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Nie Y, Zeng Y. Clinical characteristics, risk factor analysis and peripheral blood cell changes for early warning of multidrug-resistant bacteria (MDR) infection in elderly patients. Immun Inflamm Dis 2024; 12:e1347. [PMID: 39023415 PMCID: PMC11256884 DOI: 10.1002/iid3.1347] [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: 01/03/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE To explore peripheral blood indicators that may serve as early indicators for multidrug-resistant bacteria (MDR) infections in this demographic, with the goal of providing reference suggestions for the clinical prevention of MDR infections in elderly inpatients. METHODS Clinical data of patients were divided into the MDR-infected group (n = 488) and the MDR-uninfected group (n = 233) according to the results of drug sensitivity experiments, risk factors for MDR infection, and peripheral blood indicators related to MDR infections were analyzed using univariate and multivariate logistic regression in conjunction with the construction of a Chi-squared automatic interaction detector (CHAID) decision tree model, considering statistical significance at p < .05. RESULTS Of 721 patients, 488 multidrug-resistant strains were identified. Among them, with Staphylococcus spp. the most prevalent in 148 strains. The most frequent detection of MDR occurred in puncture fluid samples (167 cases). Univariate and multivariate regression analyses revealed that prolonged hospitalization, use of antibiotics preadmission, duration of antibiotics, invasive procedures or recent surgery, and coexisting lung disease were independent risk factors for contracting MDR. Subsequent analysis comparing the aforementioned influences with peripheral blood cells revealed associations between the number of antibiotic treatment days and increased neutrophil-to-lymphocyte ratio (NLR), platelet count-to-lymphocyte ratio (PLR), neutrophils, decreased lymphocytes, and increased eosinophils; preadmission antibiotic use correlated with increased PLR, NLR, neutrophils, and decreased lymphocytes; and invasive manipulation or surgery correlated with increased PLR and NLR. CONCLUSIONS Elevated NLR, PLR, neutrophils, lowered lymphocytes, and eosinophils may serve as early indicators of MDR infections in elderly hospitalized patients.
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Affiliation(s)
- Yalan Nie
- Department of Respiratory Medicine, Tongji Medical College, Liyuan HospitalHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Yulan Zeng
- Department of Respiratory Medicine, Tongji Medical College, Liyuan HospitalHuazhong University of Science and TechnologyWuhanHubeiChina
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Mai YF, Cui LW, Wang G, Tan QZ, Xian SF, Pai P. Meticulous catheter care and aseptic approach reduce catheter-related bloodstream infections significantly in hemodialysis patients: A 5-year single center study. J Vasc Access 2024:11297298241251507. [PMID: 38800939 DOI: 10.1177/11297298241251507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
AIM The use of central venous catheters as hemodialysis vascular access is a major contributor to high bloodstream infection rate. In our dialysis unit in Shenzhen Guangdong Province China, we have developed and used our own dialysis catheter care protocol since May 2013 with good results. In this study, we would like to share our experience with the other units. METHODS We have undertaken a 5-year retrospective analysis to determine our tunneled dialysis catheter-related blood stream infection rate by adding the number of infections divided by total number of catheter days × 1000. The results were compared with another study carried out in Henan Province China. Demographic data were summarized using descriptive statistics. Continuous and categorical variables were compared using t-test and χ2 test respectively. RESULTS Between 2017 and 2021, a total of 216 tunneled dialysis catheters were managed by following our own dialysis access pathway and catheter care protocol. The tunneled dialysis catheter-related bloodstream infection rate was 0.0229 per 1000 catheter days in the 5-year period. CONCLUSION Comparing with other published studies in China, our unit has achieved a very low rate of tunneled dialysis catheter-related bloodstream infection which has been sustained over time. This paper explores how our protocol and implementation might have contributed to the results.
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Affiliation(s)
- Yan-Fen Mai
- Department of Nephrology, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Li-Wen Cui
- Department of Nephrology, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Gang Wang
- Department of Nephrology, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Qiu-Zhen Tan
- Department of Nephrology, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Shao-Fang Xian
- Department of Nephrology, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Pearl Pai
- Department of Nephrology, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
- Department of Medicine, University of Hong Kong, Li Ka Shing Faculty of Medicine, Hong Kong
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Lima CSD, Vaz FB, Campos RP. Bacteremia and Mortality among Patients with Nontunneled and Tunneled Catheters for Hemodialysis. Int J Nephrol 2024; 2024:3292667. [PMID: 38352140 PMCID: PMC10864053 DOI: 10.1155/2024/3292667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Central venous catheters for hemodialysis (HD) can be nontunneled catheters (NTC) or tunneled catheters (TC). Bacteremia and dysfunction are complications that can impact morbidity and mortality. We decided to compare the rates of bacteremia and dysfunction between NTC and TC and patient survival 90 days after catheter insertion. Methods Retrospective cohort to evaluate catheters inserted between January 2011 and December 2020 in a tertiary hospital. Catheters in patients with end-stage chronic kidney disease were included. Patients with acute kidney injury, catheters that lasted less than three HD sessions, and patients who died within one week after insertion were excluded. Bacteremia and dysfunction rates, bacteremia-free survival, and dysfunction-free survival were investigated. Multivariable analysis was performed using a Cox proportional hazards regression model for patient survival at 90 days. Results 670 catheters were analyzed in 287 patients, 422 NTC (63%), and 248 TC (37%). The rates of confirmed bacteremia per 1,000 catheter-days were 1.19 for NTC and 0.20 for TC (p < 0.0001). The confirmed or possible bacteremia rates were 2.27 and 0.37 per 1,000 catheter-days for NTC and TC, respectively (p < 0.0001). The dysfunction rates were 3.96 and 0.86 for NTC and TC, respectively (p < 0.0001). Patient survival at 90 days was higher in the TC group than the NTC group (96.8% vs. 89.1%; p < 0.0001). Conclusion We found lower rates of bacteremia and dysfunction for TC and demonstrated that using NTC affects patient mortality.
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Affiliation(s)
- Carla Santos De Lima
- Postgraduate Program in Medical Sciences at the Faculty of Medicine, FAMED, Federal University of Alagoas-UFAL, Maceió, Brazil
| | - Flora Braga Vaz
- Ribamar Vaz Institute of Nephrology, Santa Casa de Misericórdia of Maceió, Maceió, Brazil
| | - Rodrigo Peixoto Campos
- Postgraduate Program in Medical Sciences at the Faculty of Medicine, FAMED, Federal University of Alagoas-UFAL, Maceió, Brazil
- Ribamar Vaz Institute of Nephrology, Santa Casa de Misericórdia of Maceió, Maceió, Brazil
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Ul Haq I, Khan TA, Krukiewicz K. Etiology, pathology, and host-impaired immunity in medical implant-associated infections. J Infect Public Health 2024; 17:189-203. [PMID: 38113816 DOI: 10.1016/j.jiph.2023.11.024] [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: 07/19/2023] [Revised: 10/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Host impaired immunity and pathogens adhesion factors are the key elements in analyzing medical implant-associated infections (MIAI). The infection chances are further influenced by surface properties of implants. This review addresses the medical implant-associated pathogens and summarizes the etiology, pathology, and host-impaired immunity in MIAI. Several bacterial and fungal pathogens have been isolated from MIAI; together, they form cross-kingdom species biofilms and support each other in different ways. The adhesion factors initiate the pathogen's adherence on the implant's surface; however, implant-induced impaired immunity promotes the pathogen's colonization and biofilm formation. Depending on the implant's surface properties, immune cell functions get slow or get exaggerated and cause immunity-induced secondary complications resulting in resistant depression and immuno-incompetent fibro-inflammatory zone that compromise implant's performance. Such consequences lead to the unavoidable and straightforward conclusion for the downstream transformation of new ideas, such as the development of multifunctional implant coatings.
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Affiliation(s)
- Ihtisham Ul Haq
- Department of Physical Chemistry and Technology of Polymers, Silesian University of Technology, M. Strzody 9, 44-100 Gliwice, Poland; Joint Doctoral School, Silesian University of Technology, Akademicka 2A, 44-100 Gliwice, Poland; Programa de Pós-graduação em Inovação Tecnológica, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil.
| | - Taj Ali Khan
- Division of Infectious Diseases & Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States; Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan.
| | - Katarzyna Krukiewicz
- Department of Physical Chemistry and Technology of Polymers, Silesian University of Technology, M. Strzody 9, 44-100 Gliwice, Poland; Centre for Organic and Nanohybrid Electronics, Silesian University of Technology, Konarskiego 22B, 44-100 Gliwice, Poland.
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Arriaga Escamilla D, Lakhani A, Antony S, Salazar Villegas KN, Gupta M, Ramnath P, Murillo Pineda MI, Bedor A, Banegas D, Calderon Martinez E. Dermatological Manifestations in Patients With Chronic Kidney Disease: A Review. Cureus 2024; 16:e52253. [PMID: 38352109 PMCID: PMC10863542 DOI: 10.7759/cureus.52253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Chronic kidney disease (CKD) is a progressive disease and has multiple clinical manifestations; when CKD reaches the end stage, at least one cutaneous manifestation appears due to some increased toxin levels or a constant proinflammatory state. Nonspecific manifestations include pruritus, xerosis, pigmentation disorders, acquired ichthyosis, purpuric spots, and nail disorders. Some specific manifestations are bullous dermatoses, acquired perforating dermatoses (APD), eruptive xanthoma, access site infections, calcifying disorders, and nephrogenic systemic fibrosis (NSF). All these cutaneous changes negatively impact patients; early recognition and diagnosis of these dermatoses will make a difference in their quality of treatment. Exploring a patient's skin is fundamental to suspect some diseases and increased toxin levels; pruritus occurs when uremic toxins are raised, and nail disorders are associated with hypoalbuminemia. This review provides the clinician with information on the clinical manifestations that occur in CKD, including epidemiology, pathophysiology, clinical manifestations, diagnosis, histopathology, treatment, and life impact of the dermatoses in CKD.
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Affiliation(s)
| | - Alisha Lakhani
- Medicine, Research MD, Vadodara, IND
- Medicine, Shantabaa Medical College, Amreli, IND
| | - Sneha Antony
- Pharmacology, K S Hegde Medical Academy, Mangalore, IND
| | | | - Manasvi Gupta
- General Practice, Jawaharlal Nehru Medical College, Aligarh, IND
| | | | | | - Alexandra Bedor
- Internal Medicine, Instituto Salvadoreño del Seguro Social, San Salvador, SLV
| | - Douglas Banegas
- General Medicine, Universidad Nacional Autonoma de Honduras, San Pedro Sula, HND
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Abbasi SH, Aftab RA, Mei Lai PS, Lim SK, Nur Zainol Abidin R. Prevalence, Microbial Etiology and Risk Factors Associated With Healthcare Associated Infections Among End Stage Renal Disease Patients on Renal Replacement Therapy. J Pharm Pract 2023; 36:1142-1155. [PMID: 35466786 DOI: 10.1177/08971900221094269] [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] [Indexed: 11/17/2022]
Abstract
End stage renal disease (ESRD) patients on renal replacement therapy (RRT) have an increased risk of morbidity and mortality due to healthcare associated infections (HCAIs). The aim of this study is to determine the prevalence, microbial etiology, and risk factors associated with HCAIs among ESRD patients on RRT. A multicenter, retrospective study was conducted from June to December 2019. ESRD patients with minimum of 6 months on RRT were included, while pregnant patients and patients <18 years were excluded. To reduce the risk of selection bias, all patients were randomly selected using a simple random sampling technique. The prevalence showing the proportion of patients that acquired HCAI since the initiation of dialysis until 2019 was calculated using the European patients' academy (EUPATI) formula. Risk factors were assessed using univariate and multivariate regression analysis. The prevalence of HCAI among ESRD patients was 174/400 (43.5%). Catheter related bloodstream infection (CRBSI) was the most common infection [64(36.8%)], followed by peritonitis [45(25.8%)] and pneumonia [37(21.2%)]. Out of 382 total pathogens identified, 204 (53.4%) were Gram positive and 162 (42.4%) were Gram negative. Both methicillin sensitive staphylococcus aureus (MSSA) and methicillin resistant staphylococcus aureus (MRSA) showed statistically significant associations (p<0.05) with CRBSI. Use of multiple accesses, increased blood sugar levels, low serum sodium levels and higher CRP concentration increased the occurrence of HCAIs. The burden of HCAIs among the patients undergoing RRT is high. Preventive strategies and optimum empirical therapy of antibiotics should be used to reduce the risk of these infections among ESRD patients.
