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Ardahan Sevgili S, Şenol S. The Effect of Gastrointestinal Mucositis Care Training Given to Pediatric Leukemic Patients and Caregivers on Mucosal Barrier Injury. Cancer Nurs 2024:00002820-990000000-00268. [PMID: 38949311 DOI: 10.1097/ncc.0000000000001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND Management of chemotherapy-induced mucosal barrier damage and oral/anal mucositis in leukemia is challenging. OBJECTIVE The aim of this study was to investigate the effect of mucositis care training given to children receiving leukemia treatment and their caregivers on caregiver knowledge and skills, the development of gastrointestinal mucositis in children, the mean oral mucositis area in children, and the mucosal barrier injury laboratory-confirmed bloodstream infection in the clinic. METHODS A stepped-wedge, quasi-experimental, unpaired control group design was used. The participants in the control group were given routine training, and the intervention group members were given mucositis care training in accordance with the guideline recommendations. RESULTS No significant difference was found between groups in developing anal mucositis, but a significant difference in developing oral mucositis was documented, with the mean mucositis area of children being 8.36 ± 3.97 cm2 in the control group and 4.66 ± 2.90 cm2 in the intervention group. The mucosal barrier injury laboratory-confirmed bloodstream infection ratio was 4 per 1000 catheter days in the control group and 3 per 1000 catheter days in the intervention group. CONCLUSION Mucositis care training had a significant positive effect on caregivers' knowledge and skills, the development of oral mucositis, and the mean oral mucositis area in children. However, the training had no effect on the development of anal mucositis or the infection rate in the clinic. IMPLICATIONS FOR PRACTICE Nurses might increase the knowledge and skill levels of caregivers with training on mucositis care, prevent the development of mucositis, and reduce the mean mucositis area. Training might also contribute to the reduction in the infection rate of the clinic.
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Affiliation(s)
- Seda Ardahan Sevgili
- Author Affiliations: Pediatric Nursing Department, Faculty of Nursing, Ege University (Dr Ardahan Sevgili), Izmir; and Department of Pediatric Nursing, Faculty of Health Sciences, Kütahya Health Sciences University (Dr Şenol), Turkey
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MacPhail A, Dendle C, Slavin M, McQuilten Z. Hospital-acquired bloodstream infections in patients with cancer: current knowledge and future directions. J Hosp Infect 2024; 148:39-50. [PMID: 38490489 DOI: 10.1016/j.jhin.2024.03.002] [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: 12/19/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Patients with cancer experience higher rates of preventable harm from hospital-acquired bloodstream infections (haBSIs) and central-line-associated bloodstream infections (CLABSIs) compared with the general hospital population. The prevention of haBSIs and CLABSIs in patients with cancer is an urgent priority, and requires standardized surveillance and reporting efforts. The application of haBSI and CLABSI definitions, classification systems and surveillance strategies for patients with cancer is complex, and there is wide variation in clinical practice. Existing systems were not designed explicitly for patients with cancer, and have different strengths and weaknesses in the cancer setting. For these reasons, epidemiological estimates of haBSIs and CLABSIs in patients with cancer also require careful interpretation. This complexity can be a barrier to identifying appropriate targets for intervention and reducing preventable harm. This review provides an overview of key concepts and challenges in haBSI surveillance and prevention specific to patients with cancer. In addition, this review summarizes the strengths and weaknesses of commonly used surveillance definitions and denominators in the setting of cancer care; existing surveillance practice; epidemiology of haBSIs and CLABSIs; prevention strategies; and current knowledge gaps. A global collaborative effort to harmonize the surveillance of hospital-acquired infections in patients with cancer would be invaluable to improve the accuracy and utility of existing data, advance efforts to prevent hospital-acquired infections, and improve patient safety.
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Affiliation(s)
- A MacPhail
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Infectious Diseases, Monash Health, Melbourne, Australia
| | - C Dendle
- Department of Infectious Diseases, Monash Health, Melbourne, Australia; School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - M Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Z McQuilten
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Haematology, Monash Health, Clayton, Australia.
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Gandra S, Singh SK, Chakravarthy M, Moni M, Dhekane P, Mohamed Z, Shameen F, Vasudevan AK, Senthil P, Saravanan T, George A, Sinclair D, Stwalley D, van Rheenen J, Westercamp M, Smith RM, Leekha S, Warren DK. Epidemiology and preventability of hospital-onset bacteremia and fungemia in 2 hospitals in India. Infect Control Hosp Epidemiol 2024; 45:157-166. [PMID: 37593953 PMCID: PMC10877540 DOI: 10.1017/ice.2023.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Studies evaluating the incidence, source, and preventability of hospital-onset bacteremia and fungemia (HOB), defined as any positive blood culture obtained after 3 calendar days of hospital admission, are lacking in low- and middle-income countries (LMICs). DESIGN, SETTING, AND PARTICIPANTS All consecutive blood cultures performed for 6 months during 2020-2021 in 2 hospitals in India were reviewed to assess HOB and National Healthcare Safety Network (NHSN) reportable central-line-associated bloodstream infection (CLABSI) events. Medical records of a convenience sample of 300 consecutive HOB events were retrospectively reviewed to determine source and preventability. Univariate and multivariable logistic regression analyses were performed to identify factors associated with HOB preventability. RESULTS Among 6,733 blood cultures obtained from 3,558 hospitalized patients, there were 409 and 59 unique HOB and NHSN-reportable CLABSI events, respectively. CLABSIs accounted for 59 (14%) of 409 HOB events. There was a moderate but non-significant correlation (r = 0.51; P = .070) between HOB and CLABSI rates. Among 300 reviewed HOB cases, CLABSIs were identified as source in only 38 (13%). Although 157 (52%) of all 300 HOB cases were potentially preventable, CLABSIs accounted for only 22 (14%) of these 157 preventable HOB events. In multivariable analysis, neutropenia, and sepsis as an indication for blood culture were associated with decreased odds of HOB preventability, whereas hospital stay ≥7 days and presence of a urinary catheter were associated with increased likelihood of preventability. CONCLUSIONS HOB may have utility as a healthcare-associated infection metric in LMIC settings because it captures preventable bloodstream infections beyond NHSN-reportable CLABSIs.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
| | | | | | - Merlin Moni
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - Zubair Mohamed
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | | | | | | | - Anu George
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Dorothy Sinclair
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
| | - Dustin Stwalley
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
| | - Jacaranda van Rheenen
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
| | - Matthew Westercamp
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Rachel M. Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Surbhi Leekha
- Division of Infectious Diseases, Department of Internal Medicine, University of Maryland Medical School, Baltimore, Maryland, United States
| | - David K. Warren
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, Missouri, United States
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El Omri H, Padmanabhan R, Taha RY, Kassem N, Elsabah H, Ellahie AY, Santimano AJJ, Al-Maslamani MA, Omrani AS, Elomri A, El Omri A. Dissecting bloodstream infections in febrile neutropenic patients with hematological malignancies, a decade-long single center retrospective observational study (2009-2019). J Infect Public Health 2024; 17:152-162. [PMID: 38029491 DOI: 10.1016/j.jiph.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The use of ill-suited antibiotics is a significant risk factor behind the increase in the mortality, morbidity, and economic burden for patients who are under treatment for hematological malignancy (HM) and bloodstream infections (BSI). Such unfitting treatment choices intensify the evolution of resistant variants which is a public health concern due to possible healthcare-associated infection spread to the general population. Hence, this study aims to evaluate antibiograms of patients with BSI and risk factors associated with septicemia. METHODS A total of 1166 febrile neutropenia episodes (FNE) among 513 patients with HM from the National Center for Cancer Care and Research (NCCCR), Qatar, during 2009-2019 were used for this study. The socio-demographic, clinical, microbial, and anti-microbial data retrieved from the patient's health records were used. RESULTS We analyzed the sensitivity of gram-negative and gram-positive bacilli reported in HM-FN-BSI patients. Out of the total 512 microorganisms isolated, 416 (81%) were gram-negative bacteria (GNB), 76 (15%) were gram-positive bacteria (GPB) and 20 (4%) were fungi. Furthermore, in 416 GNB, 298 (71.6%) were Enterobacteriaceae sp. among which 121 (41%) were ESBL (Extended Spectrum Beta-Lactamase) resistant to Cephalosporine third generation and Piperacillin-Tazobactam, 54 (18%) were Carbapenem-resistant or multidrug-resistant organism (MDRO). It's noteworthy that the predominant infectious agents in our hospital include E. coli, Klebsiella species, and P. aeruginosa. Throughout the study period, the mortality rate due to BSI was 23%. Risk factors that show a significant correlation with death are age, disease status, mono or polymicrobial BSI and septic shock. CONCLUSION Decision pertaining to the usage of antimicrobials for HM-FN-BSI patients is a critical task that relies on the latest pattern of prevalence, treatment resistance, and clinical outcomes. Analysis of the antibiogram of HM-FN-BSI patients in Qatar calls for a reconsideration of currently followed empirical antibiotic therapy towards better infection control and antimicrobial stewardship.
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Affiliation(s)
- Halima El Omri
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Regina Padmanabhan
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha 34110, Qatar
| | - Ruba Y Taha
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Nancy Kassem
- Pharmacy Department NCCCR, Hamad Medical Corporation, Doha, Qatar
| | - Hesham Elsabah
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Anil Yousaf Ellahie
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Antonio J J Santimano
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Ali S Omrani
- Communicable Disease Center, Hamad Medical Corporation, Qatar
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha 34110, Qatar
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar.
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Peri AM, Edwards F, Henden A, Harris PNA, Chatfield MD, Paterson DL, Laupland KB. Bloodstream infections in neutropenic and non-neutropenic patients with haematological malignancies: epidemiological trends and clinical outcomes in Queensland, Australia over the last 20 years. Clin Exp Med 2023; 23:4563-4573. [PMID: 37815735 PMCID: PMC10725384 DOI: 10.1007/s10238-023-01206-x] [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: 05/08/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
Knowledge of the epidemiology of bloodstream infection (BSI) in haematology patients is essential to guide patient management. We investigated the epidemiology of BSI in patients with haematological malignancies in Queensland over the last 20 years (2000-2019), including all episodes diagnosed by the state-wide microbiology service. We identified 7749 BSI in 5159 patients, 58% associated with neutropenia. Gram-negatives were the main causative pathogens (58.3%), more frequent in neutropenic than non-neutropenic patients (3308/5309, 62.3% vs 1932/3678, 52.5%, p < 0.001). Amongst 8987 isolates the most common were E. coli (15.4%) and Pseudomonas spp. (14.2%). Pseudomonas spp. (16.6% vs 10.7%, p < 0.001), Klebsiella spp. (11.6% vs 6.8%, p < 0.001), viridans-group streptococci (4.4% vs 1.2%, p < 0.001) and E. faecium (2.4% vs 0.9%, p < 0.001) were more common in neutropenic than non-neutropenic patients, while S. aureus was less common (5.9% vs 15.6%, p < 0.001). Several antimicrobial resistance rates increased over time and had higher prevalence in neutropenic than non-neutropenic patients, including ciprofloxacin-resistant E. coli (94/758, 12.4% vs 42/506, 8.3%, p = 0.021), trimethoprim-sulfamethoxazole-resistant E. coli (366/764, 47.9% vs 191/517, 36.9%, p < 0.001), penicillin-resistant streptococci (51/236, 21.6% vs 28/260, 10.8%, p < 0.001) and vancomycin-resistant enterococci (46/250, 18.4% vs 9/144, 6.3%, p < 0.001). Carbapenem-resistant Pseudomonas spp. (OR 7.32, 95%CI 2.78-19.32) and fungi, including yeasts and moulds (OR 3.33, 95%CI 2.02-5.48) were associated to the highest odds of 30-day case-fatality at a multivariable logistic regression analysis. Neutropenia was associated with survival (OR 0.66, 95%CI 0.55-0.78). Differences were observed in the BSI epidemiology according to neutropenic status, with an overall increase of resistance over time associated to adverse outcome.
