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Christison-Lagay ER, Brown EG, Bruny J, Funaro M, Glick RD, Dasgupta R, Grant CN, Engwall-Gill AJ, Lautz TB, Rothstein D, Walther A, Ehrlich PF, Aldrink JH, Rodeberg D, Baertschiger RM. Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee. J Pediatr Surg 2024; 59:1427-1443. [PMID: 38637207 DOI: 10.1016/j.jpedsurg.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/08/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Tunneled central venous catheters (CVCs) are the cornerstone of modern oncologic practice. Establishing best practices for catheter management in children with cancer is essential to optimize care, but few guidelines exist to guide placement and management. OBJECTIVES To address four questions: 1) Does catheter composition influence the incidence of complications; 2) Is there a platelet count below which catheter placement poses an increased risk of complications; 3) Is there an absolute neutrophil count (ANC) below which catheter placement poses an increased risk of complications; and 4) Are there best practices for the management of a central line associated bloodstream infection (CLABSI)? METHODS Data Sources: English language articles in Ovid Medline, PubMed, Embase, Web of Science, and Cochrane Databases. STUDY SELECTION Independently performed by 2 reviewers, disagreements resolved by a third reviewer. DATA EXTRACTION Performed by 4 reviewers on forms designed by consensus, quality assessed by GRADE methodology. RESULTS Data were extracted from 110 manuscripts. There was no significant difference in fracture rate, venous thrombosis, catheter occlusion or infection by catheter composition. Thrombocytopenia with minimum thresholds of 30,000-50,000 platelets/mcl was not associated with major hematoma. Limited evidence suggests a platelet count <30,000/mcL was associated with small increased risk of hematoma. While few studies found a significant increase in CLABSI in CVCs placed in neutropenic patients with ANC<500Kcells/dl, meta-analysis suggests a small increase in this population. Catheter removal remains recommended in complicated or persistent infections. Limited evidence supports antibiotic, ethanol, or hydrochloric lock therapy in definitive catheter salvage. No high-quality data were available to answer any of the proposed questions. CONCLUSIONS Although over 15,000 tunneled catheters are placed annually in North America into children with cancer, there is a paucity of evidence to guide practice, suggesting multiple opportunities to improve care. LEVEL OF EVIDENCE III. This study was registered as PROSPERO 2019 CRD42019124077.
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Affiliation(s)
- Emily R Christison-Lagay
- Department of Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Erin G Brown
- Department of Surgery, University of California Davis Children's Hospital, University of California Davis, Sacramento, CA, USA
| | - Jennifer Bruny
- Alaska Pediatric Surgery, Alaska Regional Hospital, Anchorage, AK, USA
| | - Melissa Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Richard D Glick
- Department of Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Roshni Dasgupta
- Department of Surgery, Cincinnati Children's Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christa N Grant
- Department of Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | | | - Timothy B Lautz
- Department of Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago IL, USA
| | - David Rothstein
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Ashley Walther
- Department of Surgery, Children's Hospital of Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Peter F Ehrlich
- Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - David Rodeberg
- Department of Surgery, Kentucky Children's Hospital, University of Kentucky, Lexington, KY, USA
| | - Reto M Baertschiger
- Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Division of Pediatirc Surgery, Children's Hospital at Dartmouth, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebaon, NH, USA.
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van den Bosch CH, Grant CN, Brown EG, Morrison ZD, Luques LM, Christison-Lagay ER, Baertschiger RM. Current surgical practice for central venous access to deliver chemotherapy and enteral access for nutritional support in pediatric patients with an oncological diagnosis. Pediatr Blood Cancer 2024:e31206. [PMID: 39030929 DOI: 10.1002/pbc.31206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/22/2024]
Abstract
Central venous access through tunneled central venous catheters (CVCs) are one of the cornerstones of modern oncologic practice in pediatric patients since CVCs provide a reliable access route for the administration of chemotherapy. Establishing best practices for CVC management in children with cancer is essential to optimize care. This article reviews current best practices, including types of devices, their placement, complications, and long-term outcomes. Additionally, nutrition status and nutritional support are also very important determinants of outcomes and care in pediatric surgical oncology patients. We review current nutritional assessment, support, access for enteral and parenteral nutrition delivery, and their complications, mainly from a surgical perspective. Overall, access surgery, whether for CVCs, or for enteral access can be challenging, and best practice guidelines supported by current though limited evidence are necessary to minimize complications and optimize outcomes.
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Affiliation(s)
| | - Christa N Grant
- Division of Pediatric Surgery, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Erin G Brown
- Department of Surgery, University of California Davis Children's Hospital, University of California Davis, Sacramento, California, USA
| | - Zachary D Morrison
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Lisandro M Luques
- Division of Pediatric Surgery, Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel
| | - Emily R Christison-Lagay
- Department of Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Reto M Baertschiger
- Division of Pediatric Surgery, Department of Surgery, DHMC, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Children's Hospital at Dartmouth, Lebanon, New Hampshire, USA
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Almangour TA, Alrasheed M. Dalbavancin for the treatment of bone and joint infections: a meta-analysis. J Infect Chemother 2024:S1341-321X(24)00191-0. [PMID: 39029624 DOI: 10.1016/j.jiac.2024.07.013] [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: 03/29/2024] [Revised: 06/18/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Bone and joint infections are challenging infectious diseases to treat and require prolonged antimicrobial treatment. Dalbavancin demonstrated promising pharmacokinetic/pharmacodynamic properties for the treatment of these infections. The objective of this meta-analysis is to compare the effectiveness of dalbavancin to standard of care (SOC) for the treatment of bone and joint infections. METHODS Two independent authors performed a comprehensive search through the major databases up to September 2023. Interventional and observational studies that compared the clinical success of dalbavancin to SOC for the treatment of osteoarticular infections (OAI) were included. RESULTS A total of 6 studies and 581 patients were included, 282 in dalbavancin group and 299 in SOC group. Only one study was randomized clinical trial. When the data from the 6 studies were pooled in a meta-analysis, clinical success did not differ in those who received dalbavancin versus SOC (OR = 1.55, 95% CI = 0.95-2.55, I-squared = 15.89%) for the treatment of OAI infections. Four studies compared the two groups in terms of hospital length of stay and demonstrated a significant shorter length of stay in dalbavancin group compared to SOC group. Treatment-emergent adverse effects were reported in up to 21.4% of patients in the dalbavancin group and up to 36.7% of patients in the SOC group. CONCLUSION This meta-analysis showed that dalbavancin is as effective as SOC for the treatment of patients with OAI infections. More data are needed to validate these findings.
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Affiliation(s)
- Thamer A Almangour
- Department of Clinical Pharmacy College of Pharmacy, King Saud University, P.O. Box 2457 Riyadh 11451, Saudi Arabia.
| | - Marwan Alrasheed
- Department of Clinical Pharmacy College of Pharmacy, King Saud University, P.O. Box 2457 Riyadh 11451, Saudi Arabia
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4
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Rickard CM, Drugeon B, Ullman A, Marsh NM, Corley A, Ball D, O'Brien C, Kleidon TM, Guenezan J, Couvreur R, McCarthy KL, Seguin S, Batiot G, Byrnes J, Schults J, Zahir SF, Mimoz O. Protect peripheral intravenous catheters: a study protocol for a randomised controlled trial of a novel antimicrobial dressing for peripheral intravenous catheters (ProP trial). BMJ Open 2024; 14:e084313. [PMID: 39013653 PMCID: PMC11253734 DOI: 10.1136/bmjopen-2024-084313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/28/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Peripheral intravenous catheters (PIVCs) are the most commonly used vascular access device in hospitalised patients. Yet PIVCs may be complicated by local or systemic infections leading to increased healthcare costs. Chlorhexidine gluconate (CHG)-impregnated dressings may help reduce PIVC-related infectious complications but have not yet been evaluated. We hypothesise an impregnated CHG transparent dressing, in comparison to standard polyurethane dressing, will be safe, effective and cost-effective in protecting against PIVC-related infectious complications and phlebitis. METHODS AND ANALYSIS The ProP trial is a multicentre, superiority, randomised clinical and cost-effectiveness trial with internal pilot, conducted across three centres in Australia and France. Patients (adults and children aged ≥6 years) requiring one PIVC for ≥48 hours are eligible. We will exclude patients with emergent PIVCs, known CHG allergy, skin injury at site of insertion or previous trial enrolment. Patients will be randomised to 3M Tegaderm Antimicrobial IV Advanced Securement dressing or standard care group. For the internal pilot, 300 patients will be enrolled to test protocol feasibility (eligibility, recruitment, retention, protocol fidelity, missing data and satisfaction of participants and staff), primary endpoint for internal pilot, assessed by independent data safety monitoring committee. Clinical outcomes will not be reviewed. Following feasibility assessment, the remaining 2624 (1312 per trial arm) patients will be enrolled following the same methods. The primary endpoint is a composite of catheter-related infectious complications and phlebitis. Recruitment began on 3 May 2023. ETHICS AND DISSEMINATION The protocol was approved by Ouest I ethic committee in France and by The Queensland Children's Hospital Human Research Ethics Committee in Australia. The findings will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05741866.
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Affiliation(s)
- Claire M Rickard
- School of Nursing Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Metro North Health, Herston Infectious Diseases Institute, Brisbane, Queensland, Australia
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast, Queensland, Australia
| | - Bertrand Drugeon
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- PHAR2 - INSERM U1070, Université de Poitiers, Poitiers, France
| | - Amanda Ullman
- School of Nursing Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast, Queensland, Australia
- Queensland Children's Hospital, Queensland Health, South Brisbane, Queensland, Australia
| | - Nicole M Marsh
- School of Nursing Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Amanda Corley
- School of Nursing Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Daner Ball
- School of Nursing Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Metro North Health, Herston Infectious Diseases Institute, Brisbane, Queensland, Australia
| | - Catherine O'Brien
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Tricia M Kleidon
- School of Nursing Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Queensland Children's Hospital, Queensland Health, South Brisbane, Queensland, Australia
| | - Jérémy Guenezan
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- PHAR2 - INSERM U1070, Université de Poitiers, Poitiers, France
| | - Raphael Couvreur
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Kate L McCarthy
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Sabrina Seguin
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Guillaume Batiot
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Joshua Byrnes
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
| | - Jessica Schults
- School of Nursing Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Metro North Health, Herston Infectious Diseases Institute, Brisbane, Queensland, Australia
| | - Syeda Farah Zahir
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Saint Lucia, Queensland, Australia
| | - Olivier Mimoz
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- PHAR2 - INSERM U1070, Université de Poitiers, Poitiers, France
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Carelli S, Posteraro B, Torelli R, De Carolis E, Vallecoccia MS, Xhemalaj R, Cutuli SL, Tanzarella ES, Dell'Anna AM, Lombardi G, Cammarota F, Caroli A, Grieco DL, Sanguinetti M, Antonelli M, De Pascale G. Prognostic value of serial (1,3)-β-D-glucan measurements in ICU patients with invasive candidiasis. Crit Care 2024; 28:236. [PMID: 38997712 PMCID: PMC11241937 DOI: 10.1186/s13054-024-05022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/06/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND To determine whether a decrease in serum (1,3)-β-D-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis. METHODS Observational cohort study in ICU patients over a ten-year period (2012-2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered. RESULTS In the study population of 103 patients (age 47 [35-62] years, SAPS II score 67 [52-77]) 68 bloodstream and 35 intrabdominal infections were recorded. Serial measurements showed that in 54 patients BDG decreased over time (BDG downslope group) while in 49 did not (N-BDG downslope group). Candida albicans was the pathogen most frequently isolated (61%) followed by C. parapsilosis (17%) and C. glabrata (12%), in absence of any inter-group difference. Invasive candidiasis related mortality was lower in BDG downslope than in N-BDG downslope group (17% vs 53%, p < 0.01). The multivariate Cox regression analysis showed the association of septic shock at infection occurrence and chronic liver disease with invasive candidiasis mortality (HR [95% CI] 3.24 [1.25-8.44] p = 0.02 and 7.27 [2.33-22.66] p < 0.01, respectively) while a BDG downslope was the only predictor of survival (HR [95% CI] 0.19 [0.09-0.43] p < 0.01). The area under the receiver operator characteristic curve for the performance of BDG downslope as predictor of good clinical outcome was 0.74 (p = 0.02) and our model showed that a BDG downslope > 70% predicted survival with both specificity and positive predictive value of 100%. CONCLUSIONS A decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis.
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Affiliation(s)
- Simone Carelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Brunella Posteraro
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Torelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena De Carolis
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Sole Vallecoccia
- Anesthesia and Intensive Care Unit, Department of Emergency and Critical Care, Santa Maria Nuova Hospital, Florence, Italy
| | - Rikardo Xhemalaj
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Lucio Cutuli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eloisa Sofia Tanzarella
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Maria Dell'Anna
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianmarco Lombardi
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabiola Cammarota
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Caroli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Luca Grieco
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Antonelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
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Shan A, Santos-Sebastián M, Saavedra-Lozano J. Lock Therapy for Treatment and Prevention of Catheter-Related Infections. Pediatr Infect Dis J 2024:00006454-990000000-00943. [PMID: 38986007 DOI: 10.1097/inf.0000000000004457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Affiliation(s)
- Adriana Shan
- From the Sección de Enfermedades Infecciosas Pediátricas, Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Mar Santos-Sebastián
- Sección de Enfermedades Infecciosas Pediátricas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERINFEC, Madrid, Spain
| | - Jesús Saavedra-Lozano
- Seccón de Enfermedades Infecciosas Pediátricas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERINFEC, Universidad Complutense de Madrid, Madrid, Spain
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Chi XW, He R, Wu XH, Wu LJ, Yang YL, Huang Z. Development of best evidence-based practice protocols for central venous catheter placement and maintenance to reduce CLABSI. Medicine (Baltimore) 2024; 103:e38652. [PMID: 38968526 PMCID: PMC11224884 DOI: 10.1097/md.0000000000038652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/31/2024] [Indexed: 07/07/2024] Open
Abstract
Although evidence-based interventions can reduce the incidence of central line-associated bloodstream infection (CLABSI), there is a large gap between evidence-based interventions and the actual practice of central venous catheter (CVC) care. Evidence-based interventions are needed to reduce the incidence of CLABSI in intensive care units (ICU) in China. Professional association, guidelines, and database websites were searched for data relevant to CLABSI in the adult ICUs from inception to February 2020. Checklists were developed for both CVC placement and maintenance. Based on the Integrated Promoting Action on Research Implementation in Health Services framework, a questionnaire collected the cognition and practice of ICU nursing and medical staff on the CLABSI evidence-based prevention guidelines. From January 2018 to December 2021, ICU CLABSI rates were collected monthly. Ten clinical guidelines were included after the screening and evaluation process and used to develop the best evidence-based protocols for CVC placement and maintenance. The CLABSI rates in 2018, 2019, and 2020 were 2.98‰ (9/3021), 1.83‰ (6/3276), and 1.69‰ (4/2364), respectively. Notably, the CLABSI rate in 2021 was 0.38‰ (1/2607). In other words, the ICU CLABSI rate decreased from 1.69‰ to 0.38‰ after implementation of the new protocols. Additionally, our data suggested that the use of ultrasound-guidance for catheter insertion, chlorhexidine body wash, and the use of a checklist for CVC placement and maintenance were important measures for reducing the CLABSI rate. The evidence-based processes developed for CVC placement and maintenance were effective at reducing the CLABSI rate in the ICU.