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Affiliation(s)
| | - Raja Ahsan Aftab
- School of Pharmacy, Taylor's University, 47500, Selangor, Malaysia
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soo Kun Lim
- Department of Medicine (Division of Nephrology), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Weldetensae MK, Weledegebriel MG, Nigusse AT, Berhe E, Gebrearegay H. Catheter-Related Blood Stream Infections and Associated Factors Among Hemodialysis Patients in a Tertiary Care Hospital. Infect Drug Resist 2023; 16:3145-3156. [PMID: 37249964 PMCID: PMC10216862 DOI: 10.2147/idr.s409400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Non-tunneled central venous catheter remains the preferred vascular access at hemodialysis initiation in developing countries despite a high burden of infection complications. The goal of this study was to determine the burden, risk factors, and microbiological spectrum of catheter-related bloodstream infections at a tertiary care center in Ethiopia. Methods A retrospective cross-sectional study design was applied among patients who underwent central venous catheter insertion for hemodialysis between January 2016 and June 2022 with no native arteriovenous fistula and stayed more than 48 hours. Data were collected from the patient's registration book, patient charts, and microbiology registry and analyzed using SPSS 21. Binary logistic regression was applied to assess the relationship between the independent and outcome variables. P-values less than 0.05 with AOR and 95% CI were used as statistically significant variables. Results In this study, 353 patients were included. The mean age was 39±17.9 years and the average duration of catheter stay was 58 ±95 days. A hundred thirty-five (38.2%) CRBSIs were documented with an incidence rate of 7.74 episodes per 1000 catheter days. The causative microorganism was predominantly gram-negatives (57.6%). Duration of a catheter (AOR: 0.3; P < 0.001), previous CVC infection (AOR: 11.9; P < 0.001), high white blood cell count (AOR: 0.31; P<0.001), urban residence (AOR: 1.92; P<0.05), and low hemoglobin levels (AOR: 2.78; P < 0.05) were independently associated with catheter-related bloodstream infections. Conclusion In conclusion, the incidence of catheter-related bloodstream infection among patients on hemodialysis was high with gram-negative predominance. Early fistula must be planned to reduce the duration of temporary vascular access.
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Affiliation(s)
- Meskelu Kidu Weldetensae
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Afewerki Tesfahunegn Nigusse
- Department of Epidemiology, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Ephrem Berhe
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hailemariam Gebrearegay
- Department of Pediatric and Child health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Zhao J, Ruan Z, Zhao J, Yang Y, Xiao S, Ji H. Study on the timing of first dressing change with alginate dressing application in PICC placement among tumor patients. J Cancer Res Ther 2022; 18:2013-2020. [PMID: 36647964 DOI: 10.4103/jcrt.jcrt_941_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective To explore how the timing of the initial dressing change influences bacterial growth when alginate dressings were used after peripherally inserted central catheter (PICC) line insertion in tumor patients. Methods In total, 186 tumor patients who had an alginate dressing after PICC insertion were randomly divided into a control group, observation group one (OG1), and observation group two (OG2). The control group had their first dressing change 48 h after PICC insertion, while OG1 was after 72 h and OG2 was after 96 h after. Samples were taken at the dressing change from the insertion site and surrounding skin. The results of the bacterial culture were compared to investigate how the timing of the first dressing change affected catheter infection. Results Of the 186 patients, 29 had a positive bacterial culture. Of these, 10 were in the control group, 9 were in OG1, and 10 were in OG2. IBM SPSS Statistics 21.0 was adopted to analyze the correlation between the timing of the first dressing change and insertion site infection. No statistical significance between the timing of the first dressing change and insertion site infections was found (P > 0.05). Conclusions The condition of each tumor patient should be comprehensively evaluated after PICC placement to determine when the first dressing change should occur, but it can likely be extended to 96 h after insertion to promote wound healing, reduce clinical workload, and lower patient economic burden.
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Affiliation(s)
- Jinyan Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University; Nursing Department, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zhen Ruan
- Nursing Department, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Junyan Zhao
- Nursing Department, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yanwei Yang
- Nursing Department, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Shuping Xiao
- Nursing Department, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Hong Ji
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University; Nursing Department, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
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Hajji M, Neji M, Agrebi S, Nessira SB, Hamida FB, Barbouch S, Harzallah A, Abderrahim E. Incidence and challenges in management of hemodialysis catheter-related infections. Sci Rep 2022; 12:20536. [PMID: 36446808 PMCID: PMC9709051 DOI: 10.1038/s41598-022-23787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/04/2022] [Indexed: 11/30/2022] Open
Abstract
Catheter-related infections (CRI) are a major cause of morbidity and mortality in chronic hemodialysis (HD) patients. In this paper, we share our experience with CRI in HD patients. We recorded 49 cases of CRI among 167 patients during a period of 40 months (January 2018-April 2021). The incidence of CRI was 3.7 per 1000 catheter-days. The revealing symptoms were dominated by fever or chills (90%). Inflammatory signs were observed in 74% of cases with respectively concurrent exit-site (51%) and tunnel infection (6%). The biological inflammatory syndrome was found in 74% of patients (average CRP level = 198.9 mg/l). Blood cultures were performed in all cases and were positive in 65% of cases. Thirteen patients have been diagnosed with Infection complications, which were respectively infective endocarditis in 7 cases, septic arthritis in 3 cases, infective myositis in one case, cerebral thrombophlebitis in 1 case and mediastinitis in 1 case. The death occurred in eleven patients, it was due to septic shock in 9 cases, pulmonary embolism in one case and neurologic alterations related to cerebral thrombophlebitis. The mean seniority in HD was 16.5 months in the group with CRI and 3.7 months in the group without CRI (p < 0.04). We did not notice significant difference in mortality between tunnelled and non-tunnelled catheters. CRI does not seem to be more severe in patients with diabetes. Duration of use of the HD catheter (p < 0.007) and ferritin level (p < 0.0001) were independent factors that predispose to CRI in our population.
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Affiliation(s)
- Meriam Hajji
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Manel Neji
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sahar Agrebi
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Saoussen Ben Nessira
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Ben Hamida
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Samia Barbouch
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Amel Harzallah
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,grid.413827.b0000 0004 0594 6356Laboratory of Renal Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzedine Abderrahim
- grid.413827.b0000 0004 0594 6356Department of Internal Medicine “A”, Charles Nicolle Hospital, Beb Saadoun, 1009 Tunis, Tunisie ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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AbuTaha SA, Al-Kharraz T, Belkebir S, Abu Taha A, Zyoud SH. Patterns of microbial resistance in bloodstream infections of hemodialysis patients: a cross-sectional study from Palestine. Sci Rep 2022; 12:18003. [PMID: 36289278 PMCID: PMC9605991 DOI: 10.1038/s41598-022-21979-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/07/2022] [Indexed: 01/24/2023] Open
Abstract
Bloodstream infections (BSIs) are a prominent cause of death and hospitalization among hemodialysis (HD) patients. The emergence of multidrug-resistant organisms (MDRO) is making the management of these infections more challenging. This study describes the clinical characteristics, microbial profiles and antibiotic resistance patterns in patients with BSIs. A retrospective cross-sectional study was conducted at An-Najah National University Hospital from January 2019 to December 2020. Clinical and demographic data regarding BSIs were collected from the hospital information system. Data regarding bacterial isolates and the antimicrobial resistance of BSIs were collected from the microbiology lab. Data were entered and analyzed using version 21 of the Statistical Package for Social Sciences program (IBM-SPSS). 111 BSIs occurred during the study period, with a rate of 1.5 infections per 100 patient-months. These patients had been on HD for the median duration of 747 (360, 1825) days and 62.2% had already had a BSI before the study period. 118 microorganisms were isolated; 99 (83.89%) were gram-positive and 19 (16.1%) were gram-negative. Among the gram-positive isolates, coagulase-negative staphylococci (CoNS) (88, 74.57%) were predominant. As for the gram-negative isolates, the most frequent were both Stenotrophomonas maltophilia and Escherichia coli, with five (4.23%) positive cultures each. Among the latter, two were Extended-Spectrum Beta-Lactamase producing (ESBL) (1.69%). The most frequently used empiric antibiotics were a combination of vancomycin and gentamicin (27%), followed by vancomycin alone (24.3%). Regarding gram-positive isolates, vancomycin was the most frequently used and effective antibiotic after cultures, whereas for gram-negative bacteria, it was found to be gentamicin. MDROs were defined as those resistant to at least one agent in three or more antimicrobial categories. 89 (75.4%) isolates were found to be MDRO, 85 (85.85%) gram-positive bacteria and 4 (21%) gram-negative bacteria. When comparing patients according to the type of vascular access, 66 (75%) infections with MDRO were found among patients with central venous catheters (CVCs). However, no statistically significant relationship was found between the type of vascular access and infection with MDRO (p = 0.523). MDRO cause a remarkably high proportion of BSIs in Palestinian patients. The results of this study support the empiric use of vancomycin and gentamicin to treat these infections. It is vital that health care providers prevent these infections via instituting and adhering to infection control policies in hemodialysis centers and providing proper antibiotic therapy of limited use and duration when necessary to avoid breeding resistance.
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Affiliation(s)
- Shatha A AbuTaha
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Tasbeeh Al-Kharraz
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Souad Belkebir
- Family and Community Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Adham Abu Taha
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Pathology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Mohazzab A, Khavanin Zadeh M, Dehesh P, Abdolvand N, Rahimi Z, Rahmani S. Investigation of risk factors for tunneled hemodialysis catheters dysfunction: competing risk analysis of a tertiary center data. BMC Nephrol 2022; 23:300. [PMID: 36056311 PMCID: PMC9440495 DOI: 10.1186/s12882-022-02927-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemodialysis tunneled catheters are prone to failure due to infection or thrombosis. Prediction of catheter dysfunction chance and finding the predisposing risk factors might help clinicians to prolong proper catheter function. The multidimensional mechanism of failures following infection or thrombosis needs a multivariable and comprehensive analytic approach. METHODS A longitudinal cross-sectional study was implemented on 1048 patients admitted for the first hemodialysis tunneled catheterization attempt between 2013 and 2019 in Shahid Hasheminejdad hospital, Tehran, Iran. Patients' information was extracted from digital and also paper records. Based on their criteria, single and multiple variable analyses were done separately in patients with catheter dysfunction due to thrombosis and infection. T-test and Chi-square test were performed in quantitative and categorical variables, respectively. Competing risk regression was performed under the assumption of proportionality for infection and thrombosis, and the sub-distributional hazard ratios (SHR) were calculated. All statistical inferences were made with a significance level of 0.05. RESULTS Four hundred sixty-six patients were enrolled in the analysis based on study criteria. Samples' mean (SD) age was 54(15.54), and 322 (69.1%) patients were female. Three hundred sixty-five catheter dysfunction cases were observed due to thrombosis 123(26.4%) and infection 242(52%). The Median (range) time to catheter dysfunction event was 243(36-1131) days. Single variable analysis showed a statistically significant higher proportion of thrombosis in females (OR = 2.66, 95% CI: 1.77-4.00) and younger patients, respectively. Multivariate competing risk regression showed a statistically significant higher risk of thrombosis in females (Sub-distributional hazard (SHR) = 1.81), hypertensive (SHR = 1.82), and more obese patients (BMI SHR = 1.037). A higher risk of infection was calculated in younger (Age SHR = 0.98) and diabetic (SHR = 1.63) patients using the same method. CONCLUSION Female and hypertensive patients are considerably at higher risk of catheter thrombosis, whereas diabetes is the most critical risk factor for infectious catheter dysfunction. Competing risk regression analysis showed a comprehensive result in the assessment of risk factors of catheter dysfunction.
