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Marie D, Dahyot-Fizelier C, Barrau S, Boisson M, Frasca D, Jamet A, Chauvet S, Ferrand N, Pichot A, Mimoz O, Kerforne T. Impact of Radial Arterial Location on Catheter Lifetime in ICU Surgical Intensive Care. Crit Care Explor 2023; 5:e0905. [PMID: 37091478 PMCID: PMC10115551 DOI: 10.1097/cce.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
The use of arterial catheters is frequent in intensive care for hemodynamic monitoring of patients and for blood sampling, but they are often removed because of dysfunction. The primary objective is to compare the prevalence of radial arterial catheter dysfunction according to location in relation to the radiocarpal joint in intensive care patients. DESIGN Prospective randomized, controlled, single-center study. SETTING The surgical ICU of the university hospital of Poitiers in France. PATIENTS From January 2016 to April 2017, all patients over 18 years old admitted to the surgical ICU and requiring an arterial catheter were included. INTERVENTIONS Randomization into two groups: catheter placed near the wrist (within 4 cm of the radiocarpal joint) and catheter placed away the wrist. The primary endpoint was the prevalence of dysfunction. We also compared the prevalence of infection and colonization. MEASUREMENTS AND MAIN RESULTS One hundred seven catheters were analyzed (14 failed placements with no difference between the two groups, and 16 catheters excluded for missing data), with 58 catheters in near the wrist group and 49 in away the wrist group. We did not find any significant difference in the number of catheter dysfunctions between the two groups (p = 0.56). The prevalence density of catheter dysfunction was 30.5 of 1,000 catheter days for near the wrist group versus 26.7 of 1,000 catheter days for away the wrist group. However, we observed a significant difference in terms of catheter-related infection in favor of away the wrist group (p = 0.04). In addition, distal positioning of the catheter was judged easier by the physicians. CONCLUSIONS The distal or proximal position of the arterial catheter in the radial position has no influence on the occurrence of dysfunction. However, there may be an association with the prevalence of infections.
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Affiliation(s)
- Damien Marie
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Claire Dahyot-Fizelier
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- CHU de Poitiers, service des urgences, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Stéphanie Barrau
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Matthieu Boisson
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Denis Frasca
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Angeline Jamet
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Stéphane Chauvet
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Nathan Ferrand
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Amélie Pichot
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Olivier Mimoz
- CHU de Poitiers, service des urgences, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Thomas Kerforne
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- INSERM U1082 (IRTOMIT), Poitiers, France
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Niemann B, Dudas L, Gray D, Pettit A, Wilson A, Bardes JM. Biofilm Formation on Central Venous Catheters: A Pilot Study. J Surg Res 2022; 280:123-128. [PMID: 35964484 DOI: 10.1016/j.jss.2022.06.072] [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: 12/31/2021] [Revised: 06/15/2022] [Accepted: 06/29/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Central line-associated bloodstream infection is a complication with serious consequences and biofilm development is thought to play a role. This study evaluated the impact of sterilization technique on central venous catheter (CVC) biofilm formation. MATERIALS AND METHODS This pilot study was conducted in the surgical intensive care unit of a tertiary care facility. All CVCs were inserted with chlorhexidine preparation (CHG). CHG-only CVCs were compared to the use of CHG with chlorhexidine gluconate-impregnated sponge (CHGIS). After removal, a punch biopsy of the CVC was taken at the noted skin level. Scanning electron microscopy identified the stage of biofilm. Confocal laser scanning microscopy with SYPRO stain confirmed the presence of glycocalyx and a volumetric analysis was completed. RESULTS Twenty four CVCs were collected. Indications for line placement were similar, with 42% placed for sepsis in the CHGIS group and 33% in the CHG group. There were no positive line cultures or bacteremia and 2/12 CHGIS patients had candidemia. CHGIS lines were in place for a mean of 91 h, compared to 60 h with CHG alone (P = 0.19). The interior of CVCs had lower stage biofilms than the exterior and lacked stage 4 biofilms. Stage 4 biofilms were present externally on 50% of CVCs (8/12 CHG and 4/12 CHGIS). Stage 3 biofilms were present on 7/12 CHG and 6/12 CHGIS interior samples. Volume analysis found an increase in biofilm and glycocalyx in CHGIS compared to CHG samples. CONCLUSIONS This study identified biofilms on both surfaces of CVCs. No significant difference in biofilm formation was found based on a sterilization technique.
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Affiliation(s)
| | | | - Dana Gray
- Medical Center Drive, Morgantown, West Virginia
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Marwah P, Ramprakash S, Prasad T R S, Gizhlaryan M, Trivedi D, Shah V, Chitaliya A, Elizabeth S, Agarwal RK, Dhanya R, Faulkner L. Is it safe and efficacious to remove central lines in pediatric bone marrow transplant patients with platelets less than 20,000/μl? EJHAEM 2022; 3:154-158. [PMID: 35846206 PMCID: PMC9175805 DOI: 10.1002/jha2.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/08/2022]
Abstract
Background Patients with tunneled central venous lines (CVL) may develop bloodstream infections which at times are difficult to control without line removal. Concomitant severe thrombocytopenia with platelet transfusion refractoriness is often considered a major contraindication to any procedure involving a major blood vessel. There is very little literature on the clinical risks of tunneled central line removal in febrile pancytopenia patients. Procedure We analyzed complications and outcomes in all our patients, a total of 52, who underwent CVL removal with platelets <20,000/μl. Results CVL removal was done on a median day of 17.5 with 47 of the 52 patients never having achieved platelets engraftment prior to line removal. No bleeding episodes or unplanned transfusions could be associated with CVL removal. No other complications were also reported. All patients had time to hemostasis within 5 min of catheter removal. Removal of CVL under local anesthesia remained complication‐free even at platelet counts less than 20,000/ul. A total of 31 patients were febrile at the time of CVL removal, of which 17 became afebrile within 2 days. We found no difference in defervescence when comparing those whose antibiotic therapy was changed/escalated versus those in whom it was not. Conclusion Our findings suggest that central lines can be safely removed with platelet counts less than 20,000/ul and that this may result in enhanced bloodstream infection control. This might be particularly relevant to neutropenic patients in this day and age of multidrug‐resistant organism emergence and paucity of new effective antibiotics.
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Affiliation(s)
- Priya Marwah
- Department of Pediatrics Mahatma Gandhi University of Medical Sciences and Technology Jaipur India
| | - Stalin Ramprakash
- Sankalp India Foundation Bangalore India
- Sankalp‐People Tree Centre for Paediatric Bone Marrow Transplantation Bangalore India
| | - Sai Prasad T R
- Sankalp India Foundation Bangalore India
- Sankalp‐People Tree Centre for Paediatric Bone Marrow Transplantation Bangalore India
| | | | - Deepa Trivedi
- Sankalp India Foundation Bangalore India
- Sankalp‐CIMS Centre for Paediatric BMT Ahmedabad India
| | - Vaibhav Shah
- Sankalp India Foundation Bangalore India
- Sankalp‐CIMS Centre for Paediatric BMT Ahmedabad India
| | | | - Sandeep Elizabeth
- Sankalp India Foundation Bangalore India
- Sankalp‐People Tree Centre for Paediatric Bone Marrow Transplantation Bangalore India
| | - Rajat Kumar Agarwal
- Sankalp India Foundation Bangalore India
- Jagriti InnoHealth Platforms Pvt. Ltd. Bangalore India
| | | | - Lawrence Faulkner
- Sankalp India Foundation Bangalore India
- Cure2Children Foundation Florence Italy
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Hospital-Acquired Blood Stream Infection in an Adult Intensive Care Unit. Crit Care Res Pract 2021; 2021:3652130. [PMID: 34285815 PMCID: PMC8275436 DOI: 10.1155/2021/3652130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Hospital-acquired blood stream infections are a common and serious complication in critically ill patients. Methods A retrospective case series was undertaken investigating the incidence and causes of bacteraemia in an adult intensive care unit with a high proportion of postoperative cardiothoracic surgical and oncology patients. Results 405 eligible patients were admitted to the intensive care unit over the course of nine months. 12 of these patients developed a unit-acquired blood stream infection. The average Acute Physiology And Chronic Health Evaluation II (APACHE II) score of patients who developed bacteraemia was greater than that of those who did not (19.8 versus 16.8, respectively). The risk of developing bacteraemia was associated with intubation and higher rates of invasive procedures. The mortality rate amongst the group of patients that developed bacteraemia was 33%; this is in contrast to the mortality rate in our unit as 27.2%. There was a higher proportion of Gram-negative bacteria isolated on blood cultures (9 out of 13 isolates) than in intensive care units reported in other studies. Conclusion Critical-care patients are at risk of secondary bloodstream infection. This study highlights the importance of measures to reduce the risk of infection in the intensive-care setting, particularly in patients who have undergone invasive procedures.
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Incidence, Risk Factors, and Attributable Mortality of Catheter-Related Bloodstream Infections in the Intensive Care Unit After Suspected Catheters Infection: A Retrospective 10-year Cohort Study. Infect Dis Ther 2021; 10:985-999. [PMID: 33861420 PMCID: PMC8051286 DOI: 10.1007/s40121-021-00429-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/27/2021] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Catheter management strategies for suspected catheter-related bloodstream infection (CRBSI) remain a major challenge in intensive care units (ICUs). The objective of this study was to determine the incidence, risk factors, and mortality attributable to CRBSIs in those patients. METHODS A population-based surveillance on suspected CRBSI was conducted from 2009 to 2018 in a tertiary care hospital in China. We used the results of catheter tip culture to identify patients with suspected CRBSIs. Demographics, systemic inflammatory response syndrome (SIRS) criteria, interventions, and microorganism culture results were analysed and compared between patients with and without confirmed CRBSIs. Univariate and multivariate analyses identified the risk factors for CRBSIs, and attributable mortality was evaluated with a time-varying Cox proportional hazard model. RESULTS In total, 686 patients with 795 episodes of suspected CRBSIs were included; 19.2% (153/795) episodes were confirmed as CRBSIs, and 17.4% (119/686) patients died within 30 days. The multifactor model shows that CRBSIs were associated with fever, hypotension, acute respiratory distress syndrome, hyperglycaemia and the use of continuous renal replacement therapy. The AUC was 77.0% (95% CI 73.3%-80.7%). The population attributable mortality fraction of CRBSI in patients was 18.2%, and mortality rate did not differ significantly between patients with and without CRBSIs (95% CI 0.464-1.279, P = 0.312). CONCLUSIONS This initial model based on the SIRS criteria is relatively better at identifying patients with CRBSI but only in domains of the sensitivity. There were no significant differences in attributable mortality due to CRBSI and other causes in patients with suspected CRBSI, which prompt catheter removal and re-insertion of new catheter may not benefit patients with suspected CRBSIs. TRIAL REGISTRATION China Clinical Trials Registration number; ChiCTR1900022175.