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Affiliation(s)
- Anna Maria Peri
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia.
| | - Felicity Edwards
- Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Andrea Henden
- Department of Haematology and Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Patrick N A Harris
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, Brisbane City, QLD, 4029, Australia
| | - Mark D Chatfield
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kevin B Laupland
- Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Intensive Care Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
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Affiliation(s)
- Naomi P O'Grady
- From the National Institutes of Health Clinical Center, Bethesda, MD
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Lazarow H, Compher C, Ziegler MJ, Gilmar C, Kucharczuk CR, Landsburg DJ. Central Line-Associated Bloodstream Infection in Patients With Hematologic Malignancy Receiving Parenteral Nutrition. JCO Oncol Pract 2023; 19:571-576. [PMID: 37200611 DOI: 10.1200/op.22.00823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/08/2023] [Accepted: 04/12/2023] [Indexed: 05/20/2023] Open
Abstract
PURPOSE Parenteral nutrition (PN) has been shown to be a safe method of feeding in the intensive care unit with modern infection prevention practices, but similar analysis in the hematology-oncology setting is lacking. METHODS A retrospective analysis of 1,617 patients with hematologic malignancies admitted and discharged from the Hospital of the University of Pennsylvania during 3,629 encounters from 2017 to 2019 was undertaken to evaluate the association of PN administration with risk of central line-associated bloodstream infection (CLABSI). Proportions of mucosal barrier injury (MBI)-CLABSI and non-MBI-CLABSI were also compared between groups. RESULTS Risk of CLABSI was associated with cancer type and duration of neutropenia but not with PN administration (odds ratio, 1.015; 95% CI, 0.986 to 1.045; P = .305) in a multivariable analysis. MBI-CLABSI comprised 73% of CLABSI in patients exposed to and 70% in patients not exposed to PN, and there was no significant difference between groups (χ2 = 0.06, P = .800). CONCLUSION PN was not associated with increased risk of CLABSI in a sample of patients with hematologic malignancy with central venous catheters when adjusting for cancer type, duration of neutropenia, and catheter days. The high proportion of MBI-CLABSI highlights the effect of gut permeability within this population.
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Affiliation(s)
- Heather Lazarow
- Hospital of the University of Pennsylvania, Philadelphia, PA
- Clinical Nutrition Support Services Silverstein 3, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | | | - Cheryl Gilmar
- Hospital of the University of Pennsylvania, Philadelphia, PA
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Gavin NC, Larsen E, Runnegar N, Mihala G, Keogh S, McMillan D, Ray‐Barruel G, Rickard CM. Association between parenteral nutrition-containing intravenous lipid emulsion and bloodstream infections in patients with single-lumen central venous access: A secondary analysis of a randomized trial. JPEN J Parenter Enteral Nutr 2023; 47:783-795. [PMID: 37288612 PMCID: PMC10946626 DOI: 10.1002/jpen.2530] [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: 08/19/2022] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Distinguishing primary bloodstream infections (BSIs) related to central venous access devices (CVADs) from those that occur through other mechanisms, such as a damaged mucosal barrier, is difficult. METHODS Secondary analysis was conducted on data from patients with CVADs that were collected for a large, randomized trial. Patients were divided into two groups: those who received parenteral nutrition (PN)-containing intravenous lipid emulsion (ILE) and those who did not have PN-containing ILE. This study investigated the influence of PN-containing ILE (ILE PN) on primary BSIs in patients with a CVAD. RESULTS Of the 807 patients, 180 (22%) received ILE PN. Most (627/807; 73%) were recruited from the hematology and hematopoietic stem cell transplant unit, followed by surgical (90/807; 11%), trauma and burns (61/807; 8%), medical (44/807; 5%), and oncology (23/807; 3%). When primary BSI was differentiated as a central line-associated BSI (CLABSI) or mucosal barrier injury laboratory-confirmed BSI (MBI-LCBI), the incidence of CLABSI was similar in the ILE PN and non-ILE PN groups (15/180 [8%] vs 57/627 [9%]; P = 0.88) and the incidence of MBI-LCBI was significantly different between groups (31/180 [17%] ILE PN vs 41/627 [7%] non-ILE PN; P < 0.01). CONCLUSION Our data indicate that twice as many primary BSIs in ILE PN patients are due to MBIs than CVADs. It is important to consider the MBI-LCBI classification, as some CLABSI prevention efforts aimed at CVADs for the ILE PN population may be better directed to gastrointestinal tract protection interventions.
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Affiliation(s)
- Nicole C. Gavin
- Cancer Care ServicesRoyal Brisbane and Women's HospitalQueenslandAustralia
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyQueenslandAustralia
- School of NursingQueensland University of TechnologyQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt LuciaQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandQueenslandAustralia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerstonAustralia
- Patient‐Centre Health Services, Menzies Health Institute QueenslandGriffith UniversityQueenslandAustralia
| | - Naomi Runnegar
- Faculty of MedicineUniversity of QueenslandQueenslandAustralia
- Infection Management ServicesPrincess Alexandra HospitalQueenslandAustralia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Medicine and DentistryGriffith UniversityQueenslandAustralia
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyQueenslandAustralia
- School of NursingQueensland University of TechnologyQueenslandAustralia
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerstonAustralia
| | - David McMillan
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Science, Technology, Engineering and Education; Centre for BioInnovationUniversity of the Sunshine CoastQueenslandAustralia
| | - Gillian Ray‐Barruel
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt LuciaQueenslandAustralia
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerstonAustralia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching and Research Group, School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt LuciaQueenslandAustralia
- Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalHerstonAustralia
- Herston Infectious Diseases InstituteMetro North HealthHerstonAustralia
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Blijlevens NMA, de Mooij CEM. Mucositis and Infection in Hematology Patients. Int J Mol Sci 2023; 24:ijms24119592. [PMID: 37298545 DOI: 10.3390/ijms24119592] [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: 05/12/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Survival in patients with hematological malignancies has improved over the years, both due to major developments in anticancer treatment, as well as in supportive care. Nevertheless, important and debilitating complications of intensive treatment regimens still frequently occur, including mucositis, fever and bloodstream infections. Exploring potential interacting mechanisms and directed therapies to counteract mucosal barrier injury is of the utmost importance if we are to continue to improve care for this increasingly growing patient population. In this perspective, I highlight recent advances in our understanding of the relation of mucositis and infection.
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Affiliation(s)
- Nicole M A Blijlevens
- Department of Haematology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Charlotte E M de Mooij
- Department of Haematology, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Applying mucosal barrier injury laboratory-confirmed bloodstream infection criteria in patients with solid tumors and hematologic malignancies: A retrospective cohort study looking for the real source of infection. Infect Control Hosp Epidemiol 2023; 44:302-304. [PMID: 35144717 DOI: 10.1017/ice.2021.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We evaluated the interference of the mucosal barrier injury (MBI) laboratory-confirmed bloodstream infection (MBI-LCBI) criteria on the central-line-associated bloodstream infection (CLABSI) incidence density, and the proportion of catheter-related bloodstream infections (CRBSIs) among those classified as MBI. We detected 339 CLABSIs: 15.0% were classified as MBI-LCBIs, and among these, 19.6% were classified as CRBSIs.
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11
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Davis A, Stevens AM, Brackett J, Marquez L, Foster CE, Sauer HE, Campbell JR. Levofloxacin prophylaxis for pediatric leukemia patients: Longitudinal follow-up for impact on health care-associated infections. Pediatr Blood Cancer 2022; 69:e29525. [PMID: 35029328 DOI: 10.1002/pbc.29525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bloodstream infections (BSIs) cause morbidity and mortality in pediatric patients with leukemia. Antibiotic prophylaxis during periods of chemotherapy-induced neutropenia may reduce the incidence of BSIs. PROCEDURE A levofloxacin prophylaxis guideline was implemented for pediatric patients with acute myeloid leukemia and relapsed acute lymphoblastic leukemia. We conducted a retrospective cohort study over 4 years (2 years pre and 2 years post implementation) of the practice guideline to assess the impact on central line-associated bloodstream infections (CLABSI) and BSI events. Secondary outcomes included incidence of Clostridioides difficile-associated diarrhea, bacteremia due to multidrug-resistant organisms (MDRO), and bacteremia due to levofloxacin nonsusceptible organisms. STATA was used for data analysis. RESULTS Sixty-three and 72 patients met inclusion criteria for the pre- and postimplementation cohorts, respectively. Demographics were similar between the groups. We observed 60 BSI events in the pre-group versus 49 events in the post-group (p = .1). Bacteremia due to Gram-negative rods (risk ratio [RR] 0.37 [0.21, 0.66], p < .001) and National Healthcare Safety Network (NHSN) CLABSIs (RR 0.62 [0.44, 0.89], p = .01) were significantly reduced in the postimplementation group. The incidences of C. difficile-associated diarrhea and MDRO bacteremia were similar between groups. However, we observed an increase in the incidence of BSI due to Gram-negative rods that were nonsusceptible to levofloxacin (RR 3.38 [0.72, 6.65], p < .001). CONCLUSION Following implementation of a levofloxacin prophylaxis guideline, we observed a significant decrease in BSIs due to Gram-negative rods and NHSN CLABSIs. Vigilant monitoring of outcomes post guideline implementation is critical to track emergence of resistant organisms.
