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MacPhail A, Nguyen A, Camus V, Chraïti MN, Dalex E, Chalandon Y, Catho G, Bosetti D, Masouridi-Levrat S, Harbarth S, Zanella MC, Buetti N. Impact of intermittent versus continuous infusions on central line-associated bloodstream infection risk in haemato-oncology patients: a quasi-experimental study. J Hosp Infect 2024:S0195-6701(24)00220-2. [PMID: 38945400 DOI: 10.1016/j.jhin.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/20/2024] [Accepted: 05/29/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Continuous fluid infusions delivered between therapies by piggy-back systems avoid disconnection and reconnection of central venous catheters (CVC), thereby reducing opportunities for line contamination. However, the impact of continuous versus intermittent infusions on central line-associated bloodstream infections (CLABSI) is unknown. AIM To investigate the effect of temporary infusion interruption and line disconnection, with or without use of a 70% isopropyl alcohol cap (IPA-C) use on CLABSI rates in haematology patients. METHODS Quasi-experimental study in two haemato-oncology units. At baseline (P1, September 2020 - August 2021), continuous intravenous piggy-back infusions were mandatory. In a first intervention phase (P2, September 2021 - August 2022), infusion disconnections were implemented with use of a 70% isopropyl alcohol cap (IPA-C) for passive decontamination. In a second intervention phase (P3, September 2022 - August 2023), infusion disconnections continued without the use of IPA-C. Rates of CLABSI were compared across the three intervention periods using segmented Poisson regression. FINDINGS A total of 11,039 catheter-days across 764 CVC and 16,226 patient-days were included. 21 CLABSI were recorded across all intervention periods. Compared with P1, incidence rate ratios (IRRs) for CLABSI did not significantly change in P2 (IRR 0.76 [95% CI 0.27-2.15]) and P3 (IRR 0.79 [CI 95% 0.28-2.22]). No CVCs were removed due to occlusion during the study period. Five of 21 CLABSI were polymicrobial, and coagulase-negative staphylococci were isolated in 19/21 cases (90%). CONCLUSION Interruption of continuous infusions in haemato-oncology patients with a CVC was not associated with a substantial change in CLABSI rates, whether or not an IPA-C was used.
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Affiliation(s)
- Aleece MacPhail
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland; Department of Infectious Diseases, Monash Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Aude Nguyen
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Véronique Camus
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Marie-Noëlle Chraïti
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Eliane Dalex
- Care Directorate, Geneva University Hospitals, Geneva, Switzerland
| | - Yves Chalandon
- Division of Haematology, Department of Oncology, Geneva University Hospitals, and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gaud Catho
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Davide Bosetti
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Stavroula Masouridi-Levrat
- Division of Haematology, Department of Oncology, Geneva University Hospitals, and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Marie-Céline Zanella
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland; Infection Antimicrobials Modeling Evolution (IAME) U 1137, INSERM, Université Paris-Cité, Paris, France.
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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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Dhaliwal M, Daneman N. Utility of Differential Time to Positivity in Diagnosing Central Line-Associated Bloodstream Infections: A Systematic Review and Meta-Analysis. Clin Infect Dis 2023; 77:428-437. [PMID: 37062596 DOI: 10.1093/cid/ciad225] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Differential time to positivity (DTP), defined as pathogen growth at least 2 hours earlier from catheter versus paired peripheral blood cultures, is sometimes used to diagnose central line-associated bloodstream infections (CLABSIs). Previous studies assessing DTP, however, have been small, provided conflicting results, and did not assess heterogeneity across important subgroups. METHODS We systematically reviewed the diagnostic characteristics of DTP for CLABSI using MEDLINE, Embase, WoS, CINAHL, LILACS, AMED, and the Cochrane database. Studies were included if they reported sensitivities, specificities, predictive values, likelihood ratios, or 2 × 2 tables of DTP for diagnosing CLABSI. Extracted data were analyzed by using forest plots, bivariate model meta-analysis, and QUADAS-2 quality assessment. RESULTS We identified 274 records, of which 23 met the criteria for meta-analysis. Among 2526 suspected CLABSIs, DTP demonstrated a summary sensitivity of 81.3% (95% confidence interval [CI]: 72.8%-87.7%), specificity of 91.8% (95% CI: 84.5%-95.8%), positive likelihood ratio of 9.89 (95% CI: 5.14-19.00), and negative likelihood ratio of 0.20 (95% CI: .14-.30). Covariate analysis based on catheter duration, study design, and patient immune status demonstrated no significant differences. However, DTP performed worse for Staphylococcus aureus (low sensitivity but high specificity) and Candida (high sensitivity but low specificity) compared to other organisms. CONCLUSIONS DTP performs well in ruling CLABSIs in or out. Obtaining paired catheter and peripheral blood cultures for DTP when the infectious source is unclear may prevent unnecessary line removal and diagnostic tests. However, this must be balanced against higher contamination rates from catheter cultures.