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Zhu Q, Zhu M, Li C, Li L, Guo M, Yang Z, Zhang Z, Liang Z. Epidemiology and microbiology of Gram-negative bloodstream infections in a tertiary-care hospital in Beijing, China: a 9-year retrospective study. Expert Rev Anti Infect Ther 2020; 19:769-776. [PMID: 33187451 DOI: 10.1080/14787210.2021.1848544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Gram-negative bacterial bloodstream infections (BSIs) are associated with high morbidity and mortality. The present study examines the incidence, clinical characteristics, microbiological features, drug resistance and mortality associated with Gram-negative bacterial BSIs at a tertiary-care hospital in Beijing, China.Methods: This retrospective cohort study of patients with Gram-negative bacterial BSIs was performed between 1 January 2010 and 31 December 2018 at the Chinese People,s Liberation Army General Hospital.Results: A total of 6867 episodes of Gram-negative bacterial BSIs occurred among 3199 patients over 9 years. The overall incidence of Gram-negative bacterial BSIs fluctuated from 2.30 to 2.55 episodes per 1000 admissions over 9 years. Escherichia coli was the major pathogen (34.3%). The antibiotic resistance of ESBLs-producing E. coli was higher than non-ESBLs producing E. coli including the majority of antibiotics, but to carbapenems (0.7% VS 5.1%). Between 2010 and 2018, the overall mortality of Gram-negative bacterial BSIs decreased from 11.41% to 9.05% (X2 = 6.95, P = 0.434).Conclusions: Cephalosporins and carbapenem antibiotics were considered as the optimal treatment for patients with Gram-negative bacterial BSIs except for A. baumannii, which was treated according to the drug sensitivity or multidrug combination.
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Affiliation(s)
- Qiang Zhu
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Minghui Zhu
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Chunyan Li
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Lina Li
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Mingxue Guo
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhen Yang
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhaorui Zhang
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhixin Liang
- Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China
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Scarborough M, Li HK, Rombach I, Zambellas R, Walker AS, McNally M, Atkins B, Kümin M, Lipsky BA, Hughes H, Bose D, Warren S, Mack D, Folb J, Moore E, Jenkins N, Hopkins S, Seaton RA, Hemsley C, Sandoe J, Aggarwal I, Ellis S, Sutherland R, Geue C, McMeekin N, Scarborough C, Paul J, Cooke G, Bostock J, Khatamzas E, Wong N, Brent A, Lomas J, Matthews P, Wangrangsimakul T, Gundle R, Rogers M, Taylor A, Thwaites GE, Bejon P. Oral versus intravenous antibiotics for bone and joint infections: the OVIVA non-inferiority RCT. Health Technol Assess 2020; 23:1-92. [PMID: 31373271 DOI: 10.3310/hta23380] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Management of bone and joint infection commonly includes 4-6 weeks of intravenous (IV) antibiotics, but there is little evidence to suggest that oral (PO) therapy results in worse outcomes. OBJECTIVE To determine whether or not PO antibiotics are non-inferior to IV antibiotics in treating bone and joint infection. DESIGN Parallel-group, randomised (1 : 1), open-label, non-inferiority trial. The non-inferiority margin was 7.5%. SETTING Twenty-six NHS hospitals. PARTICIPANTS Adults with a clinical diagnosis of bone, joint or orthopaedic metalware-associated infection who would ordinarily receive at least 6 weeks of antibiotics, and who had received ≤ 7 days of IV therapy from definitive surgery (or start of planned curative treatment in patients managed non-operatively). INTERVENTIONS Participants were centrally computer-randomised to PO or IV antibiotics to complete the first 6 weeks of therapy. Follow-on PO therapy was permitted in either arm. MAIN OUTCOME MEASURE The primary outcome was the proportion of participants experiencing treatment failure within 1 year. An associated cost-effectiveness evaluation assessed health resource use and quality-of-life data. RESULTS Out of 1054 participants (527 in each arm), end-point data were available for 1015 (96.30%) participants. Treatment failure was identified in 141 out of 1015 (13.89%) participants: 74 out of 506 (14.62%) and 67 out of 509 (13.16%) of those participants randomised to IV and PO therapy, respectively. In the intention-to-treat analysis, using multiple imputation to include all participants, the imputed risk difference between PO and IV therapy for definitive treatment failure was -1.38% (90% confidence interval -4.94% to 2.19%), thus meeting the non-inferiority criterion. A complete-case analysis, a per-protocol analysis and sensitivity analyses for missing data each confirmed this result. With the exception of IV catheter complications [49/523 (9.37%) in the IV arm vs. 5/523 (0.96%) in the PO arm)], there was no significant difference between the two arms in the incidence of serious adverse events. PO therapy was highly cost-effective, yielding a saving of £2740 per patient without any significant difference in quality-adjusted life-years between the two arms of the trial. LIMITATIONS The OVIVA (Oral Versus IntraVenous Antibiotics) trial was an open-label trial, but bias was limited by assessing all potential end points by a blinded adjudication committee. The population was heterogenous, which facilitated generalisability but limited the statistical power of subgroup analyses. Participants were only followed up for 1 year so differences in late recurrence cannot be excluded. CONCLUSIONS PO antibiotic therapy is non-inferior to IV therapy when used during the first 6 weeks in the treatment for bone and joint infection, as assessed by definitive treatment failure within 1 year of randomisation. These findings challenge the current standard of care and provide an opportunity to realise significant benefits for patients, antimicrobial stewardship and the health economy. FUTURE WORK Further work is required to define the optimal total duration of therapy for bone and joint infection in the context of specific surgical interventions. Currently, wide variation in clinical practice suggests significant redundancy that likely contributes to the excess and unnecessary use of antibiotics. TRIAL REGISTRATION Current Controlled Trials ISRCTN91566927. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 38. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Matthew Scarborough
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ho Kwong Li
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Division of Infectious Diseases, Imperial College London, London, UK
| | - Ines Rombach
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Rhea Zambellas
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - A Sarah Walker
- MRC Clinical Trials Unit, University College London, London, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Martin McNally
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Bridget Atkins
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michelle Kümin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Harriet Hughes
- Department of Microbiology and Public Health, University Hospital of Wales, Public Health Wales, Cardiff, Wales
| | - Deepa Bose
- Department of Orthopaedic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Warren
- Infectious Diseases and Microbiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.,Infectious Diseases and Microbiology, Royal Free London NHS Foundation Trust, London, UK
| | - Damien Mack
- Infectious Diseases and Microbiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.,Infectious Diseases and Microbiology, Royal Free London NHS Foundation Trust, London, UK
| | - Jonathan Folb
- Department of Microbiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Elinor Moore
- Infectious Diseases and Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Neil Jenkins
- Infectious Diseases, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Susan Hopkins
- Infectious Diseases and Microbiology, Royal Free London NHS Foundation Trust, London, UK
| | - R Andrew Seaton
- Infectious Diseases and Microbiology, Gartnaval General Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Carolyn Hemsley
- Department of Microbiology and Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan Sandoe
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ila Aggarwal
- Department of Microbiology and Infectious Diseases, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Simon Ellis
- Infectious Diseases, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Rebecca Sutherland
- Infectious Diseases Unit, Regional Infectious Diseases Unit, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | | | - John Paul
- National Infection Service, Public Health England, Horsham, UK
| | - Graham Cooke
- Division of Infectious Diseases, Imperial College London, London, UK
| | - Jennifer Bostock
- Patient and Public Representative, Division of Health and Social Care Research, King's College London, , London, UK
| | - Elham Khatamzas
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nick Wong
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Brent
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jose Lomas
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Philippa Matthews
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tri Wangrangsimakul
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Roger Gundle
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark Rogers
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian Taylor
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Guy E Thwaites
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Philip Bejon
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Clinical impact of early reinsertion of a central venous catheter after catheter removal in patients with catheter-related bloodstream infections. Infect Control Hosp Epidemiol 2020; 42:162-168. [PMID: 32900398 DOI: 10.1017/ice.2020.405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Early replacement of a new central venous catheter (CVC) may pose a risk of persistent or recurrent infection in patients with a catheter-related bloodstream infection (CRBSI). We evaluated the clinical impact of early CVC reinsertion after catheter removal in patients with CRBSIs. METHODS We conducted a retrospective chart review of adult patients with confirmed CRBSIs in 2 tertiary-care hospitals over a 7-year period. RESULTS To treat their infections, 316 patients with CRBSIs underwent CVC removal. Among them, 130 (41.1%) underwent early CVC reinsertion (≤3 days after CVC removal), 39 (12.4%) underwent delayed reinsertion (>3 days), and 147 (46.5%) did not undergo CVC reinsertion. There were no differences in baseline characteristics among the 3 groups, except for nontunneled CVC, presence of septic shock, and reason for CVC reinsertion. The rate of persistent CRBSI in the early CVC reinsertion group (22.3%) was higher than that in the no CVC reinsertion group (7.5%; P = .002) but was similar to that in the delayed CVC reinsertion group (17.9%; P > .99). The other clinical outcomes did not differ among the 3 groups, including rates of 30-day mortality, complicated infection, and recurrence. After controlling for several confounding factors, early CVC reinsertion was not significantly associated with persistent CRBSI (OR, 1.59; P = .35) or 30-day mortality compared with delayed CVC reinsertion (OR, 0.81; P = .68). CONCLUSIONS Early CVC reinsertion in the setting of CRBSI may be safe. Replacement of a new CVC should not be delayed in patients who still require a CVC for ongoing management.
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Malek AE, Raad II. Preventing catheter-related infections in cancer patients: a review of current strategies. Expert Rev Anti Infect Ther 2020; 18:531-538. [PMID: 32237923 DOI: 10.1080/14787210.2020.1750367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Central line-associated bloodstream infections (CLABSI) are a frequent cause of healthcare-associated infections, increasing healthcare costs and decreasing the quality of life for critically and chronically ill patients such as those with cancer. These infections are largely preventable and have been significantly reduced throughout the United States. However, further reduction of CLABSI requires continued innovation in preventive strategies.Areas covered: We provide an overview of the recent medical literature on catheter-related infections among cancer patients, discussing epidemiology, risk factors, and pathogenesis of CLABSI with a focus on the newest and current preventive measures. The data discussed here were retrieved mainly from clinical trials, meta-analyses, and systematic reviews published in the English language using a MEDLINE database search from 1 January 1990 until the end of December 2019.Expert opinion: The growing impact of CLABSI on the healthcare setting and mortality and morbidity rates in cancer patients calls for novel technologies for preventing central line-related infections. Advances in antimicrobial lock therapy are not limited to salvage therapy but have also provided a novel and promising prophylactic approach to CLABSI. Also, the use of antimicrobial-coated catheters with chlorhexidine-impregnated dressings, along with the application of insertion and maintenance bundles, is an effective and cost-effective approach for preventing central line-related infections.
