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Buetti N, Zahar JR, Adda M, Ruckly S, Bruel C, Schwebel C, Darmon M, Adrie C, Cohen Y, Siami S, Laurent V, Souweine B, Timsit JF. Treatment of positive catheter tip culture without bloodstream infections in critically ill patients. A case-cohort study from the OUTCOMEREA network. Intensive Care Med 2024; 50:1108-1118. [PMID: 38913096 PMCID: PMC11245435 DOI: 10.1007/s00134-024-07498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE This study aimed to evaluate the impact on subsequent infections and mortality of an adequate antimicrobial therapy within 48 h after catheter removal in intensive care unit (ICU) patients with positive catheter tip culture. METHODS We performed a retrospective analysis of prospectively collected data from 29 centers of the OUTCOMEREA network. We developed a propensity score (PS) for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a 1:1 case-cohort study matched on the PS score of being adequately treated. A PS-matched subdistribution hazard model was used for detecting subsequent infections and a PS-matched Cox model was used to evaluate the impact of antibiotic therapy on mortality. RESULTS We included 427 patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched 150 patients with an adequate antimicrobial therapy with 150 controls. In the matched population, 30 (10%) subsequent infections were observed and 62 patients died within 30 days. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day-30 was similar between treated and non-treated groups (subdistribution hazard ratio [sHR] 1.08, 95% confidence interval [CI] 0.62-1.89, p = 0.78). Using Cox proportional hazard models, the 30-day mortality risk was similar between treated and non-treated groups (HR 0.89, 95% CI 0.45-1.74, p = 0.73). CONCLUSIONS Antimicrobial therapy was not associated with decreased risk of subsequent infection or death in short-term catheter tip colonization in critically ill patients. Antibiotics may be unnecessary for positive catheter tip cultures.
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Affiliation(s)
- Niccolò Buetti
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France.
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Jean-Ralph Zahar
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- Département de Microbiologie Clinique, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Mireille Adda
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Stéphane Ruckly
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- OUTCOMEREA Network, 93700, Drancy, France
| | - Cédric Bruel
- Medical and Surgical Intensive Care Unit, Paris Saint-Joseph Hospital Network, 75014, Paris, France
| | - Carole Schwebel
- Medical Intensive Care Unit, University Hospital, Grenoble-Alpes, 38000, Grenoble, France
| | - Michael Darmon
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Université Paris Cité, Paris, France
| | - Christophe Adrie
- Réanimation Polyvalente, Centre Hospitalier Delafontaine, Saint-Denis, France
| | - Yves Cohen
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Shidasp Siami
- Réanimation Polyvalente, Centre Hospitalier Sud Essonne-Etampes, Etampes, France
| | - Virginie Laurent
- Polyvalent Intensive Care Unit, André Mignot Hospital, 78150, Le Chesnay, France
| | - Bertrand Souweine
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Jean-François Timsit
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- OUTCOMEREA Network, 93700, Drancy, France
- Medical and Infectious Diseases Intensive Care Unit, Bichat Hospital, AP-HP, Paris Cité University, 46 rue Henri Huchard, 75018, Paris, France
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Drugeon B, Marjanovic N, Boisson M, Buetti N, Mimoz O, Guenezan J. Insertion site and risk of peripheral intravenous catheter colonization and/or local infection: a post hoc analysis of the CLEAN 3 study including more than 800 catheters. Antimicrob Resist Infect Control 2024; 13:57. [PMID: 38840171 PMCID: PMC11151591 DOI: 10.1186/s13756-024-01414-4] [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: 03/13/2024] [Accepted: 05/25/2024] [Indexed: 06/07/2024] Open
Abstract
AIM Although uncommon, infections associated with peripheral intravenous catheters (PIVCs) may be responsible for severe life-threatening complications and increase healthcare costs. Few data are available on the relationship between PIVC insertion site and risk of infectious complications. METHODS We performed a post hoc analysis of the CLEAN 3 database, a randomized 2 × 2 factorial study comparing two skin disinfection procedures (2% chlorhexidine-alcohol or 5% povidone iodine-alcohol) and two types of medical devices (innovative or standard) in 989 adults patients requiring PIVC insertion before admission to a medical ward. Insertion sites were grouped into five areas: hand, wrist, forearm, cubital fossa and upper arm. We evaluated the risk of risk of PIVC colonization (i.e., tip culture eluate in broth showing at least one microorganism in a concentration of at least 1000 Colony Forming Units per mL) and/or local infection (i.e., organisms growing from purulent discharge at PIVC insertion site with no evidence of associated bloodstream infection), and the risk of positive PIVC tip culture (i.e., PIVC-tip culture eluate in broth showing at least one microorganism regardless of its amount) using multivariate Cox models. RESULTS Eight hundred twenty three PIVCs with known insertion site and sent to the laboratory for quantitative culture were included. After adjustment for confounding factors, PIVC insertion at the cubital fossa or wrist was associated with increased risk of PIVC colonization and/or local infection (HR [95% CI], 1.64 [0.92-2.93] and 2.11 [1.08-4.13]) and of positive PIVC tip culture (HR [95% CI], 1.49 [1.02-2.18] and 1.59 [0.98-2.59]). CONCLUSION PIVC insertion at the wrist or cubital fossa should be avoided whenever possible to reduce the risk of catheter colonization and/or local infection and of positive PIVC tip culture.
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Affiliation(s)
- Bertrand Drugeon
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France
- Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, QLD, Australia
| | - Nicolas Marjanovic
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France
- INSERM CIC1402, CHU de Poitiers, Poitiers, France
| | - Matthieu Boisson
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France
- Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France
- Service d'Anesthésie Et Réanimations Et Médecine Péri-Opératoire, CHU de Poitiers, Poitiers, France
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Université Paris-Cité, INSERM, IAME UMR 1137, 75018, Paris, France
| | - Olivier Mimoz
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France.
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France.
- Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.
| | - Jérémy Guenezan
- CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France
- INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France
- Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France
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Pitiriga VC, Bakalis J, Campos E, Kanellopoulos P, Sagris K, Saroglou G, Tsakris A. Central Venous Catheters versus Peripherally Inserted Central Catheters: A Comparison of Indwelling Time Resulting in Colonization by Multidrug-Resistant Pathogens. Antibiotics (Basel) 2024; 13:89. [PMID: 38247648 PMCID: PMC10812679 DOI: 10.3390/antibiotics13010089] [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: 12/07/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The use of peripherally inserted central catheters (PICCs) as an alternative to central venous catheters (CVCs) has steadily risen over the last two decades. However, there is an ongoing debate regarding research evidence that supports any clear advantages or disadvantages of them compared to traditional central venous lines. The present study was conducted to compare the indwelling time of CVC and PICC placements leading to microbial colonization by multidrug-resistant microorganisms (MDROs) in critically ill patients. METHODS A single-center retrospective descriptive study was performed that reviewed the medical records of critically ill patients with colonized CVCs and PICCs who were hospitalized during a 24-month period (May 2019-May 2021). To evaluate the association between indwelling time of catheter placement and colonization rates, events were categorized into three groups, each representing a one-week time interval of catheter indwelling time: group 1: ≤7 days, group 2: 8-14 days, and group 3: >14 days. RESULTS A total of 207 hospitalized patients with colonized PICCs or CVCs were included in the study. Of these, 144 (69.5%) had a CVC placement and 63 (30.5%) had a PICC placement. The overall colonization rate (per 1.000 catheter/days) was 14.73 in the CVC and 5.67 in the PICC cohort (p = 0.003). In the group of PICCs, 12/63 (19%) of the pathogens were MDROs and 51/63 (81%) were non-MDROs, while in the group of CVCs, 86/144 (59.7%) were MDROs and 58/144 (40.3%) were non-MDROs (p < 0.001). The colonization rate in the CVC cohort, was 6.98 for group 1, 21.57 for group 2, and 21.6 for group 3 (p = 0.019). The colonization rate of MDROs was 3.27 for group 1, 14.47 for group 2, and 12.96 for group 3 (p = 0.025). Regarding the PICC cohort, the colonization rate was 1.49 for group 1, 3.19 for group 2, and 8.99 for group 3 (p = 0.047). No significant difference existed between the three groups in terms of MDRO pathogens, with the colonization rate being 0 for group 1, 0.8 for group 2, and 1.69 for group 3 (p = 0.78). Within the CVC cohort, the most common isolated microorganism was MDR Acinetobacter baumannii (n = 44; 30.6%), followed by MDR Klebsiella pneumoniae (n = 27; 18.7%). In the PICC cohort, the predominant isolated microorganism was Candida non-albicans (n = 15; 23.8%), followed by Candida albicans, coagulase-negative staphylococci, and MDR Klebsiella pneumoniae in equal numbers (n = 6; 9.5%). CONCLUSIONS Our findings show that while the indwelling time of PICC placement was longer compared to CVCs, its colonization rate was considerably lower. Furthermore, high colonization rates by microorganisms, especially MDROs, arose later during catheterization in PICCs compared to CVCs, suggesting that in terms of vascular infections, PICCs may be a safer alternative to conventional CVCs for long-term intravenous access.
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Affiliation(s)
- Vassiliki C. Pitiriga
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
| | - John Bakalis
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Elsa Campos
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Petros Kanellopoulos
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Konstantinos Sagris
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - George Saroglou
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
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Pitiriga V, Bakalis J, Theodoridou K, Dimitroulia E, Saroglou G, Tsakris A. Comparison of microbial colonization rates between central venous catheters and peripherally inserted central catheters. Antimicrob Resist Infect Control 2023; 12:74. [PMID: 37550791 PMCID: PMC10405474 DOI: 10.1186/s13756-023-01285-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Central venous catheters (CVCs) and peripherally inserted central catheters (PICCs), have been widely used as intravascular devices in critically ill patients. However, they might evoke complications, such as catheter colonization that has been considered as predisposing factor for central line-associated bloodstream infections (CLABSIs). Although numerous studies have compared the risk of bloodstream infections between PICCs and CVCs, comparative studies on their colonization rates are limited. OBJECTIVES The episodes of catheter colonization in critically ill patients with CVCs or PICCs were retrospectively analysed during a two-year period in a Greek tertiary care hospital and colonization rates, microbial profiles and antimicrobial susceptibility patterns were compared. METHODS Clinical and laboratory data of consecutive hospitalized critically-ill patients who underwent PICC and CVC placement between May 2017-May 2019 were analysed. All catheters were examined by the semiquantitative culture technique for bacterial pathogens, either as a routine process after catheter removal or after suspicion of infection. Species identification and antimicrobial resistance patterns were determined by the Vitek2 automated system. RESULTS During the survey period a total of 122/1187 (10.28%) catheter colonization cases were identified among CVCs and 19/639 (2.97%) cases among PICCs (p = 0.001). The colonization rate was 12.48/1000 catheter-days for the CVC group and 1.71/1000 catheter-days for the PICC group (p < 0.001). The colonization rate per 1000 catheter-days due to multidrug-resistant organisms (MDROs) was 3.85 in all study cases, 7.26 (71/122) in the CVC group and 0.63 (7/19) in the PICC group (p < 0.001). Within the CVC group, the most common microorganism isolated was MDR Acinetobacter baumannii (n = 38, 31.1%) followed by MDR Klebsiella pneumoniae (n = 20, 16.4%). In the PICC group, the predominant microorganism isolated was Candida spp. (n = 5, 23.8%) followed by MDR K. pneumoniae and MDR A. baumannii in equal numbers (n = 3, 14.2%). CONCLUSION PICC lines were associated with significantly lower colonization rates comparing to the CVC ones. In addition, patterns of microbial colonization revealed a trend over the predominance of MDR gram-negatives in CVCs suggesting that PICCs might be a safer alternative for prolonged inpatient intravascular access. Prevention programs directed by local microbial ecology may diminish catheter colonization rates and CLABSIs.
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Affiliation(s)
- Vassiliki Pitiriga
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
| | - John Bakalis
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547, Athens, Greece
| | - Kalliopi Theodoridou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
| | - Evangelia Dimitroulia
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
| | - George Saroglou
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece.
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Iachkine J, Buetti N, de Grooth HJ, Briant AR, Mimoz O, Mégarbane B, Mira JP, Ruckly S, Souweine B, du Cheyron D, Mermel LA, Timsit JF, Parienti JJ. Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials. Crit Care 2022; 26:205. [PMID: 35799302 PMCID: PMC9261073 DOI: 10.1186/s13054-022-04078-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The majority of central venous catheters (CVC) removed in the ICU are not colonized, including when a catheter-related infection (CRI) is suspected. We developed and validated a predictive score to reduce unnecessary CVC removal.
Methods
We conducted a retrospective cohort study from five multicenter randomized controlled trials with systematic catheter-tip culture of consecutive CVCs. Colonization was defined as growth of ≥103 colony-forming units per mL. Risk factors for colonization were identified in the training cohort (CATHEDIA and 3SITES trials; 3899 CVCs of which 575 (15%) were colonized) through multivariable analyses. After internal validation in 500 bootstrapped samples, the CVC-OUT score was computed by attaching points to the robust (> 50% of the bootstraps) risk factors. External validation was performed in the testing cohort (CLEAN, DRESSING2 and ELVIS trials; 6848 CVCs, of which 588 (9%) were colonized).