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Affiliation(s)
- Xiu-wen Chi
- School of Nursing, Guangdong Medical University, Dongguan, China
| | - Ru He
- Nursing Department, Longgang Central District Hospital, Shenzhen, China
| | - Xiao-heng Wu
- Department of Intensive Care Unit, Longgang Central District Hospital, Shenzhen, China
| | - Li-juan Wu
- School of Nursing, Guangdong Medical University, Dongguan, China
| | - Yuan-li Yang
- Department of Intensive Care Unit, Longgang Central District Hospital, Shenzhen, China
| | - Zhen Huang
- Office of Shenzhen Clinical College, Guangzhou University of Chinese Medicine, Longgang Central District Hospital, Shenzhen, China
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Varghese G, Sarawat D, Jamwal A, Patel SS, Tejan N, Sahu C. Case Series: Microbacterium aurum Bacteremia in Immunosuppressed Patients-An Emerging Threat. Am J Trop Med Hyg 2024; 111:132-135. [PMID: 38964313 PMCID: PMC11229644 DOI: 10.4269/ajtmh.23-0701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/09/2024] [Indexed: 07/06/2024] Open
Abstract
Blood stream infection with Microbacterium species in humans is rare and frequently linked to the presence of immunosuppressed conditions such as patients on chemotherapy or corticosteroids. Presence of indwelling catheters is also a potential risk factor for M. aurum infection. No case report has been documented in the literature regarding the pathogenic potential of M. aurum in causing bacteremia. This is the first case series reporting bacteremia by M. aurum describing the risk factors and sensitivity pattern of this pathogen. In this case series, we have described bacteremia caused by M. aurum. The risk factors and sensitivity pattern of this pathogen have also been evaluated. Here, we describe the clinical course and presentation of three patients whose blood culture showed growth of M. aurum. Indwelling venous catheter for hemodialysis or for chemotherapy for the treatment of acute lymphoblastic leukemia was found to be a risk factor in two patients. Rheumatoid arthritis was the underlying condition in the second patient and was started on immunosuppressants. Blood samples were collected during the febrile period. The blood culture samples of all these patients had pure isolates of M. aurum, identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. All three patients were managed according to the sensitivity reports and were discharged in stable condition.
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Affiliation(s)
- Gerlin Varghese
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deepika Sarawat
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashima Jamwal
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sangram Singh Patel
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nidhi Tejan
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Chinmoy Sahu
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Çetin FT, Çay Ü, Polat M, Kılınç F, Ünal A, Tapaç NN, Gündeşlioğlu ÖÖ, Alabaz D, Bilen S, Kibar F, Totik N. Candida parapsilosis candidemia in children admitted to a tertiary hospital in Turkey: clinical features and antifungal susceptibility. Microbiol Spectr 2024; 12:e0056424. [PMID: 38864624 PMCID: PMC11218525 DOI: 10.1128/spectrum.00564-24] [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: 02/29/2024] [Accepted: 05/02/2024] [Indexed: 06/13/2024] Open
Abstract
In recent years, the incidence and drug resistance of Candida parapsilosis have increased. Our study aimed to determine the antifungal sensitivity of C. parapsilosis and the clinical and demographic characteristics of children with candidemia. Two hundred pediatric patients with C. parapsilosis candidemia were included in the study between 1 January 2010 and 1 August 2023. Clinical samples were evaluated on a BACTEC-FX-40 automatic blood culture device (Becton Dickinson, USA). Yeast isolates were identified to the species level via identification cards (YST) using the VITEK 2 Compact (bioMeriéux, France) system. Antifungal susceptibility was performed using antifungal cell cards (AST-YST01). Approval for the study was received from the "University Faculty of Medicine" Hospital Clinical Research Ethics Committee. Non-catheter candidemia was detected in 127 (63.5%) patients, and catheter-related candidemia was detected in 73 (36.5%) patients. It was observed that the patients' history of malignancy, mechanical ventilation, urinary catheter, nasogastric tube, and intensive care unit stay was associated with C. parapsilosis mortality. The mortality rate from candidemia was 9.5%. The most frequently preferred antifungal agents were amphotericin B and fluconazole. The fluconazole drug resistance rate was found to be 6%, and the amphotericin B drug resistance rate was 4%. Because C. parapsilosis candidemia mortality rates can be high depending on risk factors and clinical characteristics, it is important to initiate appropriate and timely antifungal therapy. We think that our study can provide important information about the clinical profiles, distributions, susceptibility profiles, and control of antifungal resistance of C. parapsilosis isolates. IMPORTANCE It has been observed that the frequency and antifungal resistance of Candida parapsilosis have increased recently. In our study, we aimed to determine the antifungal sensitivity of C. parapsilosis and the clinical and demographic characteristics of children with candidemia. It was observed that the patients' history of malignancy, mechanical ventilation, urinary catheter, nasogastric tube, and intensive care stay was associated with C. parapsilosis mortality. The mortality rate from candidemia was 9.5%. The most frequently preferred antifungal agents were amphotericin B and fluconazole. The fluconazole drug resistance rate was found to be 6%, and the amphotericin B drug resistance rate was 4%. Because C. parapsilosis candidemia mortality rates can be high depending on risk factors and clinical characteristics, it is important to initiate appropriate and timely antifungal therapy.
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Affiliation(s)
- Fatma Tuğba Çetin
- Department of Pediatric Infection, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ümmühan Çay
- Department of Pediatric Infection, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Murat Polat
- Department of Child Health and Diseases, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Fatma Kılınç
- Department of Pediatric Infection, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Asena Ünal
- Department of Pediatric Infection, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Nisa Nur Tapaç
- Department of Pediatric Infection, Faculty of Medicine, Cukurova University, Adana, Turkey
| | | | - Derya Alabaz
- Department of Pediatric Infection, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Sevcan Bilen
- Department of Pediatric Emergency Medicine, Cukurova University, Adana, Turkey
| | - Filiz Kibar
- Department of Microbiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Nazlı Totik
- Department of Biostatistics, Faculty of Medicine, Cukurova University, Adana, Turkey
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10
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Flores-Delgado RM, Volkow P, Velázquez-Acosta C, Cornejo-Juárez P. Fungemia due to opportunistic fungi in patients with cancer. Rev Iberoam Micol 2024:S1130-1406(24)00004-4. [PMID: 38960777 DOI: 10.1016/j.riam.2024.01.001] [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: 10/06/2023] [Revised: 12/05/2023] [Accepted: 01/30/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Fungemia due to uncommon fungi and secondary to multiple risk factors has become an emergent health problem, particularly in oncology patients. AIMS This study shows the following data collected during an 11-year period in a tertiary care oncologic center from patients with fungemia: demographic data, clinical characteristics, and outcome. METHODS A retrospective study was performed at Instituto Nacional de Cancerología, a 135-bed referral cancer center in Mexico City, from July 2012 to June 2023. All episodes of non-Candida fungemia were included. RESULTS Sixteen cases with uncommon fungemia were found in the database, representing 0.3% from all the blood cultures positive during the study period, and 8.5% from all the fungi isolated. The most common pathogens identified in our series were Histoplasma capsulatum, Acremonium spp., Trichosporon asahii, and Saccharomyces cerevisiae. Eight patients had hematologic malignancies, and five had severe neutropenia. In eight cases fungemia was considered catheter-related, in four cases was classified as primary, and in the last four it was diagnosed as disseminated fungal diseases. Mortality at 30 days was 43.8%. CONCLUSIONS The improved diagnostic tools have led to a better diagnosis of uncommon fungal infections. More aggressive therapeutic approaches, particularly in patients with malignancies, would increase survival rates in these potentially fatal diseases.
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Affiliation(s)
| | - Patricia Volkow
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Patricia Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
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11
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Truong TT, Lu J, Dien Bard J. Blood Cultures in Children: Maximizing Their Usefulness. Pediatr Infect Dis J 2024:00006454-990000000-00932. [PMID: 38985997 DOI: 10.1097/inf.0000000000004453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Affiliation(s)
- Thao T Truong
- From the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA
| | - Jacky Lu
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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12
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Fukuda Y, Morioka H, Yamamoto S, Iguchi M, Umeda S, Asahara T, Kanda K, Oka K, Nakayama G, Yagi T. Catheter-related bloodstream infection caused by Lacticaseibacillus paracasei: A case report and literature review. J Infect Chemother 2024; 30:664-667. [PMID: 38184108 DOI: 10.1016/j.jiac.2023.12.015] [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: 10/10/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
Catheter-related bloodstream infections (CRBSIs) caused by Lactobacillus spp. and Lacticaseibacillus spp. are rare, and their clinical course and optimal treatment remain uncertain. In this report, we present a 46-year-old male patient who experienced clinically diagnosed Lacticaseibacillus paracasei CRBSI on four separate occasions, despite receiving systemic administration of antibiotics and antimicrobial lock therapy. The patient did not develop L. paracasei bacteremia after catheter removal. This case report furthers our knowledge of CRBSI caused by Lactobacillus and related genera and highlights the need for further research.
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Affiliation(s)
- Yuto Fukuda
- Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan; Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroshi Morioka
- Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Shuta Yamamoto
- Yakult Central Institute, Yakult Honsha Co., Ltd., 5-11 Izumi, Kunitachi, Tokyo, 186-8650, Japan
| | - Mitsutaka Iguchi
- Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shinichi Umeda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Asahara
- Yakult Central Institute, Yakult Honsha Co., Ltd., 5-11 Izumi, Kunitachi, Tokyo, 186-8650, Japan
| | - Kohei Kanda
- Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Keisuke Oka
- Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Goro Nakayama
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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13
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Özen S, Kanik Yüksek S, Dinç B, Üçkardeş F, Konca HK, Erat T, Güney AY, Güneş Ö, Coşkun ZN, Gülhan B, Bayhan Gİ, Çöplü N, Parlakay ANÖ, Özbek NY. Catheter-related Infections in Pediatric Patients Due to a Rare Pathogen: Herbaspirillum huttiense. Pediatr Infect Dis J 2024; 43:e231-e234. [PMID: 38621150 DOI: 10.1097/inf.0000000000004350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Herbaspirillum species are nonfermenting, aerobic, helical or curved, Gram-negative bacteria belonging to the class Betaproteobacteria, order Burkholderiales. To date, only a few studies have reported on the epidemiology, clinical symptoms, antibiotic susceptibility profiles, treatment and outcomes of Herbaspirillum huttiense -related infections in pediatric patients. METHODS The aim of this study was to present 3 years of H.huntiense data, antibiotic susceptibility profiles, systemic antibiotics and antibiotic lock therapy (ALT) options and clinical outcomes. RESULTS Fourteen episodes of infection in 12 patients were included in this retrospective study. The patients had a male/female ratio of 1:1 and a median age of 160.5 months (range, 3-198 months). Catheter-related bloodstream infection (CRBSI) was detected in 11 patients. Only 1 patient developed catheter-related infective endocarditis. The patient's catheter was removed, and she was successfully treated with systemic antibiotics for 4 weeks. Systemic antibiotics were used in all infections related to H. huttiense . In septic, critically ill patients, the catheter was removed, and systemic antibiotics were started. Port catheters were removed in 5 patients. ALT was performed in clinically stable patients. ALT using amikacin was administered to 6 patients through the port catheter. Two patients had a 2nd attack. After the 2nd ALT treatment, 1 patient cured, and the catheter of the other patient was removed due to persistent microbial growth in cultures. Antimicrobial susceptibility testing of the reported isolates showed susceptibility to meropenem (90%), ceftazidime (87%) and piperacillin/tazobactam (65%), with 92% resistance to colistin. CONCLUSION H. huttiense is an emerging pathogen in CRBSI. Piperacillin/tazobactam, ceftazidime and meropenem appear to be good therapeutic options for the treatment of H. huttiense infections. ALT and systemic antibiotics can be used in H. huttiense -CRBSI to sterilize and preserve the central venous catheter.
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Affiliation(s)
- Seval Özen
- From the Department of Pediatric Infectious Diseases
| | | | - Bedia Dinç
- Department of Medical Microbiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Fatih Üçkardeş
- Department of Biostatistics and Medical Informatics, Adıyaman University, Adıyaman, Turkey
| | | | - Tuğba Erat
- From the Department of Pediatric Infectious Diseases
| | | | - Ömer Güneş
- From the Department of Pediatric Infectious Diseases
| | | | - Belgin Gülhan
- From the Department of Pediatric Infectious Diseases
| | | | - Nilay Çöplü
- Department of Medical Microbiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | | | - Namık Yaşar Özbek
- Department of Pediatric Hematology/Oncology and Pediatric Bone Marrow Transplantation Unit, Ankara Bilkent City Hospital, Ankara, Turkey
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14
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Nguyen T, Camins BC, Butler DA. Taurolidine and Heparin as Catheter Lock Solution for Central Venous Catheters in Hemodialysis. Am J Ther 2024; 31:e398-e409. [PMID: 38710029 DOI: 10.1097/mjt.0000000000001736] [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: 05/08/2024]
Abstract
BACKGROUND Chronic kidney disease can lead to end-stage renal disease, and the prevalence is increasing. Many patients starting hemodialysis require central venous catheters (CVCs). Catheter-related bloodstream infections (CRBSIs) are a common complication and lead to significant morbidity and mortality. Interventions to prevent CRBSI include antimicrobial lock therapy but concern for the development of antimicrobial resistance and adverse effects. Nonantimicrobial antiseptics as catheter lock solutions have also been used. Taurolidine and heparin catheter lock solution is first approved by the Food and Drug Administration for the prevention of CRBSI in patients on hemodialysis. Taurolidine has a unique mechanism of action and favorable safety profile. MECHANISM OF ACTION, PHARMACODYNAMICS, AND PHARMACOKINETICS Taurolidine and heparin catheter lock solution have both antimicrobial and anticoagulant properties. Taurolidine is derivative of the amino acid taurine, and heparin is derived from porcine intestinal mucosa. Taurolidine not only damages microbial cell walls but also prevents the adherence of microorganisms to biological surfaces, preventing biofilm formation. Taurolidine and heparin catheter lock solution is intended to be used intraluminally within the catheter and should be aspirated. Because it is used locally, limited pharmacokinetic and pharmacodynamic data are available. CLINICAL TRIALS The LOCK-IT-100 trial is a randomized, double-blind, phase 3 study, which included 795 end-stage renal disease patients on hemodialysis with CVC. Taurolidine and heparin was compared with the control heparin alone. The results of the study showed a 71% risk reduction in CRBSI for taurolidine and heparin arm (95% confident interval, 38%-86%, P = 0.0006). Other studies have also shown that taurolidine lock solution leads to decreased CRBSI episodes. Several systematic reviews and meta-analysis consisted of taurolidine in adult, and pediatric populations also showed reduction in the incidence of CRBSIs. THERAPEUTIC ADVANCE Taurolidine and heparin lock solution represents a novel preventive strategy for those undergoing hemodialysis through a CVC by reducing the risk of CRBSI. This is significant progress because there are no other similar options available for patients for whom catheters are the only options for their life-saving treatment.
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Affiliation(s)
- Timothy Nguyen
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY
| | - Bernard C Camins
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; and
| | - David A Butler
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, NY
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15
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Wales R, McCormick W, Matteo ABD, Del Pozo JL, Has P, Mermel LA. Impact of Catheter-Drawn Blood Cultures on Patient Management: A Multicenter, Retrospective Cohort Study. Open Forum Infect Dis 2024; 11:ofae339. [PMID: 38962523 PMCID: PMC11221777 DOI: 10.1093/ofid/ofae339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024] Open
Abstract
Background Nosocomial bloodstream infections associated with intravascular catheters pose significant financial burden, morbidity, and mortality. There is much debate about whether or not blood cultures should be drawn through central venous catheters, and while guidelines advocate for catheter-drawn cultures when catheter infection is suspected, there is variable practice in this regard. Methods We performed a retrospective cohort study assessing episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures in tertiary care hospitals in the United States and Spain. Results We identified 143 episodes in 122 patients meeting inclusion criteria. Thirty percent of such episodes revealed growth of potential pathogens such as Staphylococcus aureus. Overall, 21% of follow-up percutaneously-drawn blood cultures obtained within 48 hours revealed growth of the same microbe after an episode of positive catheter-drawn blood cultures with negative concomitant percutaneously-drawn cultures (33% when potential pathogens were isolated; 16% when common skin contaminants were isolated). Patients with cultures growing pathogenic organisms were more likely to receive targeted antimicrobial therapy and have their catheters removed sooner. Conclusions Many episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures lead to growth from percutaneously-drawn follow-up blood cultures. Thus, such initial discordant results should not be disregarded. Our findings advocate for a nuanced approach to blood culture interpretation, emphasizing the value of catheter-drawn blood cultures in clinical decision making and management.
