Incidence and short-term outcomes of central line-related bloodstream infection in patients admitted to the emergency department: a single-center retrospective study

Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens

Medical devices such as venous catheters (VCs) and urinary catheters (UCs) are widely used in the hospital setting. However, the implantation of these devices is often accompanied by complications. About 60 to 70% of nosocomial infections (NIs) are linked to biofilms. The main complication is the ability of microorganisms to adhere to surfaces and form biofilms which protect them and help them to persist in the host. Indeed, by crossing the skin barrier, the insertion of VC inevitably allows skin flora or accidental environmental contaminants to access the underlying tissues and cause fatal complications like bloodstream infections (BSIs). In fact, 80,000 central venous catheters-BSIs (CVC-BSIs)-mainly occur in intensive care units (ICUs) with a death rate of 12 to 25%. Similarly, catheter-associated urinary tract infections (CA-UTIs) are the most commonlyhospital-acquired infections (HAIs) worldwide.These infections represent up to 40% of NIs.In this review, we present a summary of biofilm formation steps. We provide an overview of two main and important infections in clinical settings linked to medical devices, namely the catheter-asociated bloodstream infections (CA-BSIs) and catheter-associated urinary tract infections (CA-UTIs), and highlight also the most multidrug resistant bacteria implicated in these infections. Furthermore, we draw attention toseveral useful prevention strategies, and advanced antimicrobial and antifouling approaches developed to reduce bacterial colonization on catheter surfaces and the incidence of the catheter-related infections.

Impact of an interventional bundle on complications associated with peripheral venous catheters in elderly patients

PURPOSE

Elderly patients admitted to geriatrics departments often require peripheral venous catheters (PVC), which should be inserted and maintained following a series of preventive recommendations. Our objective was to evaluate the impact of a training bundle comprising measures aimed at reducing complications associated with the use of PVC in elderly patients admitted to a tertiary teaching hospital.

METHODS

We performed a prospective study of patients who received a PVC within 24 h of admission to a geriatrics department. After a 10-month pre-interventional period, we implemented an educational and interventional bundle over a 9-month period. Follow-up was until catheter withdrawal. We analyzed and compared clinical and microbiological data between both study periods.

RESULTS

A total of 344 patients (475 PVC) were included (pre-intervention period, 204 patients (285 PVC); post-intervention period, 140 patients (190 PVC)). No statistically significant differences in demographic characteristics were observed between the study periods. The colonization and phlebitis rates per 1000 admissions in both periods were, respectively, 36.7 vs. 24.3 (p = 0.198) and 81.5 vs. 65.1 (p = 0.457). The main reason for catheter withdrawal was obstruction/malfunctioning (33.3%). Obstruction rate was higher for those inserted in the hand than for those inserted at other sites (55.7% vs. 44.3%, p = 0.045).

CONCLUSIONS

We found no statistically significant differences regarding phlebitis and catheter tip colonization rates. It is necessary to carry out randomized studies assessing the most cost-effective measure to reduce complications associated with PVC.

Taurolidine/Heparin Lock Solution and Catheter-Related Bloodstream Infection in Hemodialysis: A Randomized, Double-Blind, Active-Control, Phase 3 Study

BACKGROUND

Catheter-related bloodstream infections (CRBSIs) are one of the most prevalent, fatal, and costly complications of hemodialysis with a central venous catheter (CVC). The LOCK IT-100 trial compared the efficacy and safety of a taurolidine/heparin catheter lock solution that combines taurolidine 13.5 mg/ml and heparin (1000 units/ml) versus heparin in preventing CRBSIs in participants receiving hemodialysis via CVC.

METHODS

LOCK IT-100 was a randomized, double-blind, active-control, multicenter, phase 3 study that enrolled adults with kidney failure undergoing maintenance hemodialysis via CVC from 70 US sites. Participants were randomized 1:1 to taurolidine/heparin catheter lock solution or heparin control catheter lock solution (1000 units/ml). The primary end point was time to CRBSI as assessed by a blinded Clinical Adjudication Committee. Secondary end points were catheter removal for any reason and loss of catheter patency. On the basis of a prespecified interim analysis, the Data and Safety Monitoring Board recommended terminating the trial early for efficacy with no safety concerns.

RESULTS

In the full analysis population ( N =795), nine participants in the taurolidine/heparin arm ( n =397; 2%) and 32 participants in the heparin arm ( n =398; 8%) had a CRBSI. Event rates per 1000 catheter days were 0.13 and 0.46, respectively, with the difference in time to CRBSI being statistically significant, favoring taurolidine/heparin ( P < 0.001). The hazard ratio was 0.29 (95% confidence interval, 0.14 to 0.62), corresponding to a 71% reduction in risk of CRBSIs with taurolidine/heparin versus heparin. There were no significant differences between study arms in time to catheter removal for any reason or loss of catheter patency. The safety of taurolidine/heparin was comparable with that of heparin, and most treatment-emergent adverse events were mild or moderate.

CONCLUSIONS

Taurolidine/heparin reduced the risk of developing a CRBSI in study participants receiving hemodialysis via CVC compared with heparin with a comparable safety profile.

CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER

Study Assessing Safety & Effectiveness of a Catheter Lock Solution in Dialysis Patients to Prevent Bloodstream Infection, NCT02651428 .

Clinical Impacts and Risk Factors for Central Line-Associated Bloodstream Infection: A Systematic Review

Background A central line-associated bloodstream infection (CLABSI) is defined as a primary bloodstream infection (BSI) in a patient that had a central line within the 48-hour period before the development of the BSI and is not bloodstream-related to an infection at another site. CLABSI is a common healthcare-associated infection and a significant cause of morbidity and mortality. Methods This systematic review included studies published within the past 13 years that examined risk factors and clinical impact variables associated with CLABSI, using the Centers for Disease Control (CDC)/National Healthcare Safety Network (NHSN) criteria for defining catheter-associated infection, and included participants of all ages. The terms "CLABSI," "central line-associated bloodstream infection," "risk factors," "predictors," "morbidity," "mortality," "healthcare costs," and "length of hospital stay" were used to find relevant publications on PubMed/Medline, Google Scholar, and Science Direct. The quality assessment of the included publications utilized the modified Newcastle-Ottawa scale (NOS) for observational studies. Results After the full-text screening, we identified 15 articles that met our inclusion and exclusion criteria. The majority of these studies were of good quality and had a low risk of bias based on our bias assessment. The studies included a total of 32,198 participants and covered a time period from 2010 to 2023. The mean age of the male patients included in the studies ranged from 0.1 months to 69.1 years. All of the included studies were either observational cohort studies, cross sectional studies, case-control studies, or case reports. The major study parameters/outcomes extracted were risk factors, CLABSI-associated mortality, hospital cost, length of hospital stay, and catheter days. With respect to predisposing factors, multilumen access catheters were identified as risk factors in three studies, use of more than one central venous catheter per case in four studies, hematologic malignancy in three studies, catheterization duration in four studies, surgical complexity in four studies, length of ICU stays in three studies, and parenteral nutrition in two studies. Conclusion The decision to place a venous device should be carefully considered by evaluating individual risk factors for the development of CLABSI. This is important due to the potential for severe clinical consequences and significant healthcare expenses associated with this complication.