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Buetti N, Zahar JR, Adda M, Ruckly S, Bruel C, Schwebel C, Darmon M, Adrie C, Cohen Y, Siami S, Laurent V, Souweine B, Timsit JF. Treatment of positive catheter tip culture without bloodstream infections in critically ill patients. A case-cohort study from the OUTCOMEREA network. Intensive Care Med 2024:10.1007/s00134-024-07498-1. [PMID: 38913096 DOI: 10.1007/s00134-024-07498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE This study aimed to evaluate the impact on subsequent infections and mortality of an adequate antimicrobial therapy within 48 h after catheter removal in intensive care unit (ICU) patients with positive catheter tip culture. METHODS We performed a retrospective analysis of prospectively collected data from 29 centers of the OUTCOMEREA network. We developed a propensity score (PS) for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a 1:1 case-cohort study matched on the PS score of being adequately treated. A PS-matched subdistribution hazard model was used for detecting subsequent infections and a PS-matched Cox model was used to evaluate the impact of antibiotic therapy on mortality. RESULTS We included 427 patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched 150 patients with an adequate antimicrobial therapy with 150 controls. In the matched population, 30 (10%) subsequent infections were observed and 62 patients died within 30 days. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day-30 was similar between treated and non-treated groups (subdistribution hazard ratio [sHR] 1.08, 95% confidence interval [CI] 0.62-1.89, p = 0.78). Using Cox proportional hazard models, the 30-day mortality risk was similar between treated and non-treated groups (HR 0.89, 95% CI 0.45-1.74, p = 0.73). CONCLUSIONS Antimicrobial therapy was not associated with decreased risk of subsequent infection or death in short-term catheter tip colonization in critically ill patients. Antibiotics may be unnecessary for positive catheter tip cultures.
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Affiliation(s)
- Niccolò Buetti
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France.
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Jean-Ralph Zahar
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- Département de Microbiologie Clinique, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Mireille Adda
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Stéphane Ruckly
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- OUTCOMEREA Network, 93700, Drancy, France
| | - Cédric Bruel
- Medical and Surgical Intensive Care Unit, Paris Saint-Joseph Hospital Network, 75014, Paris, France
| | - Carole Schwebel
- Medical Intensive Care Unit, University Hospital, Grenoble-Alpes, 38000, Grenoble, France
| | - Michael Darmon
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Université Paris Cité, Paris, France
| | - Christophe Adrie
- Réanimation Polyvalente, Centre Hospitalier Delafontaine, Saint-Denis, France
| | - Yves Cohen
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Shidasp Siami
- Réanimation Polyvalente, Centre Hospitalier Sud Essonne-Etampes, Etampes, France
| | - Virginie Laurent
- Polyvalent Intensive Care Unit, André Mignot Hospital, 78150, Le Chesnay, France
| | - Bertrand Souweine
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Jean-François Timsit
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- OUTCOMEREA Network, 93700, Drancy, France
- Medical and Infectious Diseases Intensive Care Unit, Bichat Hospital, AP-HP, Paris Cité University, 46 rue Henri Huchard, 75018, Paris, France
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2
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Adelman MW, Tran TT, Shukla B. Re: 'Lower (1,3)-beta-d-glucan (BDG) sensitivity and in-vitro levels in Candida auris and Candida parapsilosis strains' by Mikulska et al. Clin Microbiol Infect 2024:S1198-743X(24)00244-1. [PMID: 38782258 DOI: 10.1016/j.cmi.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Max W Adelman
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA; Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Houston Methodist Hospital, Houston, Texas, USA; Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
| | - Truc T Tran
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA; Center for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Bhavarth Shukla
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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3
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Díaz-Navarro M, Samaniego R, Piqueras JC, Díez R, Hafian R, Manzano I, Muñoz P, Guembe M. Understanding the diagnosis of catheter-related bloodstream infection: real-time monitoring of biofilm growth dynamics using time-lapse optical microscopy. Front Cell Infect Microbiol 2023; 13:1286527. [PMID: 38125909 PMCID: PMC10731284 DOI: 10.3389/fcimb.2023.1286527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
Background The differential time to positivity (DTTP) technique is recommended for the conservative diagnosis of catheter-related bloodstream infection (C-RBSI). The technique is based on a 120-minute difference between microbial growth in blood drawn through the catheter and blood drawn through a peripheral vein. However, this cut-off has failed to confirm C-RBSI caused by Candida spp. and Staphylococcus aureus. Objective We hypothesized that the biofilm of both microorganisms disperses faster than that of other microorganisms and that microbial load is rapidly equalized between catheter and peripheral blood. Therefore, our aim was to compare the biofilm dynamics of various microorganisms. Methods Biofilm of ATCC strains of methicillin-resistant Staphylococcus epidermidis, methicillin-susceptible S. aureus, Enterococcus faecalis, Escherichia coli and Candida albicans was grown on silicon disks and analyzed using time-lapse optical microscopy. The time-lapse images of biofilms were processed using ImageJ2 software. Cell dispersal time and biofilm thickness were calculated. Results The mean (standard deviation) dispersal time in C. albicans and S. aureus biofilms was at least nearly 3 hours lower than in biofilm of S. epidermidis, and at least 15 minutes than in E. faecalis and E. coli biofilms. Conclusion Our findings could explain why early dissemination of cells in C. albicans and S. aureus prevents us from confirming or ruling out the catheter as the source of the bloodstream infection using the cut-off of 120 minutes in the DTTP technique. In addition, DTTP may not be sufficiently reliable for E. coli since their dispersion time is less than the cut-off of 120 minutes.
