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Kazak E, Önal U, Tüzemen NÜ, Aslan F, Çalışkan G, Şimşek H, Bakkaloğlu Z, Çevik YN, Heper Y, Çelebi S, Yılmaz E, Hacımustafaoğlu MK, Özakın C, Akalın EH. An evaluation of a Stenotrophomonas maltophilia outbreak due to commercial arterial blood gas collection kit. Antimicrob Resist Infect Control 2024; 13:53. [PMID: 38764050 PMCID: PMC11103820 DOI: 10.1186/s13756-024-01410-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/10/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Stenotrophomonas maltophilia is a gram-negative bacterium that can cause hospital infections and outbreaks within hospitals. This study aimed to evaluate an outbreak of Stenotrophomonas maltophilia, caused by ready-to-use commercial syringes containing liquid lithium and heparin for arterial blood gas collection in a university hospital. METHODS Upon detecting an increase in Stenotrophomonas maltophilia growth in blood cultures between 15.09.2021 and 19.11.2021, an outbreak analysis and a case-control study (52 patients for the case group, 56 patients for the control group) were performed considering risk factors for bacteremia. Samples from possible foci for bacteremia were also cultured. Growing bacteria were identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. The genetic linkage and clonal relationship isolates were investigated with pulsed-field gel electrophoresis (PFGE) in the reference laboratory. RESULTS In the case-control study, the odds ratio for the central venous catheter [3.38 (95% confidence interval [CI]: 1.444, 8.705 ; p = 0.006)], for surgery [3.387 (95% confidence interval [CI]: 1.370, 8.373 ; p = 0.008)] and for arterial blood gas collection history [18.584 (95% confidence interval [CI]:4.086, 84.197; p < 0.001)] were identified as significant risk factors. Stenotrophomonas maltophilia growth was found in ready-to-use commercial syringes used for arterial blood gas collection. Molecular analysis showed that the growths in the samples taken from commercial syringes and the growths from blood cultures were the same. It was decided that the epidemic occurred because the method for sterilization of heparinized liquid preparations were not suitable. After discontinuing the use of the kits with this lot number, the outbreak was brought under control. CONCLUSIONS According to our results, disposable or sterile medical equipment should be included as a risk factor in outbreak analyses. The method by which injectors containing liquids, such as heparin, are sterilized should be reviewed. Our study also revealed the importance of the cooperation of the infection control team with the microbiology laboratory.
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Affiliation(s)
- Esra Kazak
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludag University, Gorukle, Nilufer, Bursa, Turkey.
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey.
| | - Uğur Önal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludag University, Gorukle, Nilufer, Bursa, Turkey
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Nazmiye Ülkü Tüzemen
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Funda Aslan
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Gül Çalışkan
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Hüsniye Şimşek
- Molecular Microbiology and Reference Laboratory, General Directorate of Public Health, Ministry of Health, Republic of Turkey, Ankara, Turkey
| | - Zekiye Bakkaloğlu
- Molecular Microbiology and Reference Laboratory, General Directorate of Public Health, Ministry of Health, Republic of Turkey, Ankara, Turkey
| | - Yasemin Numanoğlu Çevik
- Molecular Microbiology and Reference Laboratory, General Directorate of Public Health, Ministry of Health, Republic of Turkey, Ankara, Turkey
| | - Yasemin Heper
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludag University, Gorukle, Nilufer, Bursa, Turkey
| | - Solmaz Çelebi
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Emel Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludag University, Gorukle, Nilufer, Bursa, Turkey
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Mustafa Kemal Hacımustafaoğlu
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Cüneyt Özakın
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Emin Halis Akalın
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludag University, Gorukle, Nilufer, Bursa, Turkey
- Infection Control Team, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
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Telli Dizman G, Metan G, Karahan G, Tanrıverdi ES, Hazırolan G, Otlu B, Sönmezer MÇ, Gül ND, Çınar B, Ünal S. Does marking as sterile mean really sterile? Stenotrophomonas maltophilia outbreak caused by a blood-gas injector containing liquid heparin. Infect Control Hosp Epidemiol 2023; 44:1683-1685. [PMID: 36775899 DOI: 10.1017/ice.2023.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
An outbreak investigation was initiated after detecting an increase in the number of patients with Stenotrophomonas maltophilia bloodstream infections (SM-BSIs) througout the hospital. S. maltophilia was isolated from the cultures of blood-gas ınjectors containing liquid heparin. The incidence density of SM-BSIs decreased significantly after prohibiting the use of those injectors.
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Affiliation(s)
- Gülçin Telli Dizman
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gizem Karahan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elif Seren Tanrıverdi
- Department of Medical Microbiology, Molecular Microbiology Laboratory, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe UniversityAnkara, Turkey
| | - Barış Otlu
- Department of Medical Microbiology, Molecular Microbiology Laboratory, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Meliha Çağla Sönmezer
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nur Dilek Gül
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Çınar
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Kanaujia R, Bandyopadhyay A, Biswal M, Sahni N, Kaur K, Vig S, Sharma V, Angrup A, Yaddanapudi LN, Ray P. Colonization of the central venous catheter by Stenotrophomonas maltophilia in an ICU setting: An impending outbreak managed in time. Am J Infect Control 2022; 50:663-667. [PMID: 34736990 DOI: 10.1016/j.ajic.2021.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stenotrophomonas maltophiliacauses opportunistic infections in immunocompromised and patients in intensive care units (ICUs). An outbreak of S. maltophilia in ICU is described which highlights the importance of the risk of infection from contaminated medical devices and suction fluids in ventilated patients. METHODS The investigation of the outbreak was carried out. Environmental sampling was done. This was followed by MALDI-TOF MS typing and recA gene-based-phylogeny. RESULTS In February, S. maltophilia was reported from the central line blood of six patients from ICU within a span of two weeks. The peripheral line blood cultures were sterile in all patients. Relevant environmental sampling of the high-touch surface and fluids revealed S. maltophilia strains in normal saline used for suction and in the inspiratory circuit of two patients. The isolated strains from patients and environment (inspiratory fluid) showed a minimum of 95.41% recA gene sequence identity between each other. Strict cleaning and disinfection procedures were followed. Continuous surveillance was done and no further case of S. maltophilia was detected. Timely diagnosis and removal of central line prevented development of central-line associated blood stream infection. CONCLUSION This outbreak report illustrates that environmental sources like suction fluid and normal saline could be the source of S. maltophilia in ICU patients.