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Affiliation(s)
- Andrea Davis
- Department of Infection Control and Prevention, Texas Children's Hospital, Houston, Texas, USA
| | - Alexandra M Stevens
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Julienne Brackett
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
| | - Lucila Marquez
- Department of Infection Control and Prevention, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Catherine E Foster
- Department of Infection Control and Prevention, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Hannah E Sauer
- Department of Pharmacy, Texas Children's Hospital, Houston, Texas, USA
| | - Judith R Campbell
- Department of Infection Control and Prevention, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
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Grading bloodstream infection risk using citrulline as a biomarker of intestinal mucositis in patients receiving intensive therapy. Bone Marrow Transplant 2022; 57:1373-1381. [DOI: 10.1038/s41409-022-01719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/08/2022]
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13
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Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc07. [PMID: 35707229 PMCID: PMC9174886 DOI: 10.3205/dgkh000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Germany, guidelines for hygiene in hospitals are given in form of recommendations by the Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, "KRINKO"). The KRINKO and its voluntary work are legitimized by the mandate according to § 23 of the Infection Protection Act (Infektionsschutzgesetz, "IfSG"). The original German version of this document was published in February 2021 and has now been made available to the international professional public in English. The guideline provides recommendations on infection prevention and control for immunocompromised individuals in health care facilities. This recommendation addresses not only measures related to direct medical care of immunocompromised patients, but also management aspects such as surveillance, screening, antibiotic stewardship, and technical/structural aspects such as patient rooms, air quality, and special measures during renovations.
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Severyn CJ, Siranosian BA, Kong STJ, Moreno A, Li MM, Chen N, Duncan CN, Margossian SP, Lehmann LE, Sun S, Andermann TM, Birbrayer O, Silverstein S, Reynolds CG, Kim S, Banaei N, Ritz J, Fodor AA, London WB, Bhatt AS, Whangbo JS. Microbiota dynamics in a randomized trial of gut decontamination during allogeneic hematopoietic cell transplantation. JCI Insight 2022; 7:e154344. [PMID: 35239511 PMCID: PMC9057614 DOI: 10.1172/jci.insight.154344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUNDGut decontamination (GD) can decrease the incidence and severity of acute graft-versus-host disease (aGVHD) in murine models of allogeneic hematopoietic cell transplantation (HCT). In this pilot study, we examined the impact of GD on gut microbiome composition and the incidence of aGVHD in HCT patients.METHODSWe randomized 20 patients undergoing allogeneic HCT to receive (GD) or not receive (no-GD) oral vancomycin-polymyxin B from day -5 through neutrophil engraftment. We evaluated shotgun metagenomic sequencing of serial stool samples to compare the composition and diversity of the gut microbiome between study arms. We assessed clinical outcomes in the 2 arms and performed strain-specific analyses of pathogens that caused bloodstream infections (BSI).RESULTSThe 2 arms did not differ in the predefined primary outcome of Shannon diversity of the gut microbiome at 2 weeks post-HCT (genus, P = 0.8; species, P = 0.44) or aGVHD incidence (P = 0.58). Immune reconstitution of T cell and B cell subsets was similar between groups. Five patients in the no-GD arm had 8 BSI episodes versus 1 episode in the GD arm (P = 0.09). The BSI-causing pathogens were traceable to the gut in 7 of 8 BSI episodes in the no-GD arm, including Staphylococcus species.CONCLUSIONWhile GD did not differentially affect Shannon diversity or clinical outcomes, our findings suggest that GD may protect against gut-derived BSI in HCT patients by decreasing the prevalence or abundance of gut pathogens.TRIAL REGISTRATIONClinicalTrials.gov NCT02641236.FUNDINGNIH, Damon Runyon Cancer Research Foundation, V Foundation, Sloan Foundation, Emerson Collective, and Stanford Maternal & Child Health Research Institute.
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Affiliation(s)
- Christopher J. Severyn
- Department of Pediatrics, Division of Pediatric Hematology/Oncology and Division of Pediatric Stem Cell Transplant and Regenerative Medicine
| | | | | | - Angel Moreno
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Michelle M. Li
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Nan Chen
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Christine N. Duncan
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Steven P. Margossian
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Leslie E. Lehmann
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Shan Sun
- Department of Bioinformatics and Genomics, College of Computing and Informatics, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Tessa M. Andermann
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Olga Birbrayer
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Carol G. Reynolds
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Soomin Kim
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Niaz Banaei
- Department of Pathology, Stanford University, Palo Alto, California, USA
- Department of Medicine, Division of Infectious Diseases, Stanford University, Palo Alto, California, USA
| | - Jerome Ritz
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Anthony A. Fodor
- Department of Bioinformatics and Genomics, College of Computing and Informatics, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Wendy B. London
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ami S. Bhatt
- Departments of Genetics and Medicine, Division of Hematology
| | - Jennifer S. Whangbo
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Belloni S, Caruso R, Cattani D, Mandelli G, Donizetti D, Mazzoleni B, Tedeschi M. Occurrence rate and risk factors for long-term central line-associated bloodstream infections in patients with cancer: A systematic review. Worldviews Evid Based Nurs 2022; 19:100-111. [PMID: 35262257 DOI: 10.1111/wvn.12574] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Central line-associated bloodstream infection (CLABSI) is a public health problem that harms patients' outcomes and healthcare costs, especially in susceptible populations such as patients with cancer. Overall, systematic queries about etiology, risks, and epidemiology are explained by data from observational studies, which better underline the relationship between factors and incidence of disease. However, no recent systematic reviews of observational studies on adult patients with cancer have been conducted on this topic, considering the wide range of all potential factors which can contribute to the increase in infection rate in the hospitalized adults with cancer. This study systematically reviewed observational studies investigating the occurrence rate of CLABSI and its risk factors for long-term inserted central catheter-related infections in hospitalized adult cancer patients. METHODS A systematic review was performed on four databases from the earliest available date until December 2020. Retrospective and prospective cohort studies focused on the occurrence rate of CLABSI and its risk factors in hospitalized adult cancer patients. The pooled occurrence rate of CLABSI (95% CI) was calculated by applying a random-effects model. RESULTS Of 1712 studies, 8 were eligible, and the data of device-related infection rate were meta-analyzed. The pooled occurrence rate of CLABSI was roughly 8% (95% CI [4%, 14%]). The device characteristics, device's management aspects, therapies administration, and select patients' clinical conditions represent the main risk factors for long-term catheter-related infection in cancer patients. LINKING EVIDENCE TO ACTION Considering the substantial infection rate among cancer patients, identifying risk rate factors is pivotal to support evidence-grounded preventive strategies and maximize cancer patient safety. This study's results could guide policymakers and healthcare leaders and future research studies to disseminate appropriate risk-reducing management culture and implement standardized research and clinical approach to the investigated phenomenon as an infection surveillance strategy.
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Affiliation(s)
- Silvia Belloni
- Educational and Research Unit, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Daniela Cattani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giorgia Mandelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Daniela Donizetti
- Educational and Research Unit, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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El Boghdadly Z, Zhao Q, Koutou J, Lustberg ME, Ludwig M, Liscynesky C, Choe H. Evaluation of central line salvage for mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) management practices in patients with hematologic malignancies. Leuk Lymphoma 2022; 63:1455-1463. [PMID: 35001802 DOI: 10.1080/10428194.2021.2020778] [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: 10/19/2022]
Abstract
Patients with underlying hematologic malignancy (HM) and/or allogeneic hematopoietic stem cell transplant (HCT) recipients are at risk for mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) secondary to bacterial translocation. There is sparse data comparing MBI-LCBI management practices, in particular central venous catheter (CVC) salvage versus removal. We created a 22-item poll of Infectious Disease specialists at major US cancer centers on management controversies. Response rate was 44% (31/70). CVC salvage was a common practice among 87.5%. This was followed by a single center retrospective study (2017-2019) comparing outcomes related to CVC practices. We identified 115 patients, 52% (60/115) admitted for chemotherapy and 33% (38/115) for allogeneic HCT. The majority of patients (78%, 90/115) had their CVC removed. There was no difference in 72 h defervescence, microbiological clearance, in-hospital mortality, and 90-day recurrent infection between CVC salvage versus removal. CVC salvage is a safe approach in certain clinical scenarios.
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Affiliation(s)
- Zeinab El Boghdadly
- Division of Infectious Diseases, The Ohio State University, Columbus, OH, USA
| | - Qiuhong Zhao
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Jean Koutou
- Department of Radiation Oncology, The Ohio State Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark E Lustberg
- Division of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Madeline Ludwig
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | | | - Hannah Choe
- Division of Hematology, The Ohio State University, Columbus, OH, USA
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17
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Liu MA, Bakow BR, Hsu TC, Chen JY, Su KY, Asiedu EK, Hsu WT, Lee CC. Temporal Trends in Sepsis Incidence and Mortality in Patients With Cancer in the US Population. Am J Crit Care 2021; 30:e71-e79. [PMID: 34195781 DOI: 10.4037/ajcc2021632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Few population-based studies assess the impact of cancer on sepsis incidence and mortality. OBJECTIVES To evaluate epidemiological trends of sepsis in patients with cancer. METHODS This retrospective cohort study included adults (≥20 years old) identified using sepsis-indicator International Classification of Diseases codes from the Nationwide Inpatient Sample database (2006-2014). A generalized linear model was used to trend incidence and mortality. Outcomes in patients with cancer and patients without cancer were compared using propensity score matching. Cox regression modeling was used to calculate hazard ratios for mortality rates. RESULTS The study included 13 996 374 patients, 13.6% of whom had cancer. Gram-positive infections were most common, but the incidence of gram-negative infections increased at a greater rate. Compared with patients without cancer, those with cancer had significantly higher rates of lower respiratory tract (35.0% vs 31.6%), intra-abdominal (5.5% vs 4.6%), fungal (4.8% vs 2.9%), and anaerobic (1.2% vs 0.9%) infections. Sepsis incidence increased at a higher rate in patients with cancer than in those without cancer, but hospital mortality rates improved equally in both groups. After propensity score matching, hospital mortality was higher in patients with cancer than in those without cancer (hazard ratio, 1.25; 95% CI, 1.24-1.26). Of patients with sepsis and cancer, those with lung cancer had the lowest survival (hazard ratio, 1.65) compared with those with breast cancer, who had the highest survival. CONCLUSIONS Cancer patients are at high risk for sepsis and associated mortality. Research is needed to guide sepsis monitoring and prevention in patients with cancer.