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Affiliation(s)
- Manreet Dhaliwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nick Daneman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Usefulness of differential time to positivity between catheter and peripheral blood cultures for diagnosing catheter-related bloodstream infection: Data analysis from routine clinical practice in the intensive care unit. J Crit Care 2023; 75:154259. [PMID: 36706553 DOI: 10.1016/j.jcrc.2023.154259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE To assess the accuracy of differential time to positivity (DTP) method for the diagnosis of catheter-related bloodstream infections (CRBSI) in the routine practice of our intensive care unit (ICU). MATERIALS AND METHODS Over a five-year study period, ICU patients with a central venous catheter in place for ≥48 h and undergoing DTP test with catheter tip culture were analyzed. We investigated: the accuracy of DTP test with the usual threshold of 120 min in confirming the clinical suspicion of CRBSI; the most accurate threshold value of DTP to detect CRBSI; the diagnostic accuracy of the ratio (rather than the difference) between times to positivity. RESULTS Among 278 episodes of paired blood cultures, 13% were CRBSIs. DTP value ≥120 min used for the diagnosis of CRBSI yielded 41% sensitivity and 74% specificity. Performance of DTP values in predicting CRBSI was low (AUC = 0.60 [95%CI: 0.48-0.72]). Cutoff value of the ratio between times to positivity was 0.80, with 46% sensitivity and 79% specificity. CONCLUSIONS The routine use of the DTP method at any cutoff point has inadequate accuracy in detecting CRBSI in the real every day clinical practice. Not even the ratio between times to positivity seems to be clinically useful.
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Parapiboon W, Sangsuk J, Nopsopon T, Pitsawong W, Tatiyanupanwong S, Kanjanabuch T, Johnson DW. Randomized Study of Urgent-Start Peritoneal Dialysis Versus Urgent-Start Temporary Hemodialysis in Patients Transitioning to Kidney Failure. Kidney Int Rep 2022; 7:1866-1877. [PMID: 35967116 PMCID: PMC9366533 DOI: 10.1016/j.ekir.2022.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 10/27/2022] Open
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Austin P, Hand K, Macnaughtan J, Saeed K, Harding S, Smith C, Elia M. An evidence-based surveillance tool to identify and report catheter/cannula bloodstream infection in patients receiving parenteral nutrition. Nutrition 2022; 98:111639. [DOI: 10.1016/j.nut.2022.111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/10/2022] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
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Risk Factors for Infections, Antibiotic Therapy, and Its Impact on Cancer Therapy Outcomes for Patients with Solid Tumors. Life (Basel) 2021; 11:life11121387. [PMID: 34947918 PMCID: PMC8705721 DOI: 10.3390/life11121387] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
Infections represent a significant cause of morbidity and mortality in cancer patients. Multiple factors related to the patient, tumor, and cancer therapy can affect the risk of infection in patients with solid tumors. A thorough understanding of such factors can aid in the identification of patients with substantial risk of infection, allowing medical practitioners to tailor therapy and apply prophylactic measures to avoid serious complications. The use of novel treatment modalities, including targeted therapy and immunotherapy, brings diagnostic and therapeutic challenges into the management of infections in cancer patients. A growing body of evidence suggests that antibiotic therapy can modulate both toxicity and antitumor response induced by chemotherapy, radiotherapy, and especially immunotherapy. This article provides a comprehensive review of potential risk factors for infections and therapeutic approaches for the most prevalent infections in patients with solid tumors, and discusses the potential effect of antibiotic therapy on toxicity and efficacy of cancer therapy.
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Cruz-Aguilar R, Carney J, Mondaini V, Vehreschild MJ, Griskaitis M, Salmanton-García J, Böll B, Kochanek M, Seifert H, Biehl LM, Farowski F. A quality improvement study on the reduction of central venous catheter-associated bloodstream infections by use of self-disinfecting venous access caps (STERILE). Am J Infect Control 2021; 49:586-592. [PMID: 32966854 DOI: 10.1016/j.ajic.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Contamination of the catheter hub is an important source of central line-associated bloodstream infections (CLABSI); catheter hub caps incorporating a 70% isopropyl alcohol aim are designed to reduce contamination and hence CLABSI rates. Supporting data in high-risk hematological and oncological patients on the clinical effectiveness of this approach are sparse. METHODS We conducted a before-after single center study accompanying the introduction of such caps at our department. Retrospective data from the year prior to the introduction were compared to 1 year of prospective data. RESULTS The control and antiseptic barrier cap (ABC) groups consisted of 309 and 289 patients presenting a CLABSI rate of 15.28 and 10.38 per 1,000 catheter days (P= .042), respectively. However, after multivariate analysis, ABCs were not identified as a statistically significant independent protective factor for the occurrence of CLABSI (hazard ratio 0.69, P= .120). There was no significant difference between the groups with respect to time to CLABSI (P= .681), nor the proportion of catheters removed due to suspicion of infection (P= .076). CONCLUSIONS The introduction of ABCs in this high-risk population did not significantly alter CLABSI rates.