Results
In the training cohort, obesity (1 point), diabetes (1 point), type of CVC (dialysis catheter, 1 point), anatomical insertion site (jugular, 4 points; femoral 5 points), rank of the catheter (second or subsequent, 1 point) and catheterization duration (≥ 5 days, 2 points) were significantly and independently associated with colonization . Area under the ROC curve (AUC) for the CVC-OUT score was 0.69, 95% confidence interval (CI) [0.67–0.72]. In the testing cohort, AUC for the CVC-OUT score was 0.60, 95% CI [0.58–0.62]. Among 1,469 CVCs removed for suspected CRI in the overall population, 1200 (82%) were not colonized. The negative predictive value (NPV) of a CVC-OUT score < 6 points was 94%, 95% CI [93%–95%].
Conclusion
The CVC-OUT score had a moderate ability to discriminate catheter-tip colonization, but the high NPV may contribute to reduce unnecessary CVCs removal. Preference of the subclavian site is the strongest and only modifiable risk factor that reduces the likelihood of catheter-tip colonization and consequently the risk of CRI.
Clinical Trials Registration: NCT00277888, NCT01479153, NCT01629550, NCT01189682, NCT00875069.
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Zhong Y, Deng L, Zhou L, Liao S, Yue L, Wen SW, Xie R, Lu Y, Zhang L, Tang J, Wu J. Association of immediate reinsertion of new catheters with subsequent mortality among patients with suspected catheter infection: a cohort study. Ann Intensive Care 2022; 12:38. [PMID: 35524924 PMCID: PMC9079203 DOI: 10.1186/s13613-022-01014-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/25/2022] [Indexed: 02/08/2023] Open
Abstract
Background Central venous catheter (CVC) insertion complications are a prevalent and important problem in the intensive care unit (ICU), and source control by immediate catheter removal is considered urgent in patients with septic shock suspected to be caused by catheter-related bloodstream infection (CRBSI). We sought to determine the impact of immediate reinsertion of a new catheter (IRINC) on mortality among patients after CVC removal for suspected CRBSI. Methods A propensity score-matched cohort of patients with suspected CRBSI who underwent IRINC or no IRINC in a 32-bed ICU in a university hospital in China from January 2009 through April 2021. Catheter tip culture and clinical symptoms were used to identify patients with suspected CRBSI. The Kaplan–Meier method was used to analyse 30-day mortality before and after propensity score matching, and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality in the matched cohort were estimated with Cox proportional hazards models. Results In total, 1,238 patients who had a CVC removed due to suspected CRBSI were identified. Among these patients, 877 (70.8%) underwent IRINC, and 361 (29.2%) did not. Among 682 propensity score-matched patients, IRINC was associated with an increased risk of 30-day mortality (HR, 1.481; 95% CI, 1.028 to 2.134) after multivariable, multilevel adjustment. Kaplan–Meier analysis found that IRINC was associated with the risk of mortality both before matching (P = 0.00096) and after matching (P = 0.018). A competing risk analysis confirmed the results of the propensity score-matched analysis. The attributable risk associated with bloodstream infection was not significantly different (HR, 1.081; 95% CI 0.964 to 1.213) among patients with suspected CRBSI in terms of 30-day mortality compared with that associated with other infections. Conclusions In this cohort study, IRINC was associated with higher 30-day mortality compared to delayed CVC or no CVC among patients with suspected CRBSI. A large-sample randomized controlled trial is needed to define the best management for CVC in cases of suspected CRBSI because IRINC may also be associated with noninfectious complications. Trial registration This study was registered with the China Clinical Trials Registry (URL: http://www.chictr.org.cn/index.aspx) under the following registration number: ChiCTR1900022175. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01014-8.
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Affiliation(s)
- Yiyue Zhong
- Department of Operating Room, Affiliated Hospital of Guangdong Medical University, No.57 People Avenue South, Zhanjiang, 524001, Guangdong, China.
| | - Liehua Deng
- Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, No. 57, People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Limin Zhou
- Department of Operating Room, Affiliated Hospital of Guangdong Medical University, No.57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Shaoling Liao
- Department of Nursing Research, Affiliated Hospital of Guangdong Medical University, No. 57, People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Liqun Yue
- Department of Nursing Research, Affiliated Hospital of Guangdong Medical University, No. 57, People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Shi Wu Wen
- Ottawa Hospital Research Institute Clinical Epidemiology Program, and School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Rihua Xie
- The Seventh Affiliated Hospital, Southern Medical University, Foshan, 528200, Guangdong, China
| | - Yuezhen Lu
- Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, No. 57, People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Liangqing Zhang
- Department of Anaesthesiology, Affiliated Hospital of Guangdong Medical University, No.57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Jing Tang
- Department of Anaesthesiology, Affiliated Hospital of Guangdong Medical University, No.57 People Avenue South, Zhanjiang, 524001, Guangdong, China
| | - Jiayuan Wu
- Department of Clinical Research, Clinical Research Service Center, Collaborative Innovation Engineering Technology Research Center of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, No.57 People Avenue South, Zhanjiang, 524001, Guangdong, China.
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Verberk JD, van der Kooi TI, Derde LP, Bonten MJ, de Greeff SC, van Mourik MS. Do we need to change catheter-related bloodstream infection surveillance in the Netherlands? A qualitative study among infection prevention professionals. BMJ Open 2021; 11:e046366. [PMID: 34408033 PMCID: PMC8375748 DOI: 10.1136/bmjopen-2020-046366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Catheter-related bloodstream infections (CRBSI) are a common healthcare-associated infection and therefore targeted by surveillance programmes in many countries. Concerns, however, have been voiced regarding the reliability and construct validity of CRBSI surveillance and the connection with the current diagnostic procedures. The aim of this study was to explore the experiences of infection control practitioners (ICPs) and medical professionals with the current CRBSI surveillance in the Netherlands and their suggestions for improvement. DESIGN Qualitative study using focus group discussions (FGDs) with ICPs and medical professionals separately, followed by semistructured interviews to investigate whether the points raised in the FGDs were recognised and confirmed by the interviewees. Analyses were performed using thematic analyses. SETTING Basic, teaching and academic hospitals in the Netherlands. PARTICIPANTS 24 ICPs and 9 medical professionals. RESULTS Main themes derived from experiences with current surveillance were (1) ICPs' doubt regarding the yield of surveillance given the low incidence of CRBSI, the high workload and IT problems; (2) the experienced lack of leadership and responsibility for recording information needed for surveillance and (3) difficulties with applying and interpreting the CRBSI definition. Suggestions were made to simplify the surveillance protocol, expand the follow-up and surveillance to homecare settings, simplify the definition and customise it for specific patient groups. Participants reported hoping for and counting on automatisation solutions to support future surveillance. CONCLUSIONS This study reveals several problems with the feasibility and acceptance of the current CRBSI surveillance and proposes several suggestions for improvement. This provides valuable input for future surveillance activities, thereby taking into account automation possibilities.
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Affiliation(s)
- Janneke Dm Verberk
- Medical Microbiology and Infection Control, UMC Utrecht, Utrecht, The Netherlands
- Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Tjallie Ii van der Kooi
- Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Lennie Pg Derde
- Department of Intensive Care Medicine, UMC Utrecht, Utrecht, The Netherlands
| | - Marc Jm Bonten
- Department of Medical Microbiology, UMC Utrecht, Utrecht, The Netherlands
| | - Sabine C de Greeff
- Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Maaike Sm van Mourik
- Medical Microbiology and Infection Control, UMC Utrecht, Utrecht, The Netherlands
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Louis G, Belveyre T, Jacquot A, Hochard H, Aissa N, Kimmoun A, Goetz C, Levy B, Novy E. Infection related catheter complications in patients undergoing prone positioning for acute respiratory distress syndrome: an exposed/unexposed study. BMC Infect Dis 2021; 21:534. [PMID: 34098888 PMCID: PMC8182343 DOI: 10.1186/s12879-021-06197-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background Prone positioning (PP) is a standard of care for patients with moderate–severe acute respiratory distress syndrome (ARDS). While adverse events associated with PP are well-documented in the literature, research examining the effect of PP on the risk of infectious complications of intravascular catheters is lacking. Method All consecutive ARDS patients treated with PP were recruited retrospectively over a two-year period and formed the exposed group. Intensive care unit (ICU) patients during the same period without ARDS for whom PP was not conducted but who had an equivalent disease severity were matched 1:1 to the exposed group based on age, sex, centre, length of ICU stay and SAPS II (unexposed group). Infection-related catheter complications were defined by a composite criterion, including catheter tip colonization or intravascular catheter-related infection. Results A total of 101 exposed patients were included in the study. Most had direct ARDS (pneumonia). The median [Q1–Q3] PP session number was 2 [1–4]. These patients were matched with 101 unexposed patients. The mortality rates of the exposed and unexposed groups were 31 and 30%, respectively. The incidence of the composite criterion was 14.2/1000 in the exposed group compared with 8.2/1000 days in the control group (p = 0.09). Multivariate analysis identified PP as a factor related to catheter colonization or infection (p = 0.04). Conclusion Our data suggest that PP is associated with a higher risk of CVC infectious complications.
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Affiliation(s)
- Guillaume Louis
- Intensive Care Unit, Metz-Thionville Regional Hospital, Mercy Hospital, 1 allée de Château, 57085, Metz, France.
| | - Thibaut Belveyre
- Intensive Care Unit, Metz-Thionville Regional Hospital, Mercy Hospital, 1 allée de Château, 57085, Metz, France
| | - Audrey Jacquot
- Medical intensive Care Unit, University Hospital of Nancy, Brabois, France
| | - Hélène Hochard
- Department of Bacteriology, Metz-Thionville Regional Hospital, Mercy Hospital, Metz, France
| | - Nejla Aissa
- Department of Bacteriology, University Hospital of Nancy, Nancy, France
| | - Antoine Kimmoun
- Medical intensive Care Unit, University Hospital of Nancy, Brabois, France
| | - Christophe Goetz
- Clinical Research Support Unit, Metz-Thionville Regional Hospital, Metz, France
| | - Bruno Levy
- Medical intensive Care Unit, University Hospital of Nancy, Brabois, France
| | - Emmanuel Novy
- Intensive Care Unit, Metz-Thionville Regional Hospital, Mercy Hospital, 1 allée de Château, 57085, Metz, France
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9
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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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10
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Timsit JF, Baleine J, Bernard L, Calvino-Gunther S, Darmon M, Dellamonica J, Desruennes E, Leone M, Lepape A, Leroy O, Lucet JC, Merchaoui Z, Mimoz O, Misset B, Parienti JJ, Quenot JP, Roch A, Schmidt M, Slama M, Souweine B, Zahar JR, Zingg W, Bodet-Contentin L, Maxime V. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care 2020; 10:118. [PMID: 32894389 PMCID: PMC7477021 DOI: 10.1186/s13613-020-00713-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.
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Affiliation(s)
- Jean-François Timsit
- APHP/Hopital Bichat-Medical and Infectious Diseases ICU (MI2), 46 rue Henri Huchard, 75018, Paris, France.,UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Université de Paris, Sorbonne Paris Cité, 75018, Paris, France
| | - Julien Baleine
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, 371 Avenue Doyen G Giraud, 34295, Montpellier Cedex 5, France
| | - Louis Bernard
- Infectious Diseases Unit, University Hospital Tours, Nîmes 2 Boulevard, 37000, Tours, France
| | - Silvia Calvino-Gunther
- CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, 38000, Grenoble, France
| | - Michael Darmon
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Jean Dellamonica
- Centre Hospitalier Universitaire de Nice, Médecine Intensive Réanimation, Archet 1, UR2CA Unité de Recherche Clinique Côte d'Azur, Université Cote d'Azur, Nice, France
| | - Eric Desruennes
- Clinique d'anesthésie pédiatrique, Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, CHU Lille, 59000, Lille, France.,Unité accès vasculaire, Centre Oscar Lambret, 3 rue Frédéric Combemale, 59000, Lille, France
| | - Marc Leone
- Anesthésie Réanimation, Hôpital Nord, 13015, Marseille, France
| | - Alain Lepape
- Service d'Anesthésie et de Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Lyon, France.,UMR CNRS 5308, Inserm U1111, Laboratoire des Pathogènes Émergents, Centre International de Recherche en Infectiologie, Lyon, France
| | - Olivier Leroy
- Medical ICU, Chatilliez Hospital, Tourcoing, France.,U934/UMR3215, Institut Curie, PSL Research University, 75005, Paris, France
| | - Jean-Christophe Lucet
- AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.,INSERM IAME, U1137, Team DesCID, University of Paris, Paris, France
| | - Zied Merchaoui
- Pediatric Intensive Care, Paris South University Hospitals AP-HP, Le Kremlin Bicêtre, France
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, 86021, Poitiers, France.,Université de Poitiers, Poitiers, France.,Inserm U1070, Poitiers, France
| | - Benoit Misset
- Department of Intensive Care, Sart-Tilman University Hospital, and University of Liège, Liège, Belgium
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research and Department of Infectious Diseases, Caen University Hospital, 14000, Caen, France.,EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0) UNICAEN, CHU Caen Medical School Université Caen Normandie, Caen, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Antoine Roch
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Service des Urgences, 13015, Marseille, France.,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Matthieu Schmidt
- Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris, France.,INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651, Paris Cedex 13, France
| | - Michel Slama
- Medical Intensive Care Unit, CHU Sud Amiens, Amiens, France
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-Ralph Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France.,Service de Microbiologie Clinique et Unité de Contrôle et de Prévention Du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Walter Zingg
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laetitia Bodet-Contentin
- Medical Intensive Care Unit, INSERM CIC 1415, CRICS-TriGGERSep Network, CHRU de Tours and Université de Tours, Tours, France
| | - Virginie Maxime
- Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230, Garches, France.