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Affiliation(s)
- Marta Díaz-Navarro
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Rafael Samaniego
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Confocal Microscopy Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Rafael Díez
- School of Biology, Universidad Complutense de Madrid, Madrid, Spain
| | - Rama Hafian
- School of Biology, Universidad Complutense de Madrid, Madrid, Spain
| | - Irene Manzano
- School of Biology, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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4
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Bassetti M, Azoulay E, Kullberg BJ, Ruhnke M, Shoham S, Vazquez J, Giacobbe DR, Calandra T. EORTC/MSGERC Definitions of Invasive Fungal Diseases: Summary of Activities of the Intensive Care Unit Working Group. Clin Infect Dis 2021; 72:S121-S127. [PMID: 33709127 DOI: 10.1093/cid/ciaa1751] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The EORTC/MSGERC recently revised and updated the consensus definitions of invasive fungal disease (IFD). These definitions primarily focus on patients with cancer and stem cell or solid-organ transplant patients. They may therefore not be suitable for intensive care unit (ICU) patients. More in detail, while the definition of proven IFD applies to a broad range of hosts, the categories of probable and possible IFD were primarily designed for classical immunocompromised hosts and may therefore not be ideal for other populations. Moreover, the scope of the possible category of IFD has been diminished in the recently revised definitions for classically immunocompromised hosts. Diagnosis of IFD in the ICU presents many challenges, which are different for invasive candidiasis and for invasive aspergillosis. The aim of this article is to review progresses made in recent years and difficulties remaining in the development of definitions applicable in the ICU setting.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Elie Azoulay
- Medical ICU, APHP, Saint-Louis Hospital, Paris, France.,Université de Paris, Paris, France
| | - Bart-Jan Kullberg
- Department of Medicine and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Markus Ruhnke
- Division of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Helios Klinikum Aue, Aue, Germany
| | - Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jose Vazquez
- Department of Medicine, Division of Infectious Diseases, Medical College of Georgia/Augusta University, Augusta, Georgia, USA
| | | | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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5
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Timsit JF, Baleine J, Bernard L, Calvino-Gunther S, Darmon M, Dellamonica J, Desruennes E, Leone M, Lepape A, Leroy O, Lucet JC, Merchaoui Z, Mimoz O, Misset B, Parienti JJ, Quenot JP, Roch A, Schmidt M, Slama M, Souweine B, Zahar JR, Zingg W, Bodet-Contentin L, Maxime V. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care 2020; 10:118. [PMID: 32894389 PMCID: PMC7477021 DOI: 10.1186/s13613-020-00713-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.
