an unusual case of 36-year-old male patient with chronic renal failure, who developed endocarditis and sepsis from Pseudomonas aeruginosa infection of the left hand arteriovenous fistula. The bacteraemia in the present case caused multiple complications including dry gangrene of bilateral lower limbs, stroke, endophthalmitis, left brachial artery thrombosis and vegetations on the interventricular septum and aortic wall. Despite antibiotic treatment, the patient suffered a cardiac arrest and could not be revived.
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Affiliation(s)
- Manav Aggarwal
- Consultant, Department of Cardiology, Amrita Institute of Medical Sciences (AIMS), Amrita Vishwa Vidyapeetham University , Kochi, Kerala, India
| | - Vikrant Vijan
- Consultant, Department of Cardiology, Amrita Institute of Medical Sciences (AIMS), Amrita Vishwa Vidyapeetham University , Kochi, Kerala, India
| | - Anjith Vupputuri
- Consultant, Department of Cardiology, Amrita Institute of Medical Sciences (AIMS), Amrita Vishwa Vidyapeetham University , Kochi, Kerala, India
| | - Sandya Nandakumar
- Technician, Department of Cardiology, Amrita Institute of Medical Sciences (AIMS), Amrita Vishwa Vidyapeetham University , Kochi, Kerala, India
| | - Navin Mathew
- Professor, Department of Cardiology, Amrita Institute of Medical Sciences (AIMS), Amrita Vishwa Vidyapeetham University , Kochi, Kerala, India
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186
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Wo Y, Brisbois EJ, Bartlett RH, Meyerhoff ME. Recent advances in thromboresistant and antimicrobial polymers for biomedical applications: just say yes to nitric oxide (NO). Biomater Sci 2016; 4:1161-83. [PMID: 27226170 PMCID: PMC4955746 DOI: 10.1039/c6bm00271d] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Biomedical devices are essential for patient diagnosis and treatment; however, when blood comes in contact with foreign surfaces or homeostasis is disrupted, complications including thrombus formation and bacterial infections can interrupt device functionality, causing false readings and/or shorten device lifetime. Here, we review some of the current approaches for developing antithrombotic and antibacterial materials for biomedical applications. Special emphasis is given to materials that release or generate low levels of nitric oxide (NO). Nitric oxide is an endogenous gas molecule that can inhibit platelet activation as well as bacterial proliferation and adhesion. Various NO delivery vehicles have been developed to improve NO's therapeutic potential. In this review, we provide a summary of the NO releasing and NO generating polymeric materials developed to date, with a focus on the chemistry of different NO donors, the polymer preparation processes, and in vitro and in vivo applications of the two most promising types of NO donors studied thus far, N-diazeniumdiolates (NONOates) and S-nitrosothiols (RSNOs).
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Affiliation(s)
- Yaqi Wo
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA.
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187
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Hicks LK, Rajasekhar A, Bering H, Carson KR, Kleinerman J, Kukreti V, Ma A, Mueller BU, O'Brien SH, Panepinto JA, Pasquini MC, Sarode R, Wood WA. Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology. Am J Hematol 2016; 91:787-92. [PMID: 27152483 DOI: 10.1002/ajh.24412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/26/2016] [Accepted: 05/03/2016] [Indexed: 01/03/2023]
Abstract
Choosing Wisely (CW) is a medical stewardship initiative led by the American Board of Internal Medicine Foundation in collaboration with professional medical societies in the United States. In an effort to learn from and leverage the work of others, the American Society of Hematology CW Task Force developed a method to identify and prioritize CW recommendations from other medical societies of high relevance and importance to patients with blood disorders and their physicians. All 380 CW recommendations were reviewed and assessed for relevance and importance. Relevance was assessed using the MORE(TM) relevance scale. Importance was assessed with regard to six guiding principles: harm avoidance, evidence, aggregate cost, relevance, frequency and impact. Harm avoidance was considered the most important principle. Ten highly relevant and important recommendations were identified from a variety of professional societies. Recommendations focused on decreasing unnecessary imaging, blood work, treatments and transfusions, as well as on increasing collaboration across disciplines and considering value when recommending treatments. Many CW recommendations have relevance beyond the society of origin. The methods developed by the ASH CW Task Force could be easily adapted by other Societies to identify additional CW recommendations of relevance and importance to their fields. Am. J. Hematol. 91:787-792, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lisa K. Hicks
- St. Michael's Hospital; University of Toronto; Toronto Ontario Canada
| | | | - Harriet Bering
- Harvard Vanguard Medical Associates; Beverly Massachusetts
| | | | | | - Vishal Kukreti
- University of Toronto, University Health Network; Toronto Ontario
| | - Alice Ma
- University of North Carolina; Chapel Hill North Carolina
| | | | | | - Julie A. Panepinto
- Medical College of Wisconsin/Children's Hospital of Wisconsin; Milwaukee Wisconsin
| | | | - Ravi Sarode
- UT Southwestern Medical Center; Dallas Texas
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188
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CRIg Functions as a Macrophage Pattern Recognition Receptor to Directly Bind and Capture Blood-Borne Gram-Positive Bacteria. Cell Host Microbe 2016; 20:99-106. [PMID: 27345697 DOI: 10.1016/j.chom.2016.06.002] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/01/2016] [Accepted: 05/11/2016] [Indexed: 12/24/2022]
Abstract
Kupffer cells (KCs), the vast pool of intravascular macrophages in the liver, help to clear blood-borne pathogens. The mechanisms by which KCs capture circulating pathogens remain unknown. Here we use intra-vital imaging of mice infected with Staphylococcus aureus to directly visualize the dynamic process of bacterial capture in the liver. Circulating S. aureus were captured by KCs in a manner dependent on the macrophage complement receptor CRIg, but the process was independent of complement. CRIg bound Staphylococcus aureus specifically through recognition of lipoteichoic acid (LTA), but not cell-wall-anchored surface proteins or peptidoglycan. Blocking the recognition between CRIg and LTA in vivo diminished the bacterial capture in liver and led to systemic bacterial dissemination. All tested Gram-positive, but not Gram-negative, bacteria bound CRIg in a complement-independent manner. These findings reveal a pattern recognition role for CRIg in the direct capture of circulating Gram-positive bacteria from the bloodstream.