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Affiliation(s)
| | | | - Manisha Biswal
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Neeru Sahni
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Kulbeer Kaur
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Shashi Vig
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Vikas Sharma
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | | | - Pallab Ray
- Department of Medical Microbiology, PGIMER, Chandigarh, India
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Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria. Antimicrob Agents Chemother 2018; 62:AAC.00569-18. [PMID: 29987150 DOI: 10.1128/aac.00569-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/29/2018] [Indexed: 11/20/2022] Open
Abstract
The management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Staphylococcus aureus Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.
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Del Pozo JL. Role of Antibiotic Lock Therapy for the Treatment of Catheter-Related Bloodstream Infections. Int J Artif Organs 2018; 32:678-88. [DOI: 10.1177/039139880903200918] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Catheter-related bloodstream infections are often difficult to treat because they are caused by organisms that embed themselves in a bio film layer on the catheter surface, resulting in an increased resistance to antimicrobial agents. Systemic antibiotics are usually administered but, although generally effective in eliminating circulating bacteria, they frequently fail to sterilize the line, leaving the patient at a continuing risk of complications or recurrence. A successful approach to managing these infections requires making an appropriate decision regarding whether the catheter should be removed or retained using antibiotic lock therapy; and choosing the type and duration of antimicrobial therapy based on the type of organism and its resistance pattern. Studies that have evaluated antibiotic lock therapy have varied in the types of antibiotics and concentrations used, the addition of heparin to the solutions, and dwell times in the catheter lumen. Guidelines from the Infectious Diseases Society of America include use of antibiotic lock therapy as a therapeutic option for intraluminal infections when the device is not removed and, although not routine, as prophylaxis for catheter-related infection in select patient populations. However, there are no published guidelines on the concentration of heparin or antibiotics that should be used, and minimal published data on the stability of heparin combinations with antibiotics. It is to be hoped that antibiotic locks will be subject to randomized controlled trials of sufficient power to confirm or refute their use.
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Affiliation(s)
- Jose L Del Pozo
- Division of Infectious Diseases and Department of Clinical Microbiology, University Clinic of Navarra, Pamplona - Spain
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Peter S, Oberhettinger P, Schuele L, Dinkelacker A, Vogel W, Dörfel D, Bezdan D, Ossowski S, Marschal M, Liese J, Willmann M. Genomic characterisation of clinical and environmental Pseudomonas putida group strains and determination of their role in the transfer of antimicrobial resistance genes to Pseudomonas aeruginosa. BMC Genomics 2017; 18:859. [PMID: 29126393 PMCID: PMC5681832 DOI: 10.1186/s12864-017-4216-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 10/16/2017] [Indexed: 02/01/2023] Open
Abstract
Background Pseudomonas putida is a Gram-negative, non-fermenting bacterium frequently encountered in various environmental niches. P. putida rarely causes disease in humans, though serious infections and outbreaks have been reported from time to time. Some have suggested that P. putida functions as an exchange platform for antibiotic resistance genes (ARG), and thus represents a serious concern in the spread of ARGs to more pathogenic organisms within a hospital. Though poorly understood, the frequency of ARG exchange between P. putida and the more virulent Pseudomonas aeruginosa and its clinical relevance are particularly important for designing efficient infection control strategies, such as deciding whether high-risk patients colonized with a multidrug resistant but typically low pathogenic P. putida strain should be contact isolated or not. Results In this study, 21,373 screening samples (stool, rectal and throat swab) were examined to determine the presence of P. putida in a high-risk group of haemato-oncology patients during a 28-month period. A total of 89 P. putida group strains were isolated from 85 patients, with 41 of 89 (46.1%) strains harbouring the metallo-beta-lactamase gene blaVIM. These 41 clinical isolates, plus 18 blaVIM positive environmental P. putida isolates, and 17 blaVIM positive P. aeruginosa isolates, were characterized by whole genome sequencing (WGS). We constructed a maximum-likelihood tree to separate the 59 blaVIM positive P. putida group strains into eight distinct phylogenetic clusters. BlaVIM-1 was present in 6 clusters while blaVIM-2 was detected in 4 clusters. Five P. putida group strains contained both, blaVIM-1 and blaVIM-2 genes. In contrast, all P. aeruginosa strains belonged to a single genetic cluster and contained the same ARGs. Apart from blaVIM-2 and sul genes, no other ARGs were shared between P. aeruginosa and P. putida. Furthermore, the blaVIM-2 gene in P. aeruginosa was predicted to be only chromosomally located. Conclusion These data provide evidence that no exchange of comprehensive ARG harbouring mobile genetic elements had occurred between P. aeruginosa and P. putida group strains during the study period, thus eliminating the need to implement enhanced infection control measures for high-risk patients colonized with a blaVIM positiv P. putida group strains in our clinical setting. Electronic supplementary material The online version of this article (10.1186/s12864-017-4216-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Silke Peter
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany. .,German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany.