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Affiliation(s)
- Jean-François Timsit
- APHP/Hopital Bichat-Medical and Infectious Diseases ICU (MI2), 46 rue Henri Huchard, 75018, Paris, France.,UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Université de Paris, Sorbonne Paris Cité, 75018, Paris, France
| | - Julien Baleine
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, 371 Avenue Doyen G Giraud, 34295, Montpellier Cedex 5, France
| | - Louis Bernard
- Infectious Diseases Unit, University Hospital Tours, Nîmes 2 Boulevard, 37000, Tours, France
| | - Silvia Calvino-Gunther
- CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, 38000, Grenoble, France
| | - Michael Darmon
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Jean Dellamonica
- Centre Hospitalier Universitaire de Nice, Médecine Intensive Réanimation, Archet 1, UR2CA Unité de Recherche Clinique Côte d'Azur, Université Cote d'Azur, Nice, France
| | - Eric Desruennes
- Clinique d'anesthésie pédiatrique, Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, CHU Lille, 59000, Lille, France.,Unité accès vasculaire, Centre Oscar Lambret, 3 rue Frédéric Combemale, 59000, Lille, France
| | - Marc Leone
- Anesthésie Réanimation, Hôpital Nord, 13015, Marseille, France
| | - Alain Lepape
- Service d'Anesthésie et de Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Lyon, France.,UMR CNRS 5308, Inserm U1111, Laboratoire des Pathogènes Émergents, Centre International de Recherche en Infectiologie, Lyon, France
| | - Olivier Leroy
- Medical ICU, Chatilliez Hospital, Tourcoing, France.,U934/UMR3215, Institut Curie, PSL Research University, 75005, Paris, France
| | - Jean-Christophe Lucet
- AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.,INSERM IAME, U1137, Team DesCID, University of Paris, Paris, France
| | - Zied Merchaoui
- Pediatric Intensive Care, Paris South University Hospitals AP-HP, Le Kremlin Bicêtre, France
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, 86021, Poitiers, France.,Université de Poitiers, Poitiers, France.,Inserm U1070, Poitiers, France
| | - Benoit Misset
- Department of Intensive Care, Sart-Tilman University Hospital, and University of Liège, Liège, Belgium
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research and Department of Infectious Diseases, Caen University Hospital, 14000, Caen, France.,EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0) UNICAEN, CHU Caen Medical School Université Caen Normandie, Caen, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Antoine Roch
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Service des Urgences, 13015, Marseille, France.,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Matthieu Schmidt
- Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris, France.,INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651, Paris Cedex 13, France
| | - Michel Slama
- Medical Intensive Care Unit, CHU Sud Amiens, Amiens, France
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-Ralph Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France.,Service de Microbiologie Clinique et Unité de Contrôle et de Prévention Du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Walter Zingg
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laetitia Bodet-Contentin
- Medical Intensive Care Unit, INSERM CIC 1415, CRICS-TriGGERSep Network, CHRU de Tours and Université de Tours, Tours, France
| | - Virginie Maxime
- Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230, Garches, France.
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Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2019; 42:5-36. [PMID: 29406956 DOI: 10.1016/j.medin.2017.09.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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7
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Buetti N, Lo Priore E, Sommerstein R, Atkinson A, Kronenberg A, Marschall J. Epidemiology of subsequent bloodstream infections in the ICU. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:259. [PMID: 30305121 PMCID: PMC6180638 DOI: 10.1186/s13054-018-2148-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022]
Abstract
Subsequent bloodstream infections (sBSI) occur with a delay after removal of the intravascular catheter (IVC) whose tip revealed microbial growth. Here we describe the epidemiology of sBSI in the intensive care setting. Serratia marcescens, Staphylococcus aureus, Pseudomonas aeruginosa, and yeast were the pathogens most frequently associated with sBSI. In contrast, Enterococci were rarely found in sBSI.
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Affiliation(s)
- Niccolò Buetti
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland.
| | - Elia Lo Priore
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
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8
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De Egea V, Guembe M, Rodríguez-Borlado A, Pérez-Granda MJ, Sánchez-Carrillo C, Bouza E. Should non-bacteraemic patients with a colonized catheter receive antimicrobial therapy? Int J Infect Dis 2017; 62:72-76. [PMID: 28743533 DOI: 10.1016/j.ijid.2017.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/04/2017] [Accepted: 07/16/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The impact of antimicrobial therapy on the outcomes of patients with colonized catheters and no bacteraemia has not been assessed. This study assessed whether targeted antibiotic therapy is related to a poor outcome in patients with positive cultures of blood drawn through a non-tunnelled central venous catheter (CVC) and without concomitant bacteraemia. METHODS This was a retrospective study involving adult patients with positive blood cultures drawn through a CVC and negative peripheral vein blood cultures. Patients were classified into two groups: those with clinical improvement and those with a poor outcome. These two groups were compared. The outcome was considered poor in the presence of one or more of the following: death, bacteraemia or other infection due to the same microorganism, and evidence of catheter-related bloodstream infection. RESULTS A total of 100 patients were included (31 with a poor outcome). The only independent predictors of a poor outcome were a McCabe and Jackson score of 1-2 and a median APACHE score of 5. No association was found between the use of targeted antimicrobial therapy and a poor outcome when its effect was adjusted for the rest of the variables. CONCLUSIONS This study showed that antimicrobial therapy was not associated with a poor outcome in non-bacteraemic patients with positive blood cultures drawn through a CVC.
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Affiliation(s)
- V De Egea
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
| | - M Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
| | - A Rodríguez-Borlado
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
| | - M J Pérez-Granda
- Red Española de Investigación en Patología Infecciosa (REIPI), RD06/0008/1025, Spain; Cardiac Surgery Postoperative Care Unit, H. G. U. Gregorio Marañón, Madrid, Spain.
| | - C Sánchez-Carrillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), RD06/0008/1025, Spain; Universidad Complutense, Madrid, Spain.