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189
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Lutz JT, Diener IV, Freiberg K, Zillmann R, Shah-Hosseini K, Seifert H, Berger-Schreck B, Wisplinghoff H. Efficacy of two antiseptic regimens on skin colonization of insertion sites for two different catheter types: a randomized, clinical trial. Infection 2016; 44:707-712. [PMID: 27142044 PMCID: PMC5121173 DOI: 10.1007/s15010-016-0899-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/18/2016] [Indexed: 11/26/2022]
Abstract
Purpose Catheter-related bloodstream infections affect patients in surgical and intensive care settings worldwide, causing complications, aggravation of existing symptoms and increased length of stay. The trial aimed at comparing two registered skin antiseptics with respect to their residual and therefore infection-preventing effects. Methods In a parallel, monocentric, prospective, triple-blind, randomized trial the difference in bacterial recolonization of catheter skin sites in central venous (CVC) and epidural catheters (EC) was investigated by comparing two alcoholic-based skin disinfectants. Patients receiving planned surgeries or intensive care were eligible for the trial. Those in the trial group received skin disinfection with the additive octenidine dihydrochloride (OCT) (n = 51), those in the control group were treated with benzalkonium chloride as additive (BAC) (n = 59) prior to catheter insertion. Randomization was carried out by assigning patients to groups week-wise. Endpoints of the investigation were skin colonization of the catheter site counted in colony forming units per swab at three time points: (1) prior to catheter insertion, on untreated skin; (2) directly after catheter insertion, prior to sterile coverage; (3) 48 h after catheter insertion. The hypothesis was tested by a Wilcoxon test with a two-sided alpha = 5 %. Results From second to third swab, recolonization of the catheter-surrounding skin was significantly lower in the trial group for both sorts of catheters: delta 2–3 OCT group: 0.72 (95 % CI: 0.42; 1.02); delta 2–3 BAC group: 1.97 (95 % CI: 1.45; 2.50); p < 0.001. None of the patients enrolled developed a catheter-related blood stream infection (CRBSI) during follow-up. Conclusions Previous studies have shown that skin colonization is strongly associated with the occurrence of CRBSI. This randomized controlled trial supports the observations made in previous trials that octenidine dihydrochloride in disinfectants is more effective than agents containing other additives with regard to skin recolonization surrounding CVC and EC insertion sites. Therefore, it is likely to also reduce the risk of CRBSI in these patient groups. The trial was approved by the North Rhine Medical Association in July 2014 (application-no.: 2014222).
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Affiliation(s)
- Juergen Thomas Lutz
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, St. Vinzenz-Hospital, Merheimer Str. 221-223, 50733, Cologne, Germany.