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Affiliation(s)
- Rebecca Wales
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Winston McCormick
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Andrés Blanco-Di Matteo
- Division of Infectious Diseases, Clínica Universidad de Navarra, Pamplona, Spain
- Division of Infectious Diseases, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - José L Del Pozo
- Division of Infectious Diseases, Clínica Universidad de Navarra, Pamplona, Spain
- Division of Infectious Diseases, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Phinnara Has
- Lifespan Biostatistics Department, Providence, Rhode Island, USA
| | - Leonard A Mermel
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Zhen S, Lin Q, Chen Z, Shen Y, Chen X, Pang A, Yang D, Zhang R, Ma Q, He Y, Wei J, Zhai W, Jiang E, Han M, Wang J, Feng S. Ceftazidime-avibactam in the treatment of bacteremia due to carbapenem-resistant gram-negative bacteria in hematological patients: Experience in a single center. J Infect Chemother 2024; 30:608-615. [PMID: 38215820 DOI: 10.1016/j.jiac.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Limited experience exists with ceftazidime-avibactam (CAZ-AVI) in treating bacteremia caused by carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA) in hematological patients. METHODS We performed a single-center, retrospective, observational study including patients who received CAZ-AVI for bacteremia due to CRE or CRPA between 2018 and 2022. The primary outcome was 30-day survival. We conducted a multivariable analysis to identify predictors of survival. RESULTS 56 patients were included and 57 (41 CRE and 16 CRPA) strains were isolated. 35 strains produced carbapenemase, including 25 metallo-beta-lactamase (MBL) and 10 serine-beta-lactamase. 48 patients (85.7 %) received combination therapy. All patients with MBL-CRE bacteremia (n = 24) received combination therapy with aztreonam (AZT). The susceptibility rates to CAZ-AVI were only 26.8 % (11/41) in CRE and 80.0 % (8/10) in CRPA. The 30-day survival rates were 85.0 % (34/40) in the CRE group and 81.3 % (13/16) in the CRPA group. In patients with MBL-CRE bacteremia, the 30-day survival was as high as 91.7 % (22/24) due to combination with AZT. Ceftazidime did not influence the activity of aztreonam-avibactam against MBL-CRE in-vitro. Multivariable cox analysis revealed neutropenia >14 days (P = 0.002, HR: 34.483, 95%CI: 3.846-333.333) and a higher Pitt bacteremia score (P = 0.005, HR: 2.074, 95%CI: 1.253-3.436) were risk factors for 30-day survival. CONCLUSIONS CAZ-AVI is highly effective in treating bacteremia due to CRPA and serine-beta-lactamase CRE. The combination of avibactam with AZT is highly effective in treating bacteremia due to AZT-resistant MBL producers.
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Affiliation(s)
- Sisi Zhen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Qingsong Lin
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Zhangjie Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Yuyan Shen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Xin Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Aiming Pang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Donglin Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Rongli Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Qiaoling Ma
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Yi He
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Jialin Wei
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Weihua Zhai
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China.
| | - Erlie Jiang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Mingzhe Han
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China; Tianjin Institutes of Health Science, Tianjin, 301600, China.
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Gumus DD, Demir OO, Aykac K, Hazirolan G, Avci H, Ceyhan M, Cengiz AB, Ozsurekci Y. Gram-negative bacteremia, the risk factors, and outcome in children. Diagn Microbiol Infect Dis 2024; 109:116324. [PMID: 38733752 DOI: 10.1016/j.diagmicrobio.2024.116324] [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: 01/23/2023] [Revised: 11/17/2023] [Accepted: 04/22/2024] [Indexed: 05/13/2024]
Abstract
We aimed to determine the epidemiology and resistance patterns of Gram-negative bacteria, the risk factors and outcome of bloodstream infection (BSI). In all, 412 episodes in children who were hospitalized with the diagnosis of bacteremia were analyzed. The most common microorganisms were Klebsiella spp. (43.9%), Escherichia coli (13.5 %) and Acinetobacter spp. (10.6 %). Among isolates, 41.2 % were multidrug-resistant, 13.5 % were extensively drug-resistant and 0.4 % were pan-drug-resistant. Carbapenem resistance was revealed in 27.6 % of isolates. Carbapenem and colistin resistance increased over the years. The most common risk factors were the presence of a central-venous catheter and pediatric intensive care unit admission. Clinical response and infection-related mortality were significantly different in cases infected with carbapenem-resistant gram-negative (CRGN) vs carbapenem-susceptible gram-negative bacteria. The increase in multi-resistant Klebsiella spp. seems to be the biggest obstacles in fight against nosocomial infections. The increasing number of CRGN infections over the years affects both the clinical response and mortality rate of BSI.
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Affiliation(s)
- Dilan Demir Gumus
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Osman Oguz Demir
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey; The Hospital for Sick Children Research Institute, Cell Biology Research Program, Toronto, ON, Canada
| | - Kubra Aykac
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Gulsen Hazirolan
- Hacettepe University Faculty of Medicine, Department of Microbiology, Ankara, Turkey
| | - Hanife Avci
- Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Mehmet Ceyhan
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Ali Bulent Cengiz
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Yasemin Ozsurekci
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey.
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Jeon K, Han SB, Kym D, Kim M, Park J, Yoon J, Hur J, Cho YS, Chun W. Central venous catheter tip colonization and associated bloodstream infection in patients with severe burns under routine catheter changing. Am J Infect Control 2024; 52:813-818. [PMID: 38355049 DOI: 10.1016/j.ajic.2024.02.003] [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: 12/08/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Although routine changing of central venous catheters (CVCs) is commonly performed in patients with severe burns, information on pathogen colonization of the CVC tip and associated bloodstream infections (BSIs) is limited in those patients. METHODS The medical records of 214 patients with severe burns who underwent routine CVC changing at 7-day intervals and their results of 686 pairs of CVC tips and concurrent blood cultures were retrospectively reviewed to evaluate the CVC colonization rate and associated BSI pathogens. RESULTS Of the 686 CVCs, 137 (20.0%) were colonized by pathogens, and 81 (59.1%) of them had BSIs caused by the same pathogen. Nonflame burn (P = .002), total body surface area burn ≥30% (P = .004), femoral catheterization (P = .001), CVC changing during pre-existing BSI (P < .001), and renal replacement therapy (P = .017) were associated with catheter-related BSI in the multivariate analysis. Most BSIs were caused by Gram-negative bacteria (most commonly Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa). CONCLUSIONS The CVC colonization rate in patients with severe burns and routine CVC changing was not high. Lengthening the CVC duration might be attempted in patients at a lower risk of catheter-related BSI although further prospective studies are necessary.
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Affiliation(s)
- Kibum Jeon
- Infection Prevention and Control Unit, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; Department of Laboratory Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Seung Beom Han
- Infection Prevention and Control Unit, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; Department of Pediatrics, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea.
| | - Dohern Kym
- Infection Prevention and Control Unit, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Myongjin Kim
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jongsoo Park
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jaechul Yoon
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jun Hur
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Yong Suk Cho
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Wook Chun
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
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19
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Lew AK, Salam ME, Gross AE, Wang SK, McGuire E, Pettit NN, Pisano J, Nguyen CT. A Multicenter Retrospective Study Evaluating Intravenous to Oral Antibiotic Stepdown for Uncomplicated Streptococcal Bacteremia. Open Forum Infect Dis 2024; 11:ofae361. [PMID: 38975249 PMCID: PMC11227220 DOI: 10.1093/ofid/ofae361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
Background The purpose of this study was to compare the efficacy and safety of intravenous (IV) versus oral (PO) stepdown therapy for uncomplicated streptococcal bacteremia. Methods This multicenter, retrospective study included adult patients with uncomplicated streptococcal bacteremia between 1 July 2019 and 1 July 2022. Patients who received IV therapy for the full treatment course were compared to patients who transitioned to PO therapy after initial IV therapy. The primary outcome was clinical success, defined as absence of infection recurrence, infection-related readmission, and infection-related mortality at 90 days. Secondary outcomes included microbiological success, length of stay (LOS), and IV line-associated complications. Results Of 238 patients included, 47.1% received PO stepdown therapy. Clinical success occurred in 94.4% and 94.6% in the IV only and PO stepdown groups, respectively (P = .946). Patients who transitioned to PO therapy received a median duration of IV therapy of 3.9 days (interquartile range, 2.9-7.3 days). Line complications were more frequent in the IV only group, primarily driven by catheter-related infections (7.2% vs 0%, P = .002). LOS was significantly shorter in the PO stepdown group (5.5 vs 9.2 days, P < .001). Conclusions Patients transitioned to PO antibiotics for uncomplicated streptococcal bacteremia had similar rates of clinical success compared to patients who received only IV therapy. With consideration of infectious source, severity of illness, and comorbidities, PO stepdown following initial IV antibiotics for uncomplicated streptococcal bacteremia in select patients is a reasonable approach that may result in decreased LOS and line-related complications.
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Affiliation(s)
- Alison K Lew
- Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois, USA
| | - Madison E Salam
- Department of Pharmacy, University of Colorado Hospital, Aurora, Colorado, USA
| | - Alan E Gross
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, Illinois, USA
| | - Sheila K Wang
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Erin McGuire
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Natasha N Pettit
- Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jennifer Pisano
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Cynthia T Nguyen
- Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois, USA
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20
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Buetti N, Zahar JR, Adda M, Ruckly S, Bruel C, Schwebel C, Darmon M, Adrie C, Cohen Y, Siami S, Laurent V, Souweine B, Timsit JF. Treatment of positive catheter tip culture without bloodstream infections in critically ill patients. A case-cohort study from the OUTCOMEREA network. Intensive Care Med 2024; 50:1108-1118. [PMID: 38913096 PMCID: PMC11245435 DOI: 10.1007/s00134-024-07498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE This study aimed to evaluate the impact on subsequent infections and mortality of an adequate antimicrobial therapy within 48 h after catheter removal in intensive care unit (ICU) patients with positive catheter tip culture. METHODS We performed a retrospective analysis of prospectively collected data from 29 centers of the OUTCOMEREA network. We developed a propensity score (PS) for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a 1:1 case-cohort study matched on the PS score of being adequately treated. A PS-matched subdistribution hazard model was used for detecting subsequent infections and a PS-matched Cox model was used to evaluate the impact of antibiotic therapy on mortality. RESULTS We included 427 patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched 150 patients with an adequate antimicrobial therapy with 150 controls. In the matched population, 30 (10%) subsequent infections were observed and 62 patients died within 30 days. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day-30 was similar between treated and non-treated groups (subdistribution hazard ratio [sHR] 1.08, 95% confidence interval [CI] 0.62-1.89, p = 0.78). Using Cox proportional hazard models, the 30-day mortality risk was similar between treated and non-treated groups (HR 0.89, 95% CI 0.45-1.74, p = 0.73). CONCLUSIONS Antimicrobial therapy was not associated with decreased risk of subsequent infection or death in short-term catheter tip colonization in critically ill patients. Antibiotics may be unnecessary for positive catheter tip cultures.
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Affiliation(s)
- Niccolò Buetti
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France.
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Jean-Ralph Zahar
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- Département de Microbiologie Clinique, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Mireille Adda
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Stéphane Ruckly
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- OUTCOMEREA Network, 93700, Drancy, France
| | - Cédric Bruel
- Medical and Surgical Intensive Care Unit, Paris Saint-Joseph Hospital Network, 75014, Paris, France
| | - Carole Schwebel
- Medical Intensive Care Unit, University Hospital, Grenoble-Alpes, 38000, Grenoble, France
| | - Michael Darmon
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Université Paris Cité, Paris, France
| | - Christophe Adrie
- Réanimation Polyvalente, Centre Hospitalier Delafontaine, Saint-Denis, France
| | - Yves Cohen
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Shidasp Siami
- Réanimation Polyvalente, Centre Hospitalier Sud Essonne-Etampes, Etampes, France
| | - Virginie Laurent
- Polyvalent Intensive Care Unit, André Mignot Hospital, 78150, Le Chesnay, France
| | - Bertrand Souweine
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Jean-François Timsit
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- OUTCOMEREA Network, 93700, Drancy, France
- Medical and Infectious Diseases Intensive Care Unit, Bichat Hospital, AP-HP, Paris Cité University, 46 rue Henri Huchard, 75018, Paris, France
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21
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Schults JA, Kleidon T, Charles K, Young ER, Ullman AJ. Peripherally inserted central catheter design and material for reducing catheter failure and complications. Cochrane Database Syst Rev 2024; 6:CD013366. [PMID: 38940297 PMCID: PMC11212118 DOI: 10.1002/14651858.cd013366.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) facilitate diagnostic and therapeutic interventions in health care. PICCs can fail due to infective and non-infective complications, which PICC materials and design may contribute to, leading to negative sequelae for patients and healthcare systems. OBJECTIVES To assess the effectiveness of PICC material and design in reducing catheter failure and complications. SEARCH METHODS The University of Queensland and Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the WHO ICTRP and ClinicalTrials.gov trials registers to 16 May 2023. We aimed to identify other potentially eligible trials or ancillary publications by searching the reference lists of retrieved included trials, as well as relevant systematic reviews, meta-analyses, and health technology assessment reports. We contacted experts in the field to ascertain additional relevant information. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating PICC design and materials. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were venous thromboembolism (VTE), PICC-associated bloodstream infection (BSI), occlusion, and all-cause mortality. Secondary outcomes were catheter failure, PICC-related BSI, catheter breakage, PICC dwell time, and safety endpoints. We assessed the certainty of evidence using GRADE. MAIN RESULTS We included 12 RCTs involving approximately 2913 participants (one multi-arm study). All studies except one had a high risk of bias in one or more risk of bias domain. Integrated valve technology compared to no valve technology for peripherally inserted central catheter design Integrated valve technology may make little or no difference to VTE risk when compared with PICCs with no valve (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.19 to 2.63; I² = 0%; 3 studies; 437 participants; low certainty evidence). We are uncertain whether integrated valve technology reduces PICC-associated BSI risk, as the certainty of the evidence is very low (RR 0.20, 95% CI 0.01 to 4.00; I² = not applicable; 2 studies (no events in 1 study); 257 participants). Integrated valve technology may make little or no difference to occlusion risk when compared with PICCs with no valve (RR 0.86, 95% CI 0.53 to 1.38; I² = 0%; 5 studies; 900 participants; low certainty evidence). We are uncertain whether use of integrated valve technology reduces all-cause mortality risk, as the certainty of evidence is very low (RR 0.85, 95% CI 0.44 to 1.64; I² = 0%; 2 studies; 473 participants). Integrated valve technology may make little or no difference to catheter failure risk when compared with PICCs with no valve (RR 0.80, 95% CI 0.62 to 1.03; I² = 0%; 4 studies; 720 participants; low certainty evidence). We are uncertain whether integrated-valve technology reduces PICC-related BSI risk (RR 0.51, 95% CI 0.19 to 1.32; I² = not applicable; 2 studies (no events in 1 study); 542 participants) or catheter breakage, as the certainty of evidence is very low (RR 1.05, 95% CI 0.22 to 5.06; I² = 20%; 4 studies; 799 participants). Anti-thrombogenic surface modification compared to no anti-thrombogenic surface modification for peripherally inserted central catheter design We are uncertain whether use of anti-thrombogenic surface modified catheters reduces risk of VTE (RR 0.67, 95% CI 0.13 to 3.54; I² = 15%; 2 studies; 257 participants) or PICC-associated BSI, as the certainty of evidence is very low (RR 0.20, 95% CI 0.01 to 4.00; I² = not applicable; 2 studies (no events in 1 study); 257 participants). We are uncertain whether use of anti-thrombogenic surface modified catheters reduces occlusion (RR 0.69, 95% CI 0.04 to 11.22; I² = 70%; 2 studies; 257 participants) or all-cause mortality risk, as the certainty of evidence is very low (RR 0.49, 95% CI 0.05 to 5.26; I² = not applicable; 1 study; 111 participants). Use of anti-thrombogenic surface modified catheters may make little or no difference to risk of catheter failure (RR 0.76, 95% CI 0.37 to 1.54; I² = 46%; 2 studies; 257 participants; low certainty evidence). No PICC-related BSIs were reported in one study (111 participants). As such, we are uncertain whether use of anti-thrombogenic surface modified catheters reduces PICC-related BSI risk (RR not estimable; I² = not applicable; very low certainty evidence). We are uncertain whether use of anti-thrombogenic surface modified catheters reduces the risk of catheter breakage, as the certainty of evidence is very low (RR 0.15, 95% CI 0.01 to 2.79; I² = not applicable; 2 studies (no events in 1 study); 257 participants). Antimicrobial impregnation compared to non-antimicrobial impregnation for peripherally inserted central catheter design We are uncertain whether use of antimicrobial-impregnated catheters reduces VTE risk (RR 0.54, 95% CI 0.05 to 5.88; I² = not applicable; 1 study; 167 participants) or PICC-associated BSI risk, as the certainty of evidence is very low (RR 2.17, 95% CI 0.20 to 23.53; I² = not applicable; 1 study; 167 participants). Antimicrobial-impregnated catheters probably make little or no difference to occlusion risk (RR 1.00, 95% CI 0.57 to 1.74; I² = 0%; 2 studies; 1025 participants; moderate certainty evidence) or all-cause mortality (RR 1.12, 95% CI 0.71 to 1.75; I² = 0%; 2 studies; 1082 participants; moderate certainty evidence). Antimicrobial-impregnated catheters may make little or no difference to risk of catheter failure (RR 1.04, 95% CI 0.82 to 1.30; I² = not applicable; 1 study; 221 participants; low certainty evidence). Antimicrobial-impregnated catheters probably make little or no difference to PICC-related BSI risk (RR 1.05, 95% CI 0.71 to 1.55; I² = not applicable; 2 studies (no events in 1 study); 1082 participants; moderate certainty evidence). Antimicrobial-impregnated catheters may make little or no difference to risk of catheter breakage (RR 0.86, 95% CI 0.19 to 3.83; I² = not applicable; 1 study; 804 participants; low certainty evidence). AUTHORS' CONCLUSIONS There is limited high-quality RCT evidence available to inform clinician decision-making for PICC materials and design. Limitations of the current evidence include small sample sizes, infrequent events, and risk of bias. There may be little to no difference in the risk of VTE, PICC-associated BSI, occlusion, or mortality across PICC materials and designs. Further rigorous RCTs are needed to reduce uncertainty.