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Lei Y, Xu Y, Jing P, Xiang B, Che K, Shen J, Ning M, Chen Y, Huang Y. The effects of TGF-β1 on staphylococcus epidermidis biofilm formation in a tree shrew biomaterial-centered infection model. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:57. [PMID: 33553350 PMCID: PMC7859740 DOI: 10.21037/atm-20-4526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transforming growth factor-β1 (TGF-β1) has a wide range of biological functions. It antagonizes lymphocyte response, inhibits pro-inflammatory cytokines, and serves as a signal to turn off the immune response and inflammatory response. To study the correlation between TGF-β1 and T helper (Th)1/Th2 cytokine levels in tree shrews, and to explore the effects of different levels of TGF-β1 on central venous catheter (CVC)-centered Staphylococcus epidermidis biofilm formation in tree shrews. Methods Tree shrews were injected with different concentrations of TGF-β1, and venous blood was drawn after 48 h to measure the levels of Th1 and Th2 cytokines. A CVC was placed into the femoral vein, and TGF-β1 at different concentrations and PIA− (ATCC12228) and PIA+ (ATCC35984) standard strains of Staphylococcus epidermidis were injected into the tree shrews to establish a biomaterial-centered infection (BCI) model. After 72 h, the CVC was removed, and biofilm formation was detected using the API bacterial identification system, semi-quantitative biofilm formation assay, and scanning electron microscopy. Results In the groups treated with TGF-β1 at different concentrations, the levels of Th1 cytokines interleukin-2 (IL-2), tumor necrosis factor (TNF), and interferon-γ (IFN-γ) were lower than those of normal group, while the levels of Th2 cytokines IL-6, IL-4 and IL-10 were higher than those of normal group. In the TGF-β1 groups at different concentrations, the positive rate of Staphylococcus epidermidis ATCC35984 biofilm formation was higher than that in non-TGF-β1 group, while there was no significant difference in the positive rate of Staphylococcus epidermidis ATCC12228 biofilm formation compared with that of the non-TGF-β1 group. Conclusions TGF-β1 causes the imbalance of Th1/Th2 cytokines and Th1/Th2 shift in tree shrews, leading to Th1 cell-led decline in cellular immune function. TGF-β1 promotes PIA+ Staphylococcus epidermidis biofilm formation in the tree shrew BCI model, but it has no significant influence on PIA-Staphylococcus epidermidis biofilm formation on the surface of CVCs.
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Affiliation(s)
- Yujie Lei
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Yunnan Cancer Center, The International Cooperation Key Laboratory of Regional Tumor in High Altitude Area, Kunming, China
| | - Yushan Xu
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Peng Jing
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Bingquan Xiang
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Yunnan Cancer Center, The International Cooperation Key Laboratory of Regional Tumor in High Altitude Area, Kunming, China
| | - Keda Che
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Yunnan Cancer Center, The International Cooperation Key Laboratory of Regional Tumor in High Altitude Area, Kunming, China
| | - Junting Shen
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Yunnan Cancer Center, The International Cooperation Key Laboratory of Regional Tumor in High Altitude Area, Kunming, China
| | - Minjie Ning
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Yunnan Cancer Center, The International Cooperation Key Laboratory of Regional Tumor in High Altitude Area, Kunming, China
| | - Ying Chen
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Yunnan Cancer Center, The International Cooperation Key Laboratory of Regional Tumor in High Altitude Area, Kunming, China
| | - Yunchao Huang
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Yunnan Cancer Center, The International Cooperation Key Laboratory of Regional Tumor in High Altitude Area, Kunming, China
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Böll B, Schalk E, Buchheidt D, Hasenkamp J, Kiehl M, Kiderlen TR, Kochanek M, Koldehoff M, Kostrewa P, Claßen AY, Mellinghoff SC, Metzner B, Penack O, Ruhnke M, Vehreschild MJGT, Weissinger F, Wolf HH, Karthaus M, Hentrich M. Central venous catheter-related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2021; 100:239-259. [PMID: 32997191 PMCID: PMC7782365 DOI: 10.1007/s00277-020-04286-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022]
Abstract
Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter-related infections (CRIs). Moreover, CRIs prolong hospitalization, cause an excess in resource utilization and treatment cost, often delay anti-cancer treatment, and are associated with a significant increase in mortality in cancer patients. We therefore summoned a panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and updated our previous guideline on CRIs in cancer patients. After conducting systematic literature searches on PubMed, Medline, and Cochrane databases, video- and meeting-based consensus discussions were held. In the presented guideline, we summarize recommendations on definition, diagnosis, management, and prevention of CRIs in cancer patients including the grading of strength of recommendations and the respective levels of evidence. This guideline supports clinicians and researchers alike in the evidence-based decision-making in the management of CRIs in cancer patients.