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Affiliation(s)
- Arash Mohazzab
- Epidemiology Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | | | - Paria Dehesh
- Epidemiology Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Abdolvand
- Department of Information Technology Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
| | - Zhaleh Rahimi
- Department of Information Technology Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
| | - Sahar Rahmani
- Department of Information Technology Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
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Mohamud Hussein A, Kizilay M, Ali Nur Adam A, Farah Yusuf Mohamud M, Dirie AMH, Hussein Mohamed A, UÇaroĞlu E. Pattern and Sensitivity of Bacterial Colonization on the Tip of Non-Tunneled Temporary Hemodialysis Catheters: Results of a Tertiary Hospital in Somalia. Int J Gen Med 2022; 15:6775-6781. [PMID: 36042934 PMCID: PMC9420442 DOI: 10.2147/ijgm.s379642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Bacterial colonization on the tip of non-tunneled temporary hemodialysis catheters (NTHCs) and associated catheter-related infections (CRI) is a common complication in hemodialysis (HD) patients. In this study, we aimed to investigate the pattern of bacterial colonization formed on the tip of non-tunneled temporary hemodialysis catheters and their antibiotic sensitivity. Methods This retrospective analysis was performed in the HD unit of an Education and Research Hospital that follows up a universe of approximately 300 patients, primarily from Mogadishu, Somalia. From September 2020 to September 2021, a total of 137 temporary HD catheters were removed and their tips were sent for culture after there was a suspicion of CRI and other sources of infection were excluded. HD Catheter tips were cultured semi-quantitatively, and the antibiogram of the positive cultures was studied. Results Gram-positive cocci were found to be the most predominant bacterial organisms in positive cultures with 27 (31.0%) for Staphylococcus aureus, 9 (10.3%) for Staphylococcus haemolyticus and 5 (5.7%) for Staphylococcus epidermidis. We found Enterococci to be 5.7% of the isolated microorganisms. Gram-negative pathogens isolated included Escherichia coli 13 (14.9%) as the most common, followed by Klebsiella pneumoniae 10 (11.5%) and Acinetobacter baumannii (4.6%). Methicillin-resistant Staphylococcus aureus (MRSA) was found to be 9.4%. Gram-positive isolates showed high sensitivity (100%) to Linezolid, Daptomycin, Vancomycin, and Tigecycline, but a low sensitivity rate to Oxacillin (41.2%). Gram-negative isolates had the highest sensitivity to Tigecycline (100%), Imipenem (88.9%), and Amikacin (87%) but low sensitivity to Ampicillin (4.8%), Trimethoprim/Sulfamethoxazole (TMP-SMX) (23.1%), and Ceftazidime (7.1%). Conclusion We conclude that each institution should have its own antibiogram in the management of HD CRIs. According to our findings in this study, we recommend intravenous Vancomycin and Imipenem as empirical therapy in patients with suspected HD CRIs.
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Affiliation(s)
- Abdinafic Mohamud Hussein
- Department of Cardiovascular Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Mehmet Kizilay
- Department of Cardiovascular Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Abdirahim Ali Nur Adam
- Department of Microbiology and Infectious Diseases, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Farah Yusuf Mohamud
- Department of Emergency Medicine, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | | | - Abdikarim Hussein Mohamed
- Department of Urology, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Erhan UÇaroĞlu
- Department of Cardiovascular Surgery, Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
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Wang Y, Hu X, Yang L, Chen C, Cheng H, Hu H, Liang W, Tong Y, Wang M, Wang H. Application of High-Throughput Sequencing Technology in the Pathogen Identification of Diverse Infectious Diseases in Nephrology Departments. Diagnostics (Basel) 2022; 12:diagnostics12092128. [PMID: 36140529 PMCID: PMC9497786 DOI: 10.3390/diagnostics12092128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The purpose of this study was to explore the clinical applications of high-throughput sequencing (HTS) in the identification of pathogens in patients with urinary tract infection (UTI), peritoneal dialysis-associated peritonitis (PDAP), central venous catheter related blood infections (CRBIs), and lung infections in the nephrology department. Methods: Midstream urine samples from 112 patients with UTI, peritoneal fluid samples from 67 patients with PDAP, blood samples from 15 patients with CRBI, and sputum specimens from 53 patients with lung infection were collected. The HTS and ordinary culture methods were carried out in parallel to identify the pathogens in each sample. Pathogen detection positive rate and efficacy were compared between the two methods. Results: The pathogen positive detection rates of HTS in UTI, PDAP, CRBI, and lung infection were strikingly higher than those of the culture method (84.8% vs. 35.7, 71.6% vs. 23.9%, 75% vs. 46.7%, 84.9% vs. 5.7%, p < 0.05, respectively). HTS was superior to the culture method in the sensitivity of detecting bacteria, fungi, atypical pathogens, and mixed microorganisms in those infections. In patients who had empirically used antibiotics before the test being conducted, HTS still exhibited a considerably higher positive rate than the culture method (81.6% vs. 39.0%, 68.1% vs. 14.9%, 72.7% vs. 36.4%, 83.3% vs. 4.2%, p < 0.05, respectively). Conclusions: HTS is remarkably more efficient than the culture method in detecting pathogens in diverse infectious diseases in nephrology, and is particularly potential in identifying the pathogens that are unable to be identified by the common culture method, such as in cases of complex infection with specific pathogens or subclinical infection due to preemptive use of antibiotics.
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Affiliation(s)
- Yujuan Wang
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Xiaoyi Hu
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Lianhua Yang
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Cheng Chen
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Hui Cheng
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Haiyun Hu
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Wei Liang
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Yongqing Tong
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
| | - Ming Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
- Correspondence: (M.W.); (H.W.)
| | - Huiming Wang
- Department of Nephrology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang District, Wuhan 430060, China
- Correspondence: (M.W.); (H.W.)
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Challenging, Safe, and Effective Use of External Iliac Vein for Insertion of Tunneled Cuffed Hemodialysis Catheters: A Single-Center Prospective Study. Int J Nephrol 2022; 2022:4576781. [PMID: 35983505 PMCID: PMC9381280 DOI: 10.1155/2022/4576781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/12/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Providing well-functioning vascular access is crucial for patients undergoing chronic hemodialysis. Peripheral arteriovenous fistulas and grafts are the preferred accesses in hemodialysis patients. Patients with bilateral obstruction of internal jugular veins and subclavian veins require a suitable vascular access. Thus, the insertion of iliac vein tunneled cuffed catheters (TCCs) by interventional nephrologists may be a good option for these patients. We aimed to evaluate the outcomes of iliac vein TCCs in patients lacking other vascular options. Methods 80 tunneled cuffed hemodialysis catheters were inserted through the iliac veins of 80 patients with an end-stage kidney disease. Catheter insertion was guided by Doppler ultrasonography followed by plain radiography to detect the catheter tip and exclude complications. Results The insertion success rate was 100%. 25 patients developed catheter-related infections. The mean survival time per catheter was 328 days. At the end of the study, 40 catheters were still functioning, 15 patients were shifted to continuous ambulatory peritoneal dialysis and 5 patients were referred to the interventional radiology department for insertion of transhepatic inferior vena cava tunneled catheters. Resistant catheter-related infection was the main cause of catheter removal in 11 patients (17.5%) in this study. Catheter malfunction was the second most common cause of catheter removal in 9 patients (11.25%). Conclusion This study concluded that iliac vein TCCs can provide suitable vascular access in hemodialysis patients with bilateral obstruction of internal jugular veins and subclavian veins.
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Coulibaly B, Gaillard C, Pelletier S, Guitton J, Fongoro S, Tangara M, Aulagner G, Maire P. Antibiotic therapy for infectious hemodialysed patients in Bamako: Pharmacokinetic analyses and first improvement suggestions. ANNALES PHARMACEUTIQUES FRANÇAISES 2022; 80:810-818. [PMID: 35662588 DOI: 10.1016/j.pharma.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/22/2022] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Balla Coulibaly
- Univ Lyon, Université Claude Bernard Lyon 1, INSA Lyon, CNRS, MATEIS, UMR5510, 69008 Lyon, France; Université des Sciences, des Techniques et des Technologies de Bamako, France
| | - Claire Gaillard
- Univ Lyon, Université Claude Bernard Lyon 1, INSA Lyon, CNRS, MATEIS, UMR5510, 69008 Lyon, France
| | - Solenne Pelletier
- Service de Néphrologie, Hôpital Lyon Sud, Hospices Civils de Lyon, France
| | - Jérôme Guitton
- Laboratoire de biologie, Hôpital Lyon Sud, Hospices Civils de Lyon, France
| | - Saharé Fongoro
- Université des Sciences, des Techniques et des Technologies de Bamako, France; Service de Néphrologie, Centre Hospitalo-Universitaire du Point-G de Bamako, France
| | - Moustapha Tangara
- Service de Néphrologie, Centre Hospitalo-Universitaire du Point-G de Bamako, France
| | - Gilles Aulagner
- Univ Lyon, Université Claude Bernard Lyon 1, INSA Lyon, CNRS, MATEIS, UMR5510, 69008 Lyon, France; Académie des sciences Pharmaceutiques de France, France.
| | - Pascal Maire
- Université Claude Bernard LyonI UMR CNRS 5558, Faculté de Médecine Lyon Sud, France
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Lee KN, Chen CA, Wu CH, Yang LY. Reduction in hemodialysis catheter-related bloodstream infections after implementation of a novel care program. Hemodial Int 2022; 26:308-313. [PMID: 35499673 DOI: 10.1111/hdi.13021] [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: 11/04/2021] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Catheter-related bloodstream infection (CRBSI) due to dialysis is the major factor causing morbidity and mortality factor for patients undergoing hemodialysis and is associated with additional costs for these patients. This study investigated the effect of a novel care program in terms of reducing CRBSIs for hemodialysis patients with nontunneled (temporary) catheters inserted in their femoral veins. METHODS This study included dialysis patients (inpatients and outpatients) from July 2018 to September 2019, covering two periods, pre-intervention (baseline period) and intervention with a novel care program (novel care period). The novel care program was initiated on December 1, 2018. The CRBSI rates (/1000 catheter-days) for the baseline and novel care periods were compared, and the characteristics of the pathogens were determined. FINDINGS Of a total of 72 patients, 33 were from the baseline period and 39 were from the novel care period. Patients in the baseline and novel care periods had the catheter inserted in their femoral veins for a median of 20 and 29 days, respectively. The CRBSI rate decreased by 82.63%, from 8.52/1000 catheter-days in the baseline period to 1.48/1000 catheter-days in the novel care period (p = 0.036). The most common organisms involved in CRBSIs were coagulase-negative staphylococcus and Burkholderia cepacia (26% for both). DISCUSSION The novel care program reduced the incidence of CRBSIs in patients with temporary catheters inserted in their femoral veins.