| | - Philipp Oberhettinger
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Leonard Schuele
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany.,Department of Medical Microbiology, Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | - Ariane Dinkelacker
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Wichard Vogel
- Medical Center, Department of Hematology, Oncology, Immunology, Rheumatology & Pulmonology, University of Tübingen, Tübingen, Germany
| | - Daniela Dörfel
- Medical Center, Department of Hematology, Oncology, Immunology, Rheumatology & Pulmonology, University of Tübingen, Tübingen, Germany.,Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner site Tübingen, Tübingen, Germany
| | - Daniela Bezdan
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York, New York, USA.,The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York, USA
| | - Stephan Ossowski
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tübingen, Germany
| | - Matthias Marschal
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Jan Liese
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Matthias Willmann
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.,German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
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Raphael E, Riley LW. Infections Caused by Antimicrobial Drug-Resistant Saprophytic Gram-Negative Bacteria in the Environment. Front Med (Lausanne) 2017; 4:183. [PMID: 29164118 PMCID: PMC5670356 DOI: 10.3389/fmed.2017.00183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/12/2017] [Indexed: 11/25/2022] Open
Abstract
Background Drug-resistance genes found in human bacterial pathogens are increasingly recognized in saprophytic Gram-negative bacteria (GNB) from environmental sources. The clinical implication of such environmental GNBs is unknown. Objectives We conducted a systematic review to determine how often such saprophytic GNBs cause human infections. Methods We queried PubMed for articles published in English, Spanish, and French between January 2006 and July 2014 for 20 common environmental saprophytic GNB species, using search terms “infections,” “human infections,” “hospital infection.” We analyzed 251 of 1,275 non-duplicate publications that satisfied our selection criteria. Saprophytes implicated in blood stream infection (BSI), urinary tract infection (UTI), skin and soft tissue infection (SSTI), post-surgical infection (PSI), osteomyelitis (Osteo), and pneumonia (PNA) were quantitatively assessed. Results Thirteen of the 20 queried GNB saprophytic species were implicated in 674 distinct infection episodes from 45 countries. The most common species included Enterobacter aerogenes, Pantoea agglomerans, and Pseudomonas putida. Of these infections, 443 (66%) had BSI, 48 (7%) had SSTI, 36 (5%) had UTI, 28 (4%) had PSI, 21 (3%) had PNA, 16 (3%) had Osteo, and 82 (12%) had other infections. Nearly all infections occurred in subjects with comorbidities. Resistant strains harbored extended-spectrum beta-lactamase (ESBL), carbapenemase, and metallo-β-lactamase genes recognized in human pathogens. Conclusion These observations show that saprophytic GNB organisms that harbor recognized drug-resistance genes cause a wide spectrum of infections, especially as opportunistic pathogens. Such GNB saprophytes may become increasingly more common in healthcare settings, as has already been observed with other environmental GNBs such as Acinetobacter baumannii and Pseudomonas aeruginosa.
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Affiliation(s)
- Eva Raphael
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Lee W Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
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Suvikas-Peltonen E, Hakoinen S, Celikkayalar E, Laaksonen R, Airaksinen M. Incorrect aseptic techniques in medicine preparation and recommendations for safer practices: a systematic review. Eur J Hosp Pharm 2016; 24:175-181. [PMID: 31156932 DOI: 10.1136/ejhpharm-2016-001015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/14/2016] [Accepted: 09/20/2016] [Indexed: 11/04/2022] Open
Abstract
Objective Many patient deaths have been reported because of administration of contaminated intravenous medicines due to incorrect aseptic techniques. Our aim was to review the literature for (1) incorrect practices in aseptic drug preparation and administration and (2) recommendations for safer practices in hospitals. Methods A systematic literature search was conducted in PubMed covering 2007-2015. Studies were included if they concerned aseptic medicine preparation and administration in hospitals by different healthcare professionals, assessed incorrect practices and made recommendations for safer aseptic preparation and administration. Results 26 studies were included of which 19 were original articles. 12 of the studies concerned description of incorrect practices that led to contamination. The studies reported 11 incorrect practices that increased the risk of contamination of parenteral medicines. The most reported incorrect practices were multiple use of phials and syringes (2/12 studies) and lack of overall disinfection during the aseptic preparation and administration (3/12 studies). 22 practices were recommended to avoid contamination, which were classified into six categories: equipment and medicines (7); disinfection (6); working environment (3); storing (3); catheter care (2) and quality of prepared medicines (1). The results indicate that pharmacists prepared syringes with less contamination than nurses because of the pharmacist's aseptic skills and environmental aspects in pharmacy units. Conclusions The review discusses many appropriate and enhanced practices in aseptic drug preparation and administration. As the change for the better in contamination rates of administered medicines seems to be challenging to achieve in hospitals, better and possibly international procedures for safe parenteral practices need to be developed.