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Affiliation(s)
- Jessica A Schults
- Herston Infectious Disease Institute, Metro North Health, Brisbane, Australia
- School of Nursing Midwifery and Social Work, The Univeristy of Queensland, Brisbane, Australia
| | - Tricia Kleidon
- Vascular Access and Management Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Karina Charles
- School of Nursing Midwifery and Social Work, The Univeristy of Queensland, Brisbane, Australia
| | - Emily Rebecca Young
- Menzies Health Institute Queensland & School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Amanda J Ullman
- School of Nursing Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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22
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Wang H, Wang F, Zhao H, Zong L. Analysis of risk factors for central venous catheter-related infection: A Prospective Observational study in adult patients after gastrointestinal surgery. Asian J Surg 2024:S1015-9584(24)01283-1. [PMID: 38937231 DOI: 10.1016/j.asjsur.2024.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Affiliation(s)
- Hongniu Wang
- Graduate School of Medicine, Changzhi Medical College, Changzhi, 046000, Shanxi Province, PR China; Department of Gastrointestinal Surgery, Changzhi People's Hospital, The Third Affiliated Hospital of Changzhi Medical College, Changzhi, 046000, Shanxi Province, PR China
| | - Fuqiang Wang
- Department of Gastrointestinal Surgery, Changzhi People's Hospital, The Third Affiliated Hospital of Changzhi Medical College, Changzhi, 046000, Shanxi Province, PR China
| | - Huiqin Zhao
- Department of Nursing, Changzhi People's Hospital, The Third Affiliated Hospital of Changzhi Medical College, Changzhi, 046000, Shanxi Province, PR China
| | - Liang Zong
- Department of Gastrointestinal Surgery, Changzhi People's Hospital, The Third Affiliated Hospital of Changzhi Medical College, Changzhi, 046000, Shanxi Province, PR China.
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23
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Ozkan E, Estes Bright LM, Kumar A, Pandey R, Devine R, Francis D, Ghalei S, Ashcraft M, Maffe P, Brooks M, Shome A, Garren M, Handa H. Bioinspired superhydrophobic surfaces with silver and nitric oxide-releasing capabilities to prevent device-associated infections and thrombosis. J Colloid Interface Sci 2024; 664:928-937. [PMID: 38503078 PMCID: PMC11025530 DOI: 10.1016/j.jcis.2024.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
Bacteria-associated infections and thrombus formation are the two major complications plaguing the application of blood-contacting medical devices. Therefore, functionalized surfaces and drug delivery for passive and active antifouling strategies have been employed. Herein, we report the novel integration of bio-inspired superhydrophobicity with nitric oxide release to obtain a functional polymeric material with anti-thrombogenic and antimicrobial characteristics. The nitric oxide release acts as an antimicrobial agent and platelet inhibitor, while the superhydrophobic components prevent non-specific biofouling. Widely used medical-grade silicone rubber (SR) substrates that are known to be susceptible to biofilm and thrombus formation were dip-coated with fluorinated silicon dioxide (SiO2) and silver (Ag) nanoparticles (NPs) using an adhesive polymer as a binder. Thereafter, the resulting superhydrophobic (SH) SR substrates were impregnated with S-nitroso-N-acetylpenicillamine (SNAP, an NO donor) to obtain a superhydrophobic, Ag-bound, NO-releasing (SH-SiAgNO) surface. The SH-SiAgNO surfaces had the lowest amount of viable adhered E. coli (> 99.9 % reduction), S. aureus (> 99.8 % reduction), and platelets (> 96.1 % reduction) as compared to controls while demonstrating no cytotoxic effects on fibroblast cells. Thus, this innovative approach is the first to combine SNAP with an antifouling SH polymer surface that possesses the immense potential to minimize medical device-associated complications without using conventional systemic anticoagulation and antibiotic treatments.
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Affiliation(s)
- Ekrem Ozkan
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA 30602, USA
| | - Lori M Estes Bright
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA 30602, USA
| | - Anil Kumar
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA 30602, USA
| | - Rashmi Pandey
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA 30602, USA
| | - Ryan Devine
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA 30602, USA
| | - Divine Francis
- Department of Chemistry, University of Georgia, Athens, GA 30602, USA
| | - Sama Ghalei
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA 30602, USA
| | - Morgan Ashcraft
- Pharmaceutical and Biomedical Sciences Department, College of Pharmacy, University of Georgia, Athens, GA 30602, USA
| | - Patrick Maffe
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA 30602, USA
| | - Megan Brooks
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA 30602, USA
| | - Arpita Shome
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA 30602, USA
| | - Mark Garren
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA 30602, USA
| | - Hitesh Handa
- School of Chemical, Materials, and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA 30602, USA; Pharmaceutical and Biomedical Sciences Department, College of Pharmacy, University of Georgia, Athens, GA 30602, USA.
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24
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Devautour C, Poey N, Lagier J, Launay E, Cerdac A, Vergnaud N, Berneau P, Parize P, Ferroni A, Tzaroukian L, Pinhas Y, Pinquier D, Lorrot M, Dubos F, Caseris M, Ouziel A, Chalumeau M, Cohen JF, Toubiana J. Salvage strategy for long-term central venous catheter-associated Staphylococcus aureus infections in children: a multi-centre retrospective study in France. J Hosp Infect 2024; 150:125-133. [PMID: 38880286 DOI: 10.1016/j.jhin.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVES Catheter removal is recommended in adults with Staphylococcus aureus central-line-associated bloodstream infection (CLABSI) but is controversial in children with long-term central venous catheters (LTCVC). We evaluated the occurrence of catheter salvage strategy (CSS) in children with S. aureus LTCVC-associated CLABSI and assessed determinants of CSS failure. METHODS We retrospectively included children (<18 years) with an LTCVC and hospitalized with S. aureus CLABSI in eight French tertiary-care hospitals (2010-2018). CSS was defined as an LTCVC left in place ≥72 h after initiating empiric antibiotic treatment for suspected bacteraemia. Characteristics of patients were reviewed, and multi-variable logistic regression was performed to identify factors associated with CSS failure (i.e., persistence, recurrence or complications of bacteraemia). RESULTS We included 273 episodes of S. aureus LTCVC-associated CLABSI. CSS was chosen in 194 out of 273 (71%) cases and failed in 74 of them (38%). The main type of CSS failure was the persistence of bacteraemia (39 of 74 cases, 53%). Factors independently associated with CSS failure were: history of catheter infection (adjusted odds ratio (aOR) 3.18, 95% confidence interval (CI) 1.38-7.36), CLABSI occurring on an implantable venous access device (aOR 7.61, 95% CI 1.98-29.20) when compared with tunnelled-cuffed CVC, polymicrobial CLABSI (aOR 3.45, 95% CI 1.25-9.50), and severe sepsis at the initial stage of infection (aOR 4.46, 95% CI 1.18-16.82). CONCLUSIONS CSS was frequently chosen in children with S. aureus LTCVC-associated CLABSI, and failure occurred in one-third of cases. The identified risk factors may help clinicians identify children at risk for CSS failure.
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Affiliation(s)
- C Devautour
- Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - N Poey
- Department of General Pediatrics and Infectious Diseases, Robert Debré University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - J Lagier
- Department of Pediatrics, Hospices Civils de Lyon, Lyon, France
| | - E Launay
- Department of Pediatrics, CHU Nantes, Nantes, France
| | - A Cerdac
- Pediatric Emergency Medicine & Infectious Diseases, CHU Lille, Lille, France
| | - N Vergnaud
- Department of General Pediatrics, Trousseau University Hospital, AP-HP, Pierre et Marie Curie University, Sorbonne Paris, Paris, France
| | - P Berneau
- Department of Pediatrics, Centre Hospitalier de Rennes, Rennes, France
| | - P Parize
- Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - A Ferroni
- Department of Clinical Microbiology, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - L Tzaroukian
- Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen, France
| | - Y Pinhas
- Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - D Pinquier
- Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen, France
| | - M Lorrot
- Department of General Pediatrics, Trousseau University Hospital, AP-HP, Pierre et Marie Curie University, Sorbonne Paris, Paris, France
| | - F Dubos
- Pediatric Emergency Medicine & Infectious Diseases, CHU Lille, Lille, France
| | - M Caseris
- Department of General Pediatrics and Infectious Diseases, Robert Debré University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - A Ouziel
- Department of Pediatrics, Hospices Civils de Lyon, Lyon, France
| | - M Chalumeau
- Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - J F Cohen
- Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - J Toubiana
- Department of General Pediatrics and Infectious Diseases, Necker-Enfants Malades University Hospital, AP-HP, Université Paris Cité, Paris, France.
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Oladapo-Shittu O, Cosgrove SE, Rock C, Hsu YJ, Klein E, Harris AD, Mejia-Chew C, Saunders H, Ching PR, Gadala A, Mayoryk S, Pineles L, Maragakis L, Salinas A, Helsel T, Keller SC. Characterizing Patients Presenting on Hospital Admission With Central Line-Associated Bloodstream Infections: A Multicenter Study. Clin Infect Dis 2024; 78:1632-1639. [PMID: 38483930 DOI: 10.1093/cid/ciae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND There are no systematic measures of central line-associated bloodstream infections (CLABSIs) in patients maintaining central venous catheters (CVCs) outside acute care hospitals. To clarify the burden of CLABSIs in these patients, we characterized patients with CLABSI present on hospital admission (POA). METHODS Retrospective cross-sectional analysis of patients with CLABSI-POA in 3 health systems covering 11 hospitals across Maryland, Washington DC, and Missouri from November 2020 to October 2021. CLABSI-POA was defined using an adaptation of the acute care CLABSI definition. Patient demographics, clinical characteristics, and outcomes were collected via record review. Cox proportional hazard analysis was used to assess factors associated with the all-cause mortality rate within 30 days. RESULTS A total of 461 patients were identified as having CLABSI-POA. CVCs were most commonly maintained in home infusion therapy (32.8%) or oncology clinics (31.2%). Enterobacterales were the most common etiologic agent (29.2%). Recurrent CLABSIs occurred in a quarter of patients (25%). Eleven percent of patients died during the hospital admission. Among patients with CLABSI-POA, mortality risk increased with age (hazard ratio vs age <20 years by age group: 20-44 years, 11.2 [95% confidence interval, 1.46-86.22]; 45-64 years, 20.88 [2.84-153.58]; ≥65 years, 22.50 [2.98-169.93]) and lack of insurance (2.46 [1.08-5.59]), and it decreased with CVC removal (0.57 [.39-.84]). CONCLUSIONS CLABSI-POA is associated with significant in-hospital mortality risk. Surveillance is required to understand the burden of CLABSI in the community to identify targets for CLABSI prevention initiatives outside acute care settings.
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Affiliation(s)
- Opeyemi Oladapo-Shittu
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Sara E Cosgrove
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Clare Rock
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Yea-Jen Hsu
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Eili Klein
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Anthony D Harris
- University of Maryland School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- University of Maryland School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
- Institute for Health Computing, University of Maryland, Baltimore, Maryland, USA
| | - Carlos Mejia-Chew
- Washington University School of Medicine, Department of Medicine, St Louis, Missouri, USA
| | - Heather Saunders
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Patrick R Ching
- Washington University School of Medicine, Department of Medicine, St Louis, Missouri, USA
- Virginia Commonwealth University School of Medicine, Department of Medicine, Richmond, Virginia, USA
| | - Avi Gadala
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Stephanie Mayoryk
- University of Maryland School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- University of Maryland School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Lisa Pineles
- University of Maryland School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- University of Maryland School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Lisa Maragakis
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Alejandra Salinas
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Taylor Helsel
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Sara C Keller
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland, USA
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26
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Azad MA, Patel R. Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections. Clin Microbiol Rev 2024; 37:e0010423. [PMID: 38506553 PMCID: PMC11237642 DOI: 10.1128/cmr.00104-23] [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] [Indexed: 03/21/2024] Open
Abstract
SUMMARYImplant-associated infections (IAIs) pose serious threats to patients and can be associated with significant morbidity and mortality. These infections may be difficult to diagnose due, in part, to biofilm formation on device surfaces, and because even when microbes are found, their clinical significance may be unclear. Despite recent advances in laboratory testing, IAIs remain a diagnostic challenge. From a therapeutic standpoint, many IAIs currently require device removal and prolonged courses of antimicrobial therapy to effect a cure. Therefore, making an accurate diagnosis, defining both the presence of infection and the involved microorganisms, is paramount. The sensitivity of standard microbial culture for IAI diagnosis varies depending on the type of IAI, the specimen analyzed, and the culture technique(s) used. Although IAI-specific culture-based diagnostics have been described, the challenge of culture-negative IAIs remains. Given this, molecular assays, including both nucleic acid amplification tests and next-generation sequencing-based assays, have been used. In this review, an overview of these challenging infections is presented, as well as an approach to their diagnosis from a microbiologic perspective.