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Affiliation(s)
- Michael A. Liu
- Michael A. Liu is a resident physician, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Brianna R. Bakow
- Brianna R. Bakow is a fellow physician, Department of Hematology/Oncology, Warren Alpert Medical School of Brown University
| | - Tzu-Chun Hsu
- Tzu-Chun Hsu is a statistician, Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jia-Yu Chen
- Jia-Yu Chen is a resident physician, Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ke-Ying Su
- Ke-Ying Su is a statistician, Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Emmanuel K. Asiedu
- Emmanuel K. Asiedu is a resident physician, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Wan-Ting Hsu
- Wan-Ting Hsu is a graduate student, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Chien-Chang Lee
- Chien-Chang Lee is an attending physician and associate professor, Department of Emergency Medicine, National Taiwan University Hospital
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18
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Anforderungen an die Infektionsprävention bei der medizinischen Versorgung von immunsupprimierten Patienten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:232-264. [PMID: 33394069 PMCID: PMC7780910 DOI: 10.1007/s00103-020-03265-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Ardura MI, Bibart MJ, Mayer LC, Guinipero T, Stanek J, Olshefski RS, Auletta JJ. Impact of a Best Practice Prevention Bundle on Central Line-associated Bloodstream Infection (CLABSI) Rates and Outcomes in Pediatric Hematology, Oncology, and Hematopoietic Cell Transplantation Patients in Inpatient and Ambulatory Settings. J Pediatr Hematol Oncol 2021; 43:e64-e72. [PMID: 32960848 DOI: 10.1097/mph.0000000000001950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric hematology, oncology, and hematopoietic cell transplantation (HCT) patients are at increased risk for bloodstream infections. The authors sought to evaluate the influence of a standardized best practice central venous catheter (CVC) maintenance bundle on the burden of and risk factors for mucosal barrier injury (MBI) and non-MBI central line-associated bloodstream infections (CLABSIs) across a common inpatient and ambulatory continuum in this high-risk population. METHODS A retrospective cohort study of patients with underlying malignancy, hematologic disorders, and HCT recipients with a CVC in place at the time of CLABSI diagnosis in both inpatient and ambulatory settings from January 1, 2012 to December 31, 2016. Descriptive, nonparametric statistics were used to describe patient characteristics and outcomes. Logistic regression analyses were applied to identify potential risk factors for inpatient versus ambulatory and MBI versus non-MBI CLABSI. RESULTS During the 5-year period, 118 of 808 (14.6%) patients had 159 laboratory-confirmed CLABSIs for ambulatory and inpatient CLABSI rates of 0.27 CLABSI/1000 and 2.2 CLABSI/1000 CVC days, respectively. CLABSI occurred more frequently in hospitalized patients after HCT and with underlying leukemia, most frequently caused by Gram-negative bacteria. MBI CLABSI accounted for 42% of all CLABSI with a 3-fold higher risk in hospitalized patients. Having multiple CVC or a CVC that was not a port independently associated with higher CLABSI risk. CONCLUSIONS In our cohort, non-MBI CLABSI continued to account for the majority of CLABSI. CVC type is independently associated with higher overall CLABSI risk. Further studies are needed to reliably define additional prevention strategies when CLABSI maintenance bundles elements are optimized in this high-risk population.
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Affiliation(s)
- Monica I Ardura
- Department of Pediatrics, Division of Infectious Diseases
- Host Defense Program
| | - Mindy J Bibart
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Lauren C Mayer
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Terri Guinipero
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Joseph Stanek
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Randal S Olshefski
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
| | - Jeffery J Auletta
- Department of Pediatrics, Division of Infectious Diseases
- Host Defense Program
- Division of Hematology/Oncology/Blood and Bone Marrow Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH
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20
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Böll B, Schalk E, Buchheidt D, Hasenkamp J, Kiehl M, Kiderlen TR, Kochanek M, Koldehoff M, Kostrewa P, Claßen AY, Mellinghoff SC, Metzner B, Penack O, Ruhnke M, Vehreschild MJGT, Weissinger F, Wolf HH, Karthaus M, Hentrich M. Central venous catheter-related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2021; 100:239-259. [PMID: 32997191 PMCID: PMC7782365 DOI: 10.1007/s00277-020-04286-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022]
Abstract
Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter-related infections (CRIs). Moreover, CRIs prolong hospitalization, cause an excess in resource utilization and treatment cost, often delay anti-cancer treatment, and are associated with a significant increase in mortality in cancer patients. We therefore summoned a panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and updated our previous guideline on CRIs in cancer patients. After conducting systematic literature searches on PubMed, Medline, and Cochrane databases, video- and meeting-based consensus discussions were held. In the presented guideline, we summarize recommendations on definition, diagnosis, management, and prevention of CRIs in cancer patients including the grading of strength of recommendations and the respective levels of evidence. This guideline supports clinicians and researchers alike in the evidence-based decision-making in the management of CRIs in cancer patients.
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Affiliation(s)
- Boris Böll
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Enrico Schalk
- Department of Hematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Center, Magdeburg, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Justin Hasenkamp
- Clinic for Hematology and Oncology, University Medicine Göttingen, Georg-August-University, Göttingen, Germany
| | - Michael Kiehl
- Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany
| | - Til Ramon Kiderlen
- Department of Hematology, Oncology and Palliative Care, Vivantes Clinic Neukoelln, Berlin, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philippe Kostrewa
- Department of Hematology and Oncology, Campus Fulda, Philipps-University Marburg, Fulda, Germany
| | - Annika Y Claßen
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Sibylle C Mellinghoff
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Bernd Metzner
- Department of Hematology and Oncology, University Hospital Oldenburg, Oldenburg, Germany
| | - Olaf Penack
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ruhnke
- Department of Hematology and Oncology, Helios Klinikum Aue, Aue, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Weissinger
- Department of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Hans-Heinrich Wolf
- Department III of Internal Medicine, Hematology, Oncology and Hemostaseology, Südharzklinikum, Nordhausen, Germany
| | - Meinolf Karthaus
- Department of Hematology, Oncology & Palliative Care, Klinikum Neuperlach, Munich, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany
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Heston SM, Young RR, Hong H, Akinboyo IC, Tanaka JS, Martin PL, Vinesett R, Jenkins K, McGill LE, Hazen KC, Seed PC, Kelly MS. Microbiology of Bloodstream Infections in Children After Hematopoietic Stem Cell Transplantation: A Single-Center Experience Over Two Decades (1997-2017). Open Forum Infect Dis 2020; 7:ofaa465. [PMID: 33209953 PMCID: PMC7652097 DOI: 10.1093/ofid/ofaa465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022] Open
Abstract
Background Bloodstream infections (BSIs) occur frequently after hematopoietic stem cell transplantation (HSCT). We examined the microbiology of BSI in pediatric HSCT recipients over a 2-decade period at our institution to inform empirical antimicrobial prescribing and infection prevention strategies. Methods We conducted a retrospective cohort study of children (<18 years) who underwent HSCT at Duke University between 1997 and 2015. We used recurrent-event gap-time Cox proportional hazards models to determine the hazards of all-cause and cause-specific BSI according to HSCT year. We compared the median time to BSI by causative organism type and evaluated for temporal trends in the prevalence of antibiotic resistance among causative organisms. Results A total of 865 BSI occurred in 1311 children, including 412 (48%) Gram-positive bacterial, 196 (23%) Gram-negative bacterial, 56 (6%) fungal, 23 (3%) mycobacterial, and 178 (21%) polymicrobial BSI. The hazard of all BSIs did not change substantially over time during the study period, but the hazard of fungal BSIs declined over time during the study period (P = .04). Most fungal BSIs (82%) occurred in the first 100 days after HSCT, whereas mycobacterial BSIs occurred later after HSCT than BSIs caused by other organisms (P < .0001). The prevalence of vancomycin resistance among BSIs caused by Enterococcus faecium increased during the study period (P = .0007). The risk of 2-year mortality in children was increased with BSI (P = .02), Gram-negative bacterial BSI (P = .02), and fungal BSI (P < .0001). Conclusions Despite expanded practices for BSI prevention over the past several decades, the incidence of BSI remains high in pediatric HSCT recipients at our institution. Additional strategies are urgently needed to effectively prevent BSIs in this high-risk population.
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Affiliation(s)
- Sarah M Heston
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Rebecca R Young
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Hwanhee Hong
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ibukunoluwa C Akinboyo
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - John S Tanaka
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Paul L Martin
- Division of Pediatric Transplant and Cellular Therapy, Duke University Medical Center, Durham, North Carolina, USA
| | - Richard Vinesett
- Division of Pediatric Transplant and Cellular Therapy, Duke University Medical Center, Durham, North Carolina, USA
| | - Kirsten Jenkins
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren E McGill
- Division of Pediatric Transplant and Cellular Therapy, Duke University Medical Center, Durham, North Carolina, USA
| | - Kevin C Hazen
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Patrick C Seed
- Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Matthew S Kelly
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
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22
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Badia P, Andersen H, Haslam D, Nelson AS, Pate AR, Golkari S, Teusink-Cross A, Flesch L, Bedel A, Hickey V, Kramer K, Lane A, Davies SM, Thikkurissy S, Dandoy CE. Improving Oral Health and Modulating the Oral Microbiome to Reduce Bloodstream Infections from Oral Organisms in Pediatric and Young Adult Hematopoietic Stem Cell Transplantation Recipients: A Randomized Controlled Trial. Biol Blood Marrow Transplant 2020; 26:1704-1710. [PMID: 32505810 PMCID: PMC11168732 DOI: 10.1016/j.bbmt.2020.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/23/2020] [Accepted: 05/24/2020] [Indexed: 12/22/2022]
Abstract
Bloodstream infections (BSIs) from oral organisms are a significant cause of morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients. There are no proven strategies to decrease BSIs from oral organisms. The aim of this study was to evaluate the impact of daily xylitol wipes in improving oral health, decreasing BSI from oral organisms, and modulating the oral microbiome in pediatric HSCT recipients. This was a single-center 1:1 randomized controlled trial in pediatric HSCT recipients age >2 years. Age-matched healthy children were enrolled to compare the oral microbiome. The oral hygiene standard of care (SOC) group continued to receive the standard oral hygiene regimen. The xylitol group received daily oral xylitol wipes (with .7 g xylitol) in addition to the SOC. The intervention started from the beginning of the transplantation chemotherapy regimen and extended to 28 days following transplantation. The primary outcome was oral health at interval time points, and secondary outcomes included BSIs from oral organisms in the first 30 days following transplantation, oral microbiome abundance, and diversity and oral pathogenic organism abundance. The study was closed early due to efficacy after an interim analysis of the first 30 HSCT recipients was performed (SOC group, n = 16; xylitol group, n = 14). The xylitol group had a significantly lower rate of gingivitis at days 7, 14, and 28 following transplantation (P = .031, .0039, and .0005, respectively); oral plaque at days 7 and 14 (P = .045 and .0023, respectively); and oral ulcers >10 mm at day 14 (P = .049) compared with the SOC group. The xylitol group had no BSI from oral organisms compared with the SOC group, which had 4 (P = .04). The xylitol group had significantly lower abundance of potential BSI pathogens, such as Staphylococcus aureus (P = .036), Klebsiella pneumoniae (P = .033), and Streptococcus spp (P = .011) at the day after transplantation compared with the SOC group. Healthy children and young adults had significantly increased oral microbiome diversity compared with all HSCT recipients (P < .001). The addition of xylitol to standard oral care significantly improves oral health, decreases BSI from oral organisms, and decreases the abundance of pathogenic oral organisms in pediatric and young adult HSCT recipients.