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Affiliation(s)
- Eeva Suvikas-Peltonen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Suvi Hakoinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Ercan Celikkayalar
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Raisa Laaksonen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
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Ozbek B, Mataraci-Kara E. Comparativein vitroefficacies of various antipseudomonal antibiotics based catheter lock solutions on eradication ofPseudomonas aeruginosabiofilms. J Chemother 2016; 28:20-4. [DOI: 10.1179/1973947814y.0000000212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Evidence-Based Criteria for the Choice and the Clinical use of the Most Appropriate Lock Solutions for Central Venous Catheters (Excluding Dialysis Catheters): A GAVeCeLT Consensus. J Vasc Access 2016; 17:453-464. [DOI: 10.5301/jva.5000576] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2016] [Indexed: 12/13/2022] Open
Abstract
Background The most appropriate lock solution for central venous access devices is still to be defined. GAVeCeLT – the Italian group for venous access devices – has developed a consensus on the evidence-based criteria for the choice and the clinical use of the most appropriate lock solution for central venous catheters (excluding dialysis catheters). Method After the constitution of a panel of experts, a systematic collection and review of the literature has been performed, focusing on clinical studies dealing with lock solutions used for prevention of occlusion (heparin, citrate, urokinase, recombinant tissue plasminogen activator [r-TPA], normal saline) or for prevention of infection (citrate, ethanol, taurolidine, ethylene-diamine-tetra-acetic acid [EDTA], vancomycin, linezolid and other antibiotics), in both adults and in pediatric patients. Studies on central lines used for dialysis or pheresis, on peripheral venous lines and on arterial lines were excluded from this analysis. Studies on lock solutions used for treatment of obstruction or infection were not considered. The consensus has been carried out according to the Delphi method. Results The panel has concluded that: (a) there is no evidence supporting the heparin lock; (b) the prevention of occlusion is based on the proper flushing and locking technique with normal saline; (c) the most appropriate lock solution for infection prevention should include citrate and/or taurolidine, which have both anti-bacterial and anti-biofilm activity, with negligible undesired effects if compared to antibiotics; (d) the patient populations most likely to benefit from citrate/taurolidine lock are yet to be defined. Conclusions The actual value of heparinization for non-dialysis catheters should be reconsidered. Also, the use of lock with substances with anti-bacterial and anti-biofilm activity (such as citrate or taurolidine) should be taken into consideration in selected populations of patients.
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Goossens GA. Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit. Nurs Res Pract 2015; 2015:985686. [PMID: 26075094 PMCID: PMC4446496 DOI: 10.1155/2015/985686] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/24/2015] [Indexed: 12/12/2022] Open
Abstract
Flushing and locking of intravenous catheters are thought to be essential in the prevention of occlusion. The clinical sign of an occlusion is catheter malfunction and flushing is strongly recommended to ensure a well-functioning catheter. Therefore fluid dynamics, flushing techniques, and sufficient flushing volumes are important matters in adequate flushing in all catheter types. If a catheter is not in use, it is locked. For years, it has been thought that the catheter has to be filled with an anticoagulant to prevent catheter occlusion. Heparin has played a key role in locking venous catheters. However, the high number of risks associated with heparin forces us to look for alternatives. A long time ago, 0.9% sodium chloride was already introduced as locking solution in peripheral cannulas. More recently, a 0.9% sodium chloride lock has also been investigated in other types of catheters. Thrombolytic agents have also been studied as a locking solution because their antithrombotic effect was suggested as superior to heparin. Other catheter lock solutions focus on the anti-infective properties of the locks such as antibiotics and chelating agents. Still, the most effective locking solution will depend on the catheter type and the patient's condition.
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Affiliation(s)
- Godelieve Alice Goossens
- Nursing Centre of Excellence, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
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Hardjo Lugito NP, Nawangsih C, Moksidy JC, Kurniawan A, Tjiang MM. Diabetic Foot Gangrene Patient with Multi-drug Resistant Pseudomonas Putida Infection in Karawaci District, Indonesia. J Glob Infect Dis 2015; 7:37-9. [PMID: 25722620 PMCID: PMC4338450 DOI: 10.4103/0974-777x.146378] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pseudomonas putida is a rod-shaped, non fermenting Gram-negative organism frequently found in the environment that utilizes aerobic metabolism, previously thought to be of low pathogenicity. It had been reported as cause of skin and soft tissue infection, especially in immunocompromised patients. A female green grocer, 51 year-old came to internal medicine out-patient clinic with gangrene and osteomyelitis on her 1st, 2nd and 3rd digit and wound on the sole of the right foot since 1 month prior. The patient had history of uncontrolled diabetes since a year ago. She was given ceftriaxone 2 grams b.i.d, metronidazole 500 mg t.i.d empirically and then amikacin 250 mg b.i.d, followed by amputation of the digits and wound debridement. The microorganism's culture from pus revealed multi drug resistant Pseudomonas putida. She recovered well after antibiotics and surgery.
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Affiliation(s)
- Nata Pratama Hardjo Lugito
- Department of Internal Medicine, Pelita Harapan University, Jendral Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, Indonesia 15811
| | - Cucu Nawangsih
- Department of Microbiology, Pelita Harapan University, Jendral Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, Indonesia 15811
| | - Jevany Claudia Moksidy
- Faculty of Medicine, Pelita Harapan University, Jendral Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, Indonesia 15811
| | - Andree Kurniawan
- Department of Internal Medicine, Pelita Harapan University, Jendral Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, Indonesia 15811
| | - Margaret Merlyn Tjiang
- Department of Internal Medicine, Pelita Harapan University, Jendral Sudirman Boulevard, Lippo Karawaci, Tangerang, Banten, Indonesia 15811
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Neulier C, Breton N, Pangon B, Monnier AL, Henry-Lagarrigue M, Dujon C, Merrer J. Pseudo-outbreak of Pseudomonas putida Respiratory Infection Caused by Laboratory Contamination. Infect Control Hosp Epidemiol 2015; 32:523-5. [DOI: 10.1086/659958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Al-Anazi KA, Al-Jasser AM. Infections Caused by Stenotrophomonas maltophilia in Recipients of Hematopoietic Stem Cell Transplantation. Front Oncol 2014; 4:232. [PMID: 25202682 PMCID: PMC4142553 DOI: 10.3389/fonc.2014.00232] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/11/2014] [Indexed: 12/19/2022] Open
Abstract
Stenotrophomonas maltophilia (S. maltophilia) is a globally emerging Gram-negative bacillus that is widely spread in environment and hospital equipment. Recently, the incidence of infections caused by this organism has increased, particularly in patients with hematological malignancy and in recipients of hematopoietic stem cell transplantation (HSCT) having neutropenia, mucositis, diarrhea, central venous catheters or graft versus host disease and receiving intensive cytotoxic chemotherapy, immunosuppressive therapy, or broad-spectrum antibiotics. The spectrum of infections in HSCT recipients includes pneumonia, urinary tract and surgical site infection, peritonitis, bacteremia, septic shock, and infection of indwelling medical devices. The organism exhibits intrinsic resistance to many classes of antibiotics including carbapenems, aminoglycosides, most of the third-generation cephalosporins, and other β-lactams. Despite the increasingly reported drug resistance, trimethoprim-sulfamethoxazole is still the drug of choice. However, the organism is still susceptible to ticarcillin-clavulanic acid, tigecycline, fluoroquinolones, polymyxin-B, and rifampicin. Genetic factors play a significant role not only in evolution of drug resistance but also in virulence of the organism. The outcome of patients having S. maltophilia infections can be improved by: using various combinations of novel therapeutic agents and aerosolized aminoglycosides or colistin, prompt administration of in vitro active antibiotics, removal of possible sources of infection such as infected indwelling intravascular catheters, and application of strict infection control measures.