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Affiliation(s)
- Marisa Ann Azad
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robin Patel
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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27
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Amadieu R, Brehin C, Chahine A, Grouteau E, Dubois D, Munzer C, Flumian C, Brissaud O, Ros B, Jean G, Brotelande C, Travert B, Savy N, Boeuf B, Ghostine G, Popov I, Duport P, Wolff R, Maurice L, Dauger S, Breinig S. Compliance with antibiotic therapy guidelines in french paediatric intensive care units: a multicentre observational study. BMC Infect Dis 2024; 24:582. [PMID: 38867164 PMCID: PMC11170905 DOI: 10.1186/s12879-024-09472-0] [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: 07/05/2023] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Bacterial infections (BIs) are widespread in ICUs. The aims of this study were to assess compliance with antibiotic recommendations and factors associated with non-compliance. METHODS We conducted an observational study in eight French Paediatric and Neonatal ICUs with an antimicrobial stewardship programme (ASP) organised once a week for the most part. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns < 72 h old, neonates < 37 weeks, age ≥ 18 years and children under surgical antimicrobial prophylaxis were excluded. RESULTS 139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% with no BI, 40.3% presumed (i.e., not documented) BI and 35.3% documented BI. Non-compliance with antibiotic recommendations occurred in 51.1%. The main reasons for non-compliance were inappropriate choice of antimicrobials (27.3%), duration of one or more antimicrobials (26.3%) and length of antibiotic therapy (18.0%). In multivariate analyses, the main independent risk factors for non-compliance were prescribing ≥ 2 antibiotics (OR 4.06, 95%CI 1.69-9.74, p = 0.0017), duration of broad-spectrum antibiotic therapy ≥ 4 days (OR 2.59, 95%CI 1.16-5.78, p = 0.0199), neurologic compromise at ICU admission (OR 3.41, 95%CI 1.04-11.20, p = 0.0431), suspected catheter-related bacteraemia (ORs 3.70 and 5.42, 95%CIs 1.32 to 15.07, p < 0.02), a BI site classified as "other" (ORs 3.29 and 15.88, 95%CIs 1.16 to 104.76, p < 0.03), sepsis with ≥ 2 organ dysfunctions (OR 4.21, 95%CI 1.42-12.55, p = 0.0098), late-onset ventilator-associated pneumonia (OR 6.30, 95%CI 1.15-34.44, p = 0.0338) and ≥ 1 risk factor for extended-spectrum β-lactamase-producing Enterobacteriaceae (OR 2.56, 95%CI 1.07-6.14, p = 0.0353). Main independent factors for compliance were using antibiotic therapy protocols (OR 0.42, 95%CI 0.19-0.92, p = 0.0313), respiratory failure at ICU admission (OR 0.36, 95%CI 0.14-0.90, p = 0.0281) and aspiration pneumonia (OR 0.37, 95%CI 0.14-0.99, p = 0.0486). CONCLUSIONS Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should reassess on a day-to-day basis the benefit of using several antimicrobials or any broad-spectrum antibiotics and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using department protocols seem necessary to reduce non-compliance. A daily ASP could also improve compliance in these situations. TRIAL REGISTRATION ClinicalTrials.gov: number NCT04642560. The date of first trial registration was 24/11/2020.
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Affiliation(s)
- Romain Amadieu
- Neonatal and Paediatric Intensive Care Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse Cedex 9, 31059, France.
| | - Camille Brehin
- Paediatric Infectious Diseases Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
- General Paediatrics Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Adéla Chahine
- Neonatal and Paediatric Intensive Care Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse Cedex 9, 31059, France
| | - Erick Grouteau
- Paediatric Infectious Diseases Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
- General Paediatrics Department, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Damien Dubois
- Bacteriology-Hygiene Department, Toulouse University Hospital, Toulouse, France
| | - Caroline Munzer
- Paediatric Clinical Research Department, Children's Hospital, Equipe MéDatAS-CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Clara Flumian
- Paediatric Clinical Research Department, Children's Hospital, Equipe MéDatAS-CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Olivier Brissaud
- Neonatal and Paediatric Intensive Care Unit, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Barbara Ros
- Neonatal and Paediatric Intensive Care Unit, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Gael Jean
- Neonatal and Paediatric Intensive Care Unit, Pellegrin University Hospital, Bordeaux University, Bordeaux, France
| | - Camille Brotelande
- Paediatric Intensive Care Unit, Arnaud de Villeneuve University Hospital, Montpellier University, Montpellier, France
| | - Brendan Travert
- Neonatal and Paediatric Intensive Care Unit, Mère-Enfant University Hospital, Nantes University, Nantes, France
| | - Nadia Savy
- Neonatal and Paediatric Intensive Care Unit, Estaing University Hospital, Clermont-Ferrand University, Clermont-Ferrand, France
| | - Benoit Boeuf
- Neonatal and Paediatric Intensive Care Unit, Estaing University Hospital, Clermont-Ferrand University, Clermont-Ferrand, France
| | - Ghida Ghostine
- Neonatal and Paediatric Intensive Care Unit, Amiens-Picardie University Hospital, Amiens University, Amiens, France
| | - Isabelle Popov
- Neonatal and Paediatric Intensive Care Unit, Amiens-Picardie University Hospital, Amiens University, Amiens, France
| | - Pauline Duport
- Neonatal and Paediatric Intensive Care Unit, Felix Guyon University Hospital, La Réunion University, Saint-Denis, Ile de la Réunion, France
| | - Richard Wolff
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Laure Maurice
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Stephane Dauger
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Sophie Breinig
- Neonatal and Paediatric Intensive Care Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse Cedex 9, 31059, France
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Sánchez Cánovas M, García Torralba E, Blaya Boluda N, Sánchez Saura A, Puche Palao G, Sánchez Fuentes A, Martínez Montesinos L, Poveda Ganga C, García Tomas L, Bayona Jiménez J, Cos Zapata Á, Muñoz Jurado CM, Pina Mingorance I, Caravaca Hernández MA, Vicente García V, Ayala de la Peña F. Thrombosis and infections associated with PICC in onco-hematological patients, what is their relevance? Clin Transl Oncol 2024:10.1007/s12094-024-03548-8. [PMID: 38865035 DOI: 10.1007/s12094-024-03548-8] [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: 03/21/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Peripherally inserted central venous catheters (PICC) in the onco-hematological patients may be associated with thrombosis or infections that may have short- to medium-term repercussions. MATERIAL AND METHODS Single-centre retrospective analysis of a prospectively collected cohort. Primary objective was to establish the PICC-thrombosis and infections incidence. Secondary objectives were to analyze profile of patients suffering from these complications and variables associated with an increased likelihood of developing these events. RESULTS 549 patients were recruited. 58.5% (n = 321) were oncology patients and 41.5% (n = 228) hematology patients. The incidence of PICC-associated thrombosis was 3.5% (n = 19). Thrombosis was associated with progression of the underlying malignant pathology in 10.6% (n = 2) of cases. No association was found between clinical variables analysed and development of thrombosis. Incidence of PICC-associated infections was 7.65% (n = 42). In the 30 days prior to PICC infection, 57.1% (n = 24) had a febrile syndrome of another focus, 73.8% (n = 11) had been hospitalized, 49.5% (n = 25) had a neutrophil count of 0-500 cells/mm3 and 47.6% (n = 20) had an episode of neutropenic fever. Variables significantly associated with the development of infection were hematological patients, high-flow PICC, 3-lm PICC or PICC insertion because of administration of vesicant therapy. CONCLUSIONS Incidence of PICC-associated thrombosis is low and apparently less prognostically aggressive than other forms of thrombosis associated with cancer, without identify predictive factors. Infection was more prevalent and the identification of risk factors in our series could facilitate its prevention.
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Affiliation(s)
- Manuel Sánchez Cánovas
- Medical Oncology Department, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain.
| | - Esmeralda García Torralba
- Medical Oncology Department, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Noel Blaya Boluda
- Medical Oncology Department, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Ana Sánchez Saura
- Medical Oncology Department, Hospital Clínico Universitario Virgen de La Arrixaca, El Palmar, Spain
| | - Gabriel Puche Palao
- Internal Medicine Department, Hospital G. Universitario Reina Sofía, Murcia, Spain
| | - Ana Sánchez Fuentes
- Hematology Department, IMIB, Morales Meseguer General University Hospital, University of Murcia, Murcia, Spain
| | - Lorena Martínez Montesinos
- Hematology Department, IMIB, Morales Meseguer General University Hospital, University of Murcia, Murcia, Spain
| | - Carmen Poveda Ganga
- Hematology Department, IMIB, Morales Meseguer General University Hospital, University of Murcia, Murcia, Spain
| | - Lucía García Tomas
- Hematology Department, IMIB, Morales Meseguer General University Hospital, University of Murcia, Murcia, Spain
| | - Josefa Bayona Jiménez
- Onco-Hematological Day Hospital Unit, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Ángeles Cos Zapata
- Onco-Hematological Day Hospital Unit, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Carmen María Muñoz Jurado
- Onco-Hematological Day Hospital Unit, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Inmaculada Pina Mingorance
- Onco-Hematological Day Hospital Unit, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - María Amor Caravaca Hernández
- Onco-Hematological Day Hospital Unit, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
| | - Vicente Vicente García
- Hematology Department, IMIB, Morales Meseguer General University Hospital, University of Murcia, Murcia, Spain
| | - Francisco Ayala de la Peña
- Medical Oncology Department, IMIB, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
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Zebian G, Kreitmann L, Houard M, Piantoni A, Piga G, Ruffier des Aimes S, Holik B, Wallet F, Labreuche J, Nseir S. Immunosuppression at ICU admission is not associated with a higher incidence of ICU-acquired bacterial bloodstream infections: the COCONUT study. Ann Intensive Care 2024; 14:83. [PMID: 38837065 PMCID: PMC11153408 DOI: 10.1186/s13613-024-01314-1] [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: 10/31/2023] [Accepted: 05/16/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Immunosuppression at intensive care unit (ICU) admission has been associated with a higher incidence of ICU-acquired infections, some of them related to opportunistic pathogens. However, the association of immunosuppression with the incidence, microbiology and outcomes of ICU-acquired bacterial bloodstream infections (BSI) has not been thoroughly investigated. METHODS Retrospective single-centered cohort study in France. All adult patients hospitalized in the ICU of Lille University-affiliated hospital for > 48 h between January 1st and December 31st, 2020, were included, regardless of their immune status. Immunosuppression was defined as active cancer or hematologic malignancy, neutropenia, hematopoietic stem cell and solid organ transplants, use of steroids or immunosuppressive drugs, human immunodeficiency virus infection and genetic immune deficiency. The primary objective was to compare the 28-day cumulative incidence of ICU-acquired bacterial BSI between immunocompromised and non-immunocompromised patients. Secondary objectives were to assess the microbiology and outcomes of ICU-acquired bacterial BSI in the two groups. RESULTS A total of 1313 patients (66.9% males, median age 62 years) were included. Among them, 271 (20.6%) were immunocompromised at ICU admission. Severity scores at admission, the use of invasive devices and antibiotic exposure during ICU stay were comparable between groups. Both prior to and after adjustment for pre-specified baseline confounders, the 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between immunocompromised and non-immunocompromised patients. The distribution of bacteria was comparable between groups, with a majority of Gram-negative bacilli (~ 64.1%). The proportion of multidrug-resistant bacteria was also similar between groups. Occurrence of ICU-acquired bacterial BSI was associated with a longer ICU length-of-stay and a longer duration of invasive mechanical ventilation, with no significant association with mortality. Immune status did not modify the association between occurrence of ICU-acquired bacterial BSI and these outcomes. CONCLUSION The 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between patients with and without immunosuppression at ICU admission.
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Affiliation(s)
- Ghadi Zebian
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Louis Kreitmann
- Department of Intensive Care Medicine, Imperial College Healthcare NHS Trust, London, UK
- Centre for Antimicrobial Optimisation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, W12 0HS, UK
| | - Marion Houard
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Antoine Piantoni
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Gaetan Piga
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Sarah Ruffier des Aimes
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Bérénice Holik
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Frédéric Wallet
- Laboratoire de Bactériologie-Hygiène, CHU de Lille, Centre de Biologie Pathologie, 59000, Lille, France
| | | | - Saad Nseir
- Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France.
- Inserm U1285, Université de Lille, CNRS, UMR 8576-UGSF, 59000, Lille, France.
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30
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Ishikawa T, Uejima Y, Okai M, Shiga K, Shoji K, Miyairi I, Kato M, Morooka S, Kubota M, Tagaya T, Tsuji S, Aoki S, Ide K, Niimi H, Uchiyama T, Onodera M, Kawai T. Melting temperature mapping method in children: Rapid identification of pathogenic microbes. J Infect Chemother 2024; 30:475-480. [PMID: 38036030 DOI: 10.1016/j.jiac.2023.11.024] [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: 09/27/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The melting temperature (Tm) mapping method (TM) identifies bacterial species by intrinsic patterns of Tm values in the 16S ribosomal RNA gene (16S rDNA) extracted directly from whole blood. We examined potential clinical application of TM in children with bloodstream infection (BSI). METHODS This was a prospective observational study at a children's hospital in Japan from 2018 to 2021. In patients with diagnosed or suspected BSI, we investigated the match rates of pathogenic bacteria identified by TM and blood culture (BC), the inspection time to identification of TM, and the amount of bacterial DNA in blood samples. RESULTS The median age of 81 patients (93 samples) was 3.6 years. Of 23 samples identified by TM, 11 samples matched the bacterial species with BC (positive-match rate, 48 %). Of 64 TM-negative samples, 62 samples were negative for BC (negative-match rate, 97 %). Six samples, including one containing two pathogenic bacterial species, were not suitable for TM identification. In total, the matched samples were 73 of 93 samples (match rate, 78 %). There were seven samples identified by TM in BC-negative samples from blood collected after antibiotic therapy. Interestingly, the bacteria were matched with BC before antibiotic administration. These TM samples contained as many 16S rDNA copies as the BC-positive samples. The median inspection time to identification using TM was 4.7 h. CONCLUSIONS In children with BSI, TM had high negative-match rates with BC, the potential to identify the pathogenic bacteria even in patients on antibiotic therapy, and more rapid identification compared to BC. REGISTERING CLINICAL TRIALS UMIN000041359https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000047220.
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Affiliation(s)
- Takashi Ishikawa
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan.
| | - Yoji Uejima
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan; Department of Clinical Laboratory and Molecular Pathology, Toyama University Hospital, Toyama, Japan
| | - Masashi Okai
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Kyoko Shiga
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatric Hematology and Oncology Research, National Center for Child Health and Development, Tokyo, Japan
| | - Shintaro Morooka
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takashi Tagaya
- Division of Pediatric Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Tsuji
- Division of Pediatric Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Aoki
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Ide
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hideki Niimi
- Department of Clinical Laboratory and Molecular Pathology, Toyama University Hospital, Toyama, Japan
| | - Toru Uchiyama
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan; Department of Human Genetics, National Center for Child Health and Development, Tokyo, Japan
| | - Masafumi Onodera
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan; Gene & Cell Therapy Promotion Center, National Center for Child Health and Development, Tokyo, Japan
| | - Toshinao Kawai
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
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Tseng KY, Huang YT, Huang YT, Su YT, Wang AN, Weng WY, Ke CL, Yeh YC, Wang JJ, Du SH, Gu ZQ, Chen WL, Lin CH, Tsai YH. Regulation of candidalysin underlies Candida albicans persistence in intravascular catheters by modulating NETosis. PLoS Pathog 2024; 20:e1012319. [PMID: 38885290 PMCID: PMC11213320 DOI: 10.1371/journal.ppat.1012319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/28/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
Candida albicans is a leading cause of intravascular catheter-related infections. The capacity for biofilm formation has been proposed to contribute to the persistence of this fungal pathogen on catheter surfaces. While efforts have been devoted to identifying microbial factors that modulate C. albicans biofilm formation in vitro, our understanding of the host factors that may shape C. albicans persistence in intravascular catheters is lacking. Here, we used multiphoton microscopy to characterize biofilms in intravascular catheters removed from candidiasis patients. We demonstrated that, NETosis, a type of neutrophil cell death with antimicrobial activity, was implicated in the interaction of immune cells with C. albicans in the catheters. The catheter isolates exhibited reduced filamentation and candidalysin gene expression, specifically in the total parenteral nutrition culture environment. Furthermore, we showed that the ablation of candidalysin expression in C. albicans reduced NETosis and conferred resistance to neutrophil-mediated fungal biofilm elimination. Our findings illustrate the role of neutrophil NETosis in modulating C. albicans biofilm persistence in an intravascular catheter, highlighting that C. albicans can benefit from reduced virulence expression to promote its persistence in an intravascular catheter.