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Affiliation(s)
- Priscila Badia
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona.
| | - Heidi Andersen
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Haslam
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Adam S Nelson
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Abigail R Pate
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sara Golkari
- Division of Pediatric Dentistry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ashley Teusink-Cross
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Laura Flesch
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ashely Bedel
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Victoria Hickey
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathi Kramer
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Adam Lane
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stella M Davies
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sarat Thikkurissy
- Division of Pediatric Dentistry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher E Dandoy
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Hakim H, Billett AL, Xu J, Tang L, Richardson T, Winkle C, Werner EJ, Hord JD, Bundy DG, Gaur AH. Mucosal barrier injury-associated bloodstream infections in pediatric oncology patients. Pediatr Blood Cancer 2020; 67:e28234. [PMID: 32386095 DOI: 10.1002/pbc.28234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/28/2020] [Accepted: 02/12/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Single-center reports of central line-associated bloodstream infection (CLABSI) and the subcategory of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) in pediatric hematology oncology transplant (PHO) patients have focused on the inpatient setting. Characterization of MBI-LCBI across PHO centers and management settings (inpatient and ambulatory) is urgently needed to inform surveillance and prevention strategies. METHODS Prospectively collected data from August 1, 2013, to December 31, 2015, on CLABSI (including MBI-LCBI) from a US PHO multicenter quality improvement network database was analyzed. CDC National Healthcare Safety Network definitions were applied for inpatient events and adapted for ambulatory events. RESULTS Thirty-five PHO centers reported 401 ambulatory and 416 inpatient MBI-LCBI events. Ambulatory and inpatient MBI-LCBI rates were 0.085 and 1.01 per 1000 line days, respectively. Fifty-three percent of inpatient CLABSIs were MBI-LCBIs versus 32% in the ambulatory setting (P < 0.01). Neutropenia was the most common criterion defining MBI-LCBI in both settings, being present in ≥90% of events. The most common organisms isolated in MBI-LCBI events were Escherichia coli (in 28% of events), Klebsiella spp. (23%), and viridans streptococci (12%) in the ambulatory setting and viridans streptococci (in 29% of events), E. coli (14%), and Klebsiella spp. (14%) in the inpatient setting. CONCLUSION In this largest study of PHO MBI-LCBI inpatient events and the first such study in the ambulatory setting, the burden of MBI-LCBI across the continuum of care of PHO patients was substantial. These data should raise awareness of MBI-LCBI among healthcare providers for PHO patients, help benchmarking across centers, and help inform prevention and treatment strategies.
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Affiliation(s)
- Hana Hakim
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amy L Billett
- Department of Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Jiahui Xu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Li Tang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Cynthia Winkle
- Nursing Department, Children's Medical Center, Dallas, Texas
| | - Eric J Werner
- Department of Oncology, Children's Specialty Group, Norfolk, Virginia
| | - Jeffrey D Hord
- Department of Oncology, Akron Children's Hospital, Akron, Ohio
| | - David G Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Aditya H Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
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24
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Valentine JC, Hall L, Verspoor KM, Worth LJ. The current scope of healthcare-associated infection surveillance activities in hospitalized immunocompromised patients: a systematic review. Int J Epidemiol 2020; 48:1768-1782. [PMID: 31363780 DOI: 10.1093/ije/dyz162] [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] [Accepted: 07/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immunocompromised patients are at increased risk of acquiring healthcare-associated infections (HAIs) and often require specialized models of care. Surveillance of HAIs is essential for effective infection-prevention programmes. However, little is known regarding standardized or specific surveillance methods currently employed for high-risk hospitalized patients. METHODS A systematic review adopting a narrative synthesis approach of published material between 1 January 2000 and 31 March 2018 was conducted. Publications describing the application of traditional and/or electronic surveillance of HAIs in immunocompromised patient settings were identified from the Ovid MEDLINE®, Ovid Embase® and Elsevier Scopus® search engines [PROSPERO international prospective register of systematic reviews (registration ID: CRD42018093651)]. RESULTS In total, 2708 studies were screened, of whom 17 fulfilled inclusion criteria. Inpatients diagnosed with haematological malignancies were the most-represented immunosuppressed population. The majority of studies described manual HAI surveillance utilizing internationally accepted definitions for infection. Chart review of diagnostic and pathology reports was most commonly employed for case ascertainment. Data linkage of disparate datasets was performed in two studies. The most frequently monitored infections were bloodstream infections and invasive fungal disease. No surveillance programmes applied risk adjustment for reporting surveillance outcomes. CONCLUSIONS Targeted, tailored monitoring of HAIs in high-risk immunocompromised settings is infrequently reported in current hospital surveillance programmes. Standardized surveillance frameworks, including risk adjustment and timely data dissemination, are required to adequately support infection-prevention programmes in these populations.
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Affiliation(s)
- Jake C Valentine
- Sir Peter MacCallum Department of Oncology, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lisa Hall
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Karin M Verspoor
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,School of Computing and Information Systems, University of Melbourne, Melbourne, Victoria, Australia.,Health and Biomedical Informatics Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Leon J Worth
- Sir Peter MacCallum Department of Oncology, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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25
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de Mooij CEM, van der Velden WJFM, Verweij PE, de Haan AFJ, van Groningen LFJ, Meijer C, Hopman J, Blijlevens NMA. Surveillance of catheter-related bloodstream infections in haemato-oncology patients: comparison of two definitions. J Hosp Infect 2020; 105:686-690. [PMID: 32339616 DOI: 10.1016/j.jhin.2020.04.027] [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: 02/07/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
In the Netherlands, the PREZIES surveillance is used for registration and surveillance of central venous catheter (CVC) -related bloodstream infections (CRBSI). We investigated how this Dutch definition correlated with internationally used definitions for CRBSI, central line-associated bloodstream infections (CLABSI) and mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBI). We determined that the Dutch PREZIES definition of CRBSI is appropriate for surveillance control of CVC care bundle use in haemato-oncology patients managed with multi-lumen CVCs.
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Affiliation(s)
- C E M de Mooij
- Radboud Institute for Health Sciences, Department of Haematology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - W J F M van der Velden
- Radboud Institute for Health Sciences, Department of Haematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P E Verweij
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A F J de Haan
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L F J van Groningen
- Radboud Institute for Health Sciences, Department of Haematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C Meijer
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J Hopman
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - N M A Blijlevens
- Radboud Institute for Health Sciences, Department of Haematology, Radboud University Medical Center, Nijmegen, the Netherlands
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26
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Beaudry J, ScottoDiMaso K. Central Line Care: Reducing Central Line-Associated Bloodstream Infections on a Hematologic Malignancy and Stem Cell Transplant Unit. Clin J Oncol Nurs 2020; 24:148-152. [PMID: 32196000 DOI: 10.1188/20.cjon.148-152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with hematologic malignancies and stem cell transplant recipients are at increased risk for infections because of their prolonged periods of profound neutropenia. Central line-associated bloodstream infections (CLABSIs) can result in lengthy hospitalizations, increased healthcare costs, and increased morbidity and mortality. OBJECTIVES The aim of this comprehensive educational training program was to reduce CLABSI rates by focusing on the standardized practices associated with use, care, and maintenance of all types of central lines. METHODS A pretest was administered to nursing staff. Based on the responses, an education program was then created. The program consisted of a comprehensive two-hour class using different modalities of teaching, including standardized practices associated with central line care. FINDINGS The comprehensive education program was effective in standardizing education and improving knowledge gaps, resulting in the reduction of CLABSI rates. Overall, staff knowledge surrounding central line care and maintenance increased by 16%. In addition, no CLABSI events have been reported on the unit from the time of program initiation.
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27
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Gastmeier P. From ‘one size fits all’ to personalized infection prevention. J Hosp Infect 2020; 104:256-260. [DOI: 10.1016/j.jhin.2019.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 12/18/2022]
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28
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Reed D, Sen J, Lassiter K, Thomas T, Harr E, Daniels E, Keng M. Prospective Initiative to Reduce Mucosal Barrier Injuries and Bloodstream Infections in Patients With Hematologic Malignancy Receiving Inpatient Chemotherapy. JCO Oncol Pract 2020; 16:e306-e312. [DOI: 10.1200/jop.19.00344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Mucosal barrier injury (MBI) occurs during periods of prolonged neutropenia in patients receiving cytotoxic chemotherapy for hematologic malignancies. This can lead to laboratory-confirmed bloodstream infections (LCBIs) and subsequent complications, including sepsis, organ failure, and possible death. There are no published prevention strategies for MBI. The purpose of our proposal was to decrease our MBI-LCBI events per month by 25%. METHODS: A multidisciplinary team was assembled to achieve this proposal. Cause-and-effect diagrams in addition to Pareto charts were used to investigate potential interventions. Using Plan-Do-Study-Act (PDSA) cycles, multiple tests of change were designed over the course of 3 years. RESULTS: The number of baseline events per month for MBI-LCBIs was 1.1. With the completion of the first PDSA cycle, the MBI-LCBI events dropped to 1.0 event per month. A second PDSA cycle involving implementation of an oral care kit improved to 0.35 events per month. This unfortunately was not sustained, and a root cause analysis demonstrated that physician noncompliance with ordering the oral kit was the main reason. After the change of a physician-driven protocol to a nurse-driven protocol, the third PDSA cycle resulted in a decrease in MBI-LCBI events to 0.89 events per month. CONCLUSION: To our knowledge, this is the first published report of an intervention to prevent MBI-LCBI events. Through a multidisciplinary approach and with quality improvement tools, we were able to demonstrate a significant reduction in MBI-LCBI events.
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Affiliation(s)
- Daniel Reed
- University of Virginia Health System, Charlottesville, VA
| | - Jeremy Sen
- University of Virginia Health System, Charlottesville, VA
| | - Katie Lassiter
- University of Virginia Health System, Charlottesville, VA
| | - Tanya Thomas
- University of Virginia Health System, Charlottesville, VA
| | - Erin Harr
- University of Virginia Health System, Charlottesville, VA
| | | | - Michael Keng
- University of Virginia Health System, Charlottesville, VA
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29
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Baier C, Linke L, Eder M, Schwab F, Chaberny IF, Vonberg RP, Ebadi E. Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients. PLoS One 2020; 15:e0227772. [PMID: 31978169 PMCID: PMC6980604 DOI: 10.1371/journal.pone.0227772] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/27/2019] [Indexed: 12/28/2022] Open
Abstract
Non-implanted central vascular catheters (CVC) are frequently required for therapy in hospitalized patients with hematological malignancies or solid tumors. However, CVCs may represent a source for bloodstream infections (central line-associated bloodstream infections, CLABSI) and, thus, may increase morbidity and mortality of these patients. A retrospective cohort study over 3 years was performed. Risk factors were determined and evaluated by a multivariable logistic regression analysis. Healthcare costs of CLABSI were analyzed in a matched case-control study. In total 610 patients got included with a CLABSI incidence of 10.6 cases per 1,000 CVC days. The use of more than one CVC per case, CVC insertion for conditioning for stem cell transplantation, acute myeloid leukemia, leukocytopenia (≤ 1000/μL), carbapenem therapy and pulmonary diseases were independent risk factors for CLABSI. Hospital costs directly attributed to the onset of CLABSI were 8,810 € per case. CLABSI had a significant impact on the overall healthcare costs. Knowledge about risk factors and infection control measures for CLABSI prevention is crucial for best clinical practice.