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Affiliation(s)
- Khalid Ahmed Al-Anazi
- Section of Adult Hematology and Oncology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Liu Y, Liu K, Yu X, Li B, Cao B. Identification and control of a Pseudomonas spp (P. fulva and P. putida) bloodstream infection outbreak in a teaching hospital in Beijing, China. Int J Infect Dis 2014; 23:105-8. [PMID: 24747963 DOI: 10.1016/j.ijid.2014.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/04/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES An outbreak of bacteremia caused by Pseudomonas spp (P. fulva and P. putida) was first identified in our hospital in the summer of 2010 and reoccurred in the following year. Based on the epidemiological data collected in these 2 years, we initiated an investigation on the source of the outbreak. The aim of this study was to report the results of the investigation, as well as the intervention strategies that resulted in successful control of the outbreak. METHODS An infection control team was set up consisting of infectious disease specialists, microbiologists, infection control practitioners, and head nurses. The microbiology and medical records of case-patients with P. fulva or P. putida bloodstream infections were reviewed. Environmental samples and intravenous (IV) solutions from the wards and the pharmacy center were collected for culturing. The molecular characteristics of the bacterial isolates were studied by pulsed-field gel electrophoresis (PFGE). Strict infection control strategies were implemented. RESULTS A total of 20 case-patients from five inpatient wards were identified during three summer seasons from 2010 to 2012. Nineteen of them recovered with proper antibiotics. Unfortunately one died from complications of heart failure. A total of 19 isolates of P. fulva and four of P. putida were identified, of which 20 were from blood, two from environmental surface samples from the hospital pharmacy, and one from an in-use compounded solution from a case-patient in the cardiology ward. Molecular analysis revealed that the P. fulva isolated from the in-use compounded solution (5% glucose solution containing insulin, isosorbide dinitrate, and potassium magnesium aspartate) and the environmental samples had the same PFGE type as the clinical isolates. CONCLUSIONS The investigation identified that contaminated IV solution was the source of the P. fulva bacteremia, which prompted us to implement intensified control measures that resulted in successful control of the outbreak.
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Affiliation(s)
- Yingmei Liu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang South Road, Chaoyang District, Beijing 100020, People's Republic of China; Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing, People's Republic of China
| | - Kun Liu
- Department of Infection Control, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaomin Yu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang South Road, Chaoyang District, Beijing 100020, People's Republic of China; Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing, People's Republic of China
| | - Binbin Li
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang South Road, Chaoyang District, Beijing 100020, People's Republic of China; Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing, People's Republic of China
| | - Bin Cao
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang South Road, Chaoyang District, Beijing 100020, People's Republic of China; Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing, People's Republic of China.
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Stenotrophomonas maltophilia Pseudo-outbreak at a University Hospital Bronchoscopy Unit in Turkey. W INDIAN MED J 2014; 63:59-61. [PMID: 25303196 DOI: 10.7727/wimj.2013.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 07/30/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Stenotrophomonas maltophilia is an opportunistic pathogen found predominantly in the environment and hospital setting. Invasive procedures and treatment methods, instruments used for diagnosis and irrational antibiotic use play major roles in the spread of this pathogen. The study aimed to evaluate consecutive S maltophilia isolation from bronchoalveolar lavage samples during bronchoscopy procedure during a week. METHODS Four patients consecutively had S maltophilia isolated during bronchoscopy between September 8 and 15, 2012. The identification of the isolates and their antibiotic susceptibility were studied by automated Vitek version 2.0 (Biomerieux, France) system. The clonal relationship between the isolates was studied by enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR). RESULTS Four consecutive S maltophilia isolates had identical band patterns and showed clonal relatedness. CONCLUSION Bronchoscopy is a common invasive procedure that is utilized in chest diseases departments and intensive care units (ICUs). Contamination may take place due to inappropriate use and cause spread of infectious pathogens. In the current study, we detected consecutive S maltophilia strains with identical band patterns isolated within a week. After appropriate disinfection and cleaning procedures, no further isolation was detected.