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9
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[Clinical significance and prognosis of isolation of Candida spp. in venous catheters]. Med Clin (Barc) 2016; 146:94-5. [PMID: 26049961 DOI: 10.1016/j.medcli.2015.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/15/2015] [Accepted: 04/23/2015] [Indexed: 11/23/2022]
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10
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Clinical significance of Candida colonization of central vascular catheters in patients with major burns requiring intensive care. Intensive Care Med 2015; 41:1143-4. [PMID: 25854306 DOI: 10.1007/s00134-015-3784-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
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11
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De Almeida BM, Breda GL, Queiroz-Telles F, Tuon FF. Positive tip culture with Candida and negative blood culture: to treat or not to treat? A systematic review with meta-analysis. ACTA ACUST UNITED AC 2014; 46:854-61. [PMID: 25288383 DOI: 10.3109/00365548.2014.952246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Invasive candidiasis is a major invasive fungal infection. It has high lethality, and even higher if not treated early. There is no consensus on antifungal treatment in patients with positive catheter tip culture for Candida spp. The objective of this study was to evaluate the impact of antifungal therapy and mortality of patients with positive culture for Candida spp. in catheter tip that have negative blood culture. METHODS The PubMed database was searched to identify articles related to Candida and catheter. Articles with adequate data were included. RESULTS Of 1208 studies initially screened, 5 met the selection criteria. All were retrospective studies. In all, 265 patients were evaluated for outcomes 'candidemia' and 'invasive candidiasis' and 158 for the outcome 'mortality.' Antifungal therapy had no impact on the development of invasive fungal disease (Odds ratio (OR) = 1.41; 95% confidence interval (CI) = 0.56-3.52). Also there was no benefit of therapy on mortality (OR = 1.02; 95% CI = 0.54-1.95). CONCLUSION Due to the poor quality of the studies no conclusion can be made. Randomized prospective studies are needed to better evaluate this therapeutic strategy.
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12
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Guembe M, Rodríguez-Créixems M, Martín-Rabadán P, Alcalá L, Muñoz P, Bouza E. The risk of catheter-related bloodstream infection after withdrawal of colonized catheters is low. Eur J Clin Microbiol Infect Dis 2013; 33:729-34. [PMID: 24173822 DOI: 10.1007/s10096-013-2004-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/16/2013] [Indexed: 11/28/2022]
Abstract
Most episodes of catheter-related bloodstream infection (C-RBSI) are documented before or at the time of catheter withdrawal. The risk of C-RBSI in the period after removing a colonized catheter in patients without bacteremia (late C-RBSI) is unknown. We assessed the risk of developing a late C-RBSI episode in an unselected population with positive catheter tip cultures and analyzed associated risk factors. We analyzed retrospectively all colonized catheter tips between 2003 and 2010 and matched them with blood cultures. C-RBSI episodes were classified as early C-RBSI (positive blood cultures were obtained ≤24 h after catheter withdrawal) or late C-RBSI (positive blood cultures were obtained ≥24 h after catheter withdrawal). We analyzed the risk factors associated with late C-RBSI episodes by comparison with a selected group of early C-RBSI episodes. We collected a total of 17,981 catheter tips: 4,533 (25.2 %) were colonized. Of them, 1,063 (23.5 %) were associated to early C-RBSI episodes and from the remaining 3,470, only 143 (4.1 %) were associated to late C-RBSI episodes. Then, they corresponded to 11.9 % of the total 1,206 C-RBSI episodes. After comparing early and late C-RBSI episodes, we found that late C-RBSI was significantly associated with the presence of methicillin-resistant Staphylococcus aureus (MRSA, p = 0.028) and with higher mortality (p = 0.030). According to our data, patients with colonized catheter tips had a 4.1 % risk of developing late C-RBSI, which was associated with higher crude mortality.
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Affiliation(s)
- M Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
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13
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Garnacho-Montero J, Díaz-Martín A, Ruiz-Pérez De Piappón M, García-Cabrera E. [Invasive fungal infection in critically ill patients]. Enferm Infecc Microbiol Clin 2012; 30:338-43. [PMID: 22503211 DOI: 10.1016/j.eimc.2012.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 02/14/2012] [Accepted: 02/15/2012] [Indexed: 12/17/2022]
Abstract
The most common organism implicated in fungal infections in the critically ill patients is Candida spp. C. albicans continues to be the species that causes the largest number of invasive candidiasis. In critically ill patients, Candida spp. are frequently isolated in non-sterile sites. Candida colonization is documented in nearly 60% of non-neutropenic critically ill patients staying more than one week in the ICU. However, only 5% of colonized patients will develop invasive candidiasis. The diagnosis of invasive non-candidemic candidiasis remains elusive in the majority of the patients. Candida in a blood culture should never be viewed as a contaminant and should always prompt treatment initiation. Patients with multifocal colonization with a Candida score >3 should also receive antifungal therapy. Fluconazole is reserved for non-severely ill patients without recent exposure to azoles. The use of an echinocandin is recommended for hemodynamically unstable patients or with a history of recent fluconazole exposure.