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11
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Wang L, Erişen DE, Yang K, Zhang B, Guan H, Chen S. Anticoagulation and antibacterial functional coating on vascular implant interventional medical catheter. J Biomed Mater Res B Appl Biomater 2020; 108:2868-2877. [PMID: 32420689 DOI: 10.1002/jbm.b.34618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/30/2020] [Accepted: 04/13/2020] [Indexed: 01/12/2023]
Abstract
Vascular implant interventional medical catheter will contact with blood firstly after implantation. The anticoagulation and antibacterial functions of this device will determine the success or failure. Copper (Cu) has been verified to possess multi-biofunctions, but it was challenging to add the Cu metal to most materials. Take advantage of its functionality; Cu has been grafted on the material surface to improve the anticoagulation function and accelerate endothelialization. In this study, a Cu-bearing chitosan coating was prepared on the catheter to endow the anticoagulation and anti-infection functions. Besides, properties characterization and functional evaluation of the coated medical catheter were investigated. Dynamic blood clotting and platelet adhesion tests were carried out to evaluate the anticoagulation property. Besides this, the antibacterial test was used to estimate the anti-infection function. The surface energy and Cu ions release from the coating were detected and calculated by contact angles and immersion tests, respectively. The results of attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) and X-ray photoelectron spectroscopy (XPS) revealed that Cu ions were grafted in the chitosan coating. Thermogravimetric analysis (TA) result showed the concentration of Cu ions in the coating. The results of dynamic blood clotting, platelet adhesion, and antibacterial tests revealed that Cu grafted in chitosan would improve the blood compatibility and anti-infection property. The surface properties and Cu ions release behavior of Cu-bearing coating revealed the reasons for multi-biofunctions. This study indicated that the Cu-bearing chitosan coating could endow the vascular implant interventional device anticoagulation and anti-infection functions, which has excellent potential for clinical application.
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Affiliation(s)
- Lirong Wang
- College of Chemistry, Liaoning University, Shenyang, China
| | - Deniz E Erişen
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China.,University of Science and Technology of China, Hefei, China
| | - Ke Yang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Bingchun Zhang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Hongyu Guan
- College of Chemistry, Liaoning University, Shenyang, China
| | - Shanshan Chen
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
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12
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Choudhury MA, Sidjabat HE, Zowawi HM, Marsh PhD N, Larsen E, Runnegar PhD N, Paterson DL, McMillan DJ, Rickard CM. Skin colonization at peripheral intravenous catheter insertion sites increases the risk of catheter colonization and infection. Am J Infect Control 2019; 47:1484-1488. [PMID: 31331714 DOI: 10.1016/j.ajic.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) break the skin barrier, and preinsertion antiseptic disinfection and sterile dressings are used to reduce risk of catheter-related bloodstream infection (CRBSI). In this study, the impact of PIVC skin site colonization on tip colonization and the development of CRBSI was investigated. METHODS A total of 137 patients' PIVC skin site swabs and paired PIVC tips were collected at catheter removal, cultured, and bacterial species and clonality were identified. RESULTS Of 137 patients, 45 (33%) had colonized skin sites and/or PIVC tips. Of 16 patients with paired colonization of both the skin site and PIVC tips, 11 (69%) were colonized with the same bacterial species. Of these, 77% were clonally related, including 1 identical clone of Pseudomonas aeruginosa in a patient with systemic infection and the same organism identified in blood culture. CONCLUSIONS The results demonstrate that opportunistic pathogen colonization at the skin site poses a significant risk for PIVC colonization and CRBSI. Further research is needed to improve current preinsertion antiseptic disinfection of PIVC skin site and the sterile insertion procedure to potentially reduce PIVC colonization and infection risk.
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Affiliation(s)
- Md Abu Choudhury
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Inflammation and Healing Research Cluster, School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Brisbane, Australia.
| | - Hanna E Sidjabat
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia
| | - Hosam M Zowawi
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia and World Health Organization Collaborating Centre for Infection Prevention and Control, Riyadh, Saudi Arabia
| | - Nicole Marsh PhD
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Naomi Runnegar PhD
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Princess Alexandra Hospital, Brisbane, Australia
| | - David L Paterson
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia
| | - David J McMillan
- Inflammation and Healing Research Cluster, School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Brisbane, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
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13
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Roethlisberger M, Moffa G, Fisch U, Wiggli B, Schoen S, Kelly C, Leu S, Croci D, Zumofen DW, Cueni N, Nogarth D, Schulz M, Bucher HC, Weisser-Rohacek M, Wasner MG, Widmer AF, Mariani L. Effectiveness of a Chlorhexidine Dressing on Silver-coated External Ventricular Drain-associated Colonization and Infection: A Prospective Single-blinded Randomized Controlled Clinical Trial. Clin Infect Dis 2019; 67:1868-1877. [PMID: 29733329 DOI: 10.1093/cid/ciy393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/02/2018] [Indexed: 11/14/2022] Open
Abstract
Background Observational studies have shown that dressings containing chlorhexidine gluconate (CHX) lower the incidence external ventricular drain (EVD)-associated infections (EVDAIs). This prospective, randomized controlled trial (RCT) studies the efficacy of CHX-containing dressings in reducing bacterial colonization. Methods In this RCT, patients aged ≥18 years undergoing emergency EVD placement were randomly given either a CHX-containing or an otherwise identical control dressing at the skin exit wound. The primary end-point was bacterial regrowth in cultured skin swab samples of the EVD exit wound. The secondary end-points were catheters processed by sonication, clinically diagnosed EVDAI and surgical treatment of hydrocephalus. Results From October 2013 to January 2016, a total of 57 patients were randomized to receive either a CHX or a control dressing (29 and 28 patients, respectively). Cutaneous bacterial regrowth at the EVD exit wound was significantly reduced over time (geometric mean ratio, 0.18; 95% confidence interval, .08-.42; P < .001). The incidence of colonized catheters was lower in the CHX group (5 of 28; 18%) than in the control group (10 of 27; 33%), with less microbial colonization on the subcutaneous portion. The infection rate was 4 of 28 (14%) in the CHX group, compared with 7 of 27 (26%) in the control group, with a substantially lower hydrocephalus treatment rate (7 of 28 [25%] vs 14 of 27 [52%], respectively). Conclusion Our data support the use of CHX dressings to reduce EVD exit site contamination, potentially reducing EVDAIs and permanent cerebrospinal fluid diversion procedures for hydrocephalus. Clinical Trials Registration NCT02078830.
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Affiliation(s)
| | - Giusi Moffa
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel, Switzerland
| | - Urs Fisch
- Department of Neurosurgery, University of Basel, Switzerland
| | - Benedikt Wiggli
- Department of Infectious Diseases & Hospital Epidemiology, University of Basel, Switzerland
| | - Stephan Schoen
- Department of Neurosurgery, University of Basel, Switzerland
| | | | - Severina Leu
- Department of Neurosurgery, University of Basel, Switzerland
| | - Davide Croci
- Department of Neurosurgery, University of Basel, Switzerland
| | | | - Nadine Cueni
- Department of Anaesthesiology and Intensive-Care, University of Basel, Switzerland
| | - Danica Nogarth
- Department of Infectious Diseases & Hospital Epidemiology, University of Basel, Switzerland.,Division of Clinical Microbiology, University Hospital Basel, University of Basel, Switzerland
| | - Marianne Schulz
- Department of Neurosurgery, University of Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel, Switzerland
| | | | | | - Andreas F Widmer
- Department of Infectious Diseases & Hospital Epidemiology, University of Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University of Basel, Switzerland
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14
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Buetti N, Ruckly S, Lucet JC, Mimoz O, Souweine B, Timsit JF. Short-term dialysis catheter versus central venous catheter infections in ICU patients: a post hoc analysis of individual data of 4 multi-centric randomized trials. Intensive Care Med 2019; 45:1774-1782. [PMID: 31624854 DOI: 10.1007/s00134-019-05812-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/27/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Little is known on catheter-related infections associated with short-term dialysis catheters (DC). Recommendations for infection prevention are mostly derived from those related to central venous catheters (CVC). A comparison of infectious risk of DCs and CVCs would be instrumental for improving infection control prevention strategies. This study aimed to describe differences in infectious risk between DC and CVC. METHODS We used individual data from 4 multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies regarding colonization, major catheter-related infections (MCRI) and catheter-related bloodstream infections (CR-BSI). We selected only catheters with non-chlorhexidine gluconate impregnated dressings. A marginal Cox model for clustered data was used for the evaluation of the daily hazard rate for catheter-tip colonization, MCRI and CR-BSI. RESULTS We included 3029 patients and 4148 catheters (31,547 catheter-days) which comprised 1872 DCs and 2276 CVCs. After adjustment on confounders, we identified an increased risk in DC compared to CVC for colonization (HR 1.45, 95% CI 1.03-2.04, p = 0.04) and for MCRI (HR 2.97, 95% CI 1.03-8.51, p = 0.04) in the first 7 days of catheter maintenance. The daily hazard rate for colonization and MCRI was generally higher for DC in the first catheter-days, whereas it was similar between DC and CVC for longer catheterizations. CONCLUSIONS The daily risk of colonization and MCRI was significantly higher in DC compared to CVC within the first 7 days of catheter maintenance. Targeted prevention strategies for DC should mostly focus on the period following the insertion.
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Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France
| | - Stéphane Ruckly
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France
| | - Jean-Christophe Lucet
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France.,AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, 86021, Poitiers, France.,Université de Poitiers, Poitiers, France.,Inserm U1070, Poitiers, France
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-François Timsit
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France. .,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.
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15
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Validity of surrogate endpoints assessing central venous catheter-related infection: evidence from individual- and study-level analyses. Clin Microbiol Infect 2019; 26:563-571. [PMID: 31586658 DOI: 10.1016/j.cmi.2019.09.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The prevention of catheter-related bloodstream infection (CRBSI) has been an area of intense research, but the heterogeneity of endpoints used to define catheter infection makes the interpretation of randomized controlled trials (RCTs) problematic. The aim of this study was to determine the validity of different endpoints for central venous catheter infections. DATA SOURCES (a) Individual-catheter data were collected from 9428 catheters from four large RCTs; (b) study-level data from 70 RCTs were identified with a systematic search. Eligible studies were RCTs published between January 1987 and October 2018 investigating various interventions to reduce infections from short-term central venous catheters or short-term dialysis catheters. For each RCT the prevalence rates of CRBSI, quantitative catheter tip colonization, catheter-associated infection (CAI) and central line-associated bloodstream infection (CLABSI) were extracted for each randomized study arm. METHODS CRBSI was used as the gold-standard endpoint, for which colonization, CAI and CLABSI were evaluated as surrogate endpoints. Surrogate validity was assessed as (1) the individual partial coefficient of determination (individual-pR2) using individual catheter data; (2) the coefficient of determination (study-R2) from mixed-effect models regressing the therapeutic effect size of the surrogates on the effect size of CRBSI, using study-level data. RESULTS Colonization showed poor agreement with CRBSI at the individual-patient level (pR2 = 0.33 95% CI 0.28-0.38) and poor capture at the study level (R2 = 0.42, 95% CI 0.21-0.58). CAI showed good agreement with CRBSI at the individual-patient level (pR2 = 0.80, 95% CI 0.76-0.83) and moderate capture at the study level (R2 = 0.71, 95% CI 0.51-0.85). CLABSI showed poor agreement with CRBSI at the individual patient level (pR2 = 0.34, 95% CI 0.23-0.46) and poor capture at the study level (R2 = 0.28, 95% CI 0.07-0.76). CONCLUSIONS CAI is a moderate to good surrogate endpoint for CRBSI. Colonization and CLABSI do not reliably reflect treatment effects on CRBSI and are consequently more suitable for surveillance than for clinical effectiveness research.
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Guenezan J, Drugeon B, O’Neill R, Caillaud D, Sénamaud C, Pouzet C, Seguin S, Frasca D, Mimoz O. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, combined or not with use of a bundle of new devices, for prevention of short-term peripheral venous catheter-related infectious complications and catheter failure: an open-label, single-centre, randomised, four-parallel group, two-by-two factorial trial: CLEAN 3 protocol study. BMJ Open 2019; 9:e028549. [PMID: 30944142 PMCID: PMC6500304 DOI: 10.1136/bmjopen-2018-028549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Short peripheral intravenous catheters (PVCs) are the most frequently used invasive medical devices in hospitals. Unfortunately, PVCs often fail before the end of treatment due to the occurrence of mechanical, vascular or infectious complications, which prolongs hospitalisation and increases healthcare costs and mortality.Prevention of these complications is mainly based on the respect of hygiene rules and the use of biocompatible catheters. In critically ill patients, 2% chlorhexidine-alcohol is superior to 5% povidone iodine-alcohol for skin preparation before central venous and arterial catheters; whether this finding can be extended to PVC inserted in the wards remains speculative. Similarly, the use of new technologies such as catheters designed to minimise blood exposure, zero-reflux needleless connectors, disinfecting caps and flushing PVCs before and after each medication administration to maintain catheter patency are of theoretical interest to prevent PVC failure, but little scientific data support their routine use. METHODS AND ANALYSIS The CLEAN 3 study is an open-label, single-centre, randomised, two-by-two factorial trial. One thousand patients visiting our emergency department and requiring hospital admission in the wards will be randomised to one of four strategies according to skin preparation and devices used. The two primary endpoints will be (1) the incidence of infectious complications related to the catheters (colonisation, local infection or bloodstream infection) and (2) the time between catheter insertion and catheter failure defined as any premature removal of PVC before end of treatment, other than for routine replacement. ETHICS AND DISSEMINATION This protocol has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER EudraCT 2018-A02535-50; NCT03757143.