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Lebeaux D, Fernández-Hidalgo N, Chauhan A, Lee S, Ghigo JM, Almirante B, Beloin C. Management of infections related to totally implantable venous-access ports: challenges and perspectives. THE LANCET. INFECTIOUS DISEASES 2014; 14:146-59. [DOI: 10.1016/s1473-3099(13)70266-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Fernández-Hidalgo N, Almirante B. Antibiotic-lock therapy: a clinical viewpoint. Expert Rev Anti Infect Ther 2013; 12:117-29. [PMID: 24308711 DOI: 10.1586/14787210.2014.863148] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antibiotic lock therapy (ALT) - instillation of high concentrations of anti-microbial agent with or without anti-coagulant into the lumen of central venous catheters - is considered a valid conservative treatment for catheter-related bloodstream infection (CRBSI) in patients highly dependent on maintaining the catheter. Results from randomized controlled studies have indicated that the effectiveness of ALT is moderate, but recent findings from experimental studies and observational case series point to considerable efficacy and safety of this therapy, which is usually associated with concomitant systemic treatment. In this article, the current knowledge about ALT for patients with CRBSI is reviewed and discussed, with emphasis on existing controversies and the results obtained according to the various uses of the catheters and the etiologies of infection.
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Affiliation(s)
- Nuria Fernández-Hidalgo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Souza Dias MB, Cavassin LG, Stempliuk V, Xavier LS, Lobo RD, Sampaio JL, Pignatari AC, Borrasca VL, Bierrenbach AL, Toscano CM. Multi-institutional outbreak of Burkholderia cepacia complex associated with contaminated mannitol solution prepared in compounding pharmacy. Am J Infect Control 2013; 41:1038-42. [PMID: 23663863 DOI: 10.1016/j.ajic.2013.01.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/17/2013] [Accepted: 01/17/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Burkholderia cepacia complex (BCC) has been described as a cause of nosocomial outbreaks. We describe an outbreak of and identify risk factors for nosocomial BCC infections associated with intrinsically contaminated mannitol 3% solution. METHODS Urinary and bloodstream infection caused by BCC were identified in hospitalized patients who underwent urologic surgery and received intraoperative irrigation of 3% mannitol solution in February 2009. The investigation included retrospective chart review, case control study, procedural review, and culture of mannitol solution. RESULTS Seven BCC infections were identified. BCC isolates were recovered from blood and/or urine from patients and lots of mannitol in use during the outbreak period. Mannitol solution was produced by a compounding pharmacy. Receipt of larger volumes of contaminated solution was identified as a significant risk factor for infection (odds ratio, 1.5; P value < .05). BCC was also cultured in lots of mannitol in use in other hospitals. CONCLUSION Manipulated mannitol solution is a potential source of infection. Contamination with paraben-degrading organisms can occur at the time of manufacture. Our findings suggest that contamination of mannitol at a compounding pharmacy occurred. Prompt communication to other hospitals and implementation of infection control measures were effective in avoiding further cases of infection.
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21
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The role of the environment in the spread of emerging pathogens in at-risk hospital wards. ACTA ACUST UNITED AC 2013. [DOI: 10.1097/mrm.0b013e328365c506] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Schoot RA, van Dalen EC, van Ommen CH, van de Wetering MD. Antibiotic and other lock treatments for tunnelled central venous catheter-related infections in children with cancer. Cochrane Database Syst Rev 2013:CD008975. [PMID: 23799867 DOI: 10.1002/14651858.cd008975.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The risk of developing a tunnelled central venous catheter (CVC)-related infection ranges between 0.1 and 2.3 per 1000 catheter days for children with cancer. These infections are difficult to treat with systemic antibiotics (salvage rate 24% - 66%) due to biofilm formation in the CVC. Lock treatments can achieve 100 - 1000 times higher concentrations locally without exposure to high systemic concentrations. OBJECTIVES Our objective was to investigate the efficacy of antibiotic and other lock treatments in the treatment of CVC-related infections in children with cancer compared to a control intervention. We also assessed adverse events of lock treatments. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, issue 3, 2011), MEDLINE/PubMed (1945 to August 2011) and EMBASE/Ovid (1980 to August 2011). In addition we searched reference lists from relevant articles and the conference proceedings of the International Society for Paediatric Oncology (SIOP) (from 2006 to 2010), American Society of Clinical Oncology (ASCO) (from 2006 to 2010), the Multinational Association of Supportive Care in Cancer (MASCC) (from 2006 to 2011), the American Society of Hematology (ASH) (from 2006 to 2010) and the International Society of Thrombosis and Haematology (ISTH) (from 2006 to 2011). We scanned the ISRCTN Register and the National Institute of Health Register for ongoing trials (www.controlled-trials.com) (August 2011). SELECTION CRITERIA Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing an antibiotic lock or other lock treatment (with or without concomitant systemic antibiotics) with a control intervention (other lock treatment with or without concomitant systemic antibiotics or systemic antibiotics alone) for the treatment of CVC-related infections in children with cancer. For the description of adverse events, cohort studies were also eligible for inclusion. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data and performed 'Risk of bias' assessments of included studies. Analyses were performed according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS Two RCTs evaluated urokinase lock treatment with concomitant systemic antibiotics (n = 56) versus systemic antibiotics alone (n = 48), and one CCT evaluated ethanol lock treatment with concomitant systemic antibiotics (n = 15) versus systemic antibiotics alone (n = 13). No RCTs or CCTs evaluating antibiotic lock treatments were identified. All studies had methodological limitations and clinical heterogeneity between studies was present. We found no evidence of significant difference between ethanol or urokinase lock treatments with concomitant systemic antibiotics and systemic antibiotics alone regarding the number of participants cured, the number of recurrent CVC-related infections, the number of days until the first negative blood culture, the number of CVCs prematurely removed, ICU admission and sepsis. Not all studies were included in all analyses. No adverse events occurred in the five publications of cohort studies (one cohort was included in two publications) assessing this outcome; CVC malfunctioning occurred in three out of five publications of cohort studies assessing this outcome. AUTHORS' CONCLUSIONS No significant effect of urokinase or ethanol lock in addition to systemic antibiotics was found. However, this could be due to low power or a too-short follow-up. The cohort studies identified no adverse events; some cohort studies reported CVC malfunctioning. No RCTs or CCTs were published on antibiotic lock treatment alone. More well-designed RCTs are needed to further explore the effect of antibiotic or other lock treatments in the treatment of CVC-related infections in children with cancer.