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Affiliation(s)
- Kai-Ni Lee
- Graduate Institute of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nephrology, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Chien-An Chen
- Department of Nephrology, Tainan Sinlau Hospital, Tainan, Taiwan.,Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan
| | - Chia-Hui Wu
- Department of Nursing, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Li-Yu Yang
- Graduate Institute of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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17
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La Russa R, Fazio V, Ferrara M, Di Fazio N, Viola RV, Piras G, Ciano G, Micheletta F, Frati P. Proactive Risk Assessment Through Failure Mode and Effect Analysis (FMEA) for Haemodialysis Facilities: A Pilot Project. Front Public Health 2022; 10:823680. [PMID: 35400067 PMCID: PMC8987154 DOI: 10.3389/fpubh.2022.823680] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Haemodialysis (HD) is one of the methods for renal replacement therapy in the management of advanced chronic kidney disease through an osmosis process that allows purification of blood in the dialysis machine. The complexity of the dialytic procedure often requires the presence of a multi-specialist, multi-disciplinary team. The dialysis process is an important target for clinical risk management. Failure Mode and Effect Analysis (FMEA) is a proactive technique, considered a purposeful and dynamic tool for clinical risk management. FMEA is noted in five phases that allow a preliminary assessment of a definite process through identification and classification of risk priorities. This study represents the first of a two-phase project where FMEA is applied to HD in the setting of San Feliciano Hospital. The dialysis center performs ~12,000 dialysis sessions per year. The dialysis process is divided into different stages. A total of 31 failure modes were identified in the whole dialysis stages; more than 2/3 of the failure modes were related to the only connecting of the patient to the dialysis machine. The first phase of the study clearly remarked that the most critical step of the dialytic process is represented by the connection between the patient and the machine, as expected. Indeed, in order to have the dialysis set up, an arteriovenous fistula must be surgically created prior to the procedure and it is one of the most important issues in the HD process because of the necessity of a constant revision of it. FMEA application to HD is a useful tool, easy to be implemented and it is likely to nimbly reveal the practical and potential solutions to the critical steps of the procedure.
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Affiliation(s)
- Raffaele La Russa
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Foggia, Italy
| | - Valentina Fazio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Michela Ferrara
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Foggia, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Nicola Di Fazio
| | - Rocco Valerio Viola
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Gianluca Piras
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | | | | | - Paola Frati
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
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18
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YEŞİLTAŞ MA, KAVALA AA, TURKYILMAZ S, KUSERLI Y, TOZ H. Comparison of the results of tunneled catheters from the subclavian vein and internal jugular vein for hemodialysis in older patients: a retrospective study. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.21.01524-2] [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]
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Abstract
Haemodialysis (HD) is the commonest form of kidney replacement therapy in the world, accounting for approximately 69% of all kidney replacement therapy and 89% of all dialysis. Over the last six decades since the inception of HD, dialysis technology and patient access to the therapy have advanced considerably, particularly in high-income countries. However, HD availability, accessibility, cost and outcomes vary widely across the world and, overall, the rates of impaired quality of life, morbidity and mortality are high. Cardiovascular disease affects more than two-thirds of people receiving HD, is the major cause of morbidity and accounts for almost 50% of mortality. In addition, patients on HD have high symptom loads and are often under considerable financial strain. Despite the many advances in HD technology and delivery systems that have been achieved since the treatment was first developed, poor outcomes among patients receiving HD remain a major public health concern. Understanding the epidemiology of HD outcomes, why they might vary across different populations and how they might be improved is therefore crucial, although this goal is hampered by the considerable heterogeneity in the monitoring and reporting of these outcomes across settings. This Review examines the epidemiology of haemodialysis outcomes — clinical, patient-reported and surrogate outcomes — across world regions and populations, including vulnerable individuals. The authors also discuss the current status of monitoring and reporting of haemodialysis outcomes and potential strategies for improvement. Nearly 4 million people in the world are living on kidney replacement therapy (KRT), and haemodialysis (HD) remains the commonest form of KRT, accounting for approximately 69% of all KRT and 89% of all dialysis. Dialysis technology and patient access to KRT have advanced substantially since the 1960s, particularly in high-income countries. However, HD availability, accessibility, cost and outcomes continue to vary widely across countries, particularly among disadvantaged populations (including Indigenous peoples, women and people at the extremes of age). Cardiovascular disease affects over two-thirds of people receiving HD, is the major cause of morbidity and accounts for almost 50% of mortality; mortality among patients on HD is significantly higher than that of their counterparts in the general population, and treated kidney failure has a higher mortality than many types of cancer. Patients on HD also experience high burdens of symptoms, poor quality of life and financial difficulties. Careful monitoring of the outcomes of patients on HD is essential to develop effective strategies for risk reduction. Outcome measures are highly variable across regions, countries, centres and segments of the population. Establishing kidney registries that collect a variety of clinical and patient-reported outcomes using harmonized definitions is therefore crucial. Evaluation of HD outcomes should include the impact on family and friends, and personal finances, and should examine inequities in disadvantaged populations, who comprise a large proportion of the HD population.
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Steiger S, Rossaint J, Zarbock A, Anders HJ. Secondary Immunodeficiency Related to Kidney Disease (SIDKD)-Definition, Unmet Need, and Mechanisms. J Am Soc Nephrol 2022; 33:259-278. [PMID: 34907031 PMCID: PMC8819985 DOI: 10.1681/asn.2021091257] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Kidney disease is a known risk factor for poor outcomes of COVID-19 and many other serious infections. Conversely, infection is the second most common cause of death in patients with kidney disease. However, little is known about the underlying secondary immunodeficiency related to kidney disease (SIDKD). In contrast to cardiovascular disease related to kidney disease, which has triggered countless epidemiologic, clinical, and experimental research activities or interventional trials, investments in tracing, understanding, and therapeutically targeting SIDKD have been sparse. As a call for more awareness of SIDKD as an imminent unmet medical need that requires rigorous research activities at all levels, we review the epidemiology of SIDKD and the numerous aspects of the abnormal immunophenotype of patients with kidney disease. We propose a definition of SIDKD and discuss the pathogenic mechanisms of SIDKD known thus far, including more recent insights into the unexpected immunoregulatory roles of elevated levels of FGF23 and hyperuricemia and shifts in the secretome of the intestinal microbiota in kidney disease. As an ultimate goal, we should aim to develop therapeutics that can reduce mortality due to infections in patients with kidney disease by normalizing host defense to pathogens and immune responses to vaccines.
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Affiliation(s)
- Stefanie Steiger
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
| | - Jan Rossaint
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, Ludwig Maximilians University Hospital of Munich, Munich, Germany
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21
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Costa CFFA, Merino-Ribas A, Ferreira C, Campos C, Silva N, Pereira L, Garcia A, Azevedo Á, Mesquita RBR, Rangel AOSS, Manaia CM, Sampaio-Maia B. Characterization of Oral Enterobacteriaceae Prevalence and Resistance Profile in Chronic Kidney Disease Patients Undergoing Peritoneal Dialysis. Front Microbiol 2022; 12:736685. [PMID: 34970231 PMCID: PMC8713742 DOI: 10.3389/fmicb.2021.736685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022] Open
Abstract
Chronic Kidney Disease (CKD) is a growing public-health concern worldwide. Patients exhibit compromised immunity and are more prone to infection than other populations. Therefore, oral colonization by clinically relevant members of the Enterobacteriaceae family, major agents of both nosocomial and dialysis-associated infections with frequent prevalence of antibiotic resistances, may constitute a serious risk. Thus, this study aimed to assess the occurrence of clinically relevant enterobacteria and their antibiotic resistance profiles in the oral cavity of CKD patients undergoing peritoneal dialysis (CKD-PD) and compare it to healthy controls. Saliva samples from all the participants were cultured on MacConkey Agar and evaluated regarding the levels of urea, ammonia, and pH. Bacterial isolates were identified and characterized for antibiotic resistance phenotype and genotype. The results showed that CKD-PD patients exhibited significantly higher salivary pH, urea, and ammonia levels than controls, that was accompanied by higher prevalence and diversity of oral enterobacteria. Out of all the species isolated, only the prevalence of Raoultella ornithinolytica varied significantly between groups, colonizing the oral cavity of approximately 30% of CKD-PD patients while absent from controls. Antibiotic resistance phenotyping revealed mostly putative intrinsic resistance phenotypes (to amoxicillin, ticarcillin, and cephalothin), and resistance to sulfamethoxazole (~43% of isolates) and streptomycin (~17%). However, all isolates were resistant to at least one of the antibiotics tested and multidrug resistance isolates were only found in CKD-PD group (31,6%). Mobile genetic elements and resistance genes were detected in isolates of the species Raoultella ornithinolytica, Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, and Enterobacter asburiae, mostly originated from CKD-PD patients. PD-related infection history revealed that Enterobacteriaceae were responsible for ~8% of peritonitis and ~ 16% of exit-site infections episodes in CKD-PD patients, although no association was found to oral enterobacteria colonization at the time of sampling. The results suggest that the CKD-induced alterations of the oral milieu might promote a dysbiosis of the commensal oral microbiome, namely the proliferation of clinically relevant Enterobacteriaceae potentially harboring acquired antibiotic resistance genes. This study highlights the importance of the oral cavity as a reservoir for pathobionts and antibiotic resistances in CKD patients undergoing peritoneal dialysis.
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Affiliation(s)
- Carolina F F A Costa
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology & Infectious Diseases R&D Group, INEB - Instituto de Engenharia Biomédica, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Ana Merino-Ribas
- Nephrology & Infectious Diseases R&D Group, INEB - Instituto de Engenharia Biomédica, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Nephrology Department, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Catarina Ferreira
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Carla Campos
- Instituto Português de Oncologia do Porto Francisco Gentil (IPO), Porto, Portugal
| | - Nádia Silva
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Luciano Pereira
- Nephrology & Infectious Diseases R&D Group, INEB - Instituto de Engenharia Biomédica, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Andreia Garcia
- Nephrology & Infectious Diseases R&D Group, INEB - Instituto de Engenharia Biomédica, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Álvaro Azevedo
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Raquel B R Mesquita
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - António O S S Rangel
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Célia M Manaia
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Benedita Sampaio-Maia
- Nephrology & Infectious Diseases R&D Group, INEB - Instituto de Engenharia Biomédica, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
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Causes and Risk Factors of Hemodialysis Catheter Infection in Dialysis Patients: A Prospective Study. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.117820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Infectious central venous catheter (CVC) complications, including mortality and care and hospitalization costs, are still a major clinical concern. This study aimed to determine the prevalence of hemodialysis catheter infection and its risk factors among hemodialysis patients. Methods: The present research was a descriptive, prospective cross-sectional study on hemodialysis patients in Babol hospitals during 2020 - 21. The participants' demographic information and some relevant data on clinical variables (namely underlying diseases, cause of dialysis, and cause of catheter removal) and catheter-related variables (namely catheter location, frequency of catheter placement, and apparent signs of catheter site) were collected and recorded directly and systematically during surgery post-surgery. Results: One hundred and twenty-two patients with temporary double-lumen acute hemodialysis catheters for dialysis, including 56 women (45.9%), were included in this study, the mean age of whom was 58.9 ± 16.4 years. Twenty-two patients (18%) developed a catheter-induced systemic infection. There was no significant relationship between the catheter site and its removal inducing infection (P > 0.05). The frequencies of microorganisms causing catheter infection included gram-positive Staphylococcus epidermis (59%) and Staphylococcus aureus (31.8%). Moreover, there was no significant correlation between demographic variables and clinical history with systemic infection induced by catheterization. Conclusions: The rate of catheter-induced infection is relatively high among patients since sterile instructions were observed during catheterization; therefore, it is recommended to pay more attention to the care and dressing of the catheter site.