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Affiliation(s)
- Jérémy Guenezan
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Bertrand Drugeon
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- UFR Medecine et Pharmacie, Universite de Poitiers, Poitiers, France
| | - Rodérick O’Neill
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Diane Caillaud
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Clément Sénamaud
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Catherine Pouzet
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Sabrina Seguin
- Intensive Care Unit and Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Denis Frasca
- Methods in Patient-Centered Outcomes and Health Research, INSERM UMR1246, Poitiers, France
| | - Olivier Mimoz
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- INSERM U1070, Universite de Poitiers, Poitiers, France
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Tetrasodium EDTA Is Effective at Eradicating Biofilms Formed by Clinically Relevant Microorganisms from Patients' Central Venous Catheters. mSphere 2018; 3:3/6/e00525-18. [PMID: 30487154 PMCID: PMC6262258 DOI: 10.1128/msphere.00525-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The colonization of catheters by microorganisms often precludes their long-term use, which can be a problem for human patients that have few body sites available for new catheters. The colonizing organisms often form biofilms, and increasingly these organisms are resistant to multiple antibiotics, making them difficult to treat. In this article, we have taken microorganisms that are associated with biofilm formation in catheters from two Canadian hospitals and tested them with tetrasodium EDTA, a new antimicrobial catheter lock solution. Tetrasodium EDTA was effective at eliminating Gram-positive, Gram-negative, and fungal species and represents a promising alternative to antibiotic treatment with less chance of the organisms developing resistance. We expect that our results will be of interest to researchers and clinicians and will lead to improved patient care. Central venous access devices (CVADs) are an essential component of modern health care. However, their prolonged use commonly results in microbial colonization, which carries the potential risk of hospital-acquired bloodstream infections. These infections complicate the treatment of already sick individuals and cost the existing health care systems around the world millions of dollars. The microbes that colonize CVADs typically form multicellular biofilms that are difficult to dislodge and are resistant to antimicrobial treatments. Clinicians are searching for better ways to extend the working life span of implanted CVADs, by preventing colonization and reducing the risk of bloodstream infections. In this study, we analyzed 210 bacterial and fungal isolates from colonized CVADs or human bloodstream infections from two hospitals geographically separated in the east and west of Canada and screened the isolates for biofilm formation in vitro. Twenty isolates, representing 12 common, biofilm-forming species, were exposed to 4% tetrasodium EDTA, an antimicrobial lock solution that was recently approved in Canada for use as a medical device. The EDTA solution was effective at eradicating surface-attached biofilms from each microbial species, indicating that it could likely be used to prevent biofilm growth within CVADs and to eliminate established biofilms. This new lock solution fits with antibiotic stewardship programs worldwide by sparing the use of important antibiotic agents, targeting prevention rather than the expensive treatment of hospital-acquired infections. IMPORTANCE The colonization of catheters by microorganisms often precludes their long-term use, which can be a problem for human patients that have few body sites available for new catheters. The colonizing organisms often form biofilms, and increasingly these organisms are resistant to multiple antibiotics, making them difficult to treat. In this article, we have taken microorganisms that are associated with biofilm formation in catheters from two Canadian hospitals and tested them with tetrasodium EDTA, a new antimicrobial catheter lock solution. Tetrasodium EDTA was effective at eliminating Gram-positive, Gram-negative, and fungal species and represents a promising alternative to antibiotic treatment with less chance of the organisms developing resistance. We expect that our results will be of interest to researchers and clinicians and will lead to improved patient care.
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18
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Peripheral arterial catheter colonization in cardiac surgical patients. Infect Control Hosp Epidemiol 2018; 39:1008-1009. [PMID: 29941061 DOI: 10.1017/ice.2018.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill. Intensive Care Med 2018; 44:742-759. [PMID: 29754308 DOI: 10.1007/s00134-018-5212-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/05/2018] [Indexed: 12/14/2022]
Abstract
Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU. It discusses the optimal therapy of catheter-related infections and thrombosis. Prevention of complications is a multidisciplinary task that combines both improvement of the process of care and introduction of new technologies. We emphasize the main component of the prevention strategies that should be used in critical care and propose areas of future investigation in this field.
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20
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Gastmeier P, Zuschneid I, Geffers C. Antimicrobially Impregnated Catheters: An Overview of Randomized Controlled Trials. J Vasc Access 2018. [DOI: 10.1177/112972980300400305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In order to acquire an overview of the effectiveness of antimicrobially impregnated catheters on the prevention of catheter related bloodstream infections (CRI), we conducted a systematic review concentrating on randomized controlled trials (RCTs). The analysis end point was CRI; therefore, studies focussing only on catheter colonization were excluded. We did not consider abstracts for analysis. We identified 24 RCTs investigating the effectiveness of antimicrobially impregnated catheters. In addition, we discovered five meta-analyses and four studies investigating cost effectiveness. For the majority of antimicrobially impregnated catheter types only a few studies were available, and not enough to draw conclusions. Therefore, despite a relatively large number of RCTs available, the routine use of antimicrobially impregnated catheters as a measure for CRI prevention remains controversial, with a need for more high quality studies.
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Affiliation(s)
- P. Gastmeier
- Institute of Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover - Germany
| | - I. Zuschneid
- Institute of Hygiene, Charitè - University Medicine in Berlin, Berlin - Germany
| | - C. Geffers
- Institute of Hygiene, Charitè - University Medicine in Berlin, Berlin - Germany
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21
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Endovascular cooling versus standard femoral catheters and intravascular complications: A propensity-matched cohort study. Resuscitation 2018; 124:1-6. [DOI: 10.1016/j.resuscitation.2017.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022]
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22
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Chong HY, Lai NM, Apisarnthanarak A, Chaiyakunapruk N. Comparative Efficacy of Antimicrobial Central Venous Catheters in Reducing Catheter-Related Bloodstream Infections in Adults: Abridged Cochrane Systematic Review and Network Meta-Analysis. Clin Infect Dis 2018; 64:S131-S140. [PMID: 28475779 DOI: 10.1093/cid/cix019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background The efficacy of antimicrobial central venous catheters (CVCs) remains questionable. In this network meta-analysis, we aimed to assess the comparative efficacy of antimicrobial CVC impregnations in reducing catheter-related infections in adults. Methods We searched 4 electronic databases (Medline, the Cochrane Central Register of Controlled Trials, Embase, CINAHL) and internet sources for randomized controlled trials, ongoing clinical trials, and unpublished studies up to August 2016. Studies that assessed CVCs with antimicrobial impregnation with nonimpregnated catheters or catheters with another impregnation were included. Primary outcomes were clinically diagnosed sepsis, catheter-related bloodstream infection (CRBSI), and all-cause mortality. We performed a network meta-analysis to estimate risk ratio (RR) with 95% confidence interval (CI). Results Sixty studies with 17255 catheters were included. The effects of 14 impregnations were investigated. Both CRBSI and catheter colonization were the most commonly evaluated outcomes. Silver-impregnated CVCs significantly reduced clinically diagnosed sepsis compared with silver-impregnated cuffs (RR, 0.54 [95% CI, .29-.99]). When compared to no impregnation, significant CRBSI reduction was associated with minocycline-rifampicin (RR, 0.29 [95% CI, .16-.52]) and silver (RR, 0.57 [95% CI, .38-.86]) impregnations. No impregnations significantly reduced all-cause mortality. For catheter colonization, significant decreases were shown by miconazole-rifampicin (RR, 0.14 [95% CI, .05-.36]), 5-fluorouracil (RR, 0.34 [95% CI, .14-.82]), and chlorhexidine-silver sulfadiazine (RR, 0.60 [95% CI, .50-.72]) impregnations compared with no impregnation. None of the studies evaluated antibiotic/antiseptic resistance as the outcome. Conclusions Current evidence suggests that the minocycline-rifampicin-impregnated CVC appears to be the most effective in preventing CRBSI. However, its overall benefits in reducing clinical sepsis and mortality remain uncertain. Surveillance for antibiotic resistance attributed to the routine use of antimicrobial-impregnated CVCs should be emphasized in future trials.
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Affiliation(s)
| | - Nai Ming Lai
- School of Pharmacy, Monash University Malaysia.,School of Medicine, Taylor's University Lakeside Campus, Malaysia
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University Hospital, Pratumthani, Thailand
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia.,School of Population Health, University of Queensland, Brisbane, Australia.,Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand ; and.,School of Pharmacy, University of Wisconsin, Madison
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23
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Yasuda H, Sanui M, Abe T, Shime N, Komuro T, Hatakeyama J, Matsukubo S, Kawano S, Yamamoto H, Andoh K, Seo R, Inoue K, Noda E, Saito N, Nogami S, Okamoto K, Fuke R, Gushima Y, Kobayashi A, Takebayashi T, Lefor AK. Comparison of the efficacy of three topical antiseptic solutions for the prevention of catheter colonization: a multicenter randomized controlled study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:320. [PMID: 29268759 PMCID: PMC5740719 DOI: 10.1186/s13054-017-1890-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND To compare the efficacy of three antiseptic solutions [0.5%, and 1.0% alcohol/chlorhexidine gluconate (CHG), and 10% aqueous povidone-iodine (PVI)] for the prevention of intravascular catheter colonization, we conducted a randomized controlled trial in patients from 16 intensive care units in Japan. METHODS Adult patients undergoing central venous or arterial catheter insertions were randomized to have one of three antiseptic solutions applied during catheter insertion and dressing changes. The primary endpoint was the incidence of catheter colonization, and the secondary endpoint was the incidence of catheter-related bloodstream infections (CRBSI). RESULTS Of 1132 catheters randomized, 796 (70%) were included in the full analysis set. Catheter-tip colonization incidence was 3.7, 3.9, and 10.5 events per 1000 catheter-days in 0.5% CHG, 1% CHG, and PVI groups, respectively (p = 0.03). Pairwise comparisons of catheter colonization between groups showed a significantly higher catheter colonization risk in the PVI group (0.5% CHG vs. PVI: hazard ratio, HR 0.33 [95% confidence interval, CI 0.12-0.95], p = 0.04; 1.0% CHG vs. PVI: HR 0.35 [95% CI 0.13-0.93], p = 0.04). Sensitivity analyses including all patients by multiple imputations showed consistent quantitative conclusions (0.5% CHG vs. PVI: HR 0.34, p = 0.03; 1.0% CHG vs. PVI: HR 0.35, p = 0.04). No significant differences were observed in the incidence of CRBSI between groups. CONCLUSIONS Both 0.5% and 1.0% alcohol CHG are superior to 10% aqueous PVI for the prevention of intravascular catheter colonization. TRIAL REGISTRATION Japanese Primary Registries Network; No.: UMIN000008725 Registered on 1 September 2012.
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Affiliation(s)
- Hideto Yasuda
- Intensive Care Unit, Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, 1-26-1, Kyounanchou, Musashino-shi, Tokyo, 180-8610, Japan.,Department of Intensive Care Unit, Kameda General Hospital, 929 Higashi-cho, Kamogawa City, Chiba Prefecture, 296-8602, Japan.,Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
| | - Takayuki Abe
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Biostatistics Unit at Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, 734-8551, Japan
| | - Tetsuya Komuro
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Junji Hatakeyama
- Department of Intensive Care Medicine, Yokohama City Minato Red Cross Hospital, 3-12-1, Shin-yamashita, Naka-ku, Yokohama-Shi, Kanagawa, 231-8682, Japan
| | - Shohei Matsukubo
- Department of Emergency Medicine, Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Shinji Kawano
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Hiroshi Yamamoto
- Department of Anesthesia, Toyonaka Municipal Hospital, 1-14-4, Shibaraha-chou, Toyonaka-shi, Osaka, 560-8565, Japan
| | - Kohkichi Andoh
- Emergency and Critical Care Department, Division of Intensive Care, Sendai City Hospital, 1-1-1, Asutonaga-chou, Taihaku-ku, Sendai-shi, Miyagi, 982-8502, Japan
| | - Ryutaro Seo
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-2-1, Minatojima-minamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Kyo Inoue
- Department of Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto-shi, Kyoto, 612-0861, Japan
| | - Eiichiro Noda
- Department of Emergency Medicine, Fukuoka City Hospital, 1-13, Yoshizuka-honmachi, Hakata-ku, Fukuoka-shi, Fukuoka, 812-0046, Japan
| | - Nobuyuki Saito
- Shock and Trauma Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Satoshi Nogami
- Department of Anesthesiology, Okayama Medical Center, 1711-1, Taeki, Kita-ku, Okayama-shi, Okayama, 701-1192, Japan
| | - Kentaro Okamoto
- Department of Intensive Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Toudaijima, Urayasu-shi, Chiba, 279-0001, Japan
| | - Ryota Fuke
- Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1, Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Yasuhiro Gushima
- Department of Acute Care and General Medicine, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto-shi, Kumamoto, 861-4193, Japan
| | - Atsuko Kobayashi
- Department of Central Laboratory and Infection Control, Takarazuka City Hospital, 4-5-1, Kohama, Takarazuka-shi, Hyogo, 665-0827, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 3311-1, Yakushiji, Simono-shi, Tochigi, 329-0498, Japan
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Comparative Efficacies of Antimicrobial Catheter Lock Solutions for Fungal Biofilm Eradication in an in Vitro Model of Catheter-Related Fungemia. J Fungi (Basel) 2017; 3:jof3010007. [PMID: 29371526 PMCID: PMC5715961 DOI: 10.3390/jof3010007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/17/2017] [Accepted: 02/04/2017] [Indexed: 12/15/2022] Open
Abstract
Fungal catheter-related bloodstream infections (CRBSIs)-primarily due to Candida species-account for over 12% of all CRBSIs, and have been progressively increasing in prevalence. They present significant health and economic burdens, and high mortality rates. Antimicrobial catheter lock solutions are an important prophylactic option for preventing fungal CRBSIs. In this study, we compared the effectiveness of two FDA-approved catheter lock solutions (heparin and saline) and three experimental antimicrobial catheter lock solutions-30% citrate, taurolidine-citrate-heparin (TCH), and nitroglycerin-citrate-ethanol (NiCE)-in an in vitro model of catheters colonized by fungi. The fungi tested were five different strains of Candida clinical isolates from cancer patients who contracted CRBSIs. Time-to-biofilm-eradication was assessed in the model with 15, 30, and 60 min exposures to the lock solutions. Only the NiCE lock solution was able to fully eradicate all fungal biofilms within 60 min. Neither 30% citrate nor TCH was able to fully eradicate any of the Candida biofilms in this time frame. The NiCE lock solution was significantly superior to TCH in eradicating biofilms of five different Candida species (p = 0.002 for all).