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Affiliation(s)
- Claas Baier
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Lena Linke
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Matthias Eder
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine, Berlin, Germany
| | - Iris Freya Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Ella Ebadi
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
- * E-mail:
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30
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Dandoy CE, Kim S, Chen M, Ahn KW, Ardura MI, Brown V, Chhabra S, Diaz MA, Dvorak C, Farhadfar N, Flagg A, Ganguly S, Hale GA, Hashmi SK, Hematti P, Martino R, Nishihori T, Nusrat R, Olsson RF, Rotz SJ, Sung AD, Perales MA, Lindemans CA, Komanduri KV, Riches ML. Incidence, Risk Factors, and Outcomes of Patients Who Develop Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infections in the First 100 Days After Allogeneic Hematopoietic Stem Cell Transplant. JAMA Netw Open 2020; 3:e1918668. [PMID: 31913492 PMCID: PMC6991246 DOI: 10.1001/jamanetworkopen.2019.18668] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Patients undergoing hematopoietic stem cell transplant (HSCT) are at risk for bloodstream infection (BSI) secondary to translocation of bacteria through the injured mucosa, termed mucosal barrier injury-laboratory confirmed bloodstream infection (MBI-LCBI), in addition to BSI secondary to indwelling catheters and infection at other sites (BSI-other). OBJECTIVE To determine the incidence, timing, risk factors, and outcomes of patients who develop MBI-LCBI in the first 100 days after HSCT. DESIGN, SETTING, AND PARTICIPANTS A case-cohort retrospective analysis was performed using data from the Center for International Blood and Marrow Transplant Research database on 16 875 consecutive pediatric and adult patients receiving a first allogeneic HSCT from January 1, 2009, to December 31, 2016. Patients were classified into 4 categories: MBI-LCBI (1481 [8.8%]), MBI-LCBI and BSI-other (698 [4.1%]), BSI-other only (2928 [17.4%]), and controls with no BSI (11 768 [69.7%]). Statistical analysis was performed from April 5 to July 17, 2018. MAIN OUTCOMES AND MEASURES Demographic characteristics and outcomes, including overall survival, chronic graft-vs-host disease, and transplant-related mortality (only for patients with malignant disease), were compared among groups. RESULTS Of the 16 875 patients in the study (9737 [57.7%] male; median [range] age, 47 [0.04-82] years) 13 686 (81.1%) underwent HSCT for a malignant neoplasm, and 3189 (18.9%) underwent HSCT for a nonmalignant condition. The cumulative incidence of MBI-LCBI was 13% (99% CI, 12%-13%) by day 100, and the cumulative incidence of BSI-other was 21% (99% CI, 21%-22%) by day 100. Median (range) time from transplant to first MBI-LCBI was 8 (<1 to 98) days vs 29 (<1 to 100) days for BSI-other. Multivariable analysis revealed an increased risk of MBI-LCBI with poor Karnofsky/Lansky performance status (hazard ratio [HR], 1.21 [99% CI, 1.04-1.41]), cord blood grafts (HR, 2.89 [99% CI, 1.97-4.24]), myeloablative conditioning (HR, 1.46 [99% CI, 1.19-1.78]), and posttransplant cyclophosphamide graft-vs-host disease prophylaxis (HR, 1.85 [99% CI, 1.38-2.48]). One-year mortality was significantly higher for patients with MBI-LCBI (HR, 1.81 [99% CI, 1.56-2.12]), BSI-other (HR, 1.81 [99% CI, 1.60-2.06]), and MBI-LCBI plus BSI-other (HR, 2.65 [99% CI, 2.17-3.24]) compared with controls. Infection was more commonly reported as a cause of death for patients with MBI-LCBI (139 of 740 [18.8%]), BSI (251 of 1537 [16.3%]), and MBI-LCBI plus BSI (94 of 435 [21.6%]) than for controls (566 of 4740 [11.9%]). CONCLUSIONS AND RELEVANCE In this cohort study, MBI-LCBI, in addition to any BSIs, were associated with significant morbidity and mortality after HSCT. Further investigation into risk reduction should be a clinical and scientific priority in this patient population.
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Affiliation(s)
- Christopher E. Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Soyoung Kim
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee
| | - Min Chen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee
| | - Monica I. Ardura
- Division of Infectious Disease, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Valerie Brown
- Division of Pediatric Oncology/Hematology, Department of Pediatrics, Penn State Hershey Children’s Hospital and College of Medicine, Hershey, Pennsylvania
| | - Saurabh Chhabra
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Divsion of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Christopher Dvorak
- Divsion of Pediatric Allergy, Immunology & Bone Marrow Transplantation, Benioff Children’s Hospital, University of California, San Francisco
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville
| | - Aron Flagg
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Yale New Haven Hospital, New Haven, Connecticut
| | - Siddartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City
| | - Gregory A. Hale
- Department of Hematology/Oncology, Johns Hopkins All Children’s Hospital, St Petersburg, Florida
| | - Shahrukh K. Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison
| | - Rodrigo Martino
- Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Roomi Nusrat
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Richard F. Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Seth J. Rotz
- Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children’s Hospital, Cleveland, Ohio
| | - Anthony D. Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Caroline A. Lindemans
- Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht University, Netherlands
- Division of Pediatric Stem Cell Transplantation, Department of Pediatrics, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Marcie L. Riches
- Division of Hematology/Oncology, The University of North Carolina at Chapel Hill
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Huang V. Effect of a patency bundle on central venous catheter complications among hospitalized adult patients: a best practice implementation project. ACTA ACUST UNITED AC 2019; 16:565-586. [PMID: 29419626 DOI: 10.11124/jbisrir-2016-003340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The aim of this project was to improve continuity of care by decreasing central catheter occlusions in adults in two acute care units with high use of central venous catheters. Specific objectives were to introduce a patency bundle and train nurses on thrombolytic administration for timely resolution of catheter occlusions. INTRODUCTION Central venous catheters are a vital component of medical care of acutely ill hospitalized patients. Occluded catheters delay treatment and can increase infection risk. There are bundles of best practices on catheter insertion, dressing and removal. However, a gap exists in nursing guidance for maintaining and restoring catheter patency. METHODS The project used the Joanna Briggs Institute's tools for promoting practice change. Getting Research into Practice (GRiP) and Practical Application of Clinical Evidence System (PACES) assisted with strategy formation and data analysis. Direct observation and medical record review were used for baseline and follow-up audits. Several teaching strategies were employed to educate direct care nurses. RESULTS Occlusion rates fluctuated greatly above and below baseline rates. Infection rates did not increase with thrombolytic administration. Nurses' compliance with catheter access and flushing techniques doubled. Timeliness of thrombolytic administration increased to 100% compliance. However, patency documentation did not improve. CONCLUSIONS Multi-modal education reached all nurses and contributed to significantly improved compliance with patency best practice. Nurses were empowered to expediently troubleshoot occlusions by using thrombolytics. However, three months of post-implementation data was not enough to demonstrate a continued downward trend in occlusion rates. Thrombolytic administration by nurses on the other adult units and improved patency documentation are in the planning stages.
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Affiliation(s)
- Vivian Huang
- UCSF Medical Center, UCSF Center for Evidence Synthesis and Implementation: a Joanna Briggs Institute Center of Excellence
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Gray KL, Steidley IG, Benson HL, Pearce CL, Bachman AM, Adamski J. Implementation and 2‐year outcomes of the first FDA‐approved implantable apheresis vascular access device. Transfusion 2019; 59:3461-3467. [DOI: 10.1111/trf.15512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 12/27/2022]
Affiliation(s)
| | - Isabella G. Steidley
- Department of Laboratory Medicine and Pathology Mayo Clinic Arizona Phoenix Arizona
| | | | | | - Amy M. Bachman
- Department of Laboratory Medicine and Pathology Mayo Clinic Arizona Phoenix Arizona
| | - Jill Adamski
- Department of Laboratory Medicine and Pathology Mayo Clinic Arizona Phoenix Arizona
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Kemp G, Hallbourg M, Altounji D, Secola R. Back to Basics: CLABSI Reduction Through Implementation of an Oral Care and Hygiene Bundle. J Pediatr Oncol Nurs 2019; 36:321-326. [DOI: 10.1177/1043454219849583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children with cancer often undergo treatments that render them severely immunocompromised. Side effects of treatment place them at risk for developing oral mucositis (OM), which can potentially lead to infection and bacteremia. Staff nurses on an inpatient pediatric oncology unit noted inconsistent daily oral hygiene practices despite assessing OM consistently. Basic oral hygiene can reduce the severity of OM, and evidence-based bundled care has shown to increase consistency of practice. Based on findings and recommendations from the literature, an oral care and hygiene bundle was developed. The oral care bundle included a soft bristled toothbrush, fluoride toothpaste, twice-daily brushing and sodium bicarbonate rinses, lip balm, and oral moisturizer. The hygiene component consisted of a daily bath or shower and daily linen changes. Education on the rationale and purpose for the use of an oral care and hygiene bundle was provided to the inpatient direct care staff prior to implementation on two inpatient oncology units. Audits were performed to measure the adherence of the oral care and hygiene bundle. Central line–associated bloodstream infections were measured in collaboration with the quality and infection prevention departments. Since the oral care and hygiene bundle was implemented, laboratory-confirmed bloodstream infection rates decreased from 1.05 to 0.54 per 1,000 catheter days, while mucosal barrier injury rates decreased from 2.98 to 1.27 per 1,000 catheter days.