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Affiliation(s)
- Reineke A Schoot
- Department of Paediatric Oncology, Emma Children’s Hospital / Academic Medical Center, Amsterdam, Netherlands.
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Predictors of Failure of Catheter Salvage in Incident Hemodialysis Patients. Int J Artif Organs 2013; 36:320-6. [PMID: 23645579 DOI: 10.5301/ijao.5000176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2012] [Indexed: 11/20/2022]
Abstract
Purpose Catheter-related bloodstream infection is a frequent complication for patients who use catheter as dialysis access. This study was performed to identify the risk factors for failed catheter salvage. Methods We enrolled patients who received non-tunneled catheters as initial vascular access during a two-year period. Catheter salvage was attempted in all symptomatically mild patients. Patients were prospectively followed for 8 weeks starting from the day of infection. Risk factors for salvage failure were explored. Results A total of 77 bacteremia episodes occurred in 69 patient, with an infection rate of 1.61 per 1,000 catheter days. Salvage was successful in 73.4% of all episodes. We found that higher ferritin levels (greater vs. lower than 500 mg/l, (odds ratio (OR) 6.388, 95% confidence interval (CI) 2.073, 19.686), higher phosphate levels (greater vs. lower than 5.5 mg/dl, OR 4.084, 95% CI 1.391, 11.978) and shorter time intervals between catheterization and infection (within vs. beyond 3 weeks, OR 4.190, 95% CI 1.279, 13.725) predicted salvage failure. Conclusions Catheter salvage can be a reasonable initial strategy for symptomatically mild patients. We propose salvaging aggressively and waiting watchfully; however, clinical judgment is prior to any specific management protocol.
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Kim SE, Park SH, Park HB, Park KH, Kim SH, Jung SI, Shin JH, Jang HC, Kang SJ. Nosocomial Pseudomonas putida Bacteremia: High Rates of Carbapenem Resistance and Mortality. Chonnam Med J 2012; 48:91-5. [PMID: 22977749 PMCID: PMC3434797 DOI: 10.4068/cmj.2012.48.2.91] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 08/09/2012] [Accepted: 08/13/2012] [Indexed: 11/10/2022] Open
Abstract
Previously, Pseudomonas putida was considered a low-virulence pathogen and was recognized as a rare cause of bacteremia. Recently, however, multidrug-resistant and carbapenem-resistant P. putida isolates have emerged, causing difficult-to-treat nosocomial infections in seriously ill patients. Currently, the outcome of multidrug-resistant or carbapenem-resistant P. putida bacteremia remains uncertain. Here, we report 18 cases of P. putida bacteremia with high rates of carbapenem resistance and mortality. From January 2005 through December 2011, all cases of nosocomial P. putida bacteremia were identified and analyzed at Chonnam National University Hospital and Chonnam National University Hwasun Hospital. Electronic medical records were reviewed retrospectively. Four (22%) and five (23%) of 18 P. putida isolates were resistant to imipenem and meropenem, respectively. Common primary infection sites were central venous catheter (7, 39%), pneumonia (5, 28%), and cholangitis (2, 11%). Fourteen (78%) patients had indwelling devices related to the primary site of infection. The 30-day mortality rate was 39% (7/18): 40% (2/5) in patients with carbapenem-resistant P. putida bacteremia vs. 38% (5/13) in patients with carbapenem-susceptible P. putida bacteremia. Nosocomial P. putida bacteremia showed high resistance rates to most potent β-lactams and carbapenems and was associated with high mortality rates.
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Affiliation(s)
- Seong Eun Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Lucía Correa A, María Mazo L, Patricia Valderrama M, Restrepo A, Jaimes F. Descripción de un brote de bacteriemia por Leclercia adecarboxylata probablemente asociado al uso de viales contaminados de heparina. INFECTIO 2012. [DOI: 10.1016/s0123-9392(12)70065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Tsai MH, Hsu JF, Lien R, Huang HR, Chiang CC, Chu SM, Liang HF, Huang YC. Catheter management in neonates with bloodstream infection and a percutaneously inserted central venous catheter in situ: removal or not? Am J Infect Control 2012; 40:59-64. [PMID: 21839544 DOI: 10.1016/j.ajic.2011.04.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 04/15/2011] [Accepted: 04/15/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study investigated whether removal of a percutaneously inserted central venous catheter (PICC) is compulsory in neonates with bloodstream infection (BSI), and also examined the risk factors for infectious complications when a PICC is retained in these patients. METHODS This was a cohort study of neonates with a PICC who developed a BSI between 2001 and 2007. BSI was defined according to Centers for Disease Control and Prevention criteria. RESULTS Of the 234 neonates in the cohort, 99 had early removal of PICC (ER-PICC, defined as removal within 3 days after the onset of clinical sepsis), and 135 had late removal of PICC (LR-PICC, defined as retention for more than 3 days after the onset of clinical sepsis). Resolution of clinical sepsis within 2 days was more frequent in the ER-PICC group compared with the LR-PICC group (80.8% vs 57.8%; P < .001). There was no significant difference between the 2 groups in terms of infectious complications and case fatalities, but the LR-PICC group had a significantly higher incidence of recurrence within 1 month after BSI (P = .002). Inappropriate initial antibiotic treatment was the only variable independently associated with infectious complications (odds ratio, 11.4; 95% confidence interval, 3.34∼39.2; P < .001). CONCLUSIONS PICCs should be removed in neonates with BSI, because retention of PICCs for more than 3 days is associated with delayed resolution of clinical sepsis and a higher incidence of recurrence within 1 month.