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Reitzel RA, Rosenblatt J, Hirsh-Ginsberg C, Murray K, Chaftari AM, Hachem R, Raad I. In Vitro Assessment of the Antimicrobial Efficacy of Optimized Nitroglycerin-Citrate-Ethanol as a Nonantibiotic, Antimicrobial Catheter Lock Solution for Prevention of Central Line-Associated Bloodstream Infections. Antimicrob Agents Chemother 2016; 60:5175-81. [PMID: 27297475 PMCID: PMC4997850 DOI: 10.1128/aac.00254-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/04/2016] [Indexed: 11/20/2022] Open
Abstract
The rapid, broad-spectrum, biofilm-eradicating activity of the combination of 0.01% nitroglycerin, 7% citrate, and 20% ethanol and its potential as a nonantibiotic, antimicrobial catheter lock solution (ACLS) were previously reported. Here, a nitroglycerin-citrate-ethanol (NiCE) ACLS optimized for clinical assessment was developed by reducing the nitroglycerin and citrate concentrations and increasing the ethanol concentration. Biofilm-eradicating activity was sustained when the ethanol concentration was increased from 20 to 22% which fully compensated for reducing the citrate concentration from 7% to 4% as well as the nitroglycerin concentration from 0.01% to 0.0015% or 0.003%. The optimized formulations demonstrated complete and rapid (2 h) eradication of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate Staphylococcus aureus (VISA), methicillin-resistant Staphylococcus epidermidis (MRSE), vancomycin-resistant enterococci (VRE), multidrug-resistant (MDR) Pseudomonas aeruginosa, MDR Klebsiella pneumoniae, MDR Enterobacter cloacae, MDR Acinetobacter baumannii, MDR Escherichia coli, MDR Stenotrophomonas maltophilia, Candida albicans, and Candida glabrata biofilms. The optimized NiCE lock solutions demonstrated anticoagulant activities comparable to those of heparin lock solutions. NiCE lock solution was significantly more effective than taurolidine-citrate-heparin lock solution in eradicating biofilms of Staphylococcus aureus and Candida glabrata The optimized, nonantibiotic, heparin-free NiCE lock solution demonstrates rapid broad-spectrum biofilm eradication as well as effective anticoagulant activity, making NiCE a high-quality ACLS candidate for clinical assessment.
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Affiliation(s)
- Ruth A Reitzel
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joel Rosenblatt
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cheryl Hirsh-Ginsberg
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kimberly Murray
- School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Issam Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Coupez E, Timsit JF, Ruckly S, Schwebel C, Gruson D, Canet E, Klouche K, Argaud L, Bohe J, Garrouste-Orgeas M, Mariat C, Vincent F, Cayot S, Cointault O, Lepape A, Darmon M, Boyer A, Azoulay E, Bouadma L, Lautrette A, Souweine B. Guidewire exchange vs new site placement for temporary dialysis catheter insertion in ICU patients: is there a greater risk of colonization or dysfunction? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:230. [PMID: 27473868 PMCID: PMC4967331 DOI: 10.1186/s13054-016-1402-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/01/2016] [Indexed: 11/18/2022]
Abstract
Background Intensive care unit (ICU) patients require dialysis catheters (DCs) for renal replacement therapy (RRT). They carry a high risk of developing end-stage renal disease, and therefore their vascular access must be preserved. Guidewire exchange (GWE) is often used to avoid venipuncture insertion (VPI) at a new site. However, the impact of GWE on infection and dysfunction of DCs in the ICU is unknown. Our aim was to compare the effect of GWE and VPI on DC colonization and dysfunction in ICU patients. Methods Using data from the ELVIS randomized controlled trial (RCT) (1496 ICU adults requiring DC for RRT or plasma exchange) we performed a matched-cohort analysis. Cases were DCs inserted by GWE (n = 178). They were matched with DCs inserted by VPI. Matching criteria were participating centre, simplified acute physiology score (SAPS) II +/-10, insertion site (jugular or femoral), side for jugular site, and length of ICU stay before DC placement. We used a marginal Cox model to estimate the effect of DC insertion (GWE vs. VPI) on DC colonization and dysfunction. Results DC colonization rate was not different between GWE-DCs and VPI-DCs (10 (5.6 %) for both groups) but DC dysfunction was more frequent with GWE-DCs (67 (37.6 %) vs. 28 (15.7 %); hazard ratio (HR), 3.67 (2.07–6.49); p < 0.01). Results were similar if analysis was restricted to DCs changed for dysfunction. Conclusions GWE for DCs in ICU patients, compared with VPI did not contribute to DC colonization or infection but was associated with more than twofold increase in DC dysfunction. Trial registration This study is registered with ClinicalTrials.gov, number NCT00563342. Registered 2 April 2009. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1402-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisabeth Coupez
- Medical Intensive Care Unit, University Hospital of Clermont-Ferrand, 58 rue Montalembert, 63000, Clermont-Ferrand, France.
| | - Jean-François Timsit
- IAME UMR 1137 Inserm Université Paris Diderot, Paris, F-75018, France.,Medical and Infectious Diseases ICU -Paris Diderot University / Bichat Hospital, Paris, France
| | - Stéphane Ruckly
- IAME UMR 1137 Inserm Université Paris Diderot, Paris, F-75018, France
| | - Carole Schwebel
- U823 "Outcome of Cancers and Critical Illness," Albert Bonniot Institute, La Tronche, France
| | - Didier Gruson
- Medical Intensive Care Unit, Pellegrin Teaching Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Saint Louis Teaching Hospital, Paris, France
| | - Kada Klouche
- Medical Intensive Care Unit, Lapeyronie Teaching Hospital, University Hospital of Montpellier, Montpellier, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Edouard Herriot Teaching Hospital, University of Lyon, Lyon, France
| | - Julien Bohe
- Medical Intensive Care Unit, University Hospital of Lyon, Lyon, France
| | | | - Christophe Mariat
- Nephrology and Critical Care Unit, Nord Teaching Hospital, University of Saint Etienne, Saint Etienne, France
| | - François Vincent
- Medical Intensive Care Unit, Avicenne Teaching Hospital, Paris, France
| | - Sophie Cayot
- Department of Anaesthesiology and Critical Care Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Cointault
- Nephrology and Critical Care Medicine, Rangueil Teaching Hospital, University of Toulouse, Toulouse, France
| | - Alain Lepape
- Department of Anaesthesiology and Critical Care Medicine Pierre Benite Teaching Hospital, University Hospital of Lyon, Lyon, France
| | - Michael Darmon
- Medical Intensive Care Unit, Nord Teaching Hospital, University of Saint Etienne, Saint Etienne, France
| | - Alexandre Boyer
- Medical Intensive Care Unit, Pellegrin Teaching Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint Louis Teaching Hospital, Paris, France
| | - Lila Bouadma
- Medical Intensive Care Unit, Bichat-Claude Bernard Teaching Hospital, Paris, France
| | - Alexandre Lautrette
- Medical Intensive Care Unit, University Hospital of Clermont-Ferrand, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, University Hospital of Clermont-Ferrand, 58 rue Montalembert, 63000, Clermont-Ferrand, France
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Pages J, Hazera P, Mégarbane B, du Cheyron D, Thuong M, Dutheil JJ, Valette X, Fournel F, Mermel LA, Mira JP, Daubin C, Parienti JJ. Comparison of alcoholic chlorhexidine and povidone-iodine cutaneous antiseptics for the prevention of central venous catheter-related infection: a cohort and quasi-experimental multicenter study. Intensive Care Med 2016; 42:1418-26. [PMID: 27311311 DOI: 10.1007/s00134-016-4406-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Compare the effectiveness of different cutaneous antiseptics in reducing risk of catheter-related infection in intensive care unit (ICU) patients. METHODS We compared the risk of central venous catheter-related infection according to four-step (scrub, rinse, dry, and disinfect) alcoholic 5 % povidone-iodine (PVI-a, n = 1521), one-step (disinfect) alcoholic 2 % chlorhexidine (2 % CHX-a, n = 1116), four-step alcoholic <1 % chlorhexidine (<1 % CHX-a, n = 357), and four-step aqueous 10 % povidone-iodine (PVI, n = 368) antiseptics used for cutaneous disinfection and catheter care during the 3SITES multicenter randomized controlled trial. Within this cohort, we performed a quasi-experimental study (i.e., before-after) involving the four ICUs which switched from PVI-a to 2 % CHX-a. We used propensity score matching (PSM, n = 776) and inverse probability weighting treatment (IPWT, n = 1592). The end point was the incidence of catheter-related infection (CRI) defined as catheter-related bloodstream infection (CRBSI) or a positive catheter tip culture plus clinical sepsis on catheter removal. RESULTS In the cohort analysis and compared with PVI-a, the incidence of CRI was lower with 2 % CHX-a [adjusted hazard ratio (aHR), 0.51; 95 % confidence interval (CI) (0.28-0.96), p = 0.037] and similar with <1 % CHX-a [aHR, 0.73; (0.36-1.48), p = 0.37] and PVI [aHR, 1.50; 95 % CI (0.85-2.64), p = 0.16] after controlling for potential confounders. In the quasi-experimental study and compared with PVI-a, the incidence of catheter-related infection was again lower with 2 % CHX-a after PSM [HR, 0.35; 95 % CI (0.15, 0.84), p = 0.02] and in the IPWT analysis [HR, 0.31; 95 % CI (0.14, 0.70), p = 0.005]. The incidence of CRBSI or adverse event was not significantly different between antiseptics in all analyses. CONCLUSIONS In comparison with PVI-a, the use of 2 % CHX-a for cutaneous disinfection of the central venous catheter insertion site and maintenance catheter care was associated with a reduced risk of catheter infection, while the benefit of <1 % CHX-a was uncertain. CLINICAL TRIALS IDENTIFIER NCT01479153.
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Affiliation(s)
- Justine Pages
- Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France
| | - Pascal Hazera
- Department of Intensive Care Medicine, General Hospital, Saint Lô, France
| | - Bruno Mégarbane
- Department of Medial and Toxicologic Intensive Care, Lariboisière University Hospital, Paris, France
| | - Damien du Cheyron
- Department of Intensive Care Medicine, Caen University Hospital, Caen, France.,EA4655 Risque Microbiens, Caen Normandie Université, Caen, France
| | - Marie Thuong
- Department of Intensive Care Medicine, General Hospital, Pontoise, France
| | - Jean-Jacques Dutheil
- Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France
| | - Xavier Valette
- Department of Intensive Care Medicine, Caen University Hospital, Caen, France
| | - François Fournel
- Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France
| | - Leonard A Mermel
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jean-Paul Mira
- Department of Medial Intensive Care, Cochin University Hospital, Paris, France
| | - Cédric Daubin
- Department of Intensive Care Medicine, Caen University Hospital, Caen, France
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France. .,EA4655 Risque Microbiens, Caen Normandie Université, Caen, France. .,Department of Infectious Diseases, Caen University Hospital, Caen, France.