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Affiliation(s)
- José Garnacho-Montero
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España.
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López-Medrano F, Fernández-Ruiz M, Origüen J, Belarte-Tornero LC, Carazo-Medina R, Panizo-Mota F, Chaves F, Sanz-Sanz F, San Juan R, Aguado JM. Clinical significance of Candida colonization of intravascular catheters in the absence of documented candidemia. Diagn Microbiol Infect Dis 2012; 73:157-61. [PMID: 22483190 DOI: 10.1016/j.diagmicrobio.2012.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 03/03/2012] [Accepted: 03/05/2012] [Indexed: 01/15/2023]
Abstract
In order to assess the significance of Candida colonization of intravascular catheters (IVC) in patients without documented candidemia, we retrospectively reviewed all Candida-positive IVC tip cultures over a 4-year period. Cases were defined as those with a culture yielding ≥15 colony-forming units of Candida spp. that either did not have blood cultures (BC) taken or had concomitant BC negative for Candida. Patients were followed up until death or 8 months after discharge. Risk factors for poor outcome following IVC removal (death, candidemia, or Candida-related complication) were analyzed. We analyzed a total of 40 patients. Overall mortality was 40.0%, with no death directly attributed to Candida infection. Twenty-two patients received antifungal therapy at the time of IVC removal. Only 1 patient developed a metastatic complication (chorioretinitis) attributable to transient candidemia (2.5% of the global cohort and 3.7% among those with concomitant BC). There were no cases of subsequent candidemia. In the multivariate analysis, the use of antifungal therapy did not show any impact on the risk of poor outcome. The risk of invasive disease in patients with isolated IVC colonization by Candida seems to be low. Nevertheless, the initiation of systemic antifungal therapy should be carefully considered in such context.
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Affiliation(s)
- Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Universidad Complutense, Madrid, Spain
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15
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Maxia A, Falconieri D, Piras A, Porcedda S, Marongiu B, Frau MA, Gonçalves MJ, Cabral C, Cavaleiro C, Salgueiro L. Chemical composition and antifungal activity of essential oils and supercritical CO2 extracts of Apium nodiflorum (L.) Lag. Mycopathologia 2012; 174:61-7. [PMID: 22237925 DOI: 10.1007/s11046-011-9519-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 12/09/2011] [Indexed: 11/26/2022]
Abstract
Aerial parts of Apium nodiflorum collected in Portugal and Italy were submitted to hydrodistillation; also a supercritical fluid extract was obtained from Italian plants. The extracts were analyzed by GC and GC/MS. Both essential oils, obtained from Portuguese and Italian plants, posses high content of phenylpropanoids (51.6 vs. 70.8%); in the former, the percentage split in myristicin (29.1%) and dillapiol (22.5%), whereas in the latter, the total percentage is only of dillapiol (70.8%). The co-occurrence of myristicin and dillapiol is frequent because dillapiol results from enzymatic methoxylation of myristicin. Antimicrobial activity of phenylpropanoids has been patented, what suggest the potential of plants with high amounts of these compounds. Minimal inhibitory concentration (MIC) and minimal lethal concentration, determined according to NCCLS, were used to evaluate the antifungal activity of the essential oils against yeasts, Aspergillus species and dermatophytes. Essential oils exhibited higher antifungal activity than other Apiaceae against dermatophytes, with MIC ranging from 0.04 to 0.32 μl/ml. These results support the potential of A. nodiflorum oil in the treatment of dermatophytosis and candidosis.