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Affiliation(s)
- Boris Böll
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Enrico Schalk
- Department of Hematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Center, Magdeburg, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Justin Hasenkamp
- Clinic for Hematology and Oncology, University Medicine Göttingen, Georg-August-University, Göttingen, Germany
| | - Michael Kiehl
- Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany
| | - Til Ramon Kiderlen
- Department of Hematology, Oncology and Palliative Care, Vivantes Clinic Neukoelln, Berlin, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philippe Kostrewa
- Department of Hematology and Oncology, Campus Fulda, Philipps-University Marburg, Fulda, Germany
| | - Annika Y Claßen
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Sibylle C Mellinghoff
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Bernd Metzner
- Department of Hematology and Oncology, University Hospital Oldenburg, Oldenburg, Germany
| | - Olaf Penack
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ruhnke
- Department of Hematology and Oncology, Helios Klinikum Aue, Aue, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Weissinger
- Department of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Hans-Heinrich Wolf
- Department III of Internal Medicine, Hematology, Oncology and Hemostaseology, Südharzklinikum, Nordhausen, Germany
| | - Meinolf Karthaus
- Department of Hematology, Oncology & Palliative Care, Klinikum Neuperlach, Munich, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany
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Christopeit M, Schmidt-Hieber M, Sprute R, Buchheidt D, Hentrich M, Karthaus M, Penack O, Ruhnke M, Weissinger F, Cornely OA, Maschmeyer G. Prophylaxis, diagnosis and therapy of infections in patients undergoing high-dose chemotherapy and autologous haematopoietic stem cell transplantation. 2020 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2020; 100:321-336. [PMID: 33079221 PMCID: PMC7572248 DOI: 10.1007/s00277-020-04297-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/03/2020] [Indexed: 12/14/2022]
Abstract
To ensure the safety of high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT), evidence-based recommendations on infectious complications after HDC/ASCT are given. This guideline not only focuses on patients with haematological malignancies but also addresses the specifics of HDC/ASCT patients with solid tumours or autoimmune disorders. In addition to HBV and HCV, HEV screening is nowadays mandatory prior to ASCT. For patients with HBs antigen and/or anti-HBc antibody positivity, HBV nucleic acid testing is strongly recommended for 6 months after HDC/ASCT or for the duration of a respective maintenance therapy. Prevention of VZV reactivation by vaccination is strongly recommended. Cotrimoxazole for the prevention of Pneumocystis jirovecii is supported. Invasive fungal diseases are less frequent after HDC/ASCT, therefore, primary systemic antifungal prophylaxis is not recommended. Data do not support a benefit of protective room ventilation e.g. HEPA filtration. Thus, AGIHO only supports this technique with marginal strength. Fluoroquinolone prophylaxis is recommended to prevent bacterial infections, although a survival advantage has not been demonstrated.
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Affiliation(s)
- Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Center Eppendorf, Hamburg, Germany.