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Serane T, Kothendaraman B. Incidence and risk factors of infections associated with peripheral intravenous catheters. J Infect Prev 2016; 17:115-120. [PMID: 28989466 DOI: 10.1177/1757177416631415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/10/2016] [Indexed: 11/16/2022] Open
Abstract
AIM To study the incidence and risk factors of bacterial colonisation of peripheral venous catheters during the early neonatal period. DESIGN Prospective observational clinical study. SETTING Level II neonatal intensive care unit. PATIENTS Consecutive neonates in whom peripheral catheter was inserted were recruited. METHODS The insertion site was cleaned with isopropyl alcohol and chlorhexidine for 30 s consecutively. A needleless catheter access device was attached to peripheral catheters. A dedicated observer reviewed the catheter sites regularly for complications. On removal, the tip of the catheter was cut under sterile conditions and sent to the laboratory for culture. Only catheters indwelling for >12 h were sent for culture. FINDINGS Bacteria were isolated from 22 out of 154 catheter tips. Methicillin-sensitive Staphylococcus aureus (n = 13) was the most common organism constituting more than 50% of isolates. In five out of 22 isolates, the organism from the catheter tip was identical to the one from the skin. Systemic sepsis at enrolment was positively associated with colonisation of peripheral catheter. None of the neonates developed peripheral catheter-related bloodstream infection. CONCLUSION When proper infection control measures are in place, risk of peripheral venous catheter-related infection appears extremely low in spite of frequent colonisation of the catheter.
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Affiliation(s)
- Tiroumourougane Serane
- Canvij Neonatal Services, A.G. Padmavati's Hospital, Arumparthapuram, Pondicherry, India
| | - Bhuvaneswari Kothendaraman
- Department of Medicine, Indira Gandhi Medical College and Research Institute, Kathirkamam, Pondicherry, India
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Lai NM, Taylor JE, Tan K, Choo YM, Ahmad Kamar A, Muhamad NA. Antimicrobial dressings for the prevention of catheter-related infections in newborn infants with central venous catheters. Cochrane Database Syst Rev 2016; 3:CD011082. [PMID: 27007217 PMCID: PMC6464939 DOI: 10.1002/14651858.cd011082.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Central venous catheters (CVCs) provide secured venous access in neonates. Antimicrobial dressings applied over the CVC sites have been proposed to reduce catheter-related blood stream infection (CRBSI) by decreasing colonisation. However, there may be concerns on the local and systemic adverse effects of these dressings in neonates. OBJECTIVES We assessed the effectiveness and safety of antimicrobial (antiseptic or antibiotic) dressings in reducing CVC-related infections in newborn infants. Had there been relevant data, we would have evaluated the effects of antimicrobial dressings in different subgroups, including infants who received different types of CVCs, infants who required CVC for different durations, infants with CVCs with and without other antimicrobial modifications, and infants who received an antimicrobial dressing with and without a clearly defined co-intervention. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group (CNRG). We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2015, Issue 9), MEDLINE (PubMed), EMBASE (EBCHOST), CINAHL and references cited in our short-listed articles using keywords and MeSH headings, up to September 2015. SELECTION CRITERIA We included randomised controlled trials that compared an antimicrobial CVC dressing against no dressing or another dressing in newborn infants. DATA COLLECTION AND ANALYSIS We extracted data using the standard methods of the CNRG. Two review authors independently assessed the eligibility and risk of bias of the retrieved records. We expressed our results using risk difference (RD) and risk ratio (RR) with 95% confidence intervals (CIs). MAIN RESULTS Out of 173 articles screened, three studies were included. There were two comparisons: chlorhexidine dressing following alcohol cleansing versus polyurethane dressing following povidone-iodine cleansing (one study); and silver-alginate patch versus control (two studies). A total of 855 infants from level III neonatal intensive care units (NICUs) were evaluated, 705 of whom were from a single study. All studies were at high risk of bias for blinding of care personnel or unclear risk of bias for blinding of outcome assessors. There was moderate-quality evidence for all major outcomes.The single study comparing chlorhexidine dressing/alcohol cleansing against polyurethane dressing/povidone-iodine cleansing showed no significant difference in the risk of CRBSI (RR 1.18, 95% CI 0.53 to 2.65; RD 0.01, 95% CI -0.02 to 0.03; 655 infants, moderate-quality evidence) and sepsis without a source (RR 1.06, 95% CI 0.75 to 1.52; RD 0.01, 95% CI -0.04 to 0.06; 705 infants, moderate-quality evidence). There was a significant reduction in the risk of catheter colonisation favouring chlorhexidine dressing/alcohol cleansing group (RR 0.62, 95% CI 0.45 to 0.86; RD -0.09, 95% CI -0.15 to -0.03; number needed to treat for an additional beneficial outcome (NNTB) 11, 95% CI 7 to 33; 655 infants, moderate-quality evidence). However, infants in the chlorhexidine dressing/alcohol cleansing group were significantly more likely to develop contact dermatitis, with 19 infants in the chlorhexidine dressing/alcohol cleansing group having developed contact dermatitis compared to none in the polyurethane dressing/povidone-iodine cleansing group (RR 43.06, 95% CI 2.61 to 710.44; RD 0.06, 95% CI 0.03 to 0.08; number needed to treat for an additional harmful outcome (NNTH) 17, 95% CI 13 to 33; 705 infants, moderate-quality evidence). The roles of chlorhexidine dressing in the outcomes reported were unclear, as the two assigned groups received different co-interventions in the form of different skin cleansing agents prior to catheter insertion and during each dressing change.In the other comparison, silver-alginate patch versus control, the data for CRBSI were analysed separately in two subgroups as the two included studies reported the outcome using different denominators: one using infants and another using catheters. There were no significant differences between infants who received silver-alginate patch against infants who received standard line dressing in CRBSI, whether expressed as the number of infants (RR 0.50, 95% CI 0.14 to 1.78; RD -0.12, 95% CI -0.33 to 0.09; 1 study, 50 participants, moderate-quality evidence) or as the number of catheters (RR 0.72, 95% CI 0.27 to 1.89; RD -0.05, 95% CI -0.20 to 0.10; 1 study, 118 participants, moderate-quality evidence). There was also no significant difference between the two groups in mortality (RR 0.55, 95% CI 0.15 to 2.05; RD -0.04, 95% CI -0.13 to 0.05; two studies, 150 infants, I² = 0%, moderate-quality evidence). No adverse skin reaction was recorded in either group. AUTHORS' CONCLUSIONS Based on moderate-quality evidence, chlorhexidine dressing/alcohol skin cleansing reduced catheter colonisation, but made no significant difference in major outcomes like sepsis and CRBSI compared to polyurethane dressing/povidone-iodine cleansing. Chlorhexidine dressing/alcohol cleansing posed a substantial risk of contact dermatitis in preterm infants, although it was unclear whether this was contributed mainly by the dressing material or the cleansing agent. While silver-alginate patch appeared safe, evidence is still insufficient for a recommendation in practice. Future research that evaluates antimicrobial dressing should ensure blinding of caregivers and outcome assessors and ensure that all participants receive the same co-interventions, such as the skin cleansing agent. Major outcomes like sepsis, CRBSI and mortality should be assessed in infants of different gestation and birth weight.
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Affiliation(s)
- Nai Ming Lai
- Taylor's UniversitySchool of MedicineSubang JayaMalaysia
| | - Jacqueline E Taylor
- Monash Medical Centre/Monash UniversityMonash Newborn246 Clayton RoadClaytonVictoriaAustralia3168
| | - Kenneth Tan
- Monash UniversityDepartment of Paediatrics246 Clayton RoadClaytonMelbourneVictoriaAustraliaVIC 3168
| | - Yao Mun Choo
- University of MalayaDepartment of PaediatricsKuala LumpurMalaysia
| | | | - Nor Asiah Muhamad
- Ministry of Health MalaysiaDisease Control DivisionPutrajayaMalaysia62590
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Vallés J, Fernández I, Alcaraz D, Chacón E, Cazorla A, Canals M, Mariscal D, Fontanals D, Morón A. Prospective Randomized Trial of 3 Antiseptic Solutions for Prevention of Catheter Colonization in an Intensive Care Unit for Adult Patients. Infect Control Hosp Epidemiol 2015; 29:847-53. [DOI: 10.1086/590259] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To compare the effectiveness for prevention of central venous and arterial catheter colonization of 3 skin antisepsis with 1 of 3 antiseptic solutions: 10% aqueous povidone iodine (aqueous PI), 2% aqueous chlorhexidine gluconate (aqueous CG), and 0.5% alcoholic chlorhexidine gluconate (alcoholic CG).Design.Prospective, randomized controlled trial.Setting.Intensive care unit in a teaching hospital.Methods.Patients were randomly assigned to 1 of the 3 skin antisepsis groups. The distal tips of catheters were semiquantitatively cultured when the catheters were no longer necessary or if there was a suspicion of catheter-related infection. Rates of catheter colonization, catheter-related sepsis, and catheter-related bacteremia were compared among the 3 groups.Results.A total of 631 catheters were included in the study (194 from the aqueous PI group, 211 from the aqueous CG group, and 226 from the alcoholic CG group). The incidence of catheter colonization was significantly lower in the alcoholic CG than in the aqueous PI group (14.2% vs 24.7%; relative risk, 0.5 [95% confidence interval, 0.3-0.8; P < .01]); it was also significantly lower in the aqueous CG group than in the aqueous PI group (16.1 % vs 24.7%; relative risk, 0.6 [95% confidence interval, 0.4-0.9; P = .03]). There were no significant differences between the aqueous CG and the alcoholic CG groups. Incidences of catheter-related bacteremia were similar for all 3 groups. The aqueous and alcoholic CG solutions were superior to the aqueous PI solution in preventing catheter colonization due to gram-positive bacteria.Conclusions.The aqueous and alcoholic CG solutions for cutaneous antisepsis were similarly effective in preventing colonization of central venous catheters and arterial catheters. Both had significantly lower incidences of colonization than did the aqueous PI solution; this effect seems to be related to the CG solutions' more efficacious prevention of colonization with gram-positive bacteria.
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Effectiveness of silver-impregnated central venous catheters for preventing catheter-related blood stream infections: a meta-analysis. Int J Infect Dis 2014; 29:279-86. [PMID: 25447733 DOI: 10.1016/j.ijid.2014.09.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/26/2014] [Accepted: 09/30/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The purpose of this meta-analysis was to examine the effectiveness of silver-impregnated central venous catheters (CVCs) in preventing catheter bacterial colonization and catheter-related blood stream infections (CRBSIs). METHODS PubMed, Cochrane, and Embase databases were searched up to April 30, 2014. Studies in which other antiseptic reagents were used (e.g., chlorhexidine, octenidine dihydrochloride, urokinase rinses, benzalkonium chloride, rifampin-minocycline) were excluded. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Tests of heterogeneity and publication bias were performed. RESULTS Twelve studies were included in the meta-analysis. The studies enrolled a total of 2854 patients; 1440 received a standard CVC and 1414 received a silver-impregnated CVC. No significant difference in catheter bacterial colonization rates was found between silver-impregnated and standard CVCs (OR 0.907, 95% CI 0.758-1.087, p=0.290). No significant difference in CRBSI rates was found between silver-impregnated and standard CVCs (pooled OR 0.721, 95% CI 0.476-1.094, p=0.124). No significant heterogeneity or publication bias was noted. CONCLUSIONS Silver-impregnated CVCs are not associated with reduced rates of bacterial colonization or CRBSI.
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Hammarskjöld F, Berg S, Hanberger H, Taxbro K, Malmvall BE. Sustained low incidence of central venous catheter-related infections over six years in a Swedish hospital with an active central venous catheter team. Am J Infect Control 2014; 42:122-8. [PMID: 24485369 DOI: 10.1016/j.ajic.2013.09.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 09/20/2013] [Accepted: 09/20/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND There are limited data on the long-term effects of implementing a central venous catheter (CVC) program for prevention of CVC infections. The aims of this study were to evaluate the incidence of CVC colonization, catheter-related infections (CRI), catheter-related bloodstream infections (CRBSI), and their risk factors over a 6-year period in a hospital with an active CVC team. METHODS We conducted a continuous prospective study aiming to include all CVCs used at our hospital during the years 2004 to 2009, evaluating colonization, CRI, CRBSI, and possible risk factors. RESULTS A total of 2,772 CVCs was used during the study period. Data on culture results and catheterization time were available for 2,045 CVCs used in 1,674 patients. The incidences of colonization, CRI, and CRBSI were 7.0, 2.2, and 0.6 per 1,000 CVC-days, respectively. Analysis of quarterly incidences revealed 1 occasion with increasing infection rates. Catheterization time was a risk factor for CRI but not for CRBSI. Other risk factors for CRI were hemodialysis and CVC use in the internal jugular vein compared with the subclavian vein. Hemodialysis was the only risk factor for CRBSI. CONCLUSION We found that a CRI prevention program led by an active CVC team and adhered to by the entire staff at a county hospital is successful in keeping CVC infections at a low rate over a long period of time.
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Affiliation(s)
- Fredrik Hammarskjöld
- Department of Anesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden; Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden.
| | - Sören Berg
- Division of Cardiothoracic Anesthesia and Intensive Care, Department of Medical and Health Science, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Håkan Hanberger
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden
| | - Knut Taxbro
- Department of Anesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| | - Bo-Eric Malmvall
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden; Futurum the Academy for Health Care, Jönköping County Council, Jönköping, Sweden
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Hentrich M, Schalk E, Schmidt-Hieber M, Chaberny I, Mousset S, Buchheidt D, Ruhnke M, Penack O, Salwender H, Wolf HH, Christopeit M, Neumann S, Maschmeyer G, Karthaus M. Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management and prevention by the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology. Ann Oncol 2014; 25:936-47. [PMID: 24399078 DOI: 10.1093/annonc/mdt545] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cancer patients are at increased risk for central venous catheter-related infections (CRIs). Thus, a comprehensive, practical and evidence-based guideline on CRI in patients with malignancies is warranted. PATIENTS AND METHODS A panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) has developed a guideline on CRI in cancer patients. Literature searches of the PubMed, Medline and Cochrane databases were carried out and consensus discussions were held. RESULTS Recommendations on diagnosis, management and prevention of CRI in cancer patients are made, and the strength of the recommendation and the level of evidence are presented. CONCLUSION This guideline is an evidence-based approach to the diagnosis, management and prevention of CRI in cancer patients.