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Affiliation(s)
- Alexandre E Malek
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Dumpa V, Adler B, Allen D, Bowman D, Gram A, Ford P, Sannoh S. Reduction in Central Line-Associated Bloodstream Infection Rates After Implementations of Infection Control Measures at a Level 3 Neonatal Intensive Care Unit .. Am J Med Qual 2019; 34:488-493. [PMID: 31479293 DOI: 10.1177/1062860619873777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Advances in neonatology led to survival of micro-preemies, who need central lines. Central line-associated bloodstream infection (CLABSI) causes prolonged hospitalization, morbidities, and mortality. Health care team education decreases CLABSIs. The objective was to decrease CLABSIs using evidence-based measures. The retrospective review compared CLABSI incidence during and after changes in catheter care. In April 2011, intravenous (IV) tubing changed from Interlink to Clearlink; IV tubing changing interval increased from 24 to 72 hours. CLABSIs increased. The following measures were implemented: July 2011, reeducation of neonatal intensive care staff on Clearlink; August 2011, IV tubing changing interval returned to 24 hours; September 2011, changed from Clearlink back to Interlink; November 2011, review of entire IV process and in-service on hand hygiene; December 2011, competencies on IV access for all nurses. CLABSIs were compared during and after interventions. Means were compared using the t test and ratios using the χ2 test; P <.05. CLABSIs decreased from 4.4/1000 to 0/1000 catheter-days; P < .05. Evidence-based interventions reduced CLABSIs.
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Affiliation(s)
| | - Bonny Adler
- 2 Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ
| | - Delena Allen
- 2 Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ
| | - Deborah Bowman
- 2 Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ
| | - Amy Gram
- 3 Saint Peter's University Hospital, New Brunswick, NY
| | - Pat Ford
- 3 Saint Peter's University Hospital, New Brunswick, NY
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Menaker J, Galvagno S, Rabinowitz R, Penchev V, Hollis A, Kon Z, Deatrick K, Amoroso A, Herr D, Mazzeffi M. Epidemiology of blood stream infection in adult extracorporeal membrane oxygenation patients: A cohort study. Heart Lung 2019; 48:236-239. [DOI: 10.1016/j.hrtlng.2019.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/04/2019] [Accepted: 01/13/2019] [Indexed: 12/12/2022]
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12
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Lee BJ, Wang SK, Constantino-Corpuz JK, Apolinario K, Nadler B, McDanel JS, Scheetz MH, Rhodes NJ. Cefazolin vs. anti-staphylococcal penicillins for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections in acutely ill adult patients: Results of a systematic review and meta-analysis. Int J Antimicrob Agents 2019; 53:225-233. [DOI: 10.1016/j.ijantimicag.2018.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/06/2018] [Accepted: 11/17/2018] [Indexed: 12/21/2022]
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13
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Blood Culture Collection in Patients with Acute Kidney Injury Receiving Renal Replacement Therapy: An Observational Study. Anaesth Intensive Care 2019; 40:813-9. [DOI: 10.1177/0310057x1204000509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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14
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Armour AL, Patrick ME, Reddy Z, Sibanda W, Naidoo L, Spicer KB. Healthcare-associated infection in the Grey’s Hospital paediatric intensive care unit: does an Infection Control Programme work? S Afr J Infect Dis 2018. [DOI: 10.1080/23120053.2018.1548677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Anne L Armour
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Grey’s Hospital, Pietermaritzburg, South Africa
| | - Mark E Patrick
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Grey’s Hospital, Pietermaritzburg, South Africa
| | - Zelda Reddy
- Grey’s Hospital, Pietermaritzburg, South Africa
- Infection Prevention and Control Department, Greys Hospital, Pietermaritzburg, South Africa
| | - Wilbert Sibanda
- Statistics Unit, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Kevin B Spicer
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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15
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Zhu Q, Yue Y, Zhu L, Cui J, Zhu M, Chen L, Yang Z, Liang Z. Epidemiology and microbiology of Gram-positive bloodstream infections in a tertiary-care hospital in Beijing, China: a 6-year retrospective study. Antimicrob Resist Infect Control 2018; 7:107. [PMID: 30202520 PMCID: PMC6122739 DOI: 10.1186/s13756-018-0398-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/21/2018] [Indexed: 01/23/2023] Open
Abstract
Background Gram-positive bacterial bloodstream infections (BSIs) are serious diseases associated with high morbidity and mortality. The following study examines the incidence, clinical characteristics and microbiological features, drug resistance situations and mortality associated with Gram-positive BSIs at a large Chinese tertiary-care hospital in Beijing, China. Methods A retrospective cohort study of patients with Gram-positive BSIs was performed between January 1, 2011, and June 31, 2017, at the Chinese People’s Liberation Army General Hospital. The patients’ data were collected and included in the reviewing electronic medical records. Results A total of 6887 episodes of Gram-positive BSIs occurred among 4275 patients over 6 years, and there were 3438 significant BSI episodes 69% of these cases were healthcare-associated, while 31% were community-associated. The overall incidence of Gram-positive BSIs fluctuated from 7.26 to 4.63 episodes per 1000 admissions over 6 years. Malignancy was the most common comorbidity and indwelling central intravenous catheter was the most common predisposing factor for BSI. Staphylococci were the major pathogen (65.5%), followed by Enterococcus spp:(17.5%), Streptococcus spp.(7.1%) and other bacterial pathogens (9.9%). The resistance rates of Staphylococci and E.faecium to penicillins were more than 90%. the vancomycin-resistant isolates were E. faecium (4.1%) and staphylococcus epidermidis (0.13%); and only E.faecalis and E.faecium showed resistance to linezolid (3.8% and 3.1%). Between 2011 and 2017, the overall mortality of Gram-positive BSIs decreased from 6.27 to 4.75% (X2 = 0.912, p = 0.892). Neverthess, the mortality in the ICU decreased from 60.46 to 47.82%, while in the general ward it increased from 39.54 to 52.18%. Conclusions The morbidity and mortality of Gram-positive BSIs have showed downward trends. Vancomycin and linezolid are still consider the best treatment for patients with Gram-positive BSIs.
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Affiliation(s)
- Qiang Zhu
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Yan Yue
- 3The postgraduate department, Chinese PLA General Hospital, Beijing, 100853 China
| | - Lichen Zhu
- Department of Respiratory Medicine, Affiliated Hospital of Nantong Third People's Hospital, Qingnian Central Street No. 99, Jiangsu Province, 226000 China
| | - Jiewei Cui
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Minghui Zhu
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Liangan Chen
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Zhen Yang
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
| | - Zhixin Liang
- 1Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853 China
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16
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Shankar-Hari M, Harrison DA, Rowan KM, Rubenfeld GD. Estimating attributable fraction of mortality from sepsis to inform clinical trials. J Crit Care 2018; 45:33-39. [DOI: 10.1016/j.jcrc.2018.01.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 11/17/2022]
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Cost-effectiveness analysis of chlorhexidine-alcohol versus povidone iodine-alcohol solution in the prevention of intravascular-catheter-related bloodstream infections in France. PLoS One 2018; 13:e0197747. [PMID: 29799871 PMCID: PMC5969756 DOI: 10.1371/journal.pone.0197747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/06/2018] [Indexed: 11/20/2022] Open
Abstract
Objective To perform a cost-effectiveness analysis of skin antiseptic solutions (chlorhexidine-alcohol (CHG) versus povidone iodine-alcohol solution (PVI)) for the prevention of intravascular-catheter-related bloodstream infections (CRBSI) in intensive care unit (ICU) in France based on an open-label, multicentre, randomised, controlled trial (CLEAN). Design A 100-day time semi-markovian model was performed to be fitted to longitudinal individual patient data from CLEAN database. This model includes eight health states and probabilistic sensitivity analyses on cost and effectiveness were performed. Costs of intensive care unit stay are based on a French multicentre study and the cost-effectiveness criterion is the cost per patient with catheter-related bloodstream infection avoided. Patients 2,349 patients (age≥18 years) were analyzed to compare the 1-time CHG group (CHG-T1, 588 patients), the 4-time CHG group (CHG-T4, 580 patients), the 1-time PVI group (PVI-T1, 587 patients), and the 4-time PVI group (PVI-T4, 594 patients). Intervention 2% chlorhexidine-70% isopropyl alcohol (chlorhexidine-alcohol) compared to 5% povidone iodine-69% ethanol (povidone iodine-alcohol). Results The mean cost per alive, discharged or dead patient was of €23,798 (95% confidence interval: €20,584; €34,331), €21,822 (€18,635; €29,701), €24,874 (€21,011; €31,678), and €24,201 (€20,507; €29,136) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. The mean number of patients with CRBSI per 1000 patients was of 3.49 (0.42; 12.57), 6.82 (1.86; 17.38), 26.04 (14.64; 42.58), and 23.05 (12.32; 39.09) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. In comparison to the 1-time PVI solution, the 1-time CHG solution avoids 22.55 CRBSI /1,000 patients, and saves €1,076 per patient. This saving is not statistically significant at a 0.05 level because of the overlap of 95% confidence intervals for mean costs per patient in each group. Conversely, the difference in effectiveness between the CHG-T1 solution and the PVI-T1 solution is statistically significant. Conclusions The CHG-T1 solution is more effective at the same cost than the PVI-T1 solution. CHG-T1, CHG-T4 and PVI-T4 solutions are statistically comparable for cost and effectiveness. This study is based on the data from the RCT from 11 French intensive care units registered with www.clinicaltrials.gov (NCT01629550).
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18
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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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19
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Buchman A, Spapperi J, Leopold P. A New Central venous Catheter Cap: Decreased Microbial Growth and Risk for Catheter-Related Bloodstream Infection. J Vasc Access 2018; 10:11-21. [DOI: 10.1177/112972980901000103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Catheter-related blood stream infection (CRBI) is a major cause of morbidity and mortality, and is a source of significant healthcare expenditures in patients that require central venous catheters for intravenous nutrition, chemotherapy, and other products. The source of many catheter-related infections is contamination of the catheter hub. Herein an antimicrobial catheter cap, the AB Cap is described. Methods The AB Cap device is a catheter cleaning device designed to keep needleless luer valves clean by encapsulating them in a cleaning solution. This device was evaluated using an in vitro model of hub contamination with Staphylococcus aureus, Staphylococcus epidermidis (S. epidermidis), Klebsiella pneumonia (K. pneumonia), Pseudomonas aeruginosa, Escherichia coli and Candida albicans (C. albicans). Following hub contamination on days 1, 3, 5 and 7, saline was infused through the AB Cap and effluent collected from the efferent end. The effluent fluid was cultured for the index organisms, and allowed to incubate in culture for up to 7 days. Negative control caps were not contaminated and positive controls lacked cleaning solution and were contaminated. Results Microbial growth developed for all index organisms, and generally within 1 day of culture growth following the first day of contamination (day 1) in effluent from all positive controls, while no growth occurred in effluent from negative controls. No growth of any organism occurred in any of the test items after the first day of contamination. Growth of three organisms was detected in two of the three test AB Caps following contamination day 3, after 1–4 days of incubation. All organisms could be cultured in the effluent from two of the three test items at contamination day 5, generally by the second day of incubation. One test item remained free of growth for the entire test period except for one organism. By day 7, this particular test item grew an additional organism and the testing was concluded. All positive growth test items remained positive on subsequent inoculations during culture of newly obtained effluent with the exception of test item A, from which effluent following inoculation on day 3 showed growth of S. epidermidis and K. pneumonia, but no growth for these organisms from effluent obtained on inoculation day 5. In addition, effluent from test item C showed growth of C. albicans from inoculation day 5, but no growth from effluent obtained on inoculation day 7. The growth of S. epidermidis from effluent of test item A from the day 3 inoculation, and C. albicans from effluent of test items B and C did not occur until day 4 of incubation, suggesting a very small amount of contamination. Conclusion An antimicrobial catheter cap is not a complete substitute for a proper catheter cleaning technique and other anti-infection precautions. However, we describe a unique catheter cap that significantly decreased the likelihood of a catheter-related infection from a non-cleaned cap in an in vitro model.