| | - Martin Schmidt-Hieber
- Department of Hematology and Oncology, Carl-Thiem-Klinikum, Cottbus, Cottbus, Germany
| | - Rosanne Sprute
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
- Partner Site Bonn-Cologne, German Centre for Infection Research, Cologne, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Marcus Hentrich
- Department of Medicine III-Hematology/Oncology, Red Cross Hospital, Munich, Germany
| | - Meinolf Karthaus
- Department of Internal Medicine, Hematology and Oncology, Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany
| | - Olaf Penack
- Department of Internal Medicine, Division of Hematology and Oncology, Charité Universitätsmedizin Berlin, Campus Rudolf Virchow, Berlin, Germany
| | - Markus Ruhnke
- Department of Hematology, Oncology and Palliative Medicine, Helios Hospital Aue, Aue, Germany
| | - Florian Weissinger
- Department of Internal Medicine, Hematology, Oncology, Stem Cell Transplantation and Palliative Medicine, Protestant Hospital of Bethel Foundation, Bielefeld, Germany
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
- Partner Site Bonn-Cologne, German Centre for Infection Research, Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Georg Maschmeyer
- Klinikum Ernst von Bergmann, Department of Hematology, Oncology and Palliative Care, Potsdam, Germany
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Time to Positivity as a Prognostic Tool in the Performance of Short-Term Subculture for MALDI-TOF MS-Based Identification of Microorganisms from Positive Blood Cultures in Pediatric Patients. Curr Microbiol 2020; 77:953-958. [DOI: 10.1007/s00284-020-01900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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de la Cruz-Hernández I, Cornejo-Juárez P, Tellez-Miranda O, Barrera-Pérez L, Sandoval-Hernández S, Vilar-Compte D, Velázquez-Acosta C, Volkow P. Microbiology and prevalence of E 2SKAPE-resistant strains in catheter-related bloodstream infections in patients with cancer. Am J Infect Control 2020; 48:40-45. [PMID: 31395288 DOI: 10.1016/j.ajic.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Central venous catheters (CVCs) are essential for treating cancer patients, but infection is a risk associated with their use, particularly by multidrug-resistant (MDR) bacteria. The aim of this study was to describe the microbiology of catheter-related bloodstream infections (CRBSIs) in cancer patients and to compare the prevalence of MDR ESKAPE microorganisms (Enterococcus faecium, Staphylococcus spp, Klebsiella spp, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp) plus Escherichia coli (E2SKAPE). METHODS Based on data from 2013 to 2015 from a prospective survey of CRBSIs by the intravenous therapy team, we describe the microbiology and compare the prevalence of MDR E2SKAPE strains between hospitalized patients and outpatients. RESULTS A total of 469 episodes of CRBSI were diagnosed: 261 (62%) were in women; 87 (18.6%) occurred in hospitalized patients, and 382 (81.4%) in ambulatory patients; 27.5% of patients had a hematologic malignancy and 72.5% a solid tumor. The median time between CVC insertion and CRBSI was 116 days (interquartile range [IQR], 48-207). The most common bacteria isolated were Staphylococcus epidermidis (18.1%), S aureus (10.9%), E coli (7.7%), and Klebsiella spp (8.6%). E2SKAPE accounted for 35.6%. Methicillin-resistant Staphylococcus aureus (MRSA) (odds ratio [OR], 16.4; 95% confidence interval [CI], 1.6-114; P = .01), extended-spectrum beta-lactamase (ESBL) Klebsiella spp (OR, 26; 95% CI, 2-286; P = .007), and ESBL E coli (OR, 26; 95% CI, 2-286; P = .007) were significantly more frequently isolated from hospitalized vs ambulatory patients. CONCLUSIONS MRSA, ESBL E. coli and ESBL Klebsiella spp were significantly more frequently isolated from hospitalized patients with CRBSI.
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Affiliation(s)
| | | | | | - Laura Barrera-Pérez
- Intravenous Therapy Team, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Diana Vilar-Compte
- Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Patricia Volkow
- Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico.
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Orihuela-Martín J, Rodríguez-Núñez O, Morata L, Cardozo C, Puerta-Alcalde P, Hernández-Meneses M, Ambrosioni J, Linares L, Bodro M, de Los Angeles Guerrero-León M, Del Río A, Garcia-Vidal C, Almela M, Pitart C, Marco F, Soriano A, Martínez JA. Performance of differential time to positivity as a routine diagnostic test for catheter-related bloodstream infections: a single-centre experience. Clin Microbiol Infect 2019; 26:383.e1-383.e7. [PMID: 31288101 DOI: 10.1016/j.cmi.2019.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/05/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the performance of differential time to positivity (DTP) for the diagnosis of catheter-related bloodstream infections (CRBSI). METHODS From all episodes of bloodstream infections (BSI) diagnosed during a 15-year period (2003-17) those in which a paired set of blood cultures drawn from a catheter and a peripheral vein were positive for the same microorganism and had a clinically and/or microbiologically defined source were selected. To assess diagnostic discrimination ability and accuracy of DTP for CRBSI, area under the receiver operating characteristic curves (AUC) and performance characteristics of a DTP ≥2 h were computed. RESULTS A total of 512 BSI were included, of which 302 (59%) were CRBSI. Discrimination ability of DTP was low for Staphylococcus aureus (AUC 0.656 ± 0.06), coagulase-negative staphylococci (AUC 0.618 ± 0.081), enterococci (AUC 0.554 ± 0.117) and non-AmpC-producing Enterobacteriaceae (AUC 0.653 ± 0.053); moderate for Pseudomonas aeruginosa (AUC 0.841 ± 0.073), and high for AmpC-producing Enterobacteriaceae (AUC 0.944 ± 0.039). For the entire sample, DTP had a low-to-moderate discrimination ability (AUC 0.698 ± 0.024). A DTP ≥2 h has a low sensitivity for coagulase-negative staphylococci (60%) and very low for S. aureus (34%), enterococci (40%) and non-AmpC-producing Enterobacteriaceae (42%). A DTP cut-off of 1 h improved sensitivity (90%) for AmpC-producing Enterobacteriaceae. CONCLUSIONS Differential time to positivity performs well for diagnosing CRBSI only when AmpC-producing Enterobacteriaceae and P. aeruginosa are involved. Performance is low for common Gram-positive organisms and non-AmpC-producing enteric bacilli; a negative test should not be used to rule out CRBSI due to these microorganisms. A DTP ≥1 h may improve accuracy for AmpC-producing Enterobacteriaceae, particularly Enterobacter spp.