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Affiliation(s)
- M Hentrich
- Department of Hematology, Oncology and Palliative Care, Harlaching Hospital and Neuperlach Hospital, Munich
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Guembe M, Rodríguez-Créixems M, Martín-Rabadán P, Alcalá L, Muñoz P, Bouza E. The risk of catheter-related bloodstream infection after withdrawal of colonized catheters is low. Eur J Clin Microbiol Infect Dis 2013; 33:729-34. [PMID: 24173822 DOI: 10.1007/s10096-013-2004-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/16/2013] [Indexed: 11/28/2022]
Abstract
Most episodes of catheter-related bloodstream infection (C-RBSI) are documented before or at the time of catheter withdrawal. The risk of C-RBSI in the period after removing a colonized catheter in patients without bacteremia (late C-RBSI) is unknown. We assessed the risk of developing a late C-RBSI episode in an unselected population with positive catheter tip cultures and analyzed associated risk factors. We analyzed retrospectively all colonized catheter tips between 2003 and 2010 and matched them with blood cultures. C-RBSI episodes were classified as early C-RBSI (positive blood cultures were obtained ≤24 h after catheter withdrawal) or late C-RBSI (positive blood cultures were obtained ≥24 h after catheter withdrawal). We analyzed the risk factors associated with late C-RBSI episodes by comparison with a selected group of early C-RBSI episodes. We collected a total of 17,981 catheter tips: 4,533 (25.2 %) were colonized. Of them, 1,063 (23.5 %) were associated to early C-RBSI episodes and from the remaining 3,470, only 143 (4.1 %) were associated to late C-RBSI episodes. Then, they corresponded to 11.9 % of the total 1,206 C-RBSI episodes. After comparing early and late C-RBSI episodes, we found that late C-RBSI was significantly associated with the presence of methicillin-resistant Staphylococcus aureus (MRSA, p = 0.028) and with higher mortality (p = 0.030). According to our data, patients with colonized catheter tips had a 4.1 % risk of developing late C-RBSI, which was associated with higher crude mortality.
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Affiliation(s)
- M Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
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Belba MK, Petrela EY, Belba AG. Epidemiology of infections in a burn unit, Albania. Burns 2013; 39:1456-67. [PMID: 23632302 DOI: 10.1016/j.burns.2013.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 03/16/2013] [Accepted: 03/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Many types of nosocomial infections (NIs) can be present in the burned patient. The purpose of this study is to calculate the rates for NI in the Intensive Care Unit of the Service of Burns and Plastic Surgery in University Hospital Centre (UHC) in Tirana, Albania. METHOD The study is prospective, clinical and analytical. The study is continued/longitudinal because monitors all patients with severe burns during a specified time period (1year). For data analysis was used SPSS 19.0. RESULTS The infection prevalence rate was 12 infected patients per 100 patients. The colonisation prevalence rate was 43 colonised patients for 100 patients. The most frequent infection microorganisms were Pseudomonas aeruginosa and Staphylococcus aureus (67% and 24%). Incidence of BSI was 3 BSI for 1000 hospitalization days. Incidence of catheter-related bloodstream infection (CRBSI) was 11.7 BSI for 1000 catheter days. Colonisation of the tip of the central catheter (CTC) was 15.6 for 1000 catheter days. CONCLUSIONS The epidemiology of burn wound infections as well as the definitions have changed due to important changes in burn wound treatment but further studies should be done documented the factors that can reduce the burn wound infection rates.
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Affiliation(s)
- Monika Kristaq Belba
- Department of Surgery, Service of Burns and Plastic Surgery, Service of Anesthesiology, University Hospital Center 'Mother Teresa', Tirana, Albania.
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International Sepsis Forum Free Paper Presentations. J Intensive Care Soc 2013. [DOI: 10.1177/17511437130141s103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Mrozek N, Lautrette A, Timsit JF, Souweine B. How to deal with dialysis catheters in the ICU setting. Ann Intensive Care 2012; 2:48. [PMID: 23174157 PMCID: PMC3526537 DOI: 10.1186/2110-5820-2-48] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 10/30/2012] [Indexed: 11/24/2022] Open
Abstract
Acute kidney insufficiency (AKI) occurs frequently in intensive care units (ICU). In the management of vascular access for renal replacement therapy (RRT), several factors need to be taken into consideration to achieve an optimal RRT dose and to limit complications. In the medium and long term, some individuals may become chronic dialysis patients and so preserving the vascular network is of major importance. Few studies have focused on the use of dialysis catheters (DC) in ICUs, and clinical practice is driven by the knowledge and management of long-term dialysis catheter in chronic dialysis patients and of central venous catheter in ICU patients. This review describes the appropriate use and management of DCs required to obtain an accurate RRT dose and to reduce mechanical and infectious complications in the ICU setting. To deliver the best RRT dose, the length and diameter of the catheter need to be sufficient. In patients on intermittent hemodialysis, the right internal jugular insertion is associated with a higher delivered dialysis dose if the prescribed extracorporeal blood flow is higher than 200 ml/min. To prevent DC colonization, the physician has to be vigilant for the jugular position when BMI < 24 and the femoral position when BMI > 28. Subclavian sites should be excluded. Ultrasound guidance should be used especially in jugular sites. Antibiotic-impregnated dialysis catheters and antibiotic locks are not recommended in routine practice. The efficacy of ethanol and citrate locks has yet to be demonstrated. Hygiene procedures must be respected during DC insertion and manipulation.
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Affiliation(s)
- Natacha Mrozek
- Réanimation médicale, Hôpital Gabriel Montpied CHU-Clermont-Ferrand, Clermont Ferrand, 63000, France
- UMR CNRS 6023, Laboratoire Microorganismes: Génome et Environnement, Clermont Université, Université d'Auvergne, Clermont Ferrand, 63000, France
| | - Alexandre Lautrette
- Réanimation médicale, Hôpital Gabriel Montpied CHU-Clermont-Ferrand, Clermont Ferrand, 63000, France
- UMR CNRS 6023, Laboratoire Microorganismes: Génome et Environnement, Clermont Université, Université d'Auvergne, Clermont Ferrand, 63000, France
| | - Jean-François Timsit
- Medical Polyvalent Intensive Care Unit, University Joseph Fourier, Albert Michallon Hospital, BP 217, Grenoble Cedex 9, 38043, France
- University Joseph Fourier, EA U823, Albert Bonniot Institute, La Tronche Cedex, 38706, France
| | - Bertrand Souweine
- Réanimation médicale, Hôpital Gabriel Montpied CHU-Clermont-Ferrand, Clermont Ferrand, 63000, France
- UMR CNRS 6023, Laboratoire Microorganismes: Génome et Environnement, Clermont Université, Université d'Auvergne, Clermont Ferrand, 63000, France
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Timsit JF, Mimoz O, Mourvillier B, Souweine B, Garrouste-Orgeas M, Alfandari S, Plantefeve G, Bronchard R, Troche G, Gauzit R, Antona M, Canet E, Bohe J, Lepape A, Vesin A, Arrault X, Schwebel C, Adrie C, Zahar JR, Ruckly S, Tournegros C, Lucet JC. Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med 2012; 186:1272-8. [PMID: 23043083 DOI: 10.1164/rccm.201206-1038oc] [Citation(s) in RCA: 152] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Most vascular catheter-related infections (CRIs) occur extraluminally in patients in the intensive care unit (ICU). Chlorhexidine-impregnated and strongly adherent dressings may decrease catheter colonization and CRI rates. OBJECTIVES To determine if chlorhexidine-impregnated and strongly adherent dressings decrease catheter colonization and CRI rates. METHODS In a 2:1:1 assessor-masked randomized trial in patients with vascular catheters inserted for an expected duration of 48 hours or more in 12 French ICUs, we compared chlorhexidine dressings, highly adhesive dressings, and standard dressings from May 2010 to July 2011. Coprimary endpoints were major CRI with or without catheter-related bloodstream infection (CR-BSI) with chlorhexidine versus nonchlorhexidine dressings and catheter colonization rate with highly adhesive nonchlorhexidine versus standard nonchlorhexidine dressings. Catheter-colonization, CR-BSIs, and skin reactions were secondary endpoints. MEASUREMENTS AND MAIN RESULTS A total of 1,879 patients (4,163 catheters and 34,339 catheter-days) were evaluated. With chlorhexidine dressings, the major-CRI rate was 67% lower (0.7 per 1,000 vs. 2.1 per 1,000 catheter-days; hazard ratio [HR], 0.328; 95% confidence interval [CI], 0.174-0.619; P = 0.0006) and the CR-BSI rate 60% lower (0.5 per 1,000 vs. 1.3 per 1,000 catheter-days; HR, 0.402; 95% CI, 0.186-0.868; P = 0.02) than with nonchlorhexidine dressings; decreases were noted in catheter colonization and skin colonization rates at catheter removal. The contact dermatitis rate was 1.1% with and 0.29% without chlorhexidine. Highly adhesive dressings decreased the detachment rate to 64.3% versus 71.9% (P < 0.0001) and the number of dressings per catheter to two (one to four) versus three (one to five) (P < 0.0001) but increased skin colonization (P < 0.0001) and catheter colonization (HR, 1.650; 95% CI, 1.21-2.26; P = 0.0016) without influencing CRI or CR-BSI rates. CONCLUSIONS A large randomized trial demonstrated that chlorhexidine-gel-impregnated dressings decreased the CRI rate in patients in the ICU with intravascular catheters. Highly adhesive dressings decreased dressing detachment but increased skin and catheter colonization. Clinical trial registered with www.clinicaltrials.gov (NCT 01189682).
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Affiliation(s)
- Jean-François Timsit
- Université Grenoble 1 (Joseph Fourrier)-U823 "Outcome of Cancers and Critical Illness," Albert Bonniot Institute, 38076, La Tronche, France.
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Comparison of triple-lumen central venous catheters impregnated with silver nanoparticles (AgTive®) vs conventional catheters in intensive care unit patients. J Hosp Infect 2012; 82:101-7. [DOI: 10.1016/j.jhin.2012.07.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/23/2012] [Indexed: 11/19/2022]
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Use of a chlorhexidine-impregnated patch does not decrease the incidence of bacterial colonization of femoral nerve catheters: a randomized trial. Can J Anaesth 2012; 59:950-7. [PMID: 22855310 DOI: 10.1007/s12630-012-9768-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/19/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Femoral nerve catheter (FNC) insertion is commonly performed for postoperative analgesia following total knee arthroplasty (TKA). A wide range of rates has been reported relating to the bacterial colonization of catheters complicating FNC insertion. The BIOPATCH® is a chlorhexidine (CHG) impregnated patch designed to inhibit bacterial growth for days. The BIOPATCH has proven to be effective at decreasing bacterial colonization in epidural and vascular catheters. We hypothesized that the BIOPATCH would be effective at decreasing the rates of FNC bacterial colonization. METHODS Following Institutional Review Board approval and written informed consent, 100 patients scheduled for TKA were prospectively enrolled in the study. Patients at elevated risk for infection were excluded from analysis. Femoral nerve catheters were inserted and tunneled under sterile conditions using ultrasound guidance following CHG skin cleansing. Participants were then randomized either to have the BIOPATCH applied to the catheter exit site or not to have the patch applied. All patients received pre/postoperative antibiotic therapy. The FNC tip and catheter exit site were cultured for bacterial growth at the conclusion of therapy. RESULTS No differences were observed between groups in regards to catheter exit site. Catheter colonization was observed in three of 48 (6.3%) BIOPATCH patients and two of 47 (4.3%) non-BIOPATCH patients (risk ratio [RR] = 1.5; 95% confidence interval [CI] 0.3 to 8.4; P = 1.0). Colonization of the catheter exit site was observed in 12 BIOPATCH and 14 non-BIOPATCH patients (RR = 0.8; 95% CI 0.4 to 1.6; P = 0.65). Local skin inflammation (non-BIOPATCH 10.6% vs BIOPATCH 2.1%) and colonization of the FNC exit site by more than one type of bacteria trended towards increased values in the non-BIOPATCH group. CONCLUSIONS The baseline rate of bacterial colonization of FNCs is quite low in the setting of short-term use, CHG skin decontamination, ultrasound guidance, subcutaneous tunneling, and perioperative antibiotic therapy. No benefit was shown by using the BIOPATCH in this patient population. (ClinicalTrials.gov number: NCT01411891).