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Affiliation(s)
- Andrea Maxia
- Dipartimento della Scienza della Vita e dell'Ambiente-Macrosezione di Botanica e Orto Botanico, Università degli Studi di Cagliari, Viale Sant' Ignazio, 09123, Cagliari, Italy
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16
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Kullberg BJ, Verweij PE, Akova M, Arendrup MC, Bille J, Calandra T, Cuenca-Estrella M, Herbrecht R, Jacobs F, Kalin M, Kibbler CC, Lortholary O, Martino P, Meis JF, Muñoz P, Odds FC, De Pauw BE, Rex JH, Roilides E, Rogers TR, Ruhnke M, Ullmann AJ, Uzun Ö, Vandewoude K, Vincent JL, Donnelly JP. European expert opinion on the management of invasive candidiasis in adults. Clin Microbiol Infect 2012; 17 Suppl 5:1-12. [PMID: 21884296 DOI: 10.1111/j.1469-0691.2011.03615.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This report discusses the present status of antifungal therapy and treatment options for candidaemia, considered by experts in the field in Europe. A conference of 26 experts from 13 European countries was held to discuss strategies for the treatment and prevention of invasive candidiasis, with the aim of providing a review on optimal management strategies. Published and unpublished comparative trials on antifungal therapy were analysed and discussed. Commonly asked questions about the management of candidaemia were selected, and possible responses to these questions were discussed. Panellists were then asked to respond to each question by using a touchpad answering system. After the initial conference, the viewpoint document has been reviewed and edited to include new insights and developments since the initial meeting. For many situations, consensus on treatment could not be reached, and the responses indicate that treatment is likely to be modified on a patient-to-patient basis, depending on factors such as degree of illness, prior exposure to azole antifungals, and the presence of potentially antifungal drug-resistant Candida species.
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Affiliation(s)
- B J Kullberg
- Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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17
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Ruhnke M, Rickerts V, Cornely OA, Buchheidt D, Glöckner A, Heinz W, Höhl R, Horré R, Karthaus M, Kujath P, Willinger B, Presterl E, Rath P, Ritter J, Glasmacher A, Lass-Flörl C, Groll AH. Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy. Mycoses 2011; 54:279-310. [PMID: 21672038 DOI: 10.1111/j.1439-0507.2011.02040.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Invasive Candida infections are important causes of morbidity and mortality in immunocompromised and hospitalised patients. This article provides the joint recommendations of the German-speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMyKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG) for diagnosis and treatment of invasive and superficial Candida infections. The recommendations are based on published results of clinical trials, case-series and expert opinion using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA). Key recommendations are summarised here: The cornerstone of diagnosis remains the detection of the organism by culture with identification of the isolate at the species level; in vitro susceptibility testing is mandatory for invasive isolates. Options for initial therapy of candidaemia and other invasive Candida infections in non-granulocytopenic patients include fluconazole or one of the three approved echinocandin compounds; liposomal amphotericin B and voriconazole are secondary alternatives because of their less favourable pharmacological properties. In granulocytopenic patients, an echinocandin or liposomal amphotericin B is recommended as initial therapy based on the fungicidal mode of action. Indwelling central venous catheters serve as a main source of infection independent of the pathogenesis of candidaemia in the individual patients and should be removed whenever feasible. Pre-existing immunosuppressive treatment, particularly by glucocorticosteroids, ought to be discontinued, if feasible, or reduced. The duration of treatment for uncomplicated candidaemia is 14 days following the first negative blood culture and resolution of all associated symptoms and findings. Ophthalmoscopy is recommended prior to the discontinuation of antifungal chemotherapy to rule out endophthalmitis or chorioretinitis. Beyond these key recommendations, this article provides detailed recommendations for specific disease entities, for antifungal treatment in paediatric patients as well as a comprehensive discussion of epidemiology, clinical presentation and emerging diagnostic options of invasive and superficial Candida infections.
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Affiliation(s)
- Markus Ruhnke
- Medizinische Klinik m S Onkologie u Hämatologie, Charité Universitätsmedizin, Charité, Campus Mitte, Berlin, Germany.
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Bloodstream infection after positive catheter cultures: what are the risks in the intensive care unit when catheters are routinely cultured on removal? Crit Care Med 2011; 39:1301-5. [PMID: 21336118 DOI: 10.1097/ccm.0b013e3182120190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study was to assess whether an isolated positive catheter culture is predictive of a subsequent bloodstream infection in intensive care unit patients. DESIGN Retrospective clinical study between 2000 and 2007. SETTING Intensive care unit of a university hospital. SUBJECTS All arterial, central venous, and dialysis catheters yielding selected pathogenic microorganisms from isolated positive catheter cultures. Positive catheter culture was defined by a catheter tip culture performed with the Brun-Buisson technique yielding ≥103 colony-forming units/mL; isolated positive catheter culture by a positive catheter culture without concomitant bloodstream infection due to the microorganism of the positive catheter culture evidenced within 48 hrs before or after catheter removal; and subsequent bloodstream infection by a bloodstream infection developing between 48 hrs and 30 days after catheter removal and due to a selected pathogenic microorganism of an isolated positive catheter culture. Active antibiotic therapy was active if at least one of the antibiotics administered was effective against the selected pathogenic microorganism of the positive catheter culture. INTERVENTION None. MEASUREMENT AND MAIN RESULTS The end point of the study was the ratio of the number of subsequent bloodstream infections to that of selected pathogenic microorganisms isolated from positive catheter culture 30 days after catheter removal. A total of 138 isolated positive catheter cultures for 149 selected pathogenic micro-organisms was included in the study. Only two cases (1.3%) of subsequent bloodstream infection were evidenced, one resulting from Escherichia coli and the other from Staphylococcus epidermidis. The incidence of subsequent bloodstream infection did not differ with regard to the presence or absence of active antibiotics at catheter removal: zero of 23 vs. two of 121 (p = 1), respectively. CONCLUSIONS Our results suggest that the risk of subsequent bloodstream infection in intensive care unit patients when the Brun-Buisson technique is used to define isolated positive catheter culture is low.