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Affiliation(s)
- J Orihuela-Martín
- Service of Internal Medicine, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - O Rodríguez-Núñez
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - L Morata
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - C Cardozo
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - P Puerta-Alcalde
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Hernández-Meneses
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J Ambrosioni
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - L Linares
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Bodro
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M de Los Angeles Guerrero-León
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A Del Río
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - C Garcia-Vidal
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Almela
- Service of Microbiology, ISGlobal, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - C Pitart
- Service of Microbiology, ISGlobal, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - F Marco
- Service of Microbiology, ISGlobal, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - A Soriano
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J A Martínez
- Service of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Volkow P, Alatorre P, Lozano VH, Cornejo-Juarez P. Mucosal Barrier Injury Laboratory Confirmed Bloodstream Infections. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018. [DOI: 10.1007/s40506-018-0167-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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One percent chlorhexidine-alcohol for preventing central venous catheter-related infection during intensive chemotherapy for patients with haematologic malignancies. J Infect Chemother 2018; 24:544-548. [PMID: 29627326 DOI: 10.1016/j.jiac.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/03/2018] [Accepted: 03/02/2018] [Indexed: 11/21/2022]
Abstract
A central venous catheter (CVC) is a catheter placed into a large vein, and is used for chemotherapy administration. However, there is little confirmatory data on which antiseptic-such as chlorhexidine or povidone-iodine (PI) -is more protective against CVC-related infectious complications in patients receiving intensive chemotherapy. We aimed to compare the effectiveness of 1% chlorhexidine gluconate in 70% alcohol (CH) vs. PI for skin disinfection before CVC insertion in patients receiving intensive chemotherapy. Methods We used either CH or 10% PI as skin antiseptics before CVC insertion, and assessed which agent was more protective against CVC-related infection. The participants were 112 patients with haematologic malignancies who underwent chemotherapy; a total of 292 CVCs were inserted over this period. Blood cultures were obtained when febrile neutropenia occurred. The CVC was removed and the catheter-tip qualitatively cultured when catheter-related infection was suspected. The cumulative incidence of febrile neutropenia, microbial growth from blood or catheter-tip culture, and catheter-related blood stream infection (CRBSI) was evaluated retrospectively. A univariate Cox proportional hazards model showed that CH significantly alleviated infectious complications. Notably, no case of CRBSI occurred in the CH group. Multivariate analysis, adjusted for prolonged neutropenia (>15 days) and older age (>52 years), also showed significant reduction in the cumulative incidence of microbial growth from catheter-tips in the CH group (hazard ratio = 0.146, 95% confidence interval: 0.023-0.502, p = 0.0008). Disinfection using CH, compared with PI, can potentially decrease catheter-related infection without causing adverse skin reactions in patients with haematologic malignancies.
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Bouzidi H, Emirian A, Marty A, Chachaty E, Laplanche A, Gachot B, Blot F. Differential time to positivity of central and peripheral blood cultures is inaccurate for the diagnosis of Staphylococcus aureus long-term catheter-related sepsis. J Hosp Infect 2018; 99:192-199. [PMID: 29432818 DOI: 10.1016/j.jhin.2018.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/11/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Differential time to positivity of cultures of blood drawn simultaneously from central venous catheter and peripheral sites is widely used to diagnose catheter-related bloodstream infections without removing the catheter. However, the accuracy of this technique for some pathogens, such as Staphylococcus aureus, is debated in routine practice. METHODS In a 320-bed reference cancer centre, the charts of patients with at least one blood culture positive for S. aureus among paired blood cultures drawn over a six-year period were studied retrospectively. Microbiological data were extracted from the prospectively compiled database of the microbiology unit. Data concerning the 149 patients included were reviewed retrospectively by independent physicians blinded to the absolute and differential times to positivity, in order to establish or refute the diagnosis of catheter-related sepsis. Due to missing data, 48 charts were excluded, so 101 cases were actually analysed. The diagnosis was established in 62 cases, refuted in 15 cases and inconclusive in the remaining 24 cases. RESULTS For the 64 patients with both central and peripheral positive blood cultures, the differential positivity time was significantly greater for patients with catheter-related bloodstream infections due to S. aureus (P<0.02). However, because of the high number of false-negative cases, the classic cut-off limit of 120 min showed 100% specificity but only 42% sensitivity for the diagnosis of catheter-related bloodstream infection due to S. aureus. CONCLUSIONS These results strongly suggest that despite its high specificity, the differential time to positivity may not be reliable to rule out catheter-related bloodstream infection due to S. aureus.