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Affiliation(s)
- Kuo-Yao Tseng
- Laboratory of Host–Microbe Interactions and Cell Dynamics, Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Tsung Huang
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Yu-Ting Huang
- Laboratory of Host–Microbe Interactions and Cell Dynamics, Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Ting Su
- Laboratory of Host–Microbe Interactions and Cell Dynamics, Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - An-Ni Wang
- Laboratory of Host–Microbe Interactions and Cell Dynamics, Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Yen Weng
- Laboratory of Host–Microbe Interactions and Cell Dynamics, Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cai-Ling Ke
- Department of Biochemical Science and Technology, College of Life Science, National Taiwan University, Taipei, Taiwan
| | - Yu-Chiao Yeh
- Department of Biochemical Science and Technology, College of Life Science, National Taiwan University, Taipei, Taiwan
| | - Jhih-Jie Wang
- Laboratory of Host–Microbe Interactions and Cell Dynamics, Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shin-Hei Du
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Zi-Qi Gu
- Laboratory of Host–Microbe Interactions and Cell Dynamics, Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Lin Chen
- Laboratory of Host–Microbe Interactions and Cell Dynamics, Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Program in Molecular Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, Taiwan
| | - Ching-Hsuan Lin
- Department of Biochemical Science and Technology, College of Life Science, National Taiwan University, Taipei, Taiwan
| | - Yu-Huan Tsai
- Laboratory of Host–Microbe Interactions and Cell Dynamics, Institute of Microbiology and Immunology, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Program in Molecular Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, Taiwan
- Center for Molecular and Clinical Immunology, Chang Gung University, Taoyuan, Taiwan
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MacPhail A, Dendle C, Slavin M, McQuilten Z. Hospital-acquired bloodstream infections in patients with cancer: current knowledge and future directions. J Hosp Infect 2024; 148:39-50. [PMID: 38490489 DOI: 10.1016/j.jhin.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Patients with cancer experience higher rates of preventable harm from hospital-acquired bloodstream infections (haBSIs) and central-line-associated bloodstream infections (CLABSIs) compared with the general hospital population. The prevention of haBSIs and CLABSIs in patients with cancer is an urgent priority, and requires standardized surveillance and reporting efforts. The application of haBSI and CLABSI definitions, classification systems and surveillance strategies for patients with cancer is complex, and there is wide variation in clinical practice. Existing systems were not designed explicitly for patients with cancer, and have different strengths and weaknesses in the cancer setting. For these reasons, epidemiological estimates of haBSIs and CLABSIs in patients with cancer also require careful interpretation. This complexity can be a barrier to identifying appropriate targets for intervention and reducing preventable harm. This review provides an overview of key concepts and challenges in haBSI surveillance and prevention specific to patients with cancer. In addition, this review summarizes the strengths and weaknesses of commonly used surveillance definitions and denominators in the setting of cancer care; existing surveillance practice; epidemiology of haBSIs and CLABSIs; prevention strategies; and current knowledge gaps. A global collaborative effort to harmonize the surveillance of hospital-acquired infections in patients with cancer would be invaluable to improve the accuracy and utility of existing data, advance efforts to prevent hospital-acquired infections, and improve patient safety.
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Affiliation(s)
- A MacPhail
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Infectious Diseases, Monash Health, Melbourne, Australia
| | - C Dendle
- Department of Infectious Diseases, Monash Health, Melbourne, Australia; School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - M Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Z McQuilten
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Haematology, Monash Health, Clayton, Australia.
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Schmidt-Hellerau K, Breuninger M, Kessel J, Vehreschild MJGT, Paul G, Reusch J, Jung N, Hellmich M, Fätkenheuer G. Flucloxacillin and cefazolin for treatment of Staphylococcus aureus bloodstream infection. Infection 2024; 52:1159-1163. [PMID: 38296936 PMCID: PMC11142999 DOI: 10.1007/s15010-023-02168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/23/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE Antistaphylococcal penicillins and cefazolin have been used as first line therapy in Methicillin-susceptible Staphylococcus aureus bloodstream infection. While efficacy of both regimens seems to be similar, the compounds may differ with regard to tolerability. This study aims to describe the clinical use of cefazolin and flucloxacillin, focussing on discontinuation or change of anti-infective agent due to adverse events. METHODS This observational prospective study was conducted at two German tertiary care centres with an internal recommendation of flucloxacillin for MSSA-BSI in one, and of cefazolin in the other centre. Adverse events were registered weekly under treatment and at a 90-day follow-up. Descriptive analysis was complemented by a propensity score analysis comparing adverse events (stratified rank-based test applied to the sum of Common Terminology Criteria for adverse events ratings per patient). RESULTS Of 71 patients included, therapy was initiated with flucloxacillin in 56 (79%), and with cefazolin in 15 (21%). The propensity score analysis indicates a statistically significant difference concerning the severity of adverse events between the treatment groups in favour of cefazolin (p = 0.019). Adverse events led to discontinuation of flucloxacillin in 7 individuals (13% of all patients receiving flucloxacillin). Clinical outcome was not different among treatment groups. CONCLUSION Using cefazolin rather than flucloxacillin as a first line agent for treatment of MSSA-BSI is supported by these clinical data.
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Affiliation(s)
- Kirsten Schmidt-Hellerau
- Department I of Internal Medicine, Infectious Diseases, Medical Faculty, University Hospital of Cologne, University of Cologne, Cologne, Germany.
| | - Marianne Breuninger
- Department I of Internal Medicine, Infectious Diseases, Medical Faculty, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Johanna Kessel
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Gregor Paul
- Department I of Internal Medicine, Infectious Diseases, Medical Faculty, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Jomana Reusch
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Infectious Diseases, Medical Faculty, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, Infectious Diseases, Medical Faculty, University Hospital of Cologne, University of Cologne, Cologne, Germany
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Jahns F, Hausen A, Keller P, Stolz V, Kalff JC, Kuetting D, von Websky MW. Life on the line - Incidence and management of central venous catheter complications in intestinal failure. Clin Nutr 2024; 43:1627-1634. [PMID: 38772069 DOI: 10.1016/j.clnu.2024.05.013] [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: 01/29/2024] [Revised: 04/16/2024] [Accepted: 05/04/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND & AIMS Loss of venous access is threatening for patients with intestinal failure (IF) under long-term parenteral nutrition (PN). We aimed to identify the incidence of central venous catheter (CVC) complications, compare different devices, and analyze interventional recanalizing procedures to restore the patency of occluded CVCs. METHODS For this retrospective cohort study, patient data from a prospective IF database spanning 16 years was analyzed at a tertiary referral center. Catheter dwell times (CDTs) were distinguished by Kaplan-Meier survival analysis and subgroup analyses were performed for different CVC types (tunneled/port catheters). Specific complications (occlusion, catheter-related infection (CRI), displacement, and material defect) were analyzed. Explantation rates and CDTs were compared. RESULTS Overall, 193 CVCs in 77 patients with IF under PN could be enrolled (62.524 "CVC-days"). Broviac type "B" was found to be significantly superior to type "A" regarding occlusion, CRI, and material defects (log-rank test: p = 0.05; p = 0.026; p = 0.005 respectively). Port catheters were displaying the highest incidence of CRI (2.13 events/1000 catheter days). Interventional catheter recanalization was performed 91 times and significantly increased the CDT from a median of 131 days (IQR: 62; 258) to 389 days (IQR: 262; 731) (Mann-Whitney-U-test: p= <0.001) without increasing complications. CONCLUSIONS Different complication rates and CDT were seen depending on CVC type. Tunneled catheters were significantly superior concerning CRI. Interventional catheter recanalization is a viable alternative to fibrinolytics to restore CVC patency, but long-term patency data is scarce.
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Affiliation(s)
- Franziska Jahns
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Annekristin Hausen
- Department of Internal Medicine, University Hospital of Bonn, Bonn, Germany
| | - Peter Keller
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Verena Stolz
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jörg C Kalff
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
| | - Martin W von Websky
- Department of General-, Visceral-, Thoracic- and Vascular Surgery, University Hospital of Bonn, Bonn, Germany.
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Beckman M, Firmenich E, Cole CR, Haslam DB, Mortensen JE, Courter JD. Characterization of initial CLABSI culture results to support antimicrobial de-escalation in pediatric GI inpatients. J Pediatr Gastroenterol Nutr 2024; 78:1234-1240. [PMID: 38682404 DOI: 10.1002/jpn3.12228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Central Line-associated Bloodstream Infections (CLABSIs) pose a serious mortality and morbidity risk. An institutional protocol was developed for the evaluation and empirical antibiotic treatment of possible CLABSIs. The potential impact of de-escalating antimicrobial therapy based on initial Gram stain and molecular identification was assessed. METHODS All positive blood cultures from patients admitted to the gastroenterology service at a large pediatric medical center were collected from 1/1/14 to 12/31/20. Cultures that were negative, repeated, or causative organisms that were unable to be identified with susceptibility data were excluded. Timepoints and organism(s) from each culture were recorded. Polymicrobial cultures were classified as containing only gram-positive organisms (polymicrobial GP), only gram-negative organisms (polymicrobial GN), or mixed spectrum. RESULTS During the 6-year period, 361 positive blood cultures were included in the study. Single isolates were identified in 79.5% (287/361) of cultures. Polymicrobial cultures from confirmed central line source accounted for 15.0% (54/361), with 6.4% (23/361) Polymicrobial GP, 4.4% (16/361) Polymicrobial GN, and 4.2% (15/361) being mixed-spectrum cultures. Both organism types were detected on initial gram-stain in 40% (6/15) of the mixed-spectrum cultures, another 26.7% (4/15) had the opposite-spectrum organism identified within an average of <3 h and the remaining 33.3% (5/15) had the opposite-spectrum organism identified by culture growth. CONCLUSIONS Polymicrobial mixed-spectrum cultures accounted for <5% of positive blood cultures and most isolates were identified within 3 h of first positivity. This may allow for further investigation of early de-escalation of therapy for this population and limit antimicrobial exposure.
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Affiliation(s)
- Martina Beckman
- Department of Pharmacy, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
| | - Emily Firmenich
- Department of Pharmacy, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
| | - Conrad R Cole
- Division of Gastroenterology, Hepatology and Nutrition, (CCHMC), Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - David B Haslam
- Division of Infectious Diseases, (CCHMC), Cincinnati, Ohio, USA
| | - Joel E Mortensen
- Diagnostic Infectious Disease Testing Laboratory, Department of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
| | - Joshua D Courter
- Department of Pharmacy, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA
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Saavedra-Lozano J, Slocker-Barrio M, Fresán-Ruiz E, Grasa C, Martín Pedraz L, Menasalvas Ruiz A, Santos Sebastián M. Consensus document of the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Intensive Care (SECIP) for the diagnosis and treatment of central venous catheter-related infections in paediatric care. An Pediatr (Barc) 2024; 100:448-464. [PMID: 38925786 DOI: 10.1016/j.anpede.2024.05.012] [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: 01/12/2024] [Accepted: 04/24/2024] [Indexed: 06/28/2024] Open
Abstract
Intravascular devices are essential for the diagnostic and therapeutic approach to multiple diseases in paediatrics, and central venous catheters (CVCs) are especially important. One of the most frequent complications is the infection of these devices, which is associated with a high morbidity and mortality. These infections are highly complex, requiring the use of substantial resources, both for their diagnosis and treatment, and affect vulnerable paediatric patients admitted to high-complexity units more frequently. There is less evidence on their management in paediatric patients compared to adults, and no consensus documents on the subject have been published in Spain. The objective of this document, developed jointly by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Intensive Care (SECIP), is to provide consensus recommendations based on the greatest degree of evidence available to optimize the diagnosis and treatment of catheter-related bloodstream infections (CRBSIs). This document focuses on non-neonatal paediatric patients with CRBSIs and does not address the prevention of these infections.
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Affiliation(s)
- Jesús Saavedra-Lozano
- Sección de Enfermedades Infecciosas Pediátricas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
| | - María Slocker-Barrio
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Madrid, Spain
| | - Elena Fresán-Ruiz
- Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Carlos Grasa
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, Fundación de Investigación Biomédica Hospital La Paz (IdiPAZ), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Laura Martín Pedraz
- Sección de Enfermedades Infecciosas Pediátricas, Hospital Regional de Málaga, Madrid, Spain
| | - Ana Menasalvas Ruiz
- Unidad de Infectología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mar Santos Sebastián
- Sección de Enfermedades Infecciosas Pediátricas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Kosmeri C, Giapros V, Serbis A, Balomenou F, Baltogianni M. Antibiofilm Strategies in Neonatal and Pediatric Infections. Antibiotics (Basel) 2024; 13:509. [PMID: 38927176 PMCID: PMC11200539 DOI: 10.3390/antibiotics13060509] [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: 04/28/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Biofilm-related infections pose significant challenges in neonatal and pediatric care, contributing to increased morbidity and mortality rates. These complex microbial communities, comprising bacteria and fungi, exhibit resilience against antibiotics and host immune responses. Bacterial species such as Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis commonly form biofilms on medical devices, exacerbating infection risks. Neonates and children, particularly those in intensive care units, are highly susceptible to biofilm-associated infections due to the prolonged use of invasive devices, such as central lines and endotracheal tubes. Enteral feeding tubes, crucial for neonatal nutritional support, also serve as potential sites for biofilm formation, contributing to recurrent microbial contamination. Moreover, Candida species, including Candida pelliculosa, present emerging challenges in neonatal care, with multi-drug resistant strains posing treatment complexities. Current antimicrobial therapies, while important in managing infections, often fall short in eradicating biofilms, necessitating alternative strategies. The aim of this review is to summarize current knowledge regarding antibiofilm strategies in neonates and in children. Novel approaches focusing on biofilm inhibition and dispersal show promise, including surface modifications, matrix-degrading enzymes, and quorum-sensing inhibitors. Prudent use of medical devices and exploration of innovative antibiofilm therapies are imperative in mitigating neonatal and pediatric biofilm infections.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, 45500 Ioannina, Greece; (C.K.); (A.S.)
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45110 Ioannina, Greece; (F.B.); (M.B.)
| | - Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, 45500 Ioannina, Greece; (C.K.); (A.S.)
| | - Foteini Balomenou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45110 Ioannina, Greece; (F.B.); (M.B.)
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 45110 Ioannina, Greece; (F.B.); (M.B.)