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Affiliation(s)
- Gina Kemp
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Rita Secola
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
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Dandoy CE, Alonso PB. MBI-LCBI and CLABSI: more than scrubbing the line. Bone Marrow Transplant 2019; 54:1932-1939. [PMID: 30809036 DOI: 10.1038/s41409-019-0489-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/15/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Christopher E Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Priscila Badia Alonso
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Velázquez-Acosta C, Cornejo-Juárez P, Volkow-Fernández P. [Multidrug resistance E-ESKAPE strains isolated from blood cultures in patients with cancer]. SALUD PUBLICA DE MEXICO 2019; 60:151-157. [PMID: 29738654 DOI: 10.21149/8767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/08/2017] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To describe the trend of multidrug resistant (MDR) strains isolated from blood in patients with cancer from 2005 to 2015. MATERIAL AND METHODS 33 127 blood cultures were processed by retrospective analysis. Identification and antimicrobial sensitivity were performed through automated methods: WaLK away (Siemens Labora- tory Diagnostics) and BD Phoenix (Becton, Dickinson and Company). Resistant strains were determined according to the minimum inhibitory concentration, following the parameters of the Clinical and Laboratory Standards Institute (CLSI). RESULTS Of 6 397 isolates, 5 604 (16.9%) were positive; 3 732 (58.4%) Gram- bacilli; 2 355 (36.9%) Gram+ cocci; 179 (2.7%) yeasts, and 126 (1.9%) Gram+ bacilli. Escherichia coli (n=1 591, 24.5%) was the most frequent bacteria, with 652 (41%) strains being extended-spectrum beta-lactamases producers (ESBL); of Enterococcus faecium (n=143, 2.1%), 45 (31.5%) were vancomycin resistant; of Staphylococcus aureus (n=571, 8.7%), 121 (21.2%) methicillin resistant (MRSA); of Klebsiella pneumoniae (n=367, 5.6%), 41 (11.2%) ESBL; of Acinetobacter baumanii (n=96, 1.4%), 23 (24%) MDR, and of Pseudomonas aeruginosa (n=384, 5.6%), 43 (11.2%) MDR. MDR strains were significantly more frequent in patients with hematological malignancies, compared to those with solid tumors: MRSA (OR=4.48, 95%CI 2.9-6.8), ESBL E. coli(OR=1.3, 95%CI 1.10-1.65) and MDR Acinetobacter baumanii (OR=3.2, 95%CI 1.2-8.3). CONCLUSIONS We observed significantly higher isolations of E-ESPAKE MDR strains in patients with hematological malignancies.
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36
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Zimmer AJ, Freifeld AG. Optimal Management of Neutropenic Fever in Patients With Cancer. J Oncol Pract 2019; 15:19-24. [DOI: 10.1200/jop.18.00269] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Febrile neutropenia remains an important complication of treatment with cytotoxic chemotherapy. It is often the first and sometimes the only sign or symptom of infection in this vulnerable patient population. Urgent and appropriate evaluation and treatment are imperative because delay in initiating appropriate antibiotic therapy may be life threatening. Selection of antibiotics should be based on the patient's symptoms, previous culture data, and institutional antibiograms. Ongoing therapy should be guided by culture and clinical data. Antimicrobial resistance is of great concern, particularly in this population, so careful attention to antibiotic selection and duration is needed.
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Establishing nationally representative central line-associated bloodstream infection surveillance data for paediatric patients in Greece. J Hosp Infect 2018; 101:53-59. [PMID: 30059747 DOI: 10.1016/j.jhin.2018.07.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/21/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Healthcare-associated infections (HCAIs) are associated with increased morbidity and mortality and with excess costs. Central line-associated bloodstream infections (CLABSIs) are the most common HCAIs in neonates and children. AIM To establish national benchmark data for rates of CLABSI in neonatal and paediatric intensive care units (NICUs and PICUs) and paediatric oncology units (ONCs). METHODS Active surveillance for CLABSI was conducted from June 2016 to February 2017. A collaborative of 14 NICUs, four PICUs, and six ONCs participated in the programme. Surveillance definitions of central line (CL), central line utilization (CLU) ratio, CLABSI event, and CLABSI rate were based on the Centers for Disease Control and Prevention's 2014 National Healthcare Safety Network criteria. Medical records were assessed daily for calculating CL-days, patient-days, and susceptibility of isolated organisms. FINDINGS A total of 111 CLABSI episodes were recorded. The overall mean CLABSI rate was 4.41 infections per 1000 CL-days, and the CLU ratio was 0.31. CLABSI rates were 6.02 in NICUs, 6.09 in PICUs, and 2.78 per 1000 CL-days in ONCs. A total of 123 pathogens were isolated. The most common pathogens were Enterobacteriaceae (36%), followed by Gram-positive cocci (29%), non-fermenting Gram-negative bacteria (16%), and fungi (16%). Overall, 37% of Gram-negative pathogens were resistant to third-generation cephalosporins and 37% to carbapenems. CONCLUSION Nationally representative CLABSI rates were determined for paediatric patients. These data could be used to benchmark and serve as baseline data for the design and evaluation of infection control and antimicrobial stewardship interventions.
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Battaglia CC, Hale K. Hospital-Acquired Infections in Critically Ill Patients With Cancer. J Intensive Care Med 2018; 34:523-536. [PMID: 30012057 DOI: 10.1177/0885066618788019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hospital-acquired infections are a common and costly problem facing critically ill patients in the intensive care unit (ICU). Critically ill patients with cancer are a particularly vulnerable subpopulation who possesses additional, nonmodifiable risk factors for developing these infections and, in many cases, are at increased risk of death as a result. This review will describe the most common nosocomial infections patients with cancer acquire while in the ICU: ventilator-associated events, central line-associated bloodstream infection, catheter-associated urinary tract infections, and Clostridium difficile infection.
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Affiliation(s)
| | - Kaye Hale
- 2 Anesthesia and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Volkow P, Alatorre P, Lozano VH, Cornejo-Juarez P. Mucosal Barrier Injury Laboratory Confirmed Bloodstream Infections. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018. [DOI: 10.1007/s40506-018-0167-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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40
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Balian C, Garcia M, Ward J. A Retrospective Analysis of Bloodstream Infections in Pediatric Allogeneic Stem Cell Transplant Recipients: The Role of Central Venous Catheters and Mucosal Barrier Injury. J Pediatr Oncol Nurs 2018; 35:210-217. [DOI: 10.1177/1043454218762706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Bloodstream infections (BSIs) are a leading cause of morbidity and mortality in children undergoing hematopoietic stem cell transplant (HSCT). Indwelling central venous catheters (CVCs) increase risk for BSIs, yet mucosal barrier injury–associated laboratory-confirmed bloodstream infection (MBI-LCBI) may also occur due to translocation of pathogenic organisms from the gastrointestinal tract into the bloodstream. The purpose of this study was to determine the association between stool organisms and BSIs in children with CVCs who underwent HSCT. Methods: We performed a retrospective analysis of 78 children who received allogeneic HSCT over 3 years (2012-2014). Surveillance stool cultures were analyzed pre- and post-HSCT to assess correlations between organisms isolated from stool and CVC cultures. Results: Twenty-four of 78 children experienced 31 BSIs. Fifteen (48%) of these isolates were identified in stool within 30 days of the positive blood culture, and 11 (36%) isolates met criteria for MBI-LCBI. Conclusions: Mucosal barrier injury leads to translocation of pathogenic organisms into the bloodstream and accounts for a significant number of BSIs in children undergoing HSCT. Nursing assessment of mucosal changes during HSCT and interventions to preserve intact mucosa are essential to prevent MBI-LCBI.
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Affiliation(s)
| | | | - Jessica Ward
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
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41
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Mucosal Barrier Injury Central-Line-Associated Bloodstream Infections: What is the Impact of Standard Prevention Bundles? Infect Control Hosp Epidemiol 2017; 38:1385-1387. [PMID: 28874212 PMCID: PMC9904451 DOI: 10.1017/ice.2017.188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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42
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Kato Y, Hagihara M, Kurumiya A, Takahashi T, Sakata M, Shibata Y, Kato H, Shiota A, Watanabe H, Asai N, Koizumi Y, Yamagishi Y, Mikamo H. Impact of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) on central line-associated bloodstream infections (CLABSIs) in department of hematology at single university hospital in Japan. J Infect Chemother 2017; 24:31-35. [PMID: 29066217 DOI: 10.1016/j.jiac.2017.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/01/2017] [Accepted: 08/17/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) are among the most serious complications especially in blood cancer patients. In January 2013, Centers for Disease and Prevention (CDC) introduced a new surveillance definition of mucosal barrier injury-associated laboratory-confirmed bloodstream infection (MBI-LCBI). This study was to determine the impact of MBI-LCBI on CLABSIs and compare the clinical characteristics of MBI versus non-MBI-LCBI cases. PATIENTS AND METHODS We retrospectively reviewed the records of 250 consecutive patients. They were admitted in department of hematology at Aichi Medical University Hospital. We applied the revised 2013 CLABSI surveillance protocol to all CLABSI cases identified during the 47-months period from May 2012 through June 2016. RESULTS A total of 44 CLABSIs were identified. The median patient age was 65 years (range, 12 to 89). Among 44 patients, 31 patients were diagnosed as leukemia (70.5%) and 12 patients as lymphoma (27.3%). Six patients underwent bone transplantation for leukemia or myelodysplastic syndrome (13.6%). A total of 20 patients (45.5%) were classified as MBI-LCBI and 24 (54.5%) were classified as non-MBI-LCBI. The primary disease type (P = 0.018), neutropenic within 3 days before CLABSI (MBI-LCBI vs. non-MBI-LCBI: 95.0% vs. 26.3%, P = <0.0001), line(s) removed owing to CLABSI (15.0% vs. 54.2%, P = 0.011) and Gram-negative organisms cultured (70.0% vs. 37.5%, P = 0.004) showed significantly difference between the groups. CONCLUSION Our data showed that MBI-LCBI cases account for 45.5% of the CLABSI cases identified in blood cancer patients, and constituted a significant burden to this high-risk patient population.
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Affiliation(s)
- Yukiko Kato
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Mao Hagihara
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University, Japan
| | - Ai Kurumiya
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Tomoko Takahashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Miki Sakata
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yuichi Shibata
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hideo Kato
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Arufumi Shiota
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroki Watanabe
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Nobuhiro Asai
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yusuke Koizumi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yuka Yamagishi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroshige Mikamo
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
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A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients. Infect Control Hosp Epidemiol 2017; 38:690-696. [PMID: 28399945 DOI: 10.1017/ice.2017.57] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the burden of bloodstream infections (BSIs) among pediatric hematology-oncology (PHO) inpatients, to propose a comprehensive, all-BSI tracking approach, and to discuss how such an approach helps better inform within-center and across-center differences in CLABSI rate DESIGN Prospective cohort study SETTING US multicenter, quality-improvement, BSI prevention network PARTICIPANTS PHO centers across the United States who agreed to follow a standardized central-line-maintenance care bundle and track all BSI events and central-line days every month. METHODS Infections were categorized as CLABSI (stratified by mucosal barrier injury-related, laboratory-confirmed BSI [MBI-LCBI] versus non-MBI-LCBI) and secondary BSI, using National Healthcare Safety Network (NHSN) definitions. Single positive blood cultures (SPBCs) with NHSN defined common commensals were also tracked. RESULTS Between 2013 and 2015, 34 PHO centers reported 1,110 BSIs. Among them, 708 (63.8%) were CLABSIs, 170 (15.3%) were secondary BSIs, and 232 (20.9%) were SPBCs. Most SPBCs (75%) occurred in patients with profound neutropenia; 22% of SPBCs were viridans group streptococci. Among the CLABSIs, 51% were MBI-LCBI. Excluding SPBCs, CLABSI rates were higher (88% vs 77%) and secondary BSI rates were lower (12% vs 23%) after the NHSN updated the definition of secondary BSI (P<.001). Preliminary analyses showed across-center differences in CLABSI versus secondary BSI and between SPBC and CLABSI versus non-CLABSI rates. CONCLUSIONS Tracking all BSIs, not just CLABSIs in PHO patients, is a patient-centered, clinically relevant approach that could help better assess across-center and within-center differences in infection rates, including CLABSI. This approach enables informed decision making by healthcare providers, payors, and the public. Infect Control Hosp Epidemiol 2017;38:690-696.