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Phongphithakchai A, Dandecha P, Raksasuk S, Srithongkul T. Urgent-start peritoneal dialysis for end-stage renal disease patients: literature review and worldwide evidence-based practice. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00384-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
AbstractThe prevalence of end-stage renal disease (ESRD) is on the rise worldwide. Meanwhile, the number of older people requiring dialysis therapy is increasing as a result of this population. We found that starting dialysis in an unplanned manner is a common occurrence, even for patients with nephrology follow-up. Most centers choose hemodialysis with a high rate of central venous catheter use at the time of initiation of dialysis. Current data has found that central venous catheter use is independently associated with increased mortality and high bacteremia rates. Peritoneal dialysis is one option to avoid bacteremia. The International Society for Peritoneal Dialysis guidelines suggests a break-in period of at least two weeks prior to an elective start of peritoneal dialysis, without mentioning urgent-start peritoneal dialysis. For unplanned ESRD patients, it is unrealistic to wait for two weeks before initiating peritoneal dialysis therapy. Urgent-start peritoneal dialysis has been suggested to be a practical approach of prompt initiation of peritoneal dialysis after catheter insertion, which may avoid an increased risk of central venous catheter-related complications, including bacteremia, central venous stenosis, and thrombosis associated with the temporary use of hemodialysis. Peritoneal dialysis is the alternative option, and many studies have presented an interest in urgent-start peritoneal dialysis. Some reports have compared urgent-start hemodialysis to peritoneal dialysis and found that urgent-start peritoneal dialysis is a safe and effective alternative to hemodialysis for an unplanned dialysis patient. This review aims to compare each literature report regarding techniques, prescriptions, outcomes, complications, and costs of urgent-start peritoneal dialysis.
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Effect of sutureless securement on hemodialysis catheter-related bloodstream infection. Sci Rep 2021; 11:21771. [PMID: 34741127 PMCID: PMC8571352 DOI: 10.1038/s41598-021-01372-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
The use of sutureless securement devices during catheterization might reduce the risk of catheter-related bloodstream infection (CRBSI) by suppressing catheter-exit infection and catheter dislodgement. However, the effectiveness of these devices in reducing CRBSI risk when securing hemodialysis catheters has not been explored. This single-center retrospective observational study examined 211 non-tunneled hemodialysis catheters (NTHCs) from 110 hemodialysis inpatients, of which 121 were secured using conventional skin sutures (Suture group) and 90 with GRIP-LOK (GRIP-LOK group). The stabilized inverse probability of treatment (SIPT)-weighting method was used to generate a new population (SIPT-weighted model) without group differences for each of the 12 predictors of CRBSI development (i.e., age, sex, dialysis history, concomitant acute kidney injury or diabetes, concurrent use of immunosuppressant drugs or aspirin, NTHC insertion site, methicillin-resistant Staphylococcus aureus, carriage, bacteremia event within 3 months before catheterization, hemoglobin level, and serum albumin titer). The effect of GRIP-LOK compared with sutures on CRBSI in the SIPT-weighted model was evaluated using univariate SIPT-weighted Cox proportional regression analysis, which showed a significant CRBSI suppression effect of GRIP-LOK compared with sutures (hazard ratio: 0.17 [95% CI 0.04–0.78], p = 0.023). GRIP-LOK affords a lower risk of CRBSI due to indwelling NTHCs than conventional securement using sutures.
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25
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Abd El-Hamid El-Kady R, Waggas D, AkL A. Microbial Repercussion on Hemodialysis Catheter-Related Bloodstream Infection Outcome: A 2-Year Retrospective Study. Infect Drug Resist 2021; 14:4067-4075. [PMID: 34621127 PMCID: PMC8491864 DOI: 10.2147/idr.s333438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background Albeit growing technical advances in the design of hemodialysis catheters, intravascular catheter-related bloodstream infection (CRBSI) still represents an utmost clinical challenge to the health-care workers (HCWs). Data regarding the influence of the culprit organism on the scenario of CRBSI in the literature are extremely lacking. Thereby, this research was carried out. Methods We undertook a retrospective cohort study over an interval of 2 years, involving patients who underwent regular hemodialysis via catheters in the Renal Dialysis Unit (RDU) of Dr. Soliman Fakeeh Hospital (DSFH), Jeddah, Kingdom of Saudi Arabia (KSA). The study enrolled 139 patients (56.8% females and 43.2% males), with mean age of 60.79 ± 11.45 years. Results The aggregate rate of CRBSI was 5.1/1000 catheter days. Amongst the 139 study candidates confirmed of having CRBSI, while 69.8% of CRBSIs were ascribed to Gram-positive cocci, about one-third of the infectious episodes were secondary to Gram-negative bacilli. Interestingly, fever was the most common presentation of S. aureus CRBSI compared to CoNS and Gram-negative bacilli CRBSIs (20.9% versus 12.9% versus 6.5%, p= 0.0001), whereas CRBSIs due to CoNS were presented mainly with rigors (19.4%). Of note, CRBSIs caused by Gram-negative bacilli had a tendency to manifest with unusual symptoms such as vomiting or hypotension. Besides, they were more prone to involve hospitalization or ICU admission. In this study, no mortality was attributed to CRBSIs. Conclusion Our study disclosed that the illicit organism has a repercussion on the clinical presentation as well as the fate of CRBSI among hemodialysis patients. This highlights the worth of identifying the infected cases in a periodic manner, to avoid the occurrence of devastating complications. A large body of work from various hemodialysis centers should take place in the near future so as to provide more insight in this perspective.
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Affiliation(s)
- Rania Abd El-Hamid El-Kady
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Department of Pathological Sciences, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia
| | - Dania Waggas
- Department of Pathological Sciences, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed AkL
- Department of Nephrology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.,Department of Internal Medicine/Adult Nephrology, Dr. Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia
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Analysis of Different Vascular Accesses on Dialysis Quality and Infection Risk Factors of Hemodialysis Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4554417. [PMID: 34484391 PMCID: PMC8413044 DOI: 10.1155/2021/4554417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/18/2021] [Indexed: 12/05/2022]
Abstract
Objective To explore the influence of different vascular accesses on dialysis quality and infection risk factors of hemodialysis patients. Methods A total of 162 patients with end-stage renal disease admitted to our hospital from February 2018 to July 2020 were divided into two groups: cuff tunnel conduit (CTC) group and native arteriovenous fistula (AVF) group. Peripheral blood was collected before and 6 months after dialysis. The incidence of vascular recirculation was measured, and the risk factors of infection were analyzed. Results The levels of HB, Alb, CRP, BUN, Scr, and TP after dialysis in the two groups were lower than those before dialysis (P < 0.05). The Kt/V of patients in both groups did not exceed 1.2, and the URR value exceeded 60%. The results of independent-samples T test analysis documented that the Kt/V level of patients in the AVF group was higher than that of those in the CTC group after dialysis (P < 0.05). The results of the urea method revealed that 22 of 68 patients (32.35%) in the CVC group and 21 of 94 (22.34%) in the AVF group had vascular pathway recirculation. The χ2 test showed that there was no remarkable difference in the incidence of vascular pathway recirculation between both groups (P > 0.05). However, the results of the nonurea method revealed that the incidence of vascular pathway recirculation in the AVF group was lower than that in the CVC group (P < 0.05). Multivariate logistic regression was used to further analyze the factors with statistical significance in the single factor results. It showed that age >60 years, dialysis duration >1 year, dialysis times, diabetes, hypertension, and CTC were all independent risk factors causing vascular access infection. Conclusion If all conditions permit, AVF hemodialysis is a better choice for patients with end-stage renal disease. For the elderly, long-term hemodialysis, and those with diabetes and hypertension, it is necessary to make detailed plans, strengthen the operation proficiency of CTC, and reduce the incidence of infection.
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Çelakıl M, Çoban Y. Etiologic-sociodemographic assessment and comparison of dialysis modalities in pediatric Syrian migrants with chronic kidney disease. ACTA ACUST UNITED AC 2021; 44:68-74. [PMID: 34499077 PMCID: PMC8943876 DOI: 10.1590/2175-8239-jbn-2020-0260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are among the important causes of mortality and morbidity in childhood. Early diagnosis and treatment of the underlying primary disease may prevent most of CKD patients from progressing to ESRD. There is no study examining chronic kidney diseases and dialysis modalities in Syrian immigrant children. We aimed to retrospectively research the etiologic, sociodemographic, and clinical factors in CKD among Syrian refugee children, and at the same time, to compare the clinical characteristics of patients with ESRD on peritoneal dialysis and hemodialysis. METHODS Our study included a total of 79 pediatric Syrian patients aged from 2-16 years monitored at Hatay State Hospital pediatric nephrology clinic with diagnosis of various stages of CKD and with ESRD. Physical-demographic features and clinical-laboratory information were retrospectively screened. RESULTS The most common cause of CKD was congenital anomalies of the kidneys and urinary tracts (CAKUT) (37.9%). Other causes were urolitiasis (15.1%), nephrotic syndrome (10.1%), spina bifida (8.8%), hemolytic uremic syndrome (7.5%), and glomerulonephritis (7.5%). Twenty-five patients used hemodialysis due to bad living conditions. Only 2 of the patients with peritoneal dialysis were using automatic peritoneal dialysis (APD), with 5 using continuous ambulatory peritoneal dialysis (CAPD). Long-term complications like left ventricle hypertrophy and retinopathy were significantly higher among hemodialysis patients. There was no difference identified between the groups in terms of hypertension and sex. CONCLUSION Progression to ESRD due to preventable reasons is very frequent among CKD patients. For more effective use of peritoneal dialysis in pediatric patients, the responsibility of states must be improved.
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Affiliation(s)
- Mehtap Çelakıl
- Hatay State Hospital, Pediatric Nephrology, Hatay, Turkey
| | - Yasemin Çoban
- Hatay State Hospital, Pediatric Intensive Care, Hatay, Turkey
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Abbasi SH, Aftab RA, Lai PSM, Lim SK, Zainol Abidin RN. Impact of Healthcare Associated Infections on Survival and Treatment Outcomes Among End Stage Renal Disease Patients on Renal Replacement Therapy. Front Pharmacol 2021; 12:707511. [PMID: 34447309 PMCID: PMC8383202 DOI: 10.3389/fphar.2021.707511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Due to frequent hospitalizations, complex dialysis procedures and immune compromising effects of end stage renal disease (ESRD), patients on dialysis are more prone to healthcare associated infections (HCAIs). Objective: To study the impact of HCAIs on survival and treatment outcomes among ESRD patients on renal replacement therapy (RRT). Methodology: A multicenter, retrospective study was conducted from June to December 2019 at two public hospitals of Malaysia. ESRD patients with minimum of 6 months on RRT were included, while pregnant patients and patients <18 years were excluded. Multinomial logistic regression was performed to identify risk factors associated with unsuccessful treatment outcomes. Kaplan Meier analysis was performed to study the survival. Results: A total of 670 records were examined, of which 400 patients were included as per the inclusion criteria. The mean survival time of patients without HCAIs [22.7 (95%CI:22.1-23.2)] was higher than the patients with HCAIs [19.9 (95%CI:18.8-20.9)]. Poor survival was seen in patients with >2 comorbidities, >60 years of age, low hemoglobin concentration and high C-reactive protein levels. The most frequent treatment outcome was cured [113 (64.9%)], followed by death [37 (21.3%)] and treatment failure [17 (9.8%)]. Advancing age, and low hemoglobin concentration were independent risk factors associated with death, while recurrent HCAIs, use of central venous catheters, and low serum sodium levels were risk factors for treatment failure. Conclusion: The high burden of HCAIs is a profound challenge faced by patients on RRT, which not only effects the treatment outcomes but also contributes substantially to the poor survival among these patients.