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Affiliation(s)
- A.L. Buchman
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL - USA
| | - J. Spapperi
- Medical Murray, Inc. North Barrington, IL - USA
| | - P. Leopold
- Medical Murray, Inc. North Barrington, IL - USA
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20
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Abstract
Promoting patient safety and increasing health care quality have dominated the health care landscape during the last 15 years. Health care regulators and payers are now tying patient safety outcomes and best practices to hospital reimbursement. Many health care leaders are searching for new technologies that not only make health care for patients safer but also reduce overall health care costs. New advances in ultrasonography have made this technology available to health care providers at the patient's bedside. Point-of-care ultrasound assistance now aids providers with real-time diagnosis and with visualization for procedural guidance. This is especially true for common deep needle procedures such as central venous catheter insertion, thoracentesis, and paracentesis.There is now mounting evidence that clinician-performed point-of-care ultrasound improves patient safety, enhances health care quality, and reduces health care cost for deep needle procedures. Furthermore, the miniaturization, ease of use, and the evolving affordability of ultrasound have now made this technology widely available. The adoption of point-of-care ultrasonography has reached a tipping point and should be seriously considered the safety standard for all hospital-based deep needle procedures.
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21
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Ullman AJ, Kleidon T, Cooke M, Rickard CM. Substantial harm associated with failure of chronic paediatric central venous access devices. BMJ Case Rep 2017; 2017:bcr-2016-218757. [PMID: 28687683 DOI: 10.1136/bcr-2016-218757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Central venous access devices (CVADs) form an important component of modern paediatric healthcare, especially for children with chronic health conditions such as cancer or gastrointestinal disorders. However device failure and complications rates are high.Over 2½ years, a child requiring parenteral nutrition and associated vascular access dependency due to 'short gut syndrome' (intestinal failure secondary to gastroschisis and resultant significant bowel resection) had ten CVADs inserted, with ninesubsequently failing. This resulted in multiple anaesthetics, invasive procedures, injuries, vascular depletion, interrupted nutrition, delayed treatment and substantial healthcare costs. A conservative estimate of the institutional costs for each insertion, or rewiring, of her tunnelled CVAD was $A10 253 (2016 Australian dollars).These complications and device failures had significant negative impact on the child and her family. Considering the commonality of conditions requiring prolonged vascular access, these failures also have a significant impact on international health service costs.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing and Midwifery, Griffith University, Nathan, Australia.,Paediatric Critical Care Research Group, Lady Cilento Children's Hospital, Brisbane, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia.,Department of Anaesthetics, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Nathan, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia
| | - Claire M Rickard
- School of Nursing and Midwifery, Griffith University, Nathan, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, Queensland, Australia
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22
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Gominet M, Compain F, Beloin C, Lebeaux D. Central venous catheters and biofilms: where do we stand in 2017? APMIS 2017; 125:365-375. [PMID: 28407421 DOI: 10.1111/apm.12665] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/29/2016] [Indexed: 12/28/2022]
Abstract
The use of central venous catheters (CVC) is associated with a risk of microbial colonization and subsequent potentially severe infection. Microbial contamination of the catheter leads to the development of a microbial consortia associated with the CVC surface and embedded in an extracellular matrix, named biofilm. This biofilm provides bacterial cells the ability to survive antimicrobial agents and the host immune system and to disseminate to other sites of the body. The best preventive strategy is to avoid any unnecessary catheterization or to reduce indwelling duration when a CVC is required. Beside aseptic care and antibiotic-impregnated catheters (like minocycline/rifampin), preventive locks can be proposed in some cases, whereas non-biocidal approaches are under active research like anti-adhesive or competitive interactions strategies. When the diagnosis of catheter-related bloodstream infection (CRBSI) is suspected on clinical symptoms, it requires a microbiological confirmation by paired blood cultures in order to avoid unnecessary catheter removal. The treatment of CRBSI relies on catheter removal and systemic antimicrobials. However, antibiotic lock technique (ALT) can be used as an attempt to eradicate biofilm formed on the inside lumen of the catheter in case of uncomplicated long-term catheter-related BSI caused by coagulase-negative staphylococci (CoNS) or Enterobacteriaceae. Recently, promising strategies have been developed to improve biofilm eradication; they rely on matrix degradation or destabilization or the development of anti-persister compounds, targeting the most tolerant bacterial cells inside the biofilm. Understanding biofilm formation at the molecular level may help us to develop new approaches to prevent or treat these frequent infections.
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Affiliation(s)
- Marie Gominet
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Paris, France
| | - Fabrice Compain
- Université Paris Descartes, Paris, France.,Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Christophe Beloin
- Unité de Génétique des Biofilms, Département de Microbiologie, Institut Pasteur, Paris, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Paris, France
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23
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Adrie C, Garrouste-Orgeas M, Ibn Essaied W, Schwebel C, Darmon M, Mourvillier B, Ruckly S, Dumenil AS, Kallel H, Argaud L, Marcotte G, Barbier F, Laurent V, Goldgran-Toledano D, Clec'h C, Azoulay E, Souweine B, Timsit JF. Attributable mortality of ICU-acquired bloodstream infections: Impact of the source, causative micro-organism, resistance profile and antimicrobial therapy. J Infect 2016; 74:131-141. [PMID: 27838521 DOI: 10.1016/j.jinf.2016.11.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 10/05/2016] [Accepted: 11/02/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES ICU-acquired bloodstream infection (ICUBSI) in Intensive Care unit (ICU) is still associated with a high mortality rate. The increase of antimicrobial drug resistance makes its treatment increasingly challenging. METHODS We analyzed 571 ICU-BSI occurring amongst 10,734 patients who were prospectively included in the Outcomerea Database and who stayed at least 4 days in ICU. The hazard ratio of death associated with ICU-BSI was estimated using a multivariate Cox model adjusted on case mix, patient severity and daily SOFA. RESULTS ICU-BSI was associated with increased mortality (HR, 1.40; 95% CI, 1.16-1.69; p = 0.0004). The relative increase in the risk of death was 130% (HR, 2.3; 95% CI, 1.8-3.0) when initial antimicrobial agents within a day of ICU-BSI onset were not adequate, versus only 20% (HR, 1.2; 95% CI, 0.9-1.5) when an adequate therapy was started within a day. The adjusted hazard ratio of death was significant overall, and even higher when the ICU-BSI source was pneumonia or unknown origin. When treated with appropriate antimicrobial agents, the death risk increase was similar for ICU-BSI due to multidrug resistant pathogens or susceptible ones. Interestingly, combination therapy with a fluoroquinolone was associated with more favorable outcome than monotherapy, whereas combination with aminoglycoside was associated with similar mortality than monotherapy. CONCLUSIONS ICU-BSI was associated with a 40% increase in the risk of 30-day mortality, particularly if the early antimicrobial therapy was not adequate. Adequacy of antimicrobial therapy, but not pathogen resistance pattern, impacted attributable mortality.
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Affiliation(s)
- Christophe Adrie
- Physiology Department, Cochin University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Descartes University, Paris, France.
| | - Maité Garrouste-Orgeas
- INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Medical-Surgical Intensive Care Unit, Saint Joseph Hospital, Paris, France
| | | | - Carole Schwebel
- Medical Intensive Care Unit, Michallon University Hospital, Grenoble, France
| | - Michael Darmon
- Medical ICU, Saint-Etienne University Hospital, Saint-Priest en Jarez, France
| | - Bruno Mourvillier
- INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Medical Intensive Care Unit, Assistance Publique des Hôpitaux de Paris (AP-HP), Bichat University Hospital, Paris, France
| | - Stéphane Ruckly
- INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Outcomerea Network, Paris, France
| | - Anne-Sylvie Dumenil
- Medical-Surgical Intensive Care Unit, Antoine Béclère University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Clamart, France
| | - Hatem Kallel
- Medical-Surgical Intensive Care Unit, Centre hospitalier de Cayenne, Guyane, France
| | - Laurent Argaud
- Medical-Intensive Care Unit, Edouard Heriot Hospital, Lyon University Hospital, Lyon, France
| | - Guillaume Marcotte
- Surgical-Intensive Care Unit, Edouard Heriot Hospital, Lyon University Hospital, Lyon, France
| | - Francois Barbier
- Medical Intensive Care Unit, La Source Hospital - CHR Orléans, Orléans, France
| | - Virginie Laurent
- Medical-Surgical Intensive Care Unit, André Mignot Hospital, Versailles-Le Chesnay, France
| | | | - Christophe Clec'h
- INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Medical Intensive Care Unit, Assistance Publique des Hôpitaux de Paris (AP-HP), Avicenne University Hospital, Bobigny, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-François Timsit
- INSERM, IAME, UMR 1137, Team DesCID, F-75018 Paris, France; Medical Intensive Care Unit, Assistance Publique des Hôpitaux de Paris (AP-HP), Bichat University Hospital, Paris, France
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24
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Thokala P, Arrowsmith M, Poku E, Martyn-St James M, Anderson J, Foster S, Elliott T, Whitehouse T. Economic impact of Tegaderm chlorhexidine gluconate (CHG) dressing in critically ill patients. J Infect Prev 2016; 17:216-223. [PMID: 27582899 PMCID: PMC4994702 DOI: 10.1177/1757177416657162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/28/2016] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To estimate the economic impact of a TegadermTM chlorhexidine gluconate (CHG) gel dressing compared with a standard intravenous (i.v.) dressing (defined as non-antimicrobial transparent film dressing), used for insertion site care of short-term central venous and arterial catheters (intravascular catheters) in adult critical care patients using a cost-consequence model populated with data from published sources. MATERIAL AND METHODS A decision analytical cost-consequence model was developed which assigned each patient with an indwelling intravascular catheter and a standard dressing, a baseline risk of associated dermatitis, local infection at the catheter insertion site and catheter-related bloodstream infections (CRBSI), estimated from published secondary sources. The risks of these events for patients with a Tegaderm CHG were estimated by applying the effectiveness parameters from the clinical review to the baseline risks. Costs were accrued through costs of intervention (i.e. Tegaderm CHG or standard intravenous dressing) and hospital treatment costs depended on whether the patients had local dermatitis, local infection or CRBSI. Total costs were estimated as mean values of 10,000 probabilistic sensitivity analysis (PSA) runs. RESULTS Tegaderm CHG resulted in an average cost-saving of £77 per patient in an intensive care unit. Tegaderm CHG also has a 98.5% probability of being cost-saving compared to standard i.v. dressings. CONCLUSIONS The analyses suggest that Tegaderm CHG is a cost-saving strategy to reduce CRBSI and the results were robust to sensitivity analyses.
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Affiliation(s)
- Praveen Thokala
- Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Edith Poku
- Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Marissa Martyn-St James
- Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Steve Foster
- 3M United Kingdom PLC, Morley St, Loughborough, UK
| | - Tom Elliott
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Tony Whitehouse
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
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Hsin HT, Hsu MS, Shieh JS. The long-term effect of bundle care for catheter-related blood stream infection: 5-year follow-up. Postgrad Med J 2016; 93:133-137. [PMID: 27474228 DOI: 10.1136/postgradmedj-2016-134261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To address the importance of bundle care for catheter-related infection (CRBSI) on the basis of long-term observation in a catheter-abundant cardiovascular intensive care unit (CVICU). DESIGN Prospective longitudinal cohort study. SETTING CVICU of a tertiary referring medical centre in northern Taiwan. PARTICIPANTS Around 1400 critically ill patients annually for 5 years in the CVICU (from January 2010 to June 2015). CRBSI bundle care has been applied ever since by a multidisciplinary team. MAIN OUTCOME MEASURES CRBSI per 1000 catheter days, bloodstream infection (BSI) per 1000 inpatient days, and catheter utilisation rates. RESULTS From January 2010 to June 2015 (22 quarters), there were in total 45 140 inpatient days and 24 163 catheter days, with an overall central venous catheter utilisation rate of 53.5%. The duration of the indwelled catheter was 6.3±1.2 days. The beginning CRBSI rate was 7.0 per 1000 catheter days and was significantly decreased to 0.7 per 1000 catheter days (p<0.001). Regarding the time series, cubic polynomial function depicted the CRBSI decrement most vividly (R2=0.501, p=0.005). In addition, the improvement in overall BSIs (2010 Q1, 4.4 per 1000 inpatient days to 2015 Q2, 0.5 per 1000 inpatient days, p<0.001) significantly correlated with the decrease in CRBSI (r=0.86, p<0.001). CONCLUSIONS Through the bundle care, we successfully reduced CRBSIs. After 5 years of follow-up, we observed that the effect of bundle care was stepwise and persistent, as long as we kept working on this integrated project.
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Affiliation(s)
- Ho-Tsung Hsin
- Cardiovascular Intensive Care Unit, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Mechanical Engineering, Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Tauyuan City, Taiwan
| | - Meng-Shiuan Hsu
- Division of Infectious Disease, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Tauyuan City, Taiwan
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Bader MS. Staphylococcus aureus Bacteremia in Older Adults: Predictors of 7-Day Mortality and Infection With a Methicillin-Resistant Strain. Infect Control Hosp Epidemiol 2016; 27:1219-25. [PMID: 17080380 DOI: 10.1086/507924] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Accepted: 12/16/2005] [Indexed: 11/03/2022]
Abstract
Objectives.To determine the predictors of 7-day mortality in older adult patients with Staphylococcus aureus bacteremia after controlling for comorbidity using the Charlson weighted index of comorbidity (WIC) and to identify the risk factors associated with bacteremia due to methicillin-resistant S. aureus (MRSA).Design.Retrospective cohort study from January 2003 until December 2004.Setting.Two tertiary care, university-affiliated hospitals.Methods.One hundred thirty-five hospitalized patients with S. aureus bacteremia were included in the study. All patients who were 60 years or older and had 1 or more blood cultures positive for S. aureus were included in the study. The primary outcome was death 7 days after the onset of S. aureus bacteremia.Results.Twenty-one patients (15.6%) died within 7 days after the onset of S. aureus bacteremia. Seventy-four patients (56.1%) had MRSA bacteremia. Multivariate analysis identified 3 independent determinants of 7-day mortality: Charlson WIC score greater than 5 (odds ratio [OR], 3.6 [95% confidence interval {CI}, 1.1-11.2]; P = .03), previous hospitalization in the past 3 months (OR, 5.0 [95% CI, 1.1-25.1]; P = .04), and altered mental status at the onset of S. aureus bacteremia (OR, 13.6 [95% CI, 2.9-64.6]; P = .001). Multivariate analysis identified .previous hospitalization in the past 3 months (OR, 2.6 [95% CI, 1.1-5.9]; P = .02), residence in a long-term care facility (OR, 4.5 [95% CI, 1.7-12.3]; P = .003), and altered mental status at the onset of S. aureus bacteremia (OR, 2.5 [95% CI, 1.5-5.6]; P = .02) to be independently associated with the presence of MRSA.Conclusions.The Charlson WIC is significantly associated with increased mortality of S. aureus bacteremia in older adults. Previous hospitalization in the past 3 months, residence in a long-term care facility, and altered mental status should be used as a guidance for empirical vancomycin therapy and application of infection control measures in older adults with suspected S. aureus bacteremia.
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Affiliation(s)
- Mazen S Bader
- Division of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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27
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Wong SW, Gantner D, McGloughlin S, Leong T, Worth LJ, Klintworth G, Scheinkestel C, Pilcher D, Cheng AC, Udy AA. The influence of intensive care unit-acquired central line-associated bloodstream infection on in-hospital mortality: A single-center risk-adjusted analysis. Am J Infect Control 2016; 44:587-92. [PMID: 26874406 DOI: 10.1016/j.ajic.2015.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the risk-adjusted association between intensive care unit (ICU)-acquired central line-associated bloodstream infection (CLABSI) and in-hospital mortality. DESIGN Retrospective observational study. SETTING Forty-five-bed adult ICU. PATIENTS All non-extracorporeal membrane oxygenation ICU admissions between July 1, 2008, and April 30, 2014, requiring a central venous catheter (CVC), with a length of stay > 48 hours, were included. METHODS Data were extracted from our infection prevention and ICU databases. A multivariable logistic regression model was constructed to identify independent risk factors for ICU-acquired CLABSI. The propensity toward developing CLABSI was then included in a logistic regression of in-hospital mortality. RESULTS Six thousand three hundred fifty-three admissions were included. Forty-six cases of ICU-acquired CLABSI were identified. The overall CLABSI rate was 1.12 per 1,000 ICU CVC-days. Significant independent risk factors for ICU-acquired CLABSI included: double lumen catheter insertion (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.16-5.77), CVC exposure > 7 days (OR, 2.07; 95% CI, 1.06-4.04), and CVC insertion before 2011 (OR, 2.20; 95% CI, 1.22-3.97). ICU-acquired CLABSI was crudely associated with greater in-hospital mortality, although this was attenuated once the propensity to develop CLABSI was adjusted for (OR, 1.20; 95% CI, 0.54-2.68). CONCLUSIONS A greater propensity toward ICU-acquired CLABSI was independently associated with higher in-hospital mortality, although line infection itself was not. The requirement for prolonged specialized central venous access appears to be a key risk factor for ICU-acquired CLABSI, and likely informs mortality as a marker of persistent organ dysfunction.
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Affiliation(s)
- S W Wong
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia
| | - D Gantner
- Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Perioperative and Critical Care Services, Intensive Care Unit, Footscray Hospital, Footscray, Victoria, Australia
| | - S McGloughlin
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia
| | - T Leong
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - L J Worth
- Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia; Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - G Klintworth
- Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - C Scheinkestel
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - D Pilcher
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - A C Cheng
- Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia; Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - A A Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia.
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Bassetti M, Righi E, Carnelutti A. Bloodstream infections in the Intensive Care Unit. Virulence 2016; 7:267-79. [PMID: 26760527 PMCID: PMC4871677 DOI: 10.1080/21505594.2015.1134072] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 12/29/2022] Open
Abstract
Bloodstream infections (BSIs) represent a common complication among critically ill patients and a leading cause of morbidity and mortality. The prompt initiation of an effective antibiotic therapy is necessary in order to reduce mortality and to improve clinical outcomes. However, the choice of the empiric antibiotic regimen is often challenging, due to the worldwide spread of multi-drug resistant (MDR) organisms with reduced susceptibility to the available broad-spectrum antimicrobials. New therapeutic strategies are 5 to improve the effectiveness of antibiotic treatment while minimizing the risk of resistance selection.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia Hospital, Udine, Italy
- Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Elda Righi
- Infectious Diseases Division, Santa Maria Misericordia Hospital, Udine, Italy
- Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Alessia Carnelutti
- Infectious Diseases Division, Santa Maria Misericordia Hospital, Udine, Italy
- Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Udine, Italy
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Sustained Nitric Oxide-Releasing Nanoparticles Induce Cell Death in Candida albicans Yeast and Hyphal Cells, Preventing Biofilm Formation In Vitro and in a Rodent Central Venous Catheter Model. Antimicrob Agents Chemother 2016; 60:2185-94. [PMID: 26810653 DOI: 10.1128/aac.02659-15] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/19/2016] [Indexed: 01/01/2023] Open
Abstract
Candida albicansis a leading nosocomial pathogen. Today, candidal biofilms are a significant cause of catheter infections, and such infections are becoming increasingly responsible for the failure of medical-implanted devices.C. albicansforms biofilms in which fungal cells are encased in an autoproduced extracellular polysaccharide matrix. Consequently, the enclosed fungi are protected from antimicrobial agents and host cells, providing a unique niche conducive to robust microbial growth and a harbor for recurring infections. Here we demonstrate that a recently developed platform comprised of nanoparticles that release therapeutic levels of nitric oxide (NO-np) inhibits candidal biofilm formation, destroys the extracellular polysaccharide matrices of mature fungal biofilms, and hinders biofilm development on surface biomaterials such as the lumen of catheters. We found NO-np to decrease both the metabolic activity of biofilms and the cell viability ofC. albicansin vitroandin vivo Furthermore, flow cytometric analysis found NO-np to induce apoptosis in biofilm yeast cellsin vitro Moreover, NO-np behave synergistically when used in combination with established antifungal drug therapies. Here we propose NO-np as a novel treatment modality, especially in combination with standard antifungals, for the prevention and/or remediation of fungal biofilms on central venous catheters and other medical devices.