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Affiliation(s)
- H Bouzidi
- Service de Réanimation, Gustave Roussy-Cancer Campus, Villejuif, France
| | - A Emirian
- Service de Microbiologie Médicale, Gustave Roussy-Cancer Campus, Villejuif, France
| | - A Marty
- Service de Réanimation, Gustave Roussy-Cancer Campus, Villejuif, France
| | - E Chachaty
- Service de Microbiologie Médicale, Gustave Roussy-Cancer Campus, Villejuif, France
| | - A Laplanche
- Département de Statistiques Médicales, Gustave Roussy-Cancer Campus, Villejuif, France
| | - B Gachot
- Unité de Pathologie Infectieuse, Gustave Roussy-Cancer Campus, Villejuif, France
| | - F Blot
- Service de Réanimation, Gustave Roussy-Cancer Campus, Villejuif, France.
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18
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Schulz S, Maitz M, Hänsel S, Renner LD, Werner C. Analyzing the antiseptic capacity of silver-functionalized poly(ethylene glycol)–heparin hydrogels after human whole blood exposure. Biomater Sci 2018. [DOI: 10.1039/c7bm01140g] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Advanced blood contacting biomaterials are designed to combine antiseptic and anticoagulant functionalities.
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Affiliation(s)
- Sandra Schulz
- Max Bergmann Center of Biomaterials
- Leibniz-Institut für Polymerforschung Dresden e.V
- Dresden
- Germany
| | - Manfred Maitz
- Max Bergmann Center of Biomaterials
- Leibniz-Institut für Polymerforschung Dresden e.V
- Dresden
- Germany
| | - Stefanie Hänsel
- Max Bergmann Center of Biomaterials
- Leibniz-Institut für Polymerforschung Dresden e.V
- Dresden
- Germany
| | - Lars D. Renner
- Max Bergmann Center of Biomaterials
- Leibniz-Institut für Polymerforschung Dresden e.V
- Dresden
- Germany
| | - Carsten Werner
- Max Bergmann Center of Biomaterials
- Leibniz-Institut für Polymerforschung Dresden e.V
- Dresden
- Germany
- Center for Regenerative Therapies Dresden
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Livio P, Alessandro B, Anna C, Marianna C, Matteo GDP, Luana F, Federica L, Francesco M, Maria TV. Risk of infection in elderly patients with AML and MDS treated with hypomethylating agents. ACTA BIO MEDICA : ATENEI PARMENSIS 2018; 89. [PMCID: PMC6502134 DOI: 10.23750/abm.v89i11-s.7988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/06/2022]
Abstract
The aim of this small volume is to raise awareness among Italian hematologists using hypomethylating drugs about risk - and even more important about “risk management” - and the treatment of the infectious events that may arise during therapy with these drugs. Since we wanted this review to be an extremely practical tool, we have included the most recent clinical case studies, the indications provided by the guidelines and expert opinions. Infectious complications are among the most common adverse events that can arise during treatment with hypomethylating drugs. For this reason, a large portion of the chapters of this small volume has been dedicated to a detailed description (on the basis of an attentive review of the literature) of what the hematologist can expect to encounter in terms of risk of infection, in patients treated with azacitidine or decitabine, and to the preventive investigations to carry out and the active prophylaxis measures recommended before commencing treatment with these drugs. What led us to write this book was the conviction that the critical sharing of the studies published in literature and of our personal experiences could contribute to prompting reflection on how we operate and that this, in turn, would lead to the best possible management of these treatments, both in patients with myelodysplasia and in patients with acute myeloid leukemia, preventing - and efficiently managing - infectious events - during therapy. We should not be misled by the fact that the treatments are prevalently administered on an outpatient basis; these patients due to their disease and, in particular, to their age, are extremely frail, and infectious and hemorrhagic complications are the main causes of their admissions to hospital. But expert knowledge and management of the risks of infection can guarantee better management of their needs on an outpatient basis, with undeniable advantages for the clinic but, first and foremost, for the patients. (www.actabiomedica.it)
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Affiliation(s)
- Pagano Livio
- Associate Professor of Hematology, Director UOSA “Geriatric Hematology and Rare Blood Disorders” - Department of Radiological, Radiotherapeutic and Hematological Sciences - Foundation Polyclinic University A. Gemelli - IRCCS - Catholic University of the Sacred Heart - Rome,Correspondence: Prof. Livio Pagano Department of Radiological, Radiotherapeutic and Hematological Sciences Foundation Polyclinic A. Gemelli - IRCCS Università Cattolica del Sacro Cuore, Roma E-mail:
| | - Busca Alessandro
- Department of Oncology, SSD Allogeneic Stem Cell Transplant Unit, AOU City of Health and Science University Hub, Turin
| | - Candoni Anna
- Clinical Hematology Unit, Health Authorities-University Hospital of Udine (ASUIUD)
| | - Criscuolo Marianna
- Department of Radiological Radiotherapeutic and Hematological Sciences, Foundation Polyclinic University A. Gemelli, IRCCS, Rome
| | | | - Fianchi Luana
- Department of Radiological, Radiotherapeutic and Hematological Sciences - Foundation Polyclinic University A. Gemelli, IRCCS, Rome
| | - Lessi Federica
- Division of Hematology and Clinical Immunology, Padua University Hospital
| | - Marchesi Francesco
- UOSD Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome
| | - Teresa Voso Maria
- Associate Professor of Hematology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome
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20
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Moir D, Bodenham A. A narrative review of long-term central venous access devices for the intensivist. J Intensive Care Soc 2017; 19:236-246. [PMID: 30159016 DOI: 10.1177/1751143717741249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Long-term central venous access devices are increasingly prevalent and consequently often encountered by intensivists. This review introduces the different types of long-term central venous access devices, outlines their potential utility, examines potential complications associated with their use and outlines an approach to the management of these complications.
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Affiliation(s)
- David Moir
- Anaesthesia and Intensive Care Medicine, Leeds Teaching Hospital, Leeds, UK
| | - Andrew Bodenham
- Anaesthesia and Intensive Care Medicine, Leeds Teaching Hospital, Leeds, UK
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21
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Heinz WJ, Buchheidt D, Christopeit M, von Lilienfeld-Toal M, Cornely OA, Einsele H, Karthaus M, Link H, Mahlberg R, Neumann S, Ostermann H, Penack O, Ruhnke M, Sandherr M, Schiel X, Vehreschild JJ, Weissinger F, Maschmeyer G. Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2017; 96:1775-1792. [PMID: 28856437 PMCID: PMC5645428 DOI: 10.1007/s00277-017-3098-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/06/2017] [Indexed: 02/07/2023]
Abstract
Fever may be the only clinical symptom at the onset of infection in neutropenic cancer patients undergoing myelosuppressive chemotherapy. A prompt and evidence-based diagnostic and therapeutic approach is mandatory. A systematic search of current literature was conducted, including only full papers and excluding allogeneic hematopoietic stem cell transplant recipients. Recommendations for diagnosis and therapy were developed by an expert panel and approved after plenary discussion by the AGIHO. Randomized clinical trials were mainly available for therapeutic decisions, and new diagnostic procedures have been introduced into clinical practice in the past decade. Stratification into a high-risk versus low-risk patient population is recommended. In high-risk patients, initial empirical antimicrobial therapy should be active against pathogens most commonly involved in microbiologically documented and most threatening infections, including Pseudomonas aeruginosa, but excluding coagulase-negative staphylococci. In patients whose expected duration of neutropenia is more than 7 days and who do not respond to first-line antibacterial treatment, specifically in the absence of mold-active antifungal prophylaxis, further therapy should be directed also against fungi, in particular Aspergillus species. With regard to antimicrobial stewardship, treatment duration after defervescence in persistently neutropenic patients must be critically reconsidered and the choice of anti-infective agents adjusted to local epidemiology. This guideline updates recommendations for diagnosis and empirical therapy of fever of unknown origin in adult neutropenic cancer patients in light of the challenges of antimicrobial stewardship.
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Affiliation(s)
- W J Heinz
- Department of Internal Medicine II, University of Würzburg Medical Center, Würzburg, Germany
| | - D Buchheidt
- Department of Internal Medicine-Hematology and Oncology, Mannheim University Hospital, Mannheim, Germany
| | - M Christopeit
- Department of Stem Cell Transplantation, University Hospital UKE, Hamburg, Germany
| | | | - O A Cornely
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany.,Clinical Trials Centre Cologne, ZKS Köln, Cölogne, Germany.,Center for Integrated Oncology CIO Köln-Bonn, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Medical Faculty, University of Cologne, Cologne, Germany
| | - H Einsele
- Department of Internal Medicine II, University of Würzburg Medical Center, Würzburg, Germany
| | - M Karthaus
- Department of Hematology, Oncology and Palliative Care, Klinikum Neuperlach and Klinikum Harlaching, München, Germany.,Department of Hematology, Oncology and Palliative Care, Klinikum Harlaching, Munich, Germany
| | - H Link
- Hematology and Medical Oncology Private Practice, Kaiserslautern, Germany
| | - R Mahlberg
- Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - S Neumann
- Medical Oncology, AMO MVZ, Wolfsburg, Germany
| | - H Ostermann
- Department of Hