The Effect of Brief Exposure to Sub-Therapeutic Concentrations of Chlorhexidine Digluconate on the Susceptibility of Staphylococci to Platelet Microbicidal Protein

Clinical experience with a chlorhexidine-coated PICC: A prospective, multicenter, observational study

INTRODUCTION

This study evaluated a chlorhexidine-coated peripherally inserted central catheter (PICC) and the incidence of associated complications within both inpatient and outpatient populations.

METHODS

This IRB-approved, multicenter, prospective observational study was performed at three large teaching hospitals in the US. All adults who required a PICC for ⩾14 days were considered. Patients were monitored throughout entire catheter dwell. Duplex venous ultrasounds were performed before insertion, after 10 to 14 days of dwell time, and upon removal. Data was collected from the hospital, outpatient clinic, and patient PICC diary records.

RESULTS

A total of 103 patients, 56% male, with mean BMI 29 ± 8.8, were enrolled. The majority (79%) of patients were from high-risk groups-cancer, infectious diseases, transplant, and trauma. Primary treatment indications were antibiotics (66.99%) and chemotherapy (25.24%). Double lumen PICCs (59.2%) were favored clinically, as was basilic vein placement (71.84%). Mean catheter dwell was 47.01 ± 25.82 days. Three (3, 2.9%) central line-associated bloodstream infections (CLABSI) were reported. Four patients (4.6%) reported symptomatic catheter-related thrombosis (CRT), confirmed with ultrasound. Three patients (3.4%) had ultrasound-confirmed fibroblastic sleeve (FS). Eight patients (9.2%) who entered the study with pre-existing superficial thrombosis, had complete resolution at the time of catheter removal. The incidence of CLABSI was 0.82/1000 days. The combined CRT and FS rate was 6.9%.

CONCLUSION

Based upon the observational findings of this study, chlorhexidine-coated PICC technology may be considered for use in patient populations who are at moderate to high-risk for catheter-related complications in both inpatient and outpatient settings.

Assessment of Microbiological Content of Private and Public Recreational Water Facilities and Their Antimicrobial Susceptibility Pattern in Al-Ahsa

BACKGROUND

Water recreational facilities like swimming pools attract people of all ages. However, these facilities are very suitable for the transmission of various microbial diseases and have been shown to pose public health concerns.

AIMS

This study assesses the presence of different Gram-negative bacteria pathogens and their antimicrobial susceptibility pattern in both private and public pools in Al-Ahsa.

METHODS

11 private and 3 public recreational water facilities were sampled for the study. Collected water samples were inoculated into nutrient broth and incubated aerobically for 24 hours. The overnight growth was plated out on blood and MacConkey agars. Pure cultures of the bacteria samples were used for identification and antimicrobial susceptibility test using the Vitek 2 compactautomated system (BioMerieux, Marcy L'Etoile, France). Minimum inhibitory concentration was also provided by the Vitek 2 compact automated system.

RESULTS

13 different Gram-negative bacteria species isolates were encountered in both pool types sampled. More of potential pathogens were isolated from the private than the public pools, of which Klebsiella pneumoniae and Pseudomonas aeruginosa constituted 50% and 43%, respectively, of all the isolates. Findings also revealed a varied minimum inhibitory concentrations (MICs) indicating that the isolates were of different strains. Antibiotic susceptibility pattern also showed variability among the isolates.

CONCLUSIONS

This study has revealed a potential health risk associated with the use of water recreational facilities. The presence of K pneumoniae and P aeruginosa suggests a public health concern and should be looked into.

A novel method to detect bacterial resistance to disinfectants

In clinical practice, the important hygienic prevention of bacterial pathogen spread is disinfection of potentially contaminated area. Benzalkonium bromide and chlorhexidine acetate are commonly used disinfectants with a broad spectrum of anti-microbial effect. It is vital to inhibit the spread of pathogen in hospital. However, a large number of pathogens with the decreased antiseptic susceptibility have been isolated from clinical samples which showed an increased minimal inhibitory concentration (MIC) against those antiseptics. These resistant pathogens are the major causes for nosocomial cross-infections in hospital. The present study demonstrated the utility of Oxford plate assay system in determining the potential disinfectant resistance of bacteria. The microbiological assay is based on the inhibitory effect of tested disinfectants upon the strains of Staphylococcus aureus and Escherichia coli. Statistical analysis of the bioassay results indicated the linear correlation (r = 0.87–0.99, P < 0.01) between the diameter of growth inhibition zone and the log dosage of the tested disinfectants. Moreover, comparison of inhibitory efficacy of benzalkonium bromide upon 29 S. aureus strains isolated from clinical samples by both Oxford plate method and broth dilution method showed that the diameter of growth inhibition zone has significantly negative correlation with the minimal inhibitory concentration (MIC) (r = −0.574, P < 0.001). These results suggest that the Oxford plate is a simple and time-saving method in detecting potential clinical disinfectant resistance and its usefulness for routine surveillance of pathogenic resistance to disinfectants warrants further investigation.