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Schnizer M, Schellong P, Rose N, Fleischmann-Struzek C, Hagel S, Abbas M, Payne B, Evans RN, Pletz MW, Weis S. Long versus short course anti-microbial therapy of uncomplicated Staphylococcus aureus bacteraemia: a systematic review. Clin Microbiol Infect 2024:S1198-743X(24)00252-0. [PMID: 38823452 DOI: 10.1016/j.cmi.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/25/2024] [Accepted: 05/26/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Current guidelines recommend at least 2 weeks duration of antibiotic therapy (DOT) for patients with uncomplicated Staphylococcus aureus bacteraemia (SAB) but the evidence for this recommendation is unclear. OBJECTIVES To perform a systematic literature review assessing current evidence for recommended DOT for patients with SAB. METHODS The following are the methods used for this study. DATA SOURCES We searched MEDLINE, ISI Web of Science, the Cochrane Database and clinicaltrials.gov from inception to March 30, 2024. References of eligible studies were screened and experts in the field contacted for additional articles. STUDY ELIGIBILITY CRITERIA All clinical studies, regardless of design, publication status and language. PARTICIPANTS Adult patients with uncomplicated SAB. INTERVENTIONS Long (>14 days; >18 days; 11-16 days) vs. short (≤14 days; 10-18 days; 6-10 days, respectively) DOT with the DOT being defined as the first until the last day of antibiotic therapy. ASSESSMENT OF RISK OF BIAS Risk of bias was assessed using the ROBINS-I-tool. METHODS OF DATA SYNTHESIS The primary outcome was 90-day all-cause mortality. Only studies presenting results of adjusted analyses for mortality were included. Data synthesis could not be performed. RESULTS Eleven nonrandomized studies were identified that fulfilled the pre-defined inclusion criteria, of which three studies reported adjusted effect ratios. Only these were included in the final analysis. We did not find any RCT. Two studies with 1230 patients reported the primary endpoint 90-day all-cause mortality. Neither found a statistically significant superiority for longer (>14 days; 11-16 days) or shorter DOT (≤14 days; 6-10 days, respectively) for patients with uncomplicated SAB. Two studies investigated the secondary endpoint 30-day all-cause mortality (>18 days; 11-16 days vs. 10-18 days; 6-10 days, respectively) and did not find a statistically significant difference. All included studies had a moderate risk of bias. CONCLUSIONS Sound evidence that supports any duration of antibiotic treatment for patients with uncomplicated SAB is lacking.
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Affiliation(s)
- Martin Schnizer
- Institute for Infectious Disease and Infection Control, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Paul Schellong
- Institute for Infectious Disease and Infection Control, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Norman Rose
- Institute for Infectious Disease and Infection Control, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Carolin Fleischmann-Struzek
- Institute for Infectious Disease and Infection Control, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Stefan Hagel
- Institute for Infectious Disease and Infection Control, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Mohamed Abbas
- Infection Control Program and WHO Collaborating Center on AMR and IPC, University of Geneva Hospitals and Faculty of Medicine, Service of Infectious Diseases, Geneva, Switzerland; MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Brendan Payne
- Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK; Department of Infection and Tropical Medicine, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Mathias W Pletz
- Institute for Infectious Disease and Infection Control, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Sebastian Weis
- Institute for Infectious Disease and Infection Control, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll Institute, Jena, Germany.
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You TY, Lo CL, Tsai WC, Jan HE, Ko WC, Lee NY. Efficacy of short- versus prolonged-courses of antimicrobial therapy for carbapenem-resistant Klebsiella pneumoniae bloodstream infections: A propensity score-matched cohort study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024:S1684-1182(24)00102-6. [PMID: 38849216 DOI: 10.1016/j.jmii.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/09/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND As limited antibiotic options are available for the treatment of carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSIs), the optimal treatment duration for CRKP BSIs is unclear. Our objective was to investigate whether short courses (6-10 days) are as effective as prolonged courses (≥11 days) of active antibiotic therapy for CRKP BSIs. METHODS A retrospective cohort study comprising adults with monomicrobial CRKP BSI receiving a short or prolonged course of in vitro active therapy at a medical center was conducted between 2010 and 2021. Comparisons of two therapeutic strategies were assessed by the logistic regression model and propensity score analysis. The primary endpoint was 30-day crude mortality. Secondary outcomes included recurrent BSIs, the emergence of multidrug-resistant organisms and candidemia during hospitalization after completing antibiotic therapy for CRKP BSIs. RESULTS Of 263 eligible adults, 160 (60.8%) were male, and the median (interquartile range) age was 69.0 (53.0-76.0) years. Common comorbidities included diabetes (143 patients, 54.4%), malignancy (75, 28.5%), cerebrovascular accident (58, 22.1%), and hemodialysis (49, 18.6%). The 30-day mortality rate was 8.4% (22 patients). Of 84 propensity score well-balanced matched pairs, the 30-day mortality was similar in the short-course and prolonged-course group (6.0% and 7.1%, respectively; P = 1.00). However, there were less episodes candidemia in the short-course group (1.2% versus 13.1%; odds ratio, 0.08; 95% confidence interval, 0.01-0.63; P = 0.005). CONCLUSION Short courses of active therapy for CRKP BSIs demonstrate comparable clinical outcomes to prolonged courses and are associated with a lower risk of subsequent candidemia.
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Affiliation(s)
- Tian-Yu You
- Department of Internal Medicine and Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Lung Lo
- Department of Internal Medicine and Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chia Tsai
- Department of Internal Medicine and Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-En Jan
- Department of Internal Medicine and Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine and Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Nan-Yao Lee
- Department of Internal Medicine and Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Irigoyen-von-Sierakowski Á, Díaz-Navarro M, Visedo A, Pérez-Granda MJ, Martín-Rabadán P, Muñoz P, Guembe M. Clinical Outcome of Patients with Escherichia coli Isolated from Catheter Lumens and/or Peripheral Blood Cultures: A Retrospective Analysis. Pathogens 2024; 13:446. [PMID: 38921744 PMCID: PMC11206651 DOI: 10.3390/pathogens13060446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/16/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Escherichia coli commonly causes catheter-related bloodstream infection (C-RBSI) in specific populations. The differential time to positivity (DTTP) technique is the recommended conservative procedure for diagnosing C-RBSIs. METHODS We conducted a retrospective study of episodes in which E. coli was isolated from catheter lumens obtained using the DTTP technique. Microbiological and clinical data were obtained based on the DTTP technique as either catheter colonization, C-RBSI, or non-C-RBSI. RESULTS A total of 89 catheter blood cultures were included, classified as follows: catheter colonization, 33.7%; C-RBSI, 9.0%; and non-C-RBSI, 57.3%. Only 15.7% of the catheters were withdrawn, with no positive catheter-tip cultures. We found no statistically significant differences in catheter type, antibiotic treatment, or clinical outcome among the groups, except for the frequency of catheter lock therapy or in the frequency of successful treatment. Mortality was associated with C-RBSI in only one patient. CONCLUSION E. coli bacteremia diagnosed by the DTTP technique was classified as non-catheter-related in most patients. As the majority of the catheters were retained, E. coli bacteremia could not be microbiologically confirmed as catheter-related by the catheter-tip culture. Future studies are needed to assess the profitability of the DTTP technique for diagnosing E. coli C-RBSIs.
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Affiliation(s)
- Álvaro Irigoyen-von-Sierakowski
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; (Á.I.-v.-S.); (M.D.-N.); (A.V.); (M.J.P.-G.); (P.M.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
| | - Marta Díaz-Navarro
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; (Á.I.-v.-S.); (M.D.-N.); (A.V.); (M.J.P.-G.); (P.M.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
| | - Andrés Visedo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; (Á.I.-v.-S.); (M.D.-N.); (A.V.); (M.J.P.-G.); (P.M.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
| | - Mª Jesús Pérez-Granda
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; (Á.I.-v.-S.); (M.D.-N.); (A.V.); (M.J.P.-G.); (P.M.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), 28029 Madrid, Spain
| | - Pablo Martín-Rabadán
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; (Á.I.-v.-S.); (M.D.-N.); (A.V.); (M.J.P.-G.); (P.M.-R.)
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), 28029 Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; (Á.I.-v.-S.); (M.D.-N.); (A.V.); (M.J.P.-G.); (P.M.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), 28029 Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain; (Á.I.-v.-S.); (M.D.-N.); (A.V.); (M.J.P.-G.); (P.M.-R.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
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Frau T, El Khatib M, De Dreuille B, Billiauws L, Nuzzo A, Joly F. Emerging drugs for the treatment of short bowel syndrome. Expert Opin Emerg Drugs 2024:1-12. [PMID: 38761162 DOI: 10.1080/14728214.2024.2357567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/16/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION SBS is a rare and disabling condition. The standard management is based on diet optimization with parenteral supplementation. In addition, glucagon-like peptide-2 (GLP-2)analogs, have shown promising results as disease-modifying therapies for SBS. AREAS COVERED Short bowel syndrome (SBS) is defined as a reduction in functional intestinal length to less than 200 cm, leading to intestinal failure (IF) leading to malnutrition and parenteral support dependency. This review discusses the current management of SBS-CIFpatients, the place of GLP-2 analog treatment in terms of efficacy, safety and availability, and the new perspectives opened by the use of enterohormones. EXPERT OPINION Clinical trials and real-world experience demonstrated that Teduglutide reduces dependence on parenteral support and has a place in the management of patients with SBS-CIF. The use of Teduglutide should be discussed in patients stabilized after resection and its introduction requires the advice of an expert center capable of assessing the benefit-risk ratio. The complex, individualized management of SBS-C IF requires theexpertise of a specialized IF center which a multidisciplinary approach. The arrival of new treatments will call for new therapeutic strategies, and the question of how to introduce and monitor them will represent a new therapeutic challenge.
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Affiliation(s)
- Tristan Frau
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
| | - Myriam El Khatib
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
| | - Brune De Dreuille
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, UFR de Médecine Paris Diderot Paris, France
| | - Lore Billiauws
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, UFR de Médecine Paris Diderot Paris, France
| | - Alexandre Nuzzo
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Hôpital Bichat, Laboratory for Vascular Translational Science, Paris, France
| | - Francisca Joly
- Hopital Beaujon - Department of Gastroenterology and Nutrition Support APHP, University Paris VII, Clichy, France
- Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Inserm UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, UFR de Médecine Paris Diderot Paris, France
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Schults JA, Reynolds H, Rickard CM, Culwick MD, Mihala G, Alexandrou E, Ullman AJ. Dressings and securement devices to prevent complications for peripheral arterial catheters. Cochrane Database Syst Rev 2024; 5:CD013023. [PMID: 38780138 PMCID: PMC11112983 DOI: 10.1002/14651858.cd013023.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Peripheral arterial catheters (ACs) are used in anaesthesia and intensive care settings for blood sampling and monitoring. Despite their importance, ACs often fail, requiring reinsertion. Dressings and securement devices maintain AC function and prevent complications such as infection. OBJECTIVES To evaluate the effectiveness of peripheral AC dressing and securement devices to prevent failure and complications in hospitalised people. SEARCH METHODS We searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL Plus up to 16 May 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform up to 16 May 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing different dressing and securement devices for the stabilisation of ACs in hospitalised people. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias using Cochrane's RoB 1 tool. We resolved disagreements by discussion, or by consulting a third review author when necessary. We assessed the certainty of evidence using GRADE. MAIN RESULTS We included five RCTs with 1228 participants and 1228 ACs. All included studies had high risk of bias in one or more domains. We present the following four comparisons, with the remaining comparisons reported in the main review. Standard polyurethane (SPU) plus tissue adhesive (TA) compared with SPU: we are very uncertain whether use of SPU plus TA impacts rates of AC failure (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.20 to 0.98; I² = 0%; 2 studies, 165 participants; very low-certainty evidence). Neither study (165 participants) reported catheter-related bloodstream infections (CRBSI), thus we are very uncertain whether SPU plus TA impacts on the incidence of CRBSI (very low-certainty evidence). It is very uncertain whether use of SPU plus TA impacts AC dislodgement risk (RR 0.54, 95% CI 0.03 to 9.62; I² = 44%; 2 studies, 165 participants; very low-certainty evidence). We are very uncertain whether use of SPU plus TA impacts AC occlusion rates (RR 1.20, 95% CI 0.37 to 3.91; I² = 3%; 2 studies, 165 participants; very low-certainty evidence). We are very uncertain whether use of SPU plus TA impacts rates of adverse events with few reported events across groups (RR 0.89, 95% CI 0.09 to 8.33; I² = 0%; 2 studies, 165 participants; very low-certainty evidence). Bordered polyurethane (BPU) compared to SPU: we are very uncertain whether use of BPU impacts rates of AC failure (RR 0.67, 95% CI 0.21 to 2.13; 1 study, 60 participants; very low-certainty evidence). BPU may make little or no difference to CRBSI compared to SPU (RR 3.05, 95% CI 0.12 to 74.45; I² = not applicable as 1 study (60 participants) reported 0 events; 2 studies, 572 participants; low-certainty evidence). BPU may make little or no difference to the risk of AC dislodgement compared with SPU (RR 0.75, 95% CI 0.17 to 3.22; I² = 0%; 2 studies, 572 participants; low-certainty evidence). BPU may make little or no difference to occlusion risk compared with SPU (RR 0.80, 95% CI 0.60 to 1.07; I² = 0%; 2 studies, 572 participants; low-certainty evidence). It is very uncertain whether BPU impacts on the risk of adverse events compared with SPU (RR 0.33, 95% CI 0.01 to 7.87; 1 study, 60 participants; very low-certainty evidence). SPU plus sutureless securement devices (SSD) compared to SPU: we are very uncertain whether SPU plus SSD impacts risk of AC failure compared with SPU (RR 0.78, 95% CI 0.40 to 1.52; I² = 0%; 2 studies, 157 participants; very low-certainty evidence). We are very uncertain if SPU plus SSD impacts CRBSI incidence rate with no events in both groups (2 studies, 157 participants; very low-certainty evidence). It is very uncertain whether SPU plus SSD impacts risk of dislodgement (RR 0.14, 95% CI 0.01 to 2.57; I² = not applicable as 1 study (96 participants) reported 0 events; 2 studies, 157 participants; very low-certainty evidence). It is very uncertain whether SPU plus SSD impacts risk of AC occlusion (RR 1.94, 95% CI 0.50 to 7.48; I² = 38%; 2 studies, 157 participants; very low-certainty evidence). We are very uncertain whether SPU plus SSD impacts on the risk of adverse events (RR 1.94, 95% CI 0.19 to 20.24; I² = not applicable as 1 study (96 participants) reported 0 events; 2 studies, 157 participants; very low-certainty evidence). Integrated securement dressings compared to SPU: integrated securement dressings may result in little or no difference in risk of AC failure compared with SPU (RR 1.96, 95% CI 0.80 to 4.84; 1 study, 105 participants; low-certainty evidence); may result in little or no difference in CRBSI incidence with no events reported (1 study, 105 participants; low-certainty evidence); may result in little or no difference in the risk of dislodgement (RR 0.33, 95% CI 0.04 to 3.04; 1 study, 105 participants; low-certainty evidence), may result in little or no difference in occlusion rates with no events reported (1 study, 105 participants; low-certainty evidence), and may result in little or no difference in the risk of adverse events (RR 0.35, 95% CI 0.01 to 8.45; 1 study, 105 participants; low-certainty evidence). AUTHORS' CONCLUSIONS There is currently limited rigorous RCT evidence available about the relative clinical effectiveness of AC dressing and securement products. Limitations of current evidence include small sample size, infrequent events, and heterogeneous outcome measurements. We found no clear difference in the incidence of AC failure, CRBSI, or adverse events across AC dressing or securement products including SPU, BPU, SSD, TA, and integrated securement products. The limitations of current evidence means further rigorous RCTs are needed to reduce uncertainty around the use of dressing and securement devices for ACs.