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Boszczowski I, Nóbrega de Almeida Júnior J, Peixoto de Miranda EJ, Pinheiro Freire M, Guimarães T, Chaves CE, Cais DP, Strabelli TMV, Risek CF, Soares RE, Rossi F, Costa SF, Levin AS. Nosocomial outbreak of Pantoea agglomerans bacteraemia associated with contaminated anticoagulant citrate dextrose solution: new name, old bug? J Hosp Infect 2012; 80:255-8. [PMID: 22245117 DOI: 10.1016/j.jhin.2011.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 12/15/2011] [Indexed: 11/17/2022]
Abstract
We describe an outbreak investigation of Pantoea agglomerans bacteraemia associated with anticoagulant citrate-dextrose 46% (ACD) solution prepared in-house. A healthy man presented with septic shock during plasmapheresis for granulocyte donation. The solution used for priming and blood samples were sent for culture. Identification of the isolate to species level was performed by gyrB sequencing. Typing was performed by pulsed-field gel electrophoresis (PFGE). In total, eight cases were identified during a three-week period. P. agglomerans was also cultured from six ACD solution bags. Isolates from patients and ACD bags were identical by PFGE. All isolates were susceptible to ampicillin, cephazolin, gentamicin, ciprofloxacin, cefepime and imipenem.
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Affiliation(s)
- I Boszczowski
- Infection Control Department, Hospital das Clínicas, University of São Paulo, Brazil.
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Funalleras G, Fernandez-Hidalgo N, Borrego A, Almirante B, Planes AM, Rodriguez D, Ruiz I, Pahissa A. Effectiveness of Antibiotic-Lock Therapy for Long-term Catheter-Related Bacteremia Due to Gram-Negative Bacilli: A Prospective Observational Study. Clin Infect Dis 2011; 53:e129-32. [DOI: 10.1093/cid/cir551] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Fernández-Cuenca F, López-Cortés LE, Rodríguez-Baño J. Contribución del laboratorio de microbiología en la vigilancia y el control de brotes nosocomiales producidos por bacilos gramnegativos no fermentadores. Enferm Infecc Microbiol Clin 2011; 29 Suppl 3:40-6. [DOI: 10.1016/s0213-005x(11)70026-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Nicolau CJ, Oliver A. Carbapenemasas en especies del género Pseudomonas. Enferm Infecc Microbiol Clin 2010; 28 Suppl 1:19-28. [DOI: 10.1016/s0213-005x(10)70004-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Del Pozo JL, Alonso M, Serrera A, Hernaez S, Aguinaga A, Leiva J. Effectiveness of the antibiotic lock therapy for the treatment of port-related enterococci, Gram-negative, or Gram-positive bacilli bloodstream infections. Diagn Microbiol Infect Dis 2009; 63:208-12. [DOI: 10.1016/j.diagmicrobio.2008.10.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 09/23/2008] [Accepted: 10/05/2008] [Indexed: 10/21/2022]
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Blossom DB, Kallen AJ, Patel PR, Elward A, Robinson L, Gao G, Langer R, Perkins KM, Jaeger JL, Kurkjian KM, Jones M, Schillie SF, Shehab N, Ketterer D, Venkataraman G, Kishimoto TK, Shriver Z, McMahon AW, Austen KF, Kozlowski S, Srinivasan A, Turabelidze G, Gould CV, Arduino MJ, Sasisekharan R. Outbreak of adverse reactions associated with contaminated heparin. N Engl J Med 2008; 359:2674-84. [PMID: 19052120 PMCID: PMC3810025 DOI: 10.1056/nejmoa0806450] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In January 2008, the Centers for Disease Control and Prevention began a nationwide investigation of severe adverse reactions that were first detected in a single hemodialysis facility. Preliminary findings suggested that heparin was a possible cause of the reactions. METHODS Information on clinical manifestations and on exposure was collected for patients who had signs and symptoms that were consistent with an allergic-type reaction after November 1, 2007. Twenty-one dialysis facilities that reported reactions and 23 facilities that reported no reactions were included in a case-control study to identify facility-level risk factors. Unopened heparin vials from facilities that reported reactions were tested for contaminants. RESULTS A total of 152 adverse reactions associated with heparin were identified in 113 patients from 13 states from November 19, 2007, through January 31, 2008. The use of heparin manufactured by Baxter Healthcare was the factor most strongly associated with reactions (present in 100.0% of case facilities vs. 4.3% of control facilities, P<0.001). Vials of heparin manufactured by Baxter from facilities that reported reactions contained a contaminant identified as oversulfated chondroitin sulfate (OSCS). Adverse reactions to the OSCS-contaminated heparin were often characterized by hypotension, nausea, and shortness of breath occurring within 30 minutes after administration. Of 130 reactions for which information on the heparin lot was available, 128 (98.5%) occurred in a facility that had OSCS-contaminated heparin on the premises. Of 54 reactions for which the lot number of administered heparin was known, 52 (96.3%) occurred after the administration of OSCS-contaminated heparin. CONCLUSIONS Heparin contaminated with OSCS was epidemiologically linked to adverse reactions in this nationwide outbreak. The reported clinical features of many of the cases further support the conclusion that contamination of heparin with OSCS was the cause of the outbreak.
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Affiliation(s)
- David B Blossom
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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