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Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis. Bone Marrow Transplant 2017; 52:1091-1106. [PMID: 28346417 DOI: 10.1038/bmt.2017.14] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/20/2016] [Accepted: 01/12/2017] [Indexed: 12/14/2022]
Abstract
Bacterial bloodstream infections (BSI) cause significant transplant-related morbidity and mortality following allogeneic hematopoietic cell transplantation (allo-HCT). This manuscript reviews the risk factors for and the bacterial pathogens causing BSIs in allo-HCT recipients in the contemporary transplant period. In addition, it offers insight into emerging resistant pathogens and reviews clinical management considerations to treat and strategies to prevent BSIs in allo-HCT patients.
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45
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Worth LJ, Bull AL, Richards MJ. Characterising health care‐associated bloodstream infections in public hospitals in Queensland, 2008–2012. Med J Aust 2016; 205:282. [DOI: 10.5694/mja16.00564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/02/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Leon J Worth
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Doherty Institute, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Ann L Bull
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Doherty Institute, Melbourne, VIC
| | - Michael J Richards
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Doherty Institute, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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Dandoy CE, Haslam D, Lane A, Jodele S, Demmel K, El-Bietar J, Flesch L, Myers KC, Pate A, Rotz S, Daniels P, Wallace G, Nelson A, Waters H, Connelly B, Davies SM. Healthcare Burden, Risk Factors, and Outcomes of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections after Stem Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:1671-1677. [PMID: 27311966 DOI: 10.1016/j.bbmt.2016.06.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/03/2016] [Indexed: 01/30/2023]
Abstract
Mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) lead to significant morbidity, mortality, and healthcare resource utilization in hematopoietic stem cell transplant (HSCT) patients. Determination of the healthcare burden of MBI-LCBIs and identification of patients at risk of MBI-LCBIs will allow researchers to identify strategies to reduce MBI-LCBI rates. The objective of our study was to describe the incidence, risk factors, timing, and outcomes of MBI-LCBIs in hematopoietic stem cell transplant patients. We performed a retrospective analysis of 374 patients who underwent HSCT at a large free-standing academic children's hospital to determine the incidence, risk factors, and outcomes of patients that developed a bloodstream infection (BSI) including MBI-LCBI, central line-associated BSI (CLABSI), or secondary BSI in the first year after HSCT. Outcome measures included nonrelapse mortality (NRM), central venous catheter removal within 7 days of positive culture, shock, admission to the pediatric intensive care unit (PICU) within 48 hours of positive culture, and death within 10 days of positive culture. One hundred seventy BSIs were diagnosed in 100 patients (27%): 80 (47%) MBI-LCBIs, 68 (40%) CLABSIs, and 22 (13%) secondary infections. MBI-LCBIs were diagnosed at a significantly higher rate in allogeneic HSCT patients (18% versus 7%, P = .007). Reduced-intensity conditioning (OR, 1.96; P = .015) and transplant-associated thrombotic microangiopathy (OR, 2.94; P = .0004) were associated with MBI-LCBI. Nearly 50% of all patients with a BSI developed septic shock, 10% died within 10 days of positive culture, and nearly 25% were transferred to the PICU. One-year NRM was significantly increased in patients with 1 (34%) and more than 1 (56%) BSIs in the first year post-HSCT compared with those who did not develop BSIs (14%) (P ≤ .0001). There was increased 1-year NRM in patients with at least 1 MBI-LCBI (OR, 1.94; P = .018) and at least 1 secondary BSI (OR, 2.87; P = .0023) but not CLABSIs (OR, 1.17; P = .68). Our data demonstrate that MBI-LCBIs lead to substantial use of healthcare resources and are associated with significant morbidity and mortality. Reduction in frequency of MBI-LCBI should be a major public health and scientific priority.
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Affiliation(s)
- Christopher E Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - David Haslam
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Adam Lane
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sonata Jodele
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathy Demmel
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Javier El-Bietar
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Laura Flesch
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kasiani C Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Abigail Pate
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Seth Rotz
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paulina Daniels
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Gregory Wallace
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Adam Nelson
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Heather Waters
- Department of Infection Control, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Beverly Connelly
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Infection Control, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stella M Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Tatarelli P, Mikulska M. Multidrug-resistant bacteria in hematology patients: emerging threats. Future Microbiol 2016; 11:767-80. [PMID: 27196948 DOI: 10.2217/fmb-2015-0014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Multidrug-resistant (MDR) bacteria, particularly Gram negatives, such as Enterobacteriaceae resistant to third-generation cephalosporins or carbapenems and MDR Pseudomonas aeruginosa, are increasingly frequent in hematology patients. The prevalence of different resistant species varies significantly between centers. Thus, the knowledge of local epidemiology is mandatory for deciding the most appr-opriate management protocols. In the era of increasing antibiotic resistance, empirical therapy of febrile neutropenia should be individualized. A de-escalation approach is recommended in case of severe clinical presentation in patients who are at high risk for infection with a resistant strain. Targeted therapy of an MDR Gram negative usually calls for a combination treatment, although no large randomized trials exist in this setting. Infection control measures are the cornerstone of limiting the spread of MDR pathogens in hematology units.
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Affiliation(s)
- Paola Tatarelli
- Division of Infectious Diseases, Department of Health Sciences (DISSA), University of Genova and IRCCS San Martino Hospital-IST, Largo R Benzi 10, 16132 Genova, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSA), University of Genova and IRCCS San Martino Hospital-IST, Largo R Benzi 10, 16132 Genova, Italy
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Simon A, Furtwängler R, Graf N, Laws HJ, Voigt S, Piening B, Geffers C, Agyeman P, Ammann RA. Surveillance of bloodstream infections in pediatric cancer centers - what have we learned and how do we move on? GMS HYGIENE AND INFECTION CONTROL 2016; 11:Doc11. [PMID: 27274442 PMCID: PMC4886351 DOI: 10.3205/dgkh000271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pediatric patients receiving conventional chemotherapy for malignant disease face an increased risk of bloodstream infection (BSI). Since BSI may represent an acute life-threatening event in patients with profound immunosuppression, and show further negative impact on quality of life and anticancer treatment, the prevention of BSI is of paramount importance to improve and guarantee patients' safety during intensive treatment. The great majority of all pediatric cancer patients (about 85%) have a long-term central venous access catheter in use (type Broviac or Port; CVAD). Referring to the current surveillance definitions a significant proportion of all BSI in pediatric patients with febrile neutropenia is categorized as CVAD-associated BSI. This state of the art review summarizes the epidemiology and the distinct pathogen profile of BSI in pediatric cancer patients from the perspective of infection surveillance. Problems in executing the current surveillance definition in this patient population are discussed and a new concept for the surveillance of BSI in pediatric cancer patients is outlined.
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Affiliation(s)
- Arne Simon
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Rhoikos Furtwängler
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Norbert Graf
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Hans Jürgen Laws
- Klinik für Pädiatrische Onkologie, Hämatologie und Immunologie, Universitätskinderklinik, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Sebastian Voigt
- Klinik für Pädiatrie m. S. Onkologie / Hämatologie / Stammzelltransplantation, Charité – Universitätsmedizin Berlin, Germany
| | - Brar Piening
- Institut für Hygiene und Umweltmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Christine Geffers
- Institut für Hygiene und Umweltmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Philipp Agyeman
- Pädiatrische Infektiologie und Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinderheilkunde, Inselspital, Bern, Switzerland
| | - Roland A. Ammann
- Pädiatrische Infektiologie und Pädiatrische Hämatologie-Onkologie, Universitätsklinik für Kinderheilkunde, Inselspital, Bern, Switzerland
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Gustinetti G, Mikulska M. Bloodstream infections in neutropenic cancer patients: A practical update. Virulence 2016; 7:280-97. [PMID: 27002635 PMCID: PMC4871679 DOI: 10.1080/21505594.2016.1156821] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/11/2016] [Accepted: 02/13/2016] [Indexed: 12/29/2022] Open
Abstract
Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel de-escalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.
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Affiliation(s)
- Giulia Gustinetti
- Division of Infectious Diseases, University of Genova (DISSAL) and IRCCS San Martino-IST, Genova, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genova (DISSAL) and IRCCS San Martino-IST, Genova, Italy
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Torres D, González ML, Loera A, Aguilera M, Relyea G, Aristizabal P, Caniza MA. The Centers for Disease Control and Prevention definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country. Am J Infect Control 2016; 44:432-7. [PMID: 26775931 DOI: 10.1016/j.ajic.2015.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/05/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The US National Healthcare Safety Network has provided a definition of mucosal barrier injury-associated, laboratory-confirmed bloodstream infection (MBI-LCBI) to improve infection surveillance. To date there is little information about its influence in pediatric oncology centers in low- to middle-income countries. OBJECTIVES To determine the influence of the definition on the rate of central line-associated bloodstream infection (CLABSI) and compare the clinical characteristics of MBI versus non-MBI LCBI cases. METHODS We retrospectively applied the National Healthcare Safety Network definition to all CLABSIs recorded at a pediatric oncology center in Tijuana, Mexico, from January 2011 through December 2014. CLABSI events were reclassified according to the MBI-LCBI definition. Clinical characteristics and outcomes of MBI and non-MBI CLABSIs were compared. RESULTS Of 55 CLABSI events, 44% (24 out of 55) qualified as MBI-LCBIs; all were MBI-LCBI subcategory 1 (intestinal flora pathogens). After the number of MBI-LCBI cases was removed from the numerator, the CLABSI rate during the study period decreased from 5.72-3.22 infections per 1,000 central line days. Patients with MBI-LCBI were significantly younger than non-MBI-LCBI patients (P = .029) and had a significantly greater frequency of neutropenia (100% vs 39%; P = .001) and chemotherapy exposure (87% vs 58%; P = .020) and significantly longer median hospitalization (34 vs 23 days; P = .008). CONCLUSION A substantial proportion of CLABSI events at our pediatric cancer center met the MBI-LCBI criteria. Our results support separate monitoring and reporting of MBI and non-MBI-LCBIs in low- to middle-income countries to allow accurate detection and tracking of preventable (non-MBI) bloodstream infections.
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