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Using New Technology to Prevent Healthcare-Associated Infection in Pediatric Patients. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0068-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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31
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Effectiveness of a programme to reduce the burden of catheter-related bloodstream infections in a tertiary hospital. Epidemiol Infect 2016; 144:2011-7. [DOI: 10.1017/s0950268815003313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYThe objective of this study was to assess the effectiveness of a catheter-related bloodstream infection (CR BSI) reduction programme and healthcare workers' compliance with recommendations. A 3-year surveillance programme of CR BSIs in all hospital settings was implemented. As part of the programme, there was a direct observation of insertion and maintenance of central venous catheters (CVCs) to determine performance. A total of 38 education courses were held over the study period and feedback reports with the results of surveillance and recommendations were delivered to healthcare workers every 6 months. A total of 6722 short-term CVCs were inserted in 4982 patients for 58 763 catheter-days. Improvements of compliance with hand hygiene was verified at the insertion (87·1–100%, P < 0·001) and maintenance (51·1–72·1%, P = 0·029) of CVCs; and the use of chlorhexidine for skin disinfection was implemented at insertion (35·7–65·4%, P < 0·001) and maintenance (33·3–45·9%, P < 0·197) of CVCs. There were 266 CR BSI incidents recorded with an annual incidence density of 5·75/1000 catheter-days in the first year, 4·38 in the second year [rate ratio (RR) 0·76, 95% confidence interval (CI) 0·57–1·01] and 3·46 in the third year (RR 0·60, 95% CI 0·44–0·81). The education programme clearly improved compliance with recommendations for CVC handling, and was effective in reducing the burden of CR BSIs.
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Souweine B, Lautrette A, Gruson D, Canet E, Klouche K, Argaud L, Bohe J, Garrouste-Orgeas M, Mariat C, Vincent F, Cayot S, Cointault O, Lepape A, Guelon D, Darmon M, Vesin A, Caillot N, Schwebel C, Boyer A, Azoulay E, Bouadma L, Timsit JF. Ethanol lock and risk of hemodialysis catheter infection in critically ill patients. A randomized controlled trial. Am J Respir Crit Care Med 2015; 191:1024-32. [PMID: 25668557 DOI: 10.1164/rccm.201408-1431oc] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Ethanol rapidly eradicated experimental biofilm. Clinical studies of ethanol lock to prevent catheter-related infections (CRIs) suggest preventive efficacy. No such studies have been done in intensive care units (ICU). OBJECTIVES To determine whether ethanol lock decreases the risk of major CRI in patients with short-term dialysis catheters (DCs). METHODS A randomized, double-blind, placebo-controlled trial was performed in 16 ICUs in seven university hospitals and one general hospital in France between June 2009 and December 2011. Adults with insertion of a nontunneled, nonantimicrobial-impregnated double-lumen DC for an expected duration greater than 48 hours, to perform renal-replacement therapy or plasma exchange, were randomly allocated (1:1) to receive a 2-minute catheter lock with either 60% wt/wt ethanol solution (ethanol group) or 0.9% saline solution (control group) at the end of DC insertion and after each renal-replacement therapy or plasma exchange session. The main outcome was major CRI defined as either catheter-related clinical sepsis without bloodstream infection or catheter-related bloodstream infection during the ICU stay. MEASUREMENTS AND MAIN RESULTS The intent-to-treat analysis included 1,460 patients (2,172 catheters, 12,944 catheter-days, and 8,442 study locks). Median DC duration was 4 days (interquartile range, 2-8) and was similar in both groups. Major CRI incidence did not differ between the ethanol and control groups (3.83 vs. 2.64 per 1,000 catheter-days, respectively; hazard ratio, 1.55; 95% confidence interval, 0.83-2.87; P = 0.17). No significant differences occurred for catheter colonization (P = 0.57) or catheter-related bloodstream infection (P = 0.99). CONCLUSIONS A 2-minute ethanol lock does not decrease the frequency of infection of DCs in ICU patients. Clinical trial registered with www.clinicaltrials.gov (NCT 00875069).
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Salama MF, Jamal W, Al Mousa H, Rotimi V. Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections. J Infect Public Health 2015; 9:34-41. [PMID: 26138518 DOI: 10.1016/j.jiph.2015.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 05/13/2015] [Accepted: 05/18/2015] [Indexed: 11/26/2022] Open
Abstract
Central line-associated bloodstream infection (CLABSIs) is an important healthcare-associated infection in the critical care units. It causes substantial morbidity, mortality and incurs high costs. The use of central venous line (CVL) insertion bundle has been shown to decrease the incidence of CLABSIs. Our aim was to study the impact of CVL insertion bundle on incidence of CLABSI and study the causative microbial agents in an intensive care unit in Kuwait. Surveillance for CLABSI was conducted by trained infection control team using National Health Safety Network (NHSN) case definitions and device days measurement methods. During the intervention period, nursing staff used central line care bundle consisting of (1) hand hygiene by inserter (2) maximal barrier precautions upon insertion by the physician inserting the catheter and sterile drape from head to toe to the patient (3) use of a 2% chlorohexidine gluconate (CHG) in 70% ethanol scrub for the insertion site (4) optimum catheter site selection. (5) Examination of the daily necessity of the central line. During the pre-intervention period, there were 5367 documented catheter-days and 80 CLABSIs, for an incidence density of 14.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 5052 catheter-days and 56 CLABSIs, for an incidence density of 11.08 per 1000 catheter-days. The reduction in the CLABSI/1000 catheter days was not statistically significant (P=0.0859). This study demonstrates that implementation of a central venous catheter post-insertion care bundle was associated with a reduction in CLABSI in an intensive care area setting.
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Affiliation(s)
- Mona F Salama
- Infection Control Department, Mubarak Al Kabeer Hospital, Jabriya, Kuwait; Department of Microbiology and Medical Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Wafaa Jamal
- Microbiology Unit, Mubarak Al Kabeer Hospital, Jabriya, Kuwait; Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Haifa Al Mousa
- Infection Control Directorate, Ministry of Health, Kuwait
| | - Vincent Rotimi
- Microbiology Unit, Mubarak Al Kabeer Hospital, Jabriya, Kuwait; Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
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Maunoury F, Motrunich A, Palka-Santini M, Bernatchez SF, Ruckly S, Timsit JF. Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units. PLoS One 2015; 10:e0130439. [PMID: 26086783 PMCID: PMC4472776 DOI: 10.1371/journal.pone.0130439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 05/20/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconate-containing securement dressing compared to non-antimicrobial transparent dressings for the protection of central vascular lines in intensive care unit patients. DESIGN This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate dressing versus transparent dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated. PATIENTS 1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours. INTERVENTION Chlorhexidine Gluconate-containing securement dressing compared to non-antimicrobial transparent dressings. RESULTS The chlorhexidine gluconate dressing prevents 11.8 infections /1,000 patients (95% confidence interval: [3.85; 19.64]) with a number needed to treat of 85 patients. The mean cost difference per patient of €141 is not statistically significant (95% confidence interval: [€-975; €1,258]). The incremental cost-effectiveness ratio is of €12,046 per catheter-related bloodstream infection prevented, and the incremental net monetary benefit per patient is of €344.88. CONCLUSIONS According to the base case scenario, the chlorhexidine gluconate dressing is more cost-effective than the reference dressing. TRIAL REGISTRATION This model is based on the data from the RCT registered with www.clinicaltrials.gov (NCT01189682).
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Affiliation(s)
| | | | | | | | | | - Jean-François Timsit
- Grenoble University Hospital, Grenoble, France
- IAME UMR1137-Team 5 Decision Sciences in Infectious Disease Prevention, Control and Care, Paris Diderot University-Inserm, Sorbonne Paris Cité, Paris, France
- Paris Diderot University—Bichat University hospital—Medical and Infectious Diseases Intensive care unit, Paris, France
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Bonne S, Mazuski JE, Sona C, Schallom M, Boyle W, Buchman TG, Bochicchio GV, Coopersmith CM, Schuerer DJE. Effectiveness of Minocycline and Rifampin vs Chlorhexidine and Silver Sulfadiazine-Impregnated Central Venous Catheters in Preventing Central Line-Associated Bloodstream Infection in a High-Volume Academic Intensive Care Unit: A Before and after Trial. J Am Coll Surg 2015. [PMID: 26199017 DOI: 10.1016/j.jamcollsurg.2015.05.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Use of chlorhexidine and silver sulfadiazine-impregnated (CSS) central venous catheters (CVCs) has not been shown to decrease the catheter-related bloodstream infection rate in an ICU. The purpose of this study was to determine if use of minocycline and rifampin-impregnated (MR) CVCs would decrease central line-associated bloodstream infection (CLABSI) rates compared with those observed with use of CSS-impregnated CVCs. STUDY DESIGN A total of 7,181 patients were admitted to a 24-bed university hospital surgical ICU: 2,551 between March 2004 and August 2005 (period 1) and 4,630 between April 2006 and July 2008 (period 2). All patients requiring CVC placement in period 1 had a CSS catheter inserted, and in period 2 all patients had MR CVCs placed. RESULTS Twenty-two CLABSIs occurred during 7,732 catheter days (2.7 per 1,000 catheter days) in the 18-month period when CSS lines were used. After the introduction of MR CVCs, 21 catheter-related bloodstream infections occurred during 15,722 catheter days (1.4 per 1,000 catheter days). This represents a significant (p < 0.05) decrease in the CLABSI rate after introduction of MR CVCs. Mean length of time to infection developing after catheterization (8.6 days for CSS vs 6.1 days for MR) was also different (p = 0.04). The presence of MR did not alter the microbiologic profile of catheter-related infections, and it did not increase the incidence of resistant organisms. CONCLUSIONS The CLABSI rate decreased more with the use of MR CVCs compared with CSS CVCs in an ICU where the CLABSI rate was already low. The types of organisms causing infection were similar. With continued use of MR-impregnated CVCs in our ICU in the subsequent 5 years, we have seen sustained low rates of CLABSIs.