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Should we still need to systematically perform catheter culture in the intensive care unit? Crit Care Med 2011; 39:1556-8. [PMID: 21610620 DOI: 10.1097/ccm.0b013e318215c0f3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Leenders NHJ, Oosterheert JJ, Ekkelenkamp MB, De Lange DW, Hoepelman AIM, Peters EJG. Candidemic complications in patients with intravascular catheters colonized with Candida species: an indication for preemptive antifungal therapy? Int J Infect Dis 2011; 15:e453-8. [PMID: 21530350 DOI: 10.1016/j.ijid.2011.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 03/13/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The impact of Candida-colonized catheter tips in patients without candidemia is unclear. METHODS A retrospective study of patients with tip cultures positive for Candida was conducted over an 8-year period, to determine the outcomes in patients with Candida cultured from an intravascular catheter tip in the absence of preceding Candida-positive blood cultures. The primary outcome measure was definite candidemia. Secondary outcomes included possible candidemia and in-hospital mortality. A possible candidemia was defined as clinical signs and symptoms of invasive candidiasis without explanation other than a candidemia, but with negative blood cultures. RESULTS Sixty-eight cultures from 64 patients were included in the study. Definite candidemia developed in three cases (4%) and possible candidemia developed in five cases (7%). In-hospital mortality was significantly increased in patients with definite or possible candidemia (63% vs. 22%, p=0.028). Risk factors for the development of definite or possible candidemia were catheter time in situ >8 days (odds ratio (OR) 6.0, 95% confidence interval (CI) 1.1-32.9) and abdominal surgery (OR 6.0, 95% CI 1.1-32.4). CONCLUSIONS Intravascular catheter tip colonization in patients without preceding blood cultures with Candida is associated with candidemia in from 4% of patients (definite candidemia) up to 12% of patients (definite and possible candidemia combined). Considering the adverse prognosis associated with delayed treatment of candidemia, preemptive treatment based on catheter tip cultures might outweigh the disadvantages of costs and side effects of antifungal therapy.
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Affiliation(s)
- N H J Leenders
- Department of Internal Medicine and Infectious Diseases, University Medical Centre, Utrecht, The Netherlands
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21
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Zuzarte M, Gonçalves MJ, Cavaleiro C, Canhoto J, Vale-Silva L, Silva MJ, Pinto E, Salgueiro L. Chemical composition and antifungal activity of the essential oils of Lavandula viridis L'Hér. J Med Microbiol 2011; 60:612-618. [DOI: 10.1099/jmm.0.027748-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Mónica Zuzarte
- Center of Pharmaceutical Studies, Department of Life Sciences, University of Coimbra, Ap. 3046, 3001-401 Coimbra, Portugal
- Center of Pharmaceutical Studies, Faculty of Pharmacy, Health Science Campus, University of Coimbra, Azinhaga de S. Comba, 3000-354 Coimbra, Portugal
| | - Maria José Gonçalves
- Center of Pharmaceutical Studies, Faculty of Pharmacy, Health Science Campus, University of Coimbra, Azinhaga de S. Comba, 3000-354 Coimbra, Portugal
| | - Carlos Cavaleiro
- Center of Pharmaceutical Studies, Faculty of Pharmacy, Health Science Campus, University of Coimbra, Azinhaga de S. Comba, 3000-354 Coimbra, Portugal
| | - Jorge Canhoto
- Center of Pharmaceutical Studies, Department of Life Sciences, University of Coimbra, Ap. 3046, 3001-401 Coimbra, Portugal
| | - Luís Vale-Silva
- Microbiology Service/CEQUIMED, Faculty of Pharmacy, University of Porto, Rua Aníbal Cunha 164, 4050-047 Porto, Portugal
| | - Maria João Silva
- Microbiology Service/CEQUIMED, Faculty of Pharmacy, University of Porto, Rua Aníbal Cunha 164, 4050-047 Porto, Portugal
| | - Eugénia Pinto
- Microbiology Service/CEQUIMED, Faculty of Pharmacy, University of Porto, Rua Aníbal Cunha 164, 4050-047 Porto, Portugal
| | - Lígia Salgueiro
- Center of Pharmaceutical Studies, Faculty of Pharmacy, Health Science Campus, University of Coimbra, Azinhaga de S. Comba, 3000-354 Coimbra, Portugal
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Aguado JM, Ruiz-Camps I, Muñoz P, Mensa J, Almirante B, Vázquez L, Rovira M, Martín-Dávila P, Moreno A, Alvarez-Lerma F, León C, Madero L, Ruiz-Contreras J, Fortún J, Cuenca-Estrella M. [Guidelines for the treatment of Invasive Candidiasis and other yeasts. Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). 2010 Update]. Enferm Infecc Microbiol Clin 2011; 29:345-61. [PMID: 21459489 DOI: 10.1016/j.eimc.2011.01.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 01/17/2011] [Indexed: 12/29/2022]