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Affiliation(s)
- Jessica A Schults
- Herston Infectious Diseases Institute, Nursing Midwifery Research Centre, Metro North Health, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Heather Reynolds
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Claire M Rickard
- Herston Infectious Diseases Institute, Nursing Midwifery Research Centre, Metro North Health, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- NHMRC Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Gabor Mihala
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
| | - Evan Alexandrou
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- School of Nursing, University of Wollongong, New South Wales, Australia
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- NHMRC Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Centre of Children's Health Research, South Brisbane, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Australia
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Lu MS, Chen CC, Chang CC, Lin CC, Hsieh CC. Risk Factors for Unplanned Early Implantable Port Catheter Removal in Adult Hematology Cancer Patients Receiving Chemotherapy: A Propensity Score Matching Study. Cancer Manag Res 2024; 16:445-454. [PMID: 38736587 PMCID: PMC11088845 DOI: 10.2147/cmar.s454063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose Implantable port catheter is a reliable vascular access for chemotherapy infusion in cancer patients. However, patients with hematology malignancies usually present with a myriad of blood cell abnormalities that put them at risk of infection and mechanical problems requiring catheter removal. This study aims to determine the risk factors associated with unplanned (catheter removal other than completion of treatment plan) early (within 90 days of catheter implantation) implantable port catheter removal. Patients and Methods A retrospective, propensity score-matched study of 386 patients with hematology malignancies who received implantable venous access ports between January 2015 and December 2022. We conducted a univariate analysis to select the variables for propensity score matching. Patients with unplanned early implantable port catheter removal (early group) were matched 1:1 to patients without unplanned early removal (non-early group). Results Univariate analysis demonstrated a statistically significant difference between early and non-early groups for age (p = 0.048), hemoglobin level (p = 0.028), thrombocytopenia (p = 0.025), and PG-SGA (p < 0.001). Thrombocytopenia was the only independent risk factor with a statistically significant difference in Cox proportional hazard analysis, HR 2.823, 95 CI 1.050-7.589, p = 0.040. The median catheter survival for patients with thrombocytopenia was 61 days (95% CI 28.58-93.42) compared to 150 days (95% CI 9.81-290.19) for patients without thrombocytopenia, p = 0.015. Patient survival is not affected by early catheter removal. The median survival for patients in the early group was 28.28 months (95% CI 27.43-29.15) compared to 32.39 months (95% CI 24.11-40.68), for the non-early group, p = 0.709. Conclusion Hematology malignancy patients with thrombocytopenia are at high risk for unplanned early port catheter removal without survival difference.
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Affiliation(s)
- Ming-Shian Lu
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chen Chen
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medicine, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
| | - Che-Chia Chang
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
| | - Chien-Chao Lin
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
| | - Ching-Chuan Hsieh
- Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Lee Y, Kim JH, Lee JA, Ahn SM, Han M, Ahn JY, Jeong SJ, Choi JY, Yeom JS, Lee SH, Ku NS. Clinical characteristics and risk factors for right-sided infective endocarditis in Korea: a 12-year retrospective cohort study. Sci Rep 2024; 14:10466. [PMID: 38714772 PMCID: PMC11076501 DOI: 10.1038/s41598-024-60638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/25/2024] [Indexed: 05/10/2024] Open
Abstract
Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (LSIE) and exhibits distinct epidemiological, clinical, and microbiological characteristics. Previous studies have focused primarily on RSIE in patients with intravenous drug use. We investigated the characteristics and risk factors for RSIE in an area where intravenous drug use is uncommon. A retrospective cohort study was conducted at a tertiary hospital in South Korea. Patients diagnosed with infective endocarditis between November 2005 and August 2017 were categorized into LSIE and RSIE groups. Of the 406 patients, 365 (89.9%) had LSIE and 41 (10.1%) had RSIE. The mortality rates were 31.7% in the RSIE group and 31.5% in the LSIE group (P = 0.860). Patients with RSIE had a higher prevalence of infection with Staphylococcus aureus (29.3% vs. 13.7%, P = 0.016), coagulase-negative staphylococci (17.1% vs. 6.0%, P = 0.022), and gram-negative bacilli other than HACEK (12.2% vs. 2.2%, P = 0.003). Younger age (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.95-0.99, P = 0.006), implanted cardiac devices (aOR 37.75, 95% CI 11.63-141.64, P ≤ 0.001), and central venous catheterization (aOR 4.25, 95% CI 1.14-15.55, P = 0.029) were independent risk factors for RSIE. Treatment strategies that consider the epidemiologic and microbiologic characteristics of RSIE are warranted.
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Affiliation(s)
- Yongseop Lee
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Jung Ho Kim
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Jung Ah Lee
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Sang Min Ahn
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Min Han
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Jin Young Ahn
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Seung Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea.
| | - Nam Su Ku
- Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea.
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Díaz-Navarro M, Hafian R, Pérez-Granda MJ, Cercenado E, Muñoz P, Guembe M. Addressing catheter lock therapy: Does heparin reduce the bioactivity of dalbavancin when together in solution during freezing? ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00116-3. [PMID: 38705748 DOI: 10.1016/j.eimce.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/06/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION The possible use of dalbavancin as a catheter lock solution was previously demonstrated by our study group. However, it was needed to assess whether heparin could affect dalbavancin bioactivity during freezing storage. METHODS We tested the bioactivity of a dalbavancin+heparin (DH) vs. dalbavancin (D) against Staphylococcal biofilms comparing DH median value of cfu counts and metabolic activity with that obtained for D before and during storage under freezing up to 6 months. RESULTS Despite there was a slight decrease in the median percentage reduction of metabolic activity at month 3 in Staphylococcus epidermidis between DH and D (97.6 vs. 100, p=0.037), considering the clinical criteria, no significant reduction in any of the variables tested was observed at the end of the experiment between D and DH solutions. CONCLUSION The addition of heparin to a dalbavancin lock solution did not affect its bioactivity against staphylococcal biofilms irrespective of its preservation time under freezing.
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Affiliation(s)
- Marta Díaz-Navarro
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Rama Hafian
- Biology Department, School of Biology, Universidad Complutense de Madrid, Spain
| | - María Jesús Pérez-Granda
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Emilia Cercenado
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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Elsheikh R, Makram AM. Multidrug-resistant Organisms: The Silent Plight of Burn Patients. J Burn Care Res 2024:irae075. [PMID: 38695094 DOI: 10.1093/jbcr/irae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Indexed: 07/20/2024]
Abstract
The global increasing spread of multidrug-resistant organisms (MRDOs) is threatening the control of various infections in vulnerable populations and patient groups. One of the most affected groups is burn patients, who are prone to hyperinfection as they suffer from a hypermetabolic state and weakened immune barriers. Those patients also share the infection risk of patients hospitalized for a long time, including ventilator-associated pneumonia and urinary tract infections. While some preventative and therapeutic management styles are still controversial, there are some consensuses that we discuss here. In this review, we aim to present the current knowledge on multidrug-resistance with a special focus on burn patients, discuss various causative organisms and their treatment options, and highlight the importance of antibiotic stewardship and teamwork in responding to an outbreak of MDROs.
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Affiliation(s)
- Randa Elsheikh
- Deanery of Biomedical Sciences at Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
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Fernández-Fernández I, Castro-Sánchez E, Blanco-Mavillard I. Determinants of the optimal selection of vascular access devices: A systematic review underpinned by the COM-B behavioural model. J Adv Nurs 2024. [PMID: 38698552 DOI: 10.1111/jan.16202] [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: 01/08/2024] [Revised: 03/21/2024] [Accepted: 04/06/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Optimal selection of vascular access devices is based on multiple factors and is the first strategy to reduce vascular access device-related complications. This process is dependent on behavioural and human factors. The COM-B (Capability, Opportunity, Motivation, Behaviour) model was used as a theoretical framework to organize the findings of this systematic review. METHODS/AIMS To synthesize the evidence on determinants shaping the optimal selection of vascular access devices, using the COM-B behavioural model as the theoretical framework. DESIGN Systematic review of studies which explore decision-making at the time of selecting vascular access devices. DATA SOURCES The Medline, Web of Science, Scopus and EbscoHost databases were interrogated to extract manuscripts published up to 31 December 2021, in English or Spanish. RESULTS Among 16 studies included in the review, 8/16 (50%) focused on physical capability, 8/16 (50%) psychological capability, 15/16 (94%) physical opportunity, 12/16 (75%) social opportunity, 1/16 (6%) reflective motivation and 0/16 (0%) automatic motivation. This distribution represents a large gap in terms of interpersonal and motivational influences and cultural and social environments. Specialist teams (teams created for the insertion or maintenance of vascular access devices) are core for the optimal selection of vascular access devices (75% physical capability, 62% psychological capability, 80% physical opportunity and 100% social opportunity). CONCLUSION Specialist teams predominantly lead all actions undertaken towards the optimal selection of vascular access devices. These actions primarily centre on assessing opportunity and capability, often overlooking motivational influences and social environments. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE A more implementation-focused professional approach could decrease inequity among patients and complications associated with vascular access devices. IMPACT Optimal selection of vascular access devices is the primary strategy in mitigating complications associated with these devices. There is a significant disparity between interpersonal and motivational influences and the cultural and social environments. Furthermore, specialized teams play a pivotal role in facilitating the optimal selection of vascular access devices. The study can benefit institutions concerned about vascular access devices and their complications. REPORTING METHOD This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Optimal selection of vascular devices remains a growing yet unresolved issue with costly clinical and patient experience impact. Interventions to improve the optimal selection of vascular devices have focused on training, education, algorithms and implementation of specialist vascular teams; alas, these approaches do not seem to have substantially addressed the problem. Specialist vascular teams should evolve and pivot towards leading the implementation of quality improvement interventions, optimizing resource use and enhancing their role.
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Affiliation(s)
| | - Enrique Castro-Sánchez
- Brunel University London, Uxbridge, UK
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK
- Global Health Research Group, University of the Balearic Islands, Palma, Spain
| | - Ian Blanco-Mavillard
- Hospital Regional Universitario de Malaga, Malaga, Spain
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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Demirok A, Illy DHC, Nagelkerke SQ, Lagerweij MF, Benninga MA, Tabbers MM. Catheter salvage or removal in catheter-related bloodstream infections with Staphylococcus aureus in children with chronic intestinal failure receiving home parenteral nutrition and the use of prophylactic taurolidine catheter lock solution: A descriptive cohort study. JPEN J Parenter Enteral Nutr 2024; 48:486-494. [PMID: 38605559 DOI: 10.1002/jpen.2630] [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: 10/27/2023] [Revised: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Children with chronic IF require long-term home parenteral nutrition (HPN), administered through a central venous catheter. Catheter-related bloodstream infection (CRBSI) with Staphylococcus aureus is known to be a serious infection with a high mortality rate and risk of complications. A standardized protocol on the management of S aureus CRBSIs in children receiving HPN is lacking. The aim of this study is to evaluate the effectiveness and safety of the current management in an HPN expertise center in the Netherlands. METHODS We performed a retrospective descriptive cohort study between 2013 and 2022 on children 0-18 years of age with chronic IF requiring long-term HPN. Our primary outcomes were the incidence of S aureus CRBSI per 1000 catheter days, catheter salvage attempt rate, and successful catheter salvage rate. Our secondary outcomes included complications and mortality. RESULTS A total of 74 patients (39 male; 53%) were included, covering 327.8 catheter years. Twenty-eight patients (38%) had a total of 52 S aureus CRBSIs, with an incidence rate of 0.4 per 1000 catheter days. The catheter salvage attempt rate was 44% (23/52). The successful catheter salvage rate was 100%. No relapse occurred, and no removal was needed after catheter salvage. All complications that occurred were already present at admission before the decision to remove the catheter or not. No patients died because of an S aureus CRBSI. CONCLUSION Catheter salvage in S aureus CRBSIs in children receiving HPN can be attempted after careful consideration by a multidisciplinary team in an HPN expertise center.
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Affiliation(s)
- Aysenur Demirok
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
| | - David H C Illy
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
| | - Sietse Q Nagelkerke
- Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel F Lagerweij
- Interventional Radiology, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
| | - Marc A Benninga
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
| | - Merit M Tabbers
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
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49
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Li JY, Li J, Fan YY, Lin XL, Huang CL, Qin HY. Application and effect evaluation of multidisciplinary team management model: On central venous access device associated skin impairment based on Delphi method. J Vasc Access 2024; 25:759-766. [PMID: 35674111 DOI: 10.1177/11297298221075166] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To establish a multidisciplinary management model based on Delphi method to guide nursing practice and reduce the incidence of CVAD-associated Skin Impairment (CASI) in tumor patients. METHODS On the basis of literature review and focus group interview, the initial item pool of CASI management model for cancer patients was determined. The Delphi method was used to conduct two rounds of letter consultation with 36 authoritative and representative experts to determine the content and weight of indicators of CASI multidisciplinary management model for cancer patients. RESULTS Most of the research group were experts with bachelor degree or above. More than 90% of experts have worked for more than 10 years; Areas of expertise include oncology care, venous therapy, wound stomatology, and dermatology. The recovery rate of the two rounds of expert correspondence questionnaire was 100%. The authority coefficient of experts was 0.898, indicating a good degree of authority. Kendall's harmony coefficients were 0.193 and 0.250, with statistically significant differences (p < 0.001). After two rounds of expert letter consultation, a multidisciplinary management model of CASI for cancer patients was initially formed, which included 15 first-level prevention indexes and 38 second-level prevention indexes of CASI for cancer patients. There were 9 first-level indexes and 16 second-level indexes of CASI treatment in tumor patients. CONCLUSION Cancer patients based on Delphi method to construct CASI multidisciplinary management model has high reliability and scientificity, multidisciplinary management model in the management of patients with tumor CASI exploration will provide new methods for central venous catheter nursing and the new way of thinking, will also be intravenous fluids will provide a scientific basis for professional development and quality improvement and practical experience.
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Affiliation(s)
- Ji-Yue Li
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jia Li
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yu-Ying Fan
- Nasopharyngeal Department, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xi-Ling Lin
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Chun-Li Huang
- Department of Catheter Clinic, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Hui-Ying Qin
- Nursing Department, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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Austin PD, Green SM, Gaisford S. Bacterial isolates from positive paired venous catheter and peripheral blood cultures taken during parenteral nutrition were the same species but different strains: A case report. Nutrition 2024; 121:112353. [PMID: 38402669 DOI: 10.1016/j.nut.2024.112353] [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: 07/31/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The same microbial species isolated from blood simultaneously drawn from a central venous catheter hub and a peripheral vein (paired blood cultures) during parenteral nutrition may be assumed to represent the same strain. This case report provides an example of this assumption being incorrect along with a comparator example of it being correct. This has implications for interpretation of differential time to positivity and differential quantitative blood cultures during investigation of suspected intraluminal intravascular catheter or cannula bloodstream infection. CASE DESCRIPTION Two patients ages ≥18 y prescribed parenteral nutrition each had positive paired blood cultures that had been taken for suspected catheter bloodstream infection because of temperature spikes ≥38°C. The paired Staphylococcus epidermidis isolates from the first patient and the paired Enterococcus faecium isolates from the second patient were each tested beyond routine clinical care to establish if they could be different strains. The central and peripheral isolates of Staphylococcus epidermidis from the first patient were different strains based on hospital-reported antibiograms, genomic DNA profiles, thermograms, and weaker growth and different sizes of colonies of the central strain compared with the peripheral strain. There were no such differences for the isolates of Enterococcus faecium from the second patient. RESULTS The central and peripheral isolates of Staphylococcus epidermidis from the first patient were different strains based on hospital-reported antibiograms, genomic DNA profiles, thermograms, and weaker growth and different sizes of colonies of the central strain compared with the peripheral strain. There were no such differences for the isolates of Enterococcus faecium from the second patient. CONCLUSION This case report indicates consideration should be given to reporting whether bacteria have been identified at either species or strain level if differential time to positivity or differential quantitative blood cultures are used to define catheter or cannula bloodstream infection.
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Affiliation(s)
- Peter D Austin
- UCL School of Pharmacy, University College London, London, UK; Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Steve M Green
- Department of Microbiology and Virology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Simon Gaisford
- UCL School of Pharmacy, University College London, London, UK
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