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Affiliation(s)
- Stephanie Bonne
- Department of Surgery, Washington University School of Medicine, St Louis, MO.
| | - John E Mazuski
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | | | | | - Walter Boyle
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
| | - Timothy G Buchman
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Grant V Bochicchio
- Department of Surgery, Washington University School of Medicine, St Louis, MO
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Gastmeier P, Menzel K, Sohr D, Rüden H. Usefulness of Severity-of-Illness Scores Based on Admission Data Only in Nosocomial Infection Surveillance Systems. Infect Control Hosp Epidemiol 2015; 28:453-8. [PMID: 17385152 DOI: 10.1086/512630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2005] [Accepted: 09/08/2005] [Indexed: 11/03/2022]
Abstract
Background.Surveillance of nosocomial infection (NI) and the use of reference data for comparison is recommended to improve the quality of patient care. In addition to standardization according to device use, another stratification of reference data according to patients' severity-of-illness scores is often required for benchmarking in intensive care units (ICUs).Objective.To determine whether severity-of-illness scores on admission to the ICU are sufficient data for predicting the development of NI.Methods.This study was performed in an interdisciplinary ICU at a teaching hospital. Two scores were studied: the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Therapeutic Intervention Scoring System (TISS). The patient's clinical condition was evaluated on admission and reevaluated daily during the period before the development of NI. In addition, we recorded the number of intubations for every patient-day, the age and sex of the patients, and their history of operations. The Fisher exact test and the stepwise multiple logistic regression model were applied to identify significant predictors of NI.Results.During a 12-month period, 270 patients with ICU stays of more than 24 hours were included in the study. Sixty-nine NIs were identified (incidence, 25.6 cases per 100 patients [95% confidence interval, 19.9-32.3]). A mean APACHE II score and a mean TISS score above the median for these scores, duration of ventilation above the median in the period before the development of NI, and patient age were significantly associated with the development of NI; the score data on admission provided a clearly poorer prediction.Conclusion.The APACHE II and TISS scores on admission are not useful predictors for NI in ICUs.
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Affiliation(s)
- Petra Gastmeier
- Institute of Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany.
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Crawford AG, Fuhr JP, Rao B. Cost–Benefit Analysis of Chlorhexidine Gluconate Dressing in the Prevention of Catheter-Related Bloodstream Infections. Infect Control Hosp Epidemiol 2015; 25:668-74. [PMID: 15357159 DOI: 10.1086/502459] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjectives:To compare the costs with the benefits of using chlorhexidine gluconate dressings on central venous catheters and to determine the effectiveness of these dressings in reducing local infections and catheter-related bloodstream infections (CRBSIs), costs, and mortality.Design:Cost–benefit analysis using randomized, controlled trial data on chlorhexidine dressing prevention of local infection and CRBSI, data on cost of chlorhexidine dressing versus standard treatment, data on averted cost of treating local infection and CRBSI, and data on mortality attributable to CRBSI. Decision analysis evaluated averted CRBSI treatment cost per patient resulting from chlorhexidine dressing use. Sensitivity analyses demonstrated net benefit of chlorhexidine dressing, varying baseline rate of CRBSI, incremental cost of treating CRBSI, and number of catheters, and evaluated mortality preventable through chlorhexidine dressing use, varying baseline rate of CRBSI, number of catheters, and mortality attributable to CRBSI.Patients and Setting:Patients of all Philadelphia area hospitals and one Philadelphia academic medical center.Results:Estimated potential annual U.S. net benefits from chlorhexidine dressing use ranged from $275 million to approximately $1.97 billion. Cost–benefit findings persisted in sensitivity analyses varying baseline rate of CRBSI, incremental cost of treating CRBSI, and overall number of catheters used. Preventable mortality analyses showed potential decreases of between 329 and 3,906 U.S. deaths annually as a result of nationwide use of chlorhexidine dressing.Conclusions:Chlorhexidine dressings would reduce costs, local infections and CRBSIs, and deaths. Use of chlorhexidine dressings should be considered to prevent infections among patients with catheters.
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Affiliation(s)
- Albert G Crawford
- Department of Health Policy, Jefferson Medical College, Suite 115, 1015 Walnut Street, Philadelphia, PA 19107, USA
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Crnich CJ. Estimating Excess Length of Stay Due to Central Line–Associated Bloodstream Infection: Separating the Wheat from the Chaff. Infect Control Hosp Epidemiol 2015; 31:1115-7. [DOI: 10.1086/656594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fabbro-Peray P, Sotto A, Defez C, Cazaban M, Molinari L, Pinède M, Mahamat A, Daures JP. Mortality Attributable to Nosocomial Infection: A Cohort of Patients With and Without Nosocomial Infection in a French University Hospital. Infect Control Hosp Epidemiol 2015; 28:265-72. [PMID: 17326016 DOI: 10.1086/512626] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 06/14/2006] [Indexed: 11/03/2022]
Abstract
ObjectiveTo assess nosocomial infection (NI) as a risk factor for death and to estimate the population-attributable risk of death from NI.Design.A prospective cohort study of patients with and without NI.Setting.Nîmes University Hospital, Nîmes, France.Patients.Patients were recruited from May 7, 2001, to January 10, 2003. Patients in acute care and long-term care units who had NI were enrolled, and patients without NI were randomly selected and matched with patients with NI for age, sex, type of care (acute care vs. long-term care) and length of stay in hospital at study inclusion.Outcome Measures.Vital status within 60 days after study inclusion was assessed. We used conditional logistic regression to estimate the relative death risk from NI after adjusting for comorbidities, severity of the underlying disease, and all other confounding factors. The adjusted population-attributable risk was assessed using the Mantel-Haenszel method.Results.We recruited 1,914 patients with NI and 5,172 patients without NI. The median age of the patients with NI was 73 years; 1,045 (54.6%) were female. NI was associated with death within 60 days (adjusted odds ratio, 1.7 [95% confidence interval {CI}, 1.4—;2.2]; P-C.001). The adjusted population-attributable risk of death for all sites of infection was 1.7% (95% CI, 1.4-2.1). If we consider the NI incidence to be 3%-6% in French hospitals, the population-attributable risk of death from NI would range from 2.1% (95% CI, 1.7%-2.5%) to 4.0% (95% CI, 3.3%-4.9%).Conclusion.In this study, NI appeared to have a significant impact on mortality. Multicenter studies will be needed to confirm these results.
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Affiliation(s)
- Pascale Fabbro-Peray
- Département de l'Information Médicale, Groupe hospitalier Carémeau, Place du Pr Debré, 30029 Nimes Cedex 9, France.
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Grupper M, Sprecher H, Mashiach T, Finkelstein R. Attributable Mortality of Nosocomial Acinetobacter Bacteremia. Infect Control Hosp Epidemiol 2015; 28:293-8. [PMID: 17326019 DOI: 10.1086/512629] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 10/27/2006] [Indexed: 11/03/2022]
Abstract
Objective.To determine the attributable mortality and outcome of nosocomial Acinetobacter bacteremia.Design.Matched, retrospective cohort study.Setting.Large, university-based, tertiary care center.Patients.Of 219 patients with nosocomial Acinetobacter bacteremia identified by prospective surveillance during a 3-year period, 52 met the criteria for the study and were matched to a control patient by age, sex, primary and secondary diagnosis, operative procedures, and date of admission.Results.A 100% success rate was achieved in the proportion of case patients and control patients matched for the compared criteria, except for major operative procedures (88%) and the presence of an important secondary underlying disease (54.5%). Twenty-nine (55.7%) of the case patients died, compared with 10 (19.2%) of the control patients (P < .001). The attributable mortality was 36.5% (95% CI, 27%-46%) and the risk ratio for death was 2.9 (95% CI, 1.58-5.32). In a multivariate survival analysis, older age, mechanical ventilation, renal failure, and Acinetobacter bacteremia (hazard ratio [HR], 4.41; 95% confidence interval [CI], 1.97-9.87; P < .001) were found to be independent predictors of mortality. There was a trend for a longer median duration of hospitalization among case patients, compared with control patients (11.5 vs. 6.5 days; P = .06). Three isolates were resistant to all but 1 antibiotic tested (colistin), and 45 isolates (86.5%) were resistant to 4 or more different antibiotic classes.Conclusions.When adjusted for risk-exposure time and severity of disease at admission, nosocomial Acinetobacter bacteremia is associated with mortality in excess of that caused by the underlying diseases alone.
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Affiliation(s)
- Mordechai Grupper
- Infectious Diseases Unit, Rambam Medical Center, 31096-Bat Galim, Haifa, Israel
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Dumpa V, Adler B, Allen D, Bowman D, Gram A, Ford P, Sannoh S. Reduction in Central Line-Associated Bloodstream Infection Rates After Implementations of Infection Control Measures at a Level 3 Neonatal Intensive Care Unit. Am J Med Qual 2014; 31:133-8. [PMID: 25372275 DOI: 10.1177/1062860614557637] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Advances in neonatology led to survival of micro-preemies, who need central lines. Central line-associated bloodstream infection (CLABSI) causes prolonged hospitalization, morbidities, and mortality. Health care team education decreases CLABSIs. The objective was to decrease CLABSIs using evidence-based measures. The retrospective review compared CLABSI incidence during and after changes in catheter care. In April 2011, intravenous (IV) tubing changed from Interlink to Clearlink; IV tubing changing interval increased from 24 to 72 hours. CLABSIs increased. The following measures were implemented: July 2011, reeducation of neonatal intensive care staff on Clearlink; August 2011, IV tubing changing interval returned to 24 hours; September 2011, changed from Clearlink back to Interlink; November 2011, review of entire IV process and in-service on hand hygiene; December 2011, competencies on IV access for all nurses. CLABSIs were compared during and after interventions. Means were compared using the t test and ratios using the χ(2) test; P <.05. CLABSIs decreased from 4.4/1000 to 0/1000 catheter-days; P < .05. Evidence-based interventions reduced CLABSIs.
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Affiliation(s)
| | - Bonny Adler
- Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ
| | - Delena Allen
- Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ
| | - Deborah Bowman
- Children's Hospital at Saint Peter's University Hospital, New Brunswick, NJ
| | - Amy Gram
- Saint Peter's University Hospital, New Brunswick, NY
| | - Pat Ford
- Saint Peter's University Hospital, New Brunswick, NY
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Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection 2014; 43:29-36. [DOI: 10.1007/s15010-014-0689-y] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/06/2014] [Indexed: 01/01/2023]
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Chlorhexidine-impregnated dressing: an efficient weapon against catheter-related bloodstream infection?*. Crit Care Med 2014; 42:1742-3. [PMID: 24933057 DOI: 10.1097/ccm.0000000000000368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gahlot R, Nigam C, Kumar V, Yadav G, Anupurba S. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci 2014; 4:162-7. [PMID: 25024944 PMCID: PMC4093967 DOI: 10.4103/2229-5151.134184] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Central-venous-catheter-related bloodstream infections (CRBSIs) are an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. Consequences depend on associated organisms, underlying pre-morbid conditions, timeliness, and appropriateness of the treatment/interventions received. We have summarized risk factors, pathogenesis, etiology, diagnosis, and management of CRBSI in this review.
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Affiliation(s)
- Rupam Gahlot
- Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Chaitanya Nigam
- Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Vikas Kumar
- Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Ghanshyam Yadav
- Department of Anaesthesia, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Shampa Anupurba
- Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
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Preventing arterial catheter-associated bloodstream infections: common sense and chlorhexidine. Crit Care Med 2014; 42:1533-4. [PMID: 24836783 DOI: 10.1097/ccm.0000000000000240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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Cobos-Trigueros N, Rinaudo M, Solé M, Castro P, Pumarol J, Hernández C, Fernández S, Nicolás JM, Mallolas J, Vila J, Morata L, Gatell JM, Soriano A, Mensa J, Martínez JA. Acquisition of resistant microorganisms and infections in HIV-infected patients admitted to the ICU. Eur J Clin Microbiol Infect Dis 2013; 33:611-20. [DOI: 10.1007/s10096-013-1995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 10/07/2013] [Indexed: 11/29/2022]
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Ullman AJ, Cooke ML, Gillies D, Marsh N, Daud A, McGrail MR, O'Riordan E, Rickard CM. Optimal timing for intravascular administration set replacement. Cochrane Database Syst Rev 2013; 2013:CD003588. [PMID: 24037784 PMCID: PMC6516986 DOI: 10.1002/14651858.cd003588.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The tubing (administration set) attached to both venous and arterial catheters may contribute to bacteraemia and other infections. The rate of infection may be increased or decreased by routine replacement of administration sets. This review was originally published in 2005 and was updated in 2012. OBJECTIVES The objective of this review was to identify any relationship between the frequency with which administration sets are replaced and rates of microbial colonization, infection and death. SEARCH METHODS We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6), MEDLINE (1950 to June 2012), CINAHL (1982 to June 2012), EMBASE (1980 to June 2012), reference lists of identified trials and bibliographies of published reviews. The original search was performed in February 2004. We also contacted researchers in the field. We applied no language restriction. SELECTION CRITERIA We included all randomized or controlled clinical trials on the frequency of venous or arterial catheter administration set replacement in hospitalized participants. DATA COLLECTION AND ANALYSIS Two review authors assessed all potentially relevant studies. We resolved disagreements between the two review authors by discussion with a third review author. We collected data for seven outcomes: catheter-related infection; infusate-related infection; infusate microbial colonization; catheter microbial colonization; all-cause bloodstream infection; mortality; and cost. We pooled results from studies that compared different frequencies of administration set replacement, for instance, we pooled studies that compared replacement ≥ every 96 hours versus every 72 hours with studies that compared replacement ≥ every 48 hours versus every 24 hours. MAIN RESULTS We identified 26 studies for this updated review, 10 of which we excluded; six did not fulfil the inclusion criteria and four did not report usable data. We extracted data from the remaining 18 references (16 studies) with 5001 participants: study designs included neonate and adult populations, arterial and venous administration sets, parenteral nutrition, lipid emulsions and crystalloid infusions. Most studies were at moderate to high risk of bias or did not adequately describe the methods that they used to minimize bias. All included trials were unable to blind personnel because of the nature of the intervention.No evidence was found for differences in catheter-related or infusate-related bacteraemia or fungaemia with more frequent administration set replacement overall or at any time interval comparison (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.67 to 1.69; RR 0.67, 95% CI 0.27 to 1.70). Infrequent administration set replacement reduced the rate of bloodstream infection (RR 0.73, 95% CI 0.54 to 0.98). No evidence revealed differences in catheter colonization or infusate colonization with more frequent administration set replacement (RR 1.08, 95% CI 0.94 to 1.24; RR 1.15, 95% CI 0.70 to 1.86, respectively). Borderline evidence suggested that infrequent administration set replacement increased the mortality rate only within the neonatal population (RR 1.84, 95% CI 1.00 to 3.36). No evidence revealed interactions between the (lack of) effects of frequency of administration set replacement and the subgroups analysed: parenteral nutrition and/or fat emulsions versus infusates not involving parenteral nutrition or fat emulsions; adult versus neonatal participants; and arterial versus venous catheters. AUTHORS' CONCLUSIONS Some evidence indicates that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the risk of infection. Other evidence suggests that mortality increased within the neonatal population with infrequent administration set replacement. However, much the evidence obtained was derived from studies of low to moderate quality.
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Affiliation(s)
- Amanda J Ullman
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
| | - Marie L Cooke
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
| | | | - Nicole Marsh
- Griffith UniversityNHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute QueenslandLevel 2, Building 34Butterfield StreetBrisbaneQueenslandAustralia4029
| | - Azlina Daud
- Griffith UniversitySchool of Nursing and Midwifery170 Kessels RoadNathanQueenslandAustralia4111
| | - Matthew R McGrail
- Monash UniversityGippsland Medical SchoolNorthways RoadChurchillVictoriaAustralia3825
| | - Elizabeth O'Riordan
- The University of Sydney and The Children's Hospital at WestmeadFaculty of Nursing and MidwiferySydneyNew South WalesAustralia2006
| | - Claire M Rickard
- Griffith UniversityNational Centre of Research Excellence in Nursing, Menzies Health Institute QueenslandBrisbaneQueenslandAustralia4111
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Njall C, Adiogo D, Bita A, Ateba N, Sume G, Kollo B, Binam F, Tchoua R. [Bacterial ecology of nosocomial infection in intensive care unit of Laquintinie hospital Douala, Cameroon]. Pan Afr Med J 2013; 14:140. [PMID: 23785545 PMCID: PMC3683522 DOI: 10.11604/pamj.2013.14.140.1818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 01/16/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction L'objectif principal de notre étude était d'identifier les bactéries associées à l'infection nosocomiale, dans le service de réanimation, de l'hôpital Laquintinie de Douala en vue d'améliorer la prise en charge et diminuer la létalité. Méthodes Il s'agissait d'une étude transversale et descriptive, menée du 1er mars au 31 mai 2011.Tous les patients hospitalisés depuis au moins 48 h étaient inclus dans l’étude et ceux présentant une infection documentée à l'admission étaient exclus. L'analyse des donnés a été faite par le logiciel SPSS 16.Les tests de Khi deux pour la signification. Résultats La prévalence de l'infection nosocomiale était de 12%, elle concernait des personnes âgées de plus de 60 ans et présentant une infection urinaire dans 79% des cas. La létalité était de 72% pour une durée moyenne de séjour de 11,7 ± 12,1 jours. Les bactéries responsables étaient en majorité des bactéries gram positifs (BGN), dont E coli dans 23,1% et les cocci gram positifs(CGP), dans 15,4% des cas. Conclusion L’étude de la résistance aux antibiotiques, montre une multi résistance, dont il faut tenir compte en mettant en place une stratégie de prévention active.
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Affiliation(s)
- Clotilde Njall
- Faculté de Médecine et des Sciences Pharmaceutiques de Douala, Université de Douala, BP 2701 Douala, Cameroun
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Exline MC, Ali NA, Zikri N, Mangino JE, Torrence K, Vermillion B, St Clair J, Lustberg ME, Pancholi P, Sopirala MM. Beyond the bundle--journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections. Crit Care 2013; 17:R41. [PMID: 23497591 PMCID: PMC3733431 DOI: 10.1186/cc12551] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 12/21/2012] [Accepted: 02/22/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION We set a goal to reduce the incidence rate of catheter-related bloodstream infections to rate of <1 per 1,000 central line days in a two-year period. METHODS This is an observational cohort study with historical controls in a 25-bed intensive care unit at a tertiary academic hospital. All patients admitted to the unit from January 2008 to December 2011 (31,931 patient days) were included. A multidisciplinary team consisting of hospital epidemiologist/infectious diseases physician, infection preventionist, unit physician and nursing leadership was convened. Interventions included: central line insertion checklist, demonstration of competencies for line maintenance and access, daily line necessity checklist, and quality rounds by nursing leadership, heightened staff accountability, follow-up surveillance by epidemiology with timely unit feedback and case reviews, and identification of noncompliance with evidence-based guidelines. Molecular epidemiologic investigation of a cluster of vancomycin-resistant Enterococcus faecium (VRE) was undertaken resulting in staff education for proper acquisition of blood cultures, environmental decontamination and daily chlorhexidine gluconate (CHG) bathing for patients. RESULTS Center for Disease Control/National Health Safety Network (CDC/NHSN) definition was used to measure central line-associated bloodstream infection (CLA-BSI) rates during the following time periods: baseline (January 2008 to December 2009), intervention year (IY) 1 (January to December 2010), and IY 2 (January to December 2011). Infection rates were as follows: baseline: 2.65 infections per 1,000 catheter days; IY1: 1.97 per 1,000 catheter days; the incidence rate ratio (IRR) was 0.74 (95% CI=0.37 to 1.65, P=0.398); residual seven CLA-BSIs during IY1 were VRE faecium blood cultures positive from central line alone in the setting of findings explicable by noninfectious conditions. Following staff education, environmental decontamination and CHG bathing (IY2): 0.53 per 1,000 catheter days; the IRR was 0.20 (95% CI=0.06 to 0.65, P=0.008) with 80% reduction compared to the baseline. Over the two-year intervention period, the overall rate decreased by 53% to 1.24 per 1,000 catheter-days (IRR of 0.47 (95% CI=0.25 to 0.88, P=0.019) with zero CLA-BSI for a total of 15 months. CONCLUSIONS Residual CLA-BSIs, despite strict adherence to central line bundle, may be related to blood culture contamination categorized as CLA-BSIs per CDC/NHSN definition. Efforts to reduce residual CLA-BSIs require a strategic multidisciplinary team approach focused on epidemiologic investigations of practitioner- or unit-specific etiologies.
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Affiliation(s)
- Matthew C Exline
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of
Internal Medicine, Ohio State University Wexner Medical Center, 201 Davis Heart
& Lung Research Institute, 473 West 12th Ave, Columbus, OH, 43210, USA
| | - Naeem A Ali
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of
Internal Medicine, Ohio State University Wexner Medical Center, 201 Davis Heart
& Lung Research Institute, 473 West 12th Ave, Columbus, OH, 43210, USA
| | - Nancy Zikri
- Department of Clinical Epidemiology, Ohio State University Wexner Medical Center,
410 West 10th Ave, Columbus, OH, 43210, USA
| | - Julie E Mangino
- Division of Infectious Diseases, Department of Internal Medicine, Department of
Clinical Epidemiology, Ohio State University Wexner Medical Center, 410 West 10th
Ave, Columbus, OH, 43210, USA
| | - Kelly Torrence
- Department of Nursing, Ohio State University Wexner Medical Center, 410 West 10th
Ave, Columbus, OH, 43210, USA
| | - Brenda Vermillion
- Department of Nursing, Ohio State University Wexner Medical Center, 410 West 10th
Ave, Columbus, OH, 43210, USA
| | - Jamie St Clair
- Department of Nursing, Ohio State University Wexner Medical Center, 410 West 10th
Ave, Columbus, OH, 43210, USA
| | - Mark E Lustberg
- Division of Infectious Diseases, Department of Internal Medicine, Ohio State
University Wexner Medical Center, 410 West 10th Ave, Columbus, OH, 43210, USA
| | - Preeti Pancholi
- Department of Pathology, Ohio State University Wexner Medical Center, 1492 East
Broad St Columbus, OH, 43205, USA
| | - Madhuri M Sopirala
- Division of Infectious Diseases, Department of Internal Medicine, Department of
Clinical Epidemiology, Ohio State University Wexner Medical Center, 410 West 10th
Ave, Columbus, OH, 43210, USA
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