Abstract
These guidelines are an update of the recommendations of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) that were issued in 2004 (Enferm Infecc Microbiol Clin. 2004, 22:32-9) on the treatment of Invasive Candidiasis and infections produced by other yeasts. This 2010 update includes a comprehensive review of the new drugs that have appeared in recent years, as well as the levels of evidence for recommending them. These guidelines have been developed following the rules of the SEIMC by a working group composed of specialists in infectious diseases, clinical microbiology, critical care medicine, paediatrics and oncology-haematology. It provides a series of general recommendations regarding the management of invasive candidiasis and other yeast infections, as well as specific guidelines for prophylaxis and treatment, which have been divided into four sections: oncology-haematology, solid organ transplantation recipients, critical patients, and paediatric patients.
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Affiliation(s)
- José María Aguado
- Servicio de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, España. Red Española de Investigación en Patología Infecciosa (REIPI RD06/0008)
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Playford EG, Lipman J, Sorrell TC. Management of Invasive Candidiasis in the Intensive Care Unit. Drugs 2010; 70:823-39. [DOI: 10.2165/10898550-000000000-00000] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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25
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Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Lemaire F, Gerlach H, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Pugin J, Wernerman J, Zhang H. Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control. Intensive Care Med 2010; 36:196-209. [PMID: 20057995 PMCID: PMC2816797 DOI: 10.1007/s00134-009-1742-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 12/18/2009] [Indexed: 12/17/2022]
Affiliation(s)
- Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy.
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Park KH, Kim SH, Song EH, Jang EY, Lee EJ, Chong YP, Choi SH, Lee SO, Woo JH, Kim YS. Development of bacteraemia or fungaemia after removal of colonized central venous catheters in patients with negative concomitant blood cultures. Clin Microbiol Infect 2009; 16:742-6. [PMID: 19747217 DOI: 10.1111/j.1469-0691.2009.02926.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are limited data on the clinical significance of positive central venous catheter (CVC) tip cultures associated with concomitant negative blood cultures performed at the time of CVC removal. A retrospective cohort study of all patients who yielded isolated positive CVC tip cultures was conducted in a tertiary-care hospital with 2200 beds during a 10-year period. All patients with isolated positive CVC tip cultures were observed for the development of subsequent bacteraemia or fungaemia between 2 and 28 days after CVC removal. An isolated positive CVC tip culture was defined as a case in which (i) a CVC tip culture yielded > or = 15 colonies using a semiquantitative culture method and (ii) at least two sets of blood samples revealed no organism at, or close to, the time of CVC removal (48 h before to 48 h after CVC removal). During the study period, 312 patients with isolated positive CVC cultures were enrolled. Eight (2.6%; 95% CI 1.2-5.1) of the 312 patients yielding isolated bacterial or fungal CVC tip cultures developed subsequent bloodstream infection (BSI) caused by the same species as that isolated from the tip culture (Staphylococcus aureus, 1: Enterococcus spp.; 2: Pseudomonas aeruginosa; and 3: Candida spp.). Among 125 patients from whose CVC tips the above four organisms were grown, seven (12.3%) of 57 patients who did not receive appropriate antibiotic therapy within 48 h after CVC removal subsequently developed BSI, but only one (1.5%) of 68 patients who did receive appropriate therapy developed BSI (OR 0.11, p 0.02).
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Affiliation(s)
- K-H Park
- Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, University of Ulsan, Seoul, Korea
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27
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On track to limit antifungal overuse! Intensive Care Med 2009; 35:582-4. [DOI: 10.1007/s00134-009-1432-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 01/25/2009] [Indexed: 11/27/2022]
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