| | - Isabel Victoria Diener
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, St. Vinzenz-Hospital, Merheimer Str. 221-223, 50733, Cologne, Germany
| | - Kerstin Freiberg
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, St. Vinzenz-Hospital, Merheimer Str. 221-223, 50733, Cologne, Germany
| | - Robert Zillmann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, St. Vinzenz-Hospital, Merheimer Str. 221-223, 50733, Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Gleueler Str. 46, 50931, Cologne, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19-21, 50935, Cologne, Germany
| | | | - Hilmar Wisplinghoff
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstr. 19-21, 50935, Cologne, Germany
- Laboratory Dr. Wisplinghoff, Classen-Kappelmann-Str. 24, 50931, Cologne, Germany
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190
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Bassetti M, Righi E, Carnelutti A. Bloodstream infections in the Intensive Care Unit. Virulence 2016; 7:267-79. [PMID: 26760527 PMCID: PMC4871677 DOI: 10.1080/21505594.2015.1134072] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 12/29/2022] Open
Abstract
Bloodstream infections (BSIs) represent a common complication among critically ill patients and a leading cause of morbidity and mortality. The prompt initiation of an effective antibiotic therapy is necessary in order to reduce mortality and to improve clinical outcomes. However, the choice of the empiric antibiotic regimen is often challenging, due to the worldwide spread of multi-drug resistant (MDR) organisms with reduced susceptibility to the available broad-spectrum antimicrobials. New therapeutic strategies are 5 to improve the effectiveness of antibiotic treatment while minimizing the risk of resistance selection.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia Hospital, Udine, Italy
- Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Elda Righi
- Infectious Diseases Division, Santa Maria Misericordia Hospital, Udine, Italy
- Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Alessia Carnelutti
- Infectious Diseases Division, Santa Maria Misericordia Hospital, Udine, Italy
- Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
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191
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Abstract
The use of vascular access devices (VAD) is common in healthcare provision but there is a significant risk of acquiring an infection. Central venous catheters (CVC) are associated with the highest risk of intravenous catheter-related bloodstream infection (CRBSI). 3M™ Tegaderm™ CHG IV dressing is a semi-permeable transparent adhesive dressing with an integrated gel pad containing chlorhexidine gluconate 2%. This product was reviewed by the National Institute for Health and Care Excellence (NICE) in 2015, recommending that Tegaderm CHG could be used for CVC and arterial line dressings in high-dependency and intensive-care settings. This article discusses issues around CRBSI, interventions to reduce the risk of CRBSI, and the use of Tegaderm CHG dressing.
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Affiliation(s)
- Annette Jeanes
- Consultant Nurse Infection Control and Director of Infection Prevention and Control
| | - James Bitmead
- Infection Control Intravenous Clinical Nurse Specialist, both at University College London Hospitals NHS Foundation Trust, London
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192
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Pierre JF, Busch RA, Kudsk KA. The gastrointestinal immune system: Implications for the surgical patient. Curr Probl Surg 2015; 53:11-47. [PMID: 26699624 DOI: 10.1067/j.cpsurg.2015.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/13/2015] [Indexed: 12/27/2022]
Affiliation(s)
- Joseph F Pierre
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL
| | - Rebecca A Busch
- Department of Surgery, Division of General Surgery, University of Wisconsin-Madison, Madison, WI
| | - Kenneth A Kudsk
- Department of Surgery, Division of General Surgery, University of Wisconsin-Madison, Madison, WI; Veterans Administration Surgical Services, William S. Middleton Memorial Veterans Hospital, Madison, WI.
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193
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Zhang X, Tong MM, Zhang MZ, Zhu HP. Risk factors of nosocomial bloodstream infections in surgical intensive care unit. Int J Clin Exp Med 2015; 8:16682-16687. [PMID: 26629203 PMCID: PMC4659091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Many studies have examined risk factors of nosocomial bloodstream infections. However risk factors of nosocomial bloodstream infections in surgical intensive care unit have never been reported. The aim of this study was to investigate this topic. METHODS Retrospective surgical intensive care unit patients' data were collected in a tertiary hospital from January 2010 to August 2014. Infected and non-infected patients were compared with univariate analysis of categorical variables to obtain statistical significance risk factors. Then multivariate logistic regression analysis was performed to acquire the final risk factors. RESULTS 98 patients were diagnosed with nosocomial bloodstream infections in total. Mortality rate was 29.6% (n=29). The data indicated gram-positive cocci were the main pathogens (64.3%; n=63). Multivariate logistic analysis indicated that age (>65 years old) (OR, 2.297; CI95, 0.870 to 6.062), acute physiology and chronic health evaluation II score (>18) (OR, 6.981; CI95, 2.330 to 15.865), multiple organ dysfunction score (>8) (OR, 9.857; CI95, 6.395 to 19.505), mechanical ventilation (OR, 4.583; CI95, 2.134 to 10.956), central venous catheter (OR, 5.875; CI95, 2.212 to 13.456) and selective surgery (OR, 3.455; CI95, 3.442-9.235) were risk factors of nosocomial BSI. CONCLUSIONS Patients with nosocomial bloodstream infections in surgical intensive care unit setting often have a poor prognosis. Age (>65 years old), chronic health evaluation II score (>18), multiple organ dysfunction score (>8), usage of mechanical ventilation, central venous catheter and selective surgery can be regarded as risk factors.
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Affiliation(s)
- Xing Zhang
- Department of General Surgery, Ningbo University Affiliated Yin Zhou Hospital251# Baizhang East Road, Ningbo315040, China
| | - Meng-Meng Tong
- Department of Nursing, Ningbo Women and Children’s HospitalNingbo, China
| | - Miao-Zun Zhang
- Department of General Surgery, Zhejiang University Affiliated Sir Run Run Shaw HospitalHangzhou, China
| | - Hui-Peng Zhu
- Department of General Surgery, Ningbo University Affiliated Yin Zhou Hospital251# Baizhang East Road, Ningbo315040, China
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