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Timsit JF, L‘Hériteau F, Lepape A, Francais A, Ruckly S, Venier AG, Jarno P, Boussat S, Coignard B, Savey A. A multicentre analysis of catheter-related infection based on a hierarchical model. Intensive Care Med 2012; 38:1662-72. [DOI: 10.1007/s00134-012-2645-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 06/22/2012] [Indexed: 01/26/2023]
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Koh DBC, Robertson IK, Watts M, Davies AN. Density of microbial colonization on external and internal surfaces of concurrently placed intravascular devices. Am J Crit Care 2012; 21:162-71. [PMID: 22549572 DOI: 10.4037/ajcc2012675] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Intravascular devices provide essential vascular access for management of critically ill patients but can be associated with bloodstream infections. OBJECTIVES To determine colonization rates in segments of concurrently placed peripheral arterial, nontunnelled short-term central venous catheters and peripherally inserted central catheters and the pattern of heaviest colonization when the catheters are removed. METHODS A prospective study was conducted on inpatients with intravascular devices in place for 9 days or more. At removal, each catheter was cut into 3 segments, and each segment was cultured separately. The density of colonization on external and internal surfaces of each segment was compared by estimating odds ratios by repeated-measures ordinal logistic regression. RESULTS A total of 48 peripheral arterial, 135 central venous, and 106 peripherally inserted central catheters were obtained from 289 patients. Colonization was greatest at the proximal external segment of all catheters. On the external surface, colonization was lower on the middle (odds ratio, 0.70; P < .001) and distal (odds ratio, 0.56; P < .001) segments than on the proximal segments. On the internal surface, colonization was lower on the proximal (odds ratio, 0.39; P < .001), middle (odds ratio, 0.30; P < .001), and distal (odds ratio, 0.31; P < .001) segments than on the external proximal segments. This trend was similar for all catheter types. CONCLUSION Colonization of intravascular devices was heaviest on proximal segments.
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Affiliation(s)
- David Boon Chai Koh
- David Boon Chai Koh is a registered critical care nurse in the intensive care unit, Launceston General Hospital, School of Human Life Sciences, University of Tasmania, Tasmania, Australia, Iain Kilpatrick Robertson is a senior research fellow, School of Human Life Sciences, University of Tasmania, and Clifford Craig Medical Research Trust, Launceston General Hospital, and Marianne Watts and Andrew Neil Davies are lecturers, School of Human Life Sciences, University of Tasmania
| | - Iain Kilpatrick Robertson
- David Boon Chai Koh is a registered critical care nurse in the intensive care unit, Launceston General Hospital, School of Human Life Sciences, University of Tasmania, Tasmania, Australia, Iain Kilpatrick Robertson is a senior research fellow, School of Human Life Sciences, University of Tasmania, and Clifford Craig Medical Research Trust, Launceston General Hospital, and Marianne Watts and Andrew Neil Davies are lecturers, School of Human Life Sciences, University of Tasmania
| | - Marianne Watts
- David Boon Chai Koh is a registered critical care nurse in the intensive care unit, Launceston General Hospital, School of Human Life Sciences, University of Tasmania, Tasmania, Australia, Iain Kilpatrick Robertson is a senior research fellow, School of Human Life Sciences, University of Tasmania, and Clifford Craig Medical Research Trust, Launceston General Hospital, and Marianne Watts and Andrew Neil Davies are lecturers, School of Human Life Sciences, University of Tasmania
| | - Andrew Neil Davies
- David Boon Chai Koh is a registered critical care nurse in the intensive care unit, Launceston General Hospital, School of Human Life Sciences, University of Tasmania, Tasmania, Australia, Iain Kilpatrick Robertson is a senior research fellow, School of Human Life Sciences, University of Tasmania, and Clifford Craig Medical Research Trust, Launceston General Hospital, and Marianne Watts and Andrew Neil Davies are lecturers, School of Human Life Sciences, University of Tasmania
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Culture Positivity of CVCs Used for TPN: Investigation of an Association with Catheter-Related Infection and Comparison of Causative Organisms between ICU and Non-ICU CVCs. J Nutr Metab 2012; 2012:257959. [PMID: 22577526 PMCID: PMC3345241 DOI: 10.1155/2012/257959] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 10/20/2011] [Accepted: 01/16/2012] [Indexed: 01/21/2023] Open
Abstract
A relationship between central venous catheter (CVC) tip colonisation and catheter-related blood-stream infection (CRBSI) has been suggested. We examined culture positivity of CVC tips (colonised and infected CVCs) in a total parenteral nutrition (TPN) population. Our aims were to define the relationship between culture positivity and CRBSI, and to compare causative organisms between culture positive and CRBSI CVCS, and between ward and ICU CVCs. All patients receiving TPN via non-tunnelled CVCs during the study (1997–2009) were included. All CVC tips were analysed. Data were collated contemporaneously. A TPN audit committee determined whether CVC tip culture positivity reflected colonisation/CRBSI using CDC criteria. 1,392 patients received TPN via 2,565 CVCs over 15,397 CVC days. 25.4% of CVCs tips were culture positive, of these 32% developed CRBSI. There was a nonsignificant trend of higher Gram negative Bacilli isolation in ICU CVCs (P = 0.1), ward CVCs were associated with higher rates of staphylococcal isolation (P = 0.01). A similar pattern of organisms were cultured from CRBSI and culture positive CVCs. The consistent relationship between CRBSI and culture positive CVCs, and similar pattern of causative organisms further supports an aetiological relationship between culture positive CVC tips and CRBSI, supporting the contention that CVC culture-positivity may be a useful surrogate marker for CRBSI rates.
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Ye X, Rupnow M, Bastide P, Lafuma A, Ovington L, Jarvis WR. Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States. Am J Infect Control 2011; 39:647-654. [PMID: 21641681 DOI: 10.1016/j.ajic.2010.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 11/15/2010] [Accepted: 11/16/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND The economic impact of adding chlorhexidine gluconate (CHG)-impregnated sponge dressing to standard care (ie, chg-impregnated sponge dressing + skin preparation and transparent film dressing vs skin preparation and transparent film dressing) for the prevention of central-line infections was evaluated. METHODS Clinical and economic data were obtained from peer-reviewed published studies to populate the decision model. The efficacy of reducing catheter-related bloodstream infection (CR-BSI) incidence with CHG-impregnated sponge dressing came from 2 recent randomized controlled trials. One-way and two-way sensitivity analyses were performed on key clinical and economic parameters. RESULTS Based on model calculations, a hypothetical 400-bed hospital inserting 3,078 central venous catheters (CVCs) per year is expected to avoid an average of 35 CR-BSIs, 145 local infections, and 281 intensive care unit days annually with the systematic use of CHG-impregnated sponge dressing. Potential hospital net cost savings (mainly because of reduced CR-BSIs with use of the dressing) would be $895,000 annually. Results were robust across a range of values in sensitivity analyses. CONCLUSION CHG-impregnated sponge dressing is a cost-effective CR-BSI prevention treatment option for patients requiring CVCs. The importance of these results should be considered in the context of federal government and insurance company policies that no longer permit enhanced reimbursement for CR-BSI.
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Affiliation(s)
- Xin Ye
- Ethicon, Inc, Somerville, NJ.
| | | | | | - Antoine Lafuma
- Cemka Eval Outcomes Research and Epidemiology, Bourg la Reine, France
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Bloodstream infection after positive catheter cultures: what are the risks in the intensive care unit when catheters are routinely cultured on removal? Crit Care Med 2011; 39:1301-5. [PMID: 21336118 DOI: 10.1097/ccm.0b013e3182120190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study was to assess whether an isolated positive catheter culture is predictive of a subsequent bloodstream infection in intensive care unit patients. DESIGN Retrospective clinical study between 2000 and 2007. SETTING Intensive care unit of a university hospital. SUBJECTS All arterial, central venous, and dialysis catheters yielding selected pathogenic microorganisms from isolated positive catheter cultures. Positive catheter culture was defined by a catheter tip culture performed with the Brun-Buisson technique yielding ≥103 colony-forming units/mL; isolated positive catheter culture by a positive catheter culture without concomitant bloodstream infection due to the microorganism of the positive catheter culture evidenced within 48 hrs before or after catheter removal; and subsequent bloodstream infection by a bloodstream infection developing between 48 hrs and 30 days after catheter removal and due to a selected pathogenic microorganism of an isolated positive catheter culture. Active antibiotic therapy was active if at least one of the antibiotics administered was effective against the selected pathogenic microorganism of the positive catheter culture. INTERVENTION None. MEASUREMENT AND MAIN RESULTS The end point of the study was the ratio of the number of subsequent bloodstream infections to that of selected pathogenic microorganisms isolated from positive catheter culture 30 days after catheter removal. A total of 138 isolated positive catheter cultures for 149 selected pathogenic micro-organisms was included in the study. Only two cases (1.3%) of subsequent bloodstream infection were evidenced, one resulting from Escherichia coli and the other from Staphylococcus epidermidis. The incidence of subsequent bloodstream infection did not differ with regard to the presence or absence of active antibiotics at catheter removal: zero of 23 vs. two of 121 (p = 1), respectively. CONCLUSIONS Our results suggest that the risk of subsequent bloodstream infection in intensive care unit patients when the Brun-Buisson technique is used to define isolated positive catheter culture is low.
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Should we still need to systematically perform catheter culture in the intensive care unit? Crit Care Med 2011; 39:1556-8. [PMID: 21610620 DOI: 10.1097/ccm.0b013e318215c0f3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Anti-infective external coating of central venous catheters: a randomized, noninferiority trial comparing 5-fluorouracil with chlorhexidine/silver sulfadiazine in preventing catheter colonization. Crit Care Med 2010; 38:2095-102. [PMID: 20711070 DOI: 10.1097/ccm.0b013e3181f265ba] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The antimetabolite drug, 5-fluorouracil, inhibits microbial growth. Coating of central venous catheters with 5-fluorouracil may reduce the risk of catheter infection. Our objective was to compare the safety and efficacy of central venous catheters externally coated with 5-fluorouracil with those coated with chlorhexidine and silver sulfadiazine. DESIGN Prospective, single-blind, randomized, active-controlled, multicentered, noninferiority trial. SETTING Twenty-five US medical center intensive care units. PATIENTS A total of 960 adult patients requiring central venous catheterization for up to 28 days. INTERVENTIONS Patients were randomized to receive a central venous catheter externally coated with either 5-fluorouracil (n = 480) or chlorhexidine and silver sulfadiazine (n = 480). MEASUREMENTS AND MAIN RESULTS The primary antimicrobial outcome was a dichotomous measure (<15 colony-forming units or ≥ 15 colony-forming units) for catheter colonization determined by the roll plate method. Secondary antimicrobial outcomes included local site infection and catheter-related bloodstream infection. Central venous catheters coated with 5-fluorouracil were noninferior to chlorhexidine and silver sulfadiazine coated central venous catheters with respect to the incidence of catheter colonization (2.9% vs. 5.3%, respectively). Local site infection occurred in 1.4% of the 5-fluorouracil group and 0.9% of the chlorhexidine and silver sulfadiazine group. No episode of catheter-related bloodstream infection occurred in the 5-fluorouracil group, whereas two episodes were noted in the chlorhexidine and silver sulfadiazine group. Only Gram-positive organisms were cultured from 5-fluorouracil catheters, whereas Gram-positive bacteria, Gram-negative bacteria, and Candida were cultured from the chlorhexidine and silver sulfadiazine central venous catheters. Adverse events were comparable between the two central venous catheter coatings. CONCLUSIONS Our results suggest that central venous catheters externally coated with 5-fluorouracil are a safe and effective alternative to catheters externally coated with chlorhexidine and silver sulfadiazine when used in critically ill patients.
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Recognition and prevention of nosocomial vascular device and related bloodstream infections in the intensive care unit. Crit Care Med 2010; 38:S363-72. [DOI: 10.1097/ccm.0b013e3181e6cdca] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Parienti JJ, Dugué AE, Daurel C, Mira JP, Mégarbane B, Mermel LA, Daubin C, du Cheyron D. Continuous renal replacement therapy may increase the risk of catheter infection. Clin J Am Soc Nephrol 2010; 5:1489-96. [PMID: 20558562 DOI: 10.2215/cjn.02130310] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Little is known about the risks of catheter-related infections in patients undergoing intermittent hemodialysis (IHD) as compared with continuous renal replacement therapy (CRRT) techniques. We compared the two modalities among critically ill adults requiring acute renal replacement therapy (RRT). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used the multicenter Cathedia study cohort of 736 critically ill adults requiring RRT. Cox marginal structural models were used to compare time to catheter-tip colonization at removal (intent-to-treat, primary endpoint) among patients who started IHD (n = 470) versus CRRT (n = 266). On-treatment analysis was also conducted to take into account changes in prescription of RRT modality. RESULTS Hazard rate of catheter-tip colonization did not increase within the first 10 days of catheter use. Predictors of catheter-tip colonization were higher lactate levels and hypertension, while systemic antibiotics, antiseptics-impregnated catheters, and mechanical ventilation were associated with decreased risk. The incidence of catheter-tip colonization per 1000 catheter-days was 42.7 in the IHD group and 27.7 in the CRRT group (P < 0.01). This association was no longer significant after correction for channeling bias (weighted HR, 0.96; 95% CI: 0.77 to 1.20, P = 0.73). On-treatment analysis revealed an increased risk of primary endpoint during CRRT exposure as compared with IHD exposure (weighted HR, 0.71; 95% CI: 0.56 to 0.92, P < 0.009). CONCLUSIONS Our results do not support the use of CRRT when IHD could be an alternative to reduce the risk of catheter-related infection.
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Affiliation(s)
- Jean-Jacques Parienti
- Biostatistics and Clinical Research, Côte de Nacre University Hospital, Caen, France.
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