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Affiliation(s)
| | | | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soo Kun Lim
- Department of Medicine (Division of Nephrology), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Ibáñez Pallarès S, Esteve Simó V, Velescu A, Tapia González I, Collado Nieto S, Clara Velasco A. Are continued policies of prioritizing native vascular access in patients on hemodialysis programs useful? Ther Apher Dial 2021; 26:434-440. [PMID: 34296527 DOI: 10.1111/1744-9987.13711] [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: 02/10/2021] [Revised: 07/08/2021] [Accepted: 07/17/2021] [Indexed: 11/30/2022]
Abstract
The guidelines recommend establishing native vascular access as opposed to prosthetic or catheter-based access despite information relating to its effectiveness being scarce from a patient-orientated perspective. We analyzed the effectiveness of a continued policy of native vascular access (CPNVA) in patients undergoing hemodialysis. A retrospective, observational study, including 150 patients undergoing hemodialysis between 2006 and 2012 at our center, and who underwent a CPNVA. Statistical analysis was based on treatment intention. In 138 patients (92%), the first useful access (FUA) was native, and in 12 patients (8%), it was prosthetic. In 50 patients (33.3%), more than one procedure had to be carried out in to order to achieve FUA. The probability of dialysis occurring via a FUA was 67.1% and 45.3% at 1 and 5 years respectively. Over the follow-up period (mean time = 30 months), 84 patients (56%) required repairs or new access, extending the effectiveness of the CPNVA to 88.3% and 73.2% at 1 and 5 years respectively. The effectiveness of the CPNVA was reduced if the patient: required a catheter initially (HR: 3.6, p = 0.007); in cases of initially elevated glomerular filtration rate (HR: 1.1, p = 0.040); in cases of history of previous access failure before FUA (HR: 3.9, p = 0.001); and in female patients (HR: 2.4, p = 0.031). The long-term effectiveness of a CPNVA is high. However, the percentage of patients requiring diverse procedures in order to achieve FUA and the need for re-interventions yield the necessity to optimize preoperative evaluation and postoperative follow-up.
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Affiliation(s)
- Sara Ibáñez Pallarès
- Vascular Surgery Department, Hospital de Terrassa, Barcelona, Spain.,Surgery and Morphologic Sciences Department, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | | | - Alina Velescu
- Vascular Surgery Department, Hospital del Mar, Barcelona, Spain
| | - Irati Tapia González
- Nephrology Department, Hospital de Terrassa, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
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Catheter-Related Bloodstream Infections and Catheter Colonization among Haemodialysis Patients: Prevalence, Risk Factors, and Outcomes. Int J Nephrol 2021; 2021:5562690. [PMID: 34249377 PMCID: PMC8238579 DOI: 10.1155/2021/5562690] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/13/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Catheter-related bloodstream infection (CRBSI) and catheter colonization (CC) are two complications among haemodialysis (HD) patients that lead to increased morbidity and mortality. This study aims to evaluate the prevalence of CRBSI and CC among HD patients registered at Universiti Kebangsaan Malaysia Medical Centre and to identify the factors involved by focusing on the demographic profile of the patients as well as their clinical characteristics and outcomes. Method This is a retrospective study of end-stage renal disease patients with suspected CRBSI during the period from 1 January 2016 to 31 December 2018. Data on patients who fulfilled the blood culture criteria for CRBSI and CC diagnosis were further analysed for clinical manifestations, comorbidities, history of dialysis, catheter characteristics, and microbiological culture results. The outcomes of CRBSI and CC were also assessed. Findings. In the 3-year period under study, there were 496 suspected CRBSI cases with a total of 175 events in 119 patients who fulfilled the inclusion criteria. During that time, the percentage of patients who experienced CRBSI and CC was 4.2% and 4.8%, respectively. The majority of the cohort consisted of male (59.4%), Malay ethnicity (75%), and patients on a tunnelled dialysis catheter (83%). Patients who were fistula naïve and had an internal jugular catheter were more common in the CRBSI group than in the CC group. The predominant microorganisms that were isolated were Gram-positive organisms. In terms of clinical presentation and outcome, no differences were found between the CRBSI and CC groups. Patients with Gram-negative bacteraemia, high initial c-reactive protein, and catheter salvation were likely to have poor outcomes. Recurrence of CRBSI occurred in 31% of the cohort. Neither catheter salvation nor antibiotic-lock therapy were associated with the recurrence of CRBSI. On the other hand, the femoral vein catheter site was associated with risk of recurrence. The overall mortality rate was 1.1%. Discussion. From the analysis, it was concluded that clinical assessment and positive culture are crucial in diagnosing CRBSI with or without peripheral culture. This study provides essential information for the local setting which will enable healthcare providers to implement measures for the better management of CRBSI.
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Effects of a Quality Improvement Program to Reduce Central Venous Catheter-Related Infections in Hemodialysis Patients. Am J Med Sci 2020; 361:461-468. [PMID: 33781388 DOI: 10.1016/j.amjms.2020.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/02/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Central catheter infections are of concern in patients on hemodialysis because of the high risk of catheter-related bloodstream infections, sepsis, and death. Adequate nursing is critical for the prevention of such infections. This study aimed to use the PDCA (plan-do-check-act) method to reduce the incidence of central venous catheter infection using management in the maintenance of central venous catheter in patients on hemodialysis, compared with routine care. METHODS This pilot study recruited patients on hemodialysis via central venous catheterization at the Blood Purification Center of Ruijin Hospital between November 2017 and November 2018. The patients were randomized to the routine and PDCA groups. All participants received routine nursing. The PDCA group received central venous catheter management by PDCA. The incidence of central venous catheterization-related infections, nursing satisfaction, and quality of life were compared between the two groups. RESULTS A total of 122 participants were enrolled in each group. The incidence of central catheter-related bloodstream infection, as the primary outcome, was 0.8 and 8.8 cases per 1000 catheter days in the PDCA and routine groups, respectively (P < 0.001). In addition, as the secondary outcomes, the scores of nursing satisfaction (health guidance, nursing technology, and therapeutic effects) score and quality of life (physiological, psychological, social, and environmental status) were better in the PDCA group than in the routine group (all P < 0.01). CONCLUSIONS This pilot study suggests that the PDCA cycle model can effectively reduce the incidence of central venous catheter-related infections and improve satisfaction and quality of life in patients on hemodialysis.
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Risk factors associated with nosocomial infections among end stage renal disease patients undergoing hemodialysis: A systematic review. PLoS One 2020; 15:e0234376. [PMID: 32569265 PMCID: PMC7307739 DOI: 10.1371/journal.pone.0234376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/26/2020] [Indexed: 02/07/2023] Open
Abstract
Background Profound healthcare challenges confront societies with an increase in prevalence of end-stage renal disease (ESRD), which is one of the leading causes of morbidity and mortality worldwide. Due to several facility and patient related factors, ESRD is significantly associated with increased morbidity and mortality attributed to infections. Aims and objective The aim of this study was to assess systematically the characteristics of patients and risk factors associated with nosocomial infections among ESRD patients undergoing hemodialysis. Methods A systematic literature search was performed to identify eligible studies published during the period from inception to December 2018 pertaining to risk factors associated with nosocomial infections among hemodialysis patients. The relevant studies were generated through a computerized search on five databases (PubMed, EBSCOhost, Google Scholar, ScienceDirect and Scopus) using the Mesh Words: nosocomial infections, hospital acquired infections, healthcare associated infections, end stage renal disease, end stage renal failure, hemodialysis, and risk factors. The complete protocol has been registered under PROSPERO (CRD42019124099). Results Initially, 1411 articles were retrieved. Out of these, 24 were duplicates and hence were removed. Out of 1387 remaining articles, 1337 were removed based on irrelevant titles and/or abstracts. Subsequently, the full texts of 50 articles were reviewed and 41 studies were excluded at this stage due to lack of relevant information. Finally, nine articles were selected for this review. Longer hospital stay, longer duration on hemodialysis, multiple catheter sites, longer catheterization, age group, lower white blood cell count, history of blood transfusion, and diabetes were identified as the major risk factors for nosocomial infections among hemodialysis patients. Conclusion The results of this review indicate an information gap and potential benefits of additional preventive measures to further reduce the risk of infections in hemodialysis population. Moreover, several patient-related and facility-related risk factors were consistently observed in the studies included in this review, which require optimal control measures.
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33
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Chen ML, Gao Y, Guo W, Zuo L, Wang TB. [Infection prevention and control of bedside blood purification treatment in patients with COVID-19]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52:414-419. [PMID: 32541971 DOI: 10.19723/j.issn.1671-167x.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore the infection prevention and control strategy of bedside blood purification treatment in corona virus disease 2019 (COVID-19) isolation ward, and to evaluate the effect of infection prevention and control management measures. METHODS We summarized and analyzed the clinical features, infection status, outcome and infection prevention and control measures of bedside blood purification treatment patients in COVID-19 isolation ward from February 8, 2020 to March 31, 2020, analyzed the COVID-19 cross-infection between the patients and medical staffs, and the blood-borne pathogens cross-infection situation between the patients, and analyzed the effect of bundle prevention and control measures in controlling the occurrence and spread of cross-infection. RESULTS A total of 101 COVID-19 patients were hospitalized in this COVID-19 isolation ward, of whom 10 patients (9.90%) received bedside blood purification treatment and the blood purification treatment method was continuous hemodialysis filtration (CVVHDF), and the 10 patients received 79 times of blood purification treatment in total. The prevention and control management measures adopted included divisional isolation, patient behavior isolation and patient placement, operator personal protection and hand hygiene, dialysis waste fluid disposal, isolation room air purification, object surfaces, medical devices and medical fabrics dis-infection management. There were no occurrence and spread of COVID-19 in the medical healthcare workers and blood-borne pathogens cross-infection in the patients. And all the twice throat swabs (two sampling interval > 1 day) of the medical staffs in COVID-19 virus nucleic acid test were negative. The 2 suspected COVID-19 patients' throat swab virus nucleic acid test and the COVID-19 IgG, IgM were always both negative, the chest CT showed no viral pneumonia. CONCLUSION Bedside blood purification treatment in the COVID-19 isolation ward, the occurrence and spread of healthcare associated infection can be effectively controlled through effective infection prevention and control management, including divisional isolation, patient behavior isolation and patient placement, operator personal protection and hand hygiene, dialysis waste fluid disposal, isolation room's air purification, object surfaces, medical devices and medical fabrics disinfection, which can provide experience for diagnosis, treatment and prevention and control of patients in the respiratory infectious disease ward.
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Affiliation(s)
- M L Chen
- Department of Infection Control, Peking University People's Hospital, Beijing 100044, China
| | - Y Gao
- Department of Infection Control, Peking University People's Hospital, Beijing 100044, China.,Department of Infectious Disease, Peking University People's Hospital, Beijing 100044, China
| | - W Guo
- Trauma center, Peking University People's Hospital, Beijing 100044, China
| | - L Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing 100044, China
| | - T B Wang
- Trauma center, Peking University People's Hospital, Beijing 100044, China
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Harun NH, Mydin RBSMN, Sreekantan S, Saharudin KA, Basiron N, Aris F, Wan Mohd Zain WN, Seeni A. Bactericidal Capacity of a Heterogeneous TiO 2/ZnO Nanocomposite against Multidrug-Resistant and Non-Multidrug-Resistant Bacterial Strains Associated with Nosocomial Infections. ACS OMEGA 2020; 5:12027-12034. [PMID: 32548381 PMCID: PMC7271038 DOI: 10.1021/acsomega.0c00213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/04/2020] [Indexed: 05/29/2023]
Abstract
The surge of medical devices associated with nosocomial infection (NI) cases, especially by multidrug-resistant (MDR) bacterial strains, is one of the pressing issues of present health care systems. Metal oxide nanoparticles (MNPs) have become promising antibacterial agents against a wide range of bacterial strains. This work study is on the bactericidal capacity of heterogeneous TiO2/ZnO nanocomposites with different weight percentages and concentrations against common MDR and non-MDR bacterial strains. The profiles on disk diffusion, minimum inhibitory concentration, minimum bactericidal concentration, tolerance determination, time-kill, and biofilm inhibition assay were determined after 24 h of direct contact with the nanocomposite samples. Findings from this work revealed that the heterogeneous TiO2/ZnO nanocomposite with a 25T75Z weight ratio showed an optimal tolerance ratio against Gram-positive and -negative bacteria, indicating their bactericidal capacity. Further observation suggests that higher molar ratio of Zn2+ may possibly involve generation of active ion species that enhance bactericidal effect against Gram-positive bacterial strains, especially for the MDR strains. Nano-based technology using MNPs may provide a promising solution for the prevention and control of NIs. Further work on biocompatibility and cytotoxicity profiles of this nanocomposite are needed.
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Affiliation(s)
- Nor Hazliana Harun
- Oncological
and Radiological Sciences Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Kepala Batas 13200, Pulau Pinang, Malaysia
| | - Rabiatul Basria S. M. N. Mydin
- Oncological
and Radiological Sciences Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Kepala Batas 13200, Pulau Pinang, Malaysia
- Department
of Biological Sciences, National University
of Singapore, 14 Science
Drive 4, 117543, Singapore
| | - Srimala Sreekantan
- School
of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal 14300, Pulau Pinang, Malaysia
| | - Khairul Arifah Saharudin
- School
of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal 14300, Pulau Pinang, Malaysia
- Qdos
Interconnect Sdn. Bhd., Persiaran Cassia Selatan 4, Taman Perindustrian Nibong Tebal Bandar
Cassia, Kampung Batu Kawan, George Town 14110, Pulau Pinang, Malaysia
| | - Norfatehah Basiron
- School
of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal 14300, Pulau Pinang, Malaysia
| | - Farizan Aris
- Biomolecular
Sciences, School of Biology, Faculty of Applied Sciences, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
| | | | - Azman Seeni
- Integrative
Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Kepala Batas 13200, Pulau Pinang, Malaysia
- Malaysian
Institute of Pharmaceuticals and Nutraceuticals (IPHARM), National Institute of Biotechnology Malaysia, Ministry
of Science, Technology and Innovation, Bukit Gambir, Gelugor 11700, Pulau Pinang, Malaysia
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Jamal A, Babazono A, Li Y, Yoshida S, Fujita T. Multilevel analysis of hemodialysis-associated infection among end-stage renal disease patients: results of a retrospective cohort study utilizing the insurance claim data of Fukuoka Prefecture, Japan. Medicine (Baltimore) 2020; 99:e19871. [PMID: 32358355 PMCID: PMC7440133 DOI: 10.1097/md.0000000000019871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 01/22/2023] Open
Abstract
The presence of comorbid conditions along with heterogeneity in terms of healthcare practices and service delivery could have a significant impact on the patient's outcomes. With a strong interest in social epidemiology to examine the impact of health services and variations on health outcomes, the current study was conducted to analyse the incidence of hemodialysis-associated infection (HAI) as well as its associated factors, and to quantify the extent to which the contextual effects of the care facility and regional variations influence the risk of HAI.A total of 6111 patients with end-stage renal disease who received hemodialysis treatment between 1 October 2015 and 31 March 2016 were identified from the insurance claim database as a population-based, close-cohort retrospective study. Patients were followed for one year from April 1, 2016 to March 31, 2017. A total of 200 HAI cases were observed during the follow-up and 12 patients died within 90 days of the onset of HAI. Increased risks for HAI were associated with moderate (HR 1.73, 95% confidence interval [CI] 1.00-2.98) and severe (HR 1.87, 95% CI 1.11-3.14) comorbid conditions as well as malignancy (HR 1.36, 95% CI 1.00-1.85). Increased risk was also seen among patients who received hemodialysis treatment from clinics (HR 2.49, 95% CI 1.1-5.33). However, these statistics were no longer significant when variations at the level of care facilities were statistically controlled. In univariate analyses, no statistically significant association was observed between 90-day mortality and baseline patients, and the characteristics of the care facility.The results of the multivariate, multilevel analyses indicated that HAI variations were only significant at the care facility level (σ 2.07, 95% CI 1.3-3.2) and were largely explained by the heterogeneity between care facilities. The results of this study highlight the need to look beyond the influence of patient-level characteristics when developing policies that aim at improving the quality of hemodialysis healthcare and service delivery in Japan.
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Affiliation(s)
- Aziz Jamal
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Health Administration Program, Faculty of Business and Management, University Teknologi MARA, Selangor, Malaysia
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yunfei Li
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichiro Yoshida
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takako Fujita
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Japan
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Rteil A, Kazma JM, El Sawda J, Gharamti A, Koubar SH, Kanafani ZA. Clinical characteristics, risk factors and microbiology of infections in patients receiving chronic hemodialysis. J Infect Public Health 2020; 13:1166-1171. [PMID: 32276873 DOI: 10.1016/j.jiph.2020.01.314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/09/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The infectious complications in hemodialysis patients are still among the main reasons for their increased morbidity and mortality. The possible reasons behind this might be due to impairments in the host defense mechanisms, comorbidities, invasive procedures and pathogenicity of the infecting organisms. With the increased incidence of bacteremia in hemodialysis patients and the overt use of antibiotics, we have witnessed a rise in the number of new multidrug resistant (MDR) strains in those patients. AIM We aim to determine the epidemiology, risk factors and complications of infections in patients receiving chronic hemodialysis, particularly bloodstream infections. METHODS This is a retrospective case-control study involving patients undergoing hemodialysis at a tertiary care center. We studied the prevalence of infectious complications among those patients as well as the responsible agent in each respective infectious episode and the risk factors associated with bacteremia. FINDINGS 46.6% of the studied population had at least one documented episode of infection. The most common were blood and respiratory infections (33.2% and 32.7% respectively). Among patients with bacteremia, coagulase-negative Staphylococcus was the predominant pathogen (49% of cases), followed by Staphylococcus aureus and Escherichia coli. Mortality was higher in patients who had MDR bacteremia, and in those who had mechanical ventilation or intensive care unit (ICU) admission. CONCLUSION Due to the alarming increase in the incidence of infection among hemodialysis patients and its strong association with mortality, further studies are needed to look for risk factors associated with infection and for ways to control those risk factors.
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Affiliation(s)
- Ali Rteil
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jamil M Kazma
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jack El Sawda
- Divison of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amal Gharamti
- Divison of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sahar H Koubar
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina A Kanafani
- Divison of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Perondi F, Petrescu VF, Fratini F, Brovida C, Porciello F, Ceccherini G, Lippi I. Bacterial colonization of non-permanent central venous catheters in hemodialysis dogs. Heliyon 2020; 6:e03224. [PMID: 32021926 PMCID: PMC6994843 DOI: 10.1016/j.heliyon.2020.e03224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/02/2019] [Accepted: 01/10/2020] [Indexed: 01/02/2023] Open
Abstract
Non-permanent central venous catheters (CVCs), are the most commonly used vascular access in veterinary patients undergoing hemodialysis. In human dialysis patients, CVC infection represents a common cause of morbidity and mortality. The aim of this retrospective observational study was to evaluate the prevalence of bacterial colonization of CVCs in dogs submitted to hemodialysis treatment at time of CVC removal. The CVCs of all dogs submitted to hemodialysis (n = 23) at the Veterinary Teaching Hospital ''Mario Modenato'' of the University of Pisa between January 2015 and December 2016 were considered. For all dogs, data regarding signalment, reason for hemodialysis treatment, duration of catheterization (≤15 or >15 days), CVC complications, and 30-day survival were considered. Statistical analysis was performed using Graph Pad Prism™. Five over 23 dogs (22%) showed positive bacterial culture of CVC (+), and 18/23 dogs (78%) negative culture of CVC (-). The most prevalent microorganism was Staphylococcus Spp (3/5; 60%). No significant difference was found in the prevalence of CVC infection according to age, gender, reason for hemodialysis, CVC complications, duration of catheterization, and outcome. No statistically significant difference (p = 0.64) in survival curves was reported at log rank analysis between dogs with CVC - and CVC +. The prevalence of bacterial CVC contamination in our dialysis dogs showed relatively low. Exclusive use of CVC for hemodialysis, good hygiene practice during CVC management, and use of chlorhexidine as an antiseptic should be strongly encouraged.
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Affiliation(s)
- Francesca Perondi
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
- Corresponding author.
| | - Vasilica-Flory Petrescu
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126, Perugia, Italy
| | - Filippo Fratini
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
| | - Claudio Brovida
- ANUBI Ospedale per Animali da Compagnia, Strada Genova 299/A, 10024, Monalieri, Italy
| | - Francesco Porciello
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126, Perugia, Italy
| | - Gianila Ceccherini
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
| | - Ilaria Lippi
- Department of Veterinary Medicine, University of Pisa, Via Livornese lato monte, San Piero a grado, 56122, Pisa, Italy
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Jesus-Silva SGD, Oliveira JDS, Ramos KTF, Morais LA, Silva MADM, Krupa AE, Cardoso RS. Análise das taxas de infecção e duração de cateteres de hemodiálise de curta e longa permanência em hospital de ensino. J Vasc Bras 2020; 19:e20190142. [PMID: 34290749 PMCID: PMC8276652 DOI: 10.1590/1677-5449.190142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/24/2020] [Indexed: 11/22/2022] Open
Abstract
Resumo Contexto Os cateteres venosos centrais para hemodiálise (CVCH) de curta permanência (CCP) e cateteres tunelizáveis de longa permanência (CTLP) são fundamentais para a terapia hemodialítica. Entretanto, há escassa casuística nacional acerca da incidência de complicações desses dois tipos de cateteres. Objetivos Analisar as complicações e tempo de duração de CVCHs em centro de hemodiálise de hospital de ensino. Métodos Foi feito um estudo unicêntrico, longitudinal e retrospectivo de 115 pacientes consecutivos submetidos a implante de cateteres para hemodiálise (67 CCP e 48 CTLP) em um período de 2 anos, com análise de sobrevida geral, perviedade, perda do acesso e incidência de complicações. Resultados Sessenta por cento eram do sexo masculino e a média de idade foi de 62 anos. O principal sítio de punção foi a veia jugular interna direita. Hipertensão arterial sistêmica estava presente em 95% dos casos. A mediana de permanência do cateter foi de 50 dias (CCP) versus 112 dias (CTLP; p < 0,0001). Não houve diferença na sobrevida global. Infecção relacionada ao cateter apresentou maior incidência nos CCP, sendo Staphylococcus sp. o microrganismo mais encontrado. A taxa de infecção por 1.000 dias foi maior nos CCP em relação aos CTLP (16,7 eventos/1.000 dias versus 7,0 eventos/1.000 dias, respectivamente). Baixa renda foi o único fator relacionado a maior incidência de infecção. Conclusões O tempo de permanência dos CTLP foi significativamente maior que os CCP, porém ainda assim abaixo dos valores relatados na literatura e sem impacto na sobrevida global. Baixa renda foi um fator associado a infecção de cateter.
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Agrawal V, Valson AT, Mohapatra A, David VG, Alexander S, Jacob S, Bakthavatchalam YD, Prakash JAJ, Balaji V, Varughese S. Fast and furious: a retrospective study of catheter-associated bloodstream infections with internal jugular nontunneled hemodialysis catheters at a tropical center. Clin Kidney J 2019; 12:737-744. [PMID: 31583098 PMCID: PMC6768464 DOI: 10.1093/ckj/sfy138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nontunneled hemodialysis catheters (NTHCs) remain the preferred vascular access at hemodialysis (HD) initiation in developing countries. We studied the incidence, risk factors and microbiological spectrum of jugular NTHC-associated bloodstream infections (CABSIs) at a tertiary care center in South Asia. METHODS In this retrospective cohort study, all adult (≥18 years) incident patients who underwent jugular NTHC insertion for HD between January 2016 and June 2017, had no prior history of temporary vascular access insertion and were followed up for ≥14 days were included. RESULTS A total of 897 patients underwent NTHC insertion during the study period and 169 patients fulfilled the inclusion criteria and contributed 7079 patient days of follow-up. CABSI incidence was 7.34 episodes per 1000 catheter days and median infection-free survival and time to CABSI were 96 and 24.5 days, respectively. In multivariate Cox regression analysis, immunosuppressive medication {hazard ratio [HR] 2.87 [95% confidence interval (CI) 1.09-7.55]; P = 0.033} and intravenous cefazolin use [HR 0.51 (95% CI 0.28-0.94); P = 0.031] was independently associated with CABSI. The cumulative hazard of CABSI was 8.3, 13.3, 17.6 and 20.9% at Weeks 1, 2, 3 and 4, respectively. Gram-negative organisms were the most common etiological agents (54.7%) and 40.3% of CABSIs were caused by drug-resistant organisms. Gram-negative and Gram-positive CABSIs were associated with neutrophil left shift and higher procalcitonin compared with coagulase-negative staphylococcal CABSIs. CONCLUSION In South Asia, NTHC-associated CABSIs occur early and are predominantly Gram negative. We hypothesize that poor hygiene practices may play a role in this phenomenon.
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Affiliation(s)
- Varun Agrawal
- Department of Nephrology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Anna T Valson
- Department of Nephrology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Anjali Mohapatra
- Department of Nephrology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Vinoi George David
- Department of Nephrology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Suceena Alexander
- Department of Nephrology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Shibu Jacob
- Department of Nephrology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | | | | | - Veeraraghavan Balaji
- Department of Microbiology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Sánchez Villar I, Lorenzo Sellares V. ¿Se infectan más los catéteres tunelizados para hemodiálisis cuando los pacientes ingresan en el hospital? ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000300005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
La infección de los catéteres para hemodiálisis constituye una de las causas de mayor morbimortalidad. La hipótesis intuitiva de que los catéteres se infectan más durante la hospitalización no ha sido verificada en la literatura.
Objetivo: Conocer si la hospitalización es un factor de riesgo de bacteriemia relacionada con catéter.
Material y Método: Análisis retrospectivo de las bacteriemias asociadas a catéter durante un período de 4 años de un centro periférico extrahospitalario de hemodiálisis dependiente de un Servicio de Nefrología de un hospital de tercer nivel durante el período 2014-2017.
Se recogieron los tiempos de empleo de catéteres y las bacteriemias relacionadas con catéter divididos en 2 escenarios: Hospital y centro periférico.
Se aplicó el Modelo de Regresión de Poisson para comparar las bacteriemias Hospital vs centro periférico. Un mismo paciente pudo padecer bacteriemia más de una vez y en los dos escenarios.
Resultados: Se emplearon 361 catéteres en 174 pacientes con tiempo total de uso 91.491 días, con 103 episodios de bacteriemia.Tasas de bacteriemias: hospitalizado 7,81/1000 días/catéter y centro periférico 0,81/1000 días/catéter.
El riesgo de sufrir bacteriemia se multiplicó por 9,6 durante la hospitalización vs centro periférico (p
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Abstract
The prevalence of antimicrobial resistance among many common bacterial pathogens is increasing. The emergence and global dissemination of these antibiotic-resistant bacteria (ARB) is fuelled by antibiotic selection pressure, inter-organism transmission of resistance determinants, suboptimal infection prevention practices and increasing ease and frequency of international travel, among other factors. Patients with chronic kidney disease, particularly those with end-stage renal disease who require dialysis and/or kidney transplantation, have some of the highest rates of colonization and infection with ARB worldwide. These ARB include methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp. and several multidrug-resistant Gram-negative organisms. Antimicrobial resistance limits treatment options and increases the risk of infection-related morbidity and mortality. Several new antibiotic agents with activity against some of the most common ARB have been developed, but resistance to these agents is already emerging and highlights the dire need for new treatment options as well as consistent implementation and improvement of basic infection prevention practices. Clinicians involved in the care of patients with renal disease must be familiar with the local epidemiology of ARB, remain vigilant for the emergence of novel resistance patterns and adhere strictly to practices proven to prevent transmission of ARB and other pathogens.
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Affiliation(s)
- Tina Z Wang
- NewYork Presbyterian-Weill Cornell Medical Center, New York, NY, USA
| | | | - David P Calfee
- NewYork Presbyterian-Weill Cornell Medical Center, New York, NY, USA.
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA.
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de Sousa JKT, Haddad JPA, de Oliveira AC, Vieira CD, Dos Santos SG. In vitro activity of antimicrobial-impregnated catheters against biofilms formed by KPC-producing Klebsiella pneumoniae. J Appl Microbiol 2019; 127:1018-1027. [PMID: 31278820 DOI: 10.1111/jam.14372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 06/07/2019] [Accepted: 07/01/2019] [Indexed: 12/30/2022]
Abstract
AIM To evaluate the activity and effectiveness of impregnated central venous catheters (CVC) against Klebsiella pneumoniae biofilms. METHODS AND RESULTS The antimicrobial activity and durability of impregnated-CVCs were evaluated over time and the size of zones of inhibition (ZI) was measured. Biofilm formation was observed by quantitative culture and also by scanning electron microscopy. The catheters impregnated with chlorhexidine/silver sulfadiazine (CHX/SS) reduced bacteria counts by 0·3 log and were most effective (P < 0·01) against Klebsiella pneumoniae biofilms N-acetylcysteine/levofloxacin (NAC/LEV) catheters. It was observed that the catheter impregnated with NAC/LEV had initially the largest average ZI size being statistically significant (P < 0·01). The NAC/LEV combination remained active until day 30, whereas the combination of CHX/SS was completely inactivated from day 15 on. CONCLUSIONS The NAC/LEV combination showed greater durability on the catheters, but it was the CHX/SS combination that had the greater initial efficacy in bacterial inhibition. It was also observed that NAC/LEV-impregnated catheters do not prevent the emergence of resistant subpopulations inside the inhibition halos during antimicrobial susceptibility tests. SIGNIFICANCE AND IMPACT OF THE STUDY Our results highlighted that the in vitro efficacy of antimicrobial-impregnated CVCs is limited by time and that their colonization occurred earlier than expected. Our data also demonstrated that NAC/LEV remained active until day 30 of evaluation and CHX/SS combination was completely inactivated from day 15 on. Our findings suggested that implantable devices should be carefully used by medical community.
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Affiliation(s)
- J K T de Sousa
- Oral Microbiology and Anaerobe Laboratory, Institute of Biological Science, Federal University of Minas Gerais - Avenida Presidente Antônio Carlos, Belo Horizonte, MG, Brazil
| | - J P A Haddad
- Department of Preventive Veterinary Medicine, Veterinary School-Avenida Presidente Antônio Carlos, Belo Horizonte, MG, Brazil
| | - A C de Oliveira
- Department of Basic Nursing, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - C D Vieira
- Oral Microbiology and Anaerobe Laboratory, Institute of Biological Science, Federal University of Minas Gerais - Avenida Presidente Antônio Carlos, Belo Horizonte, MG, Brazil
| | - S G Dos Santos
- Oral Microbiology and Anaerobe Laboratory, Institute of Biological Science, Federal University of Minas Gerais - Avenida Presidente Antônio Carlos, Belo Horizonte, MG, Brazil
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Nilsson A, Uvelius E, Cederberg D, Kronvall E. Silver-Coated Ventriculostomy Catheters Do Not Reduce Rates of Clinically Diagnosed Ventriculitis. World Neurosurg 2018; 117:e411-e416. [DOI: 10.1016/j.wneu.2018.06.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/24/2022]
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Mesrati I, Saidani M, Jemili M, Ferjeni S, Slim A, Boubaker IBB. Virulence determinants, biofilm production and antimicrobial susceptibility in Staphylococcus aureus causing device-associated infections in a Tunisian hospital. Int J Antimicrob Agents 2018; 52:922-929. [PMID: 29775684 DOI: 10.1016/j.ijantimicag.2018.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/22/2018] [Accepted: 05/07/2018] [Indexed: 11/19/2022]
Abstract
Staphylococcus aureus is a clinically relevant pathogen that causes device-related infections (DRI) driven by several virulence factors. This study characterized S. aureus isolates involved in DRI in Tunisian patients. Forty consecutive S. aureus strains causing DRI and 47 randomly selected S. aureus strains causing non-device-related infections (NDRI) were collected. All strains were screened phenotypically for antibiotic susceptibility and biofilm forming ability. They were investigated for accessory gene regulator (agr) types, biofilm encoding genes (icaADBC), adhesins, leukotoxins, toxic shock toxin, enterotoxins and exotoxins encoding genes by polymerase chain reaction. Meticillin-resistant S. aureus (MRSA) strains were further characterized by staphylococcal cassette chromosome mec (SCCmec) typing. MRSA rates among DRI and NDRI isolates were 23% and 49% (P=0.02), respectively. The DRI isolates formed biofilm more frequently (n=32) than the NDRI isolates (n=28) (P=0.04), with predominance of the moderate biofilm producer category (P=0.027). All biofilm-positive isolates except four harboured icaADBC genes. A significant difference was observed between DRI and NDRI isolates for fnbA (53-77%), spa (45-26%), sdrD (80-55%) and sen (33-11%) genes. DRI strains were agrI (48%) and agrII (30%) types, whereas NDRI strains were agrI (36%) and agrIII (43%) types. SCCmec type IV was carried by 50% of MRSA isolates. This study highlights the virulence potential displayed by S. aureus isolated from DRI in comparison with NDRI.
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Affiliation(s)
- I Mesrati
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory of Antimicrobial Resistance, Tunis, Tunisia.
| | - M Saidani
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory of Antimicrobial Resistance, Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, Tunis, Tunisia
| | - M Jemili
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory of Antimicrobial Resistance, Tunis, Tunisia
| | - S Ferjeni
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory of Antimicrobial Resistance, Tunis, Tunisia
| | - A Slim
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory of Antimicrobial Resistance, Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, Tunis, Tunisia
| | - I Boutiba-Ben Boubaker
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory of Antimicrobial Resistance, Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, Tunis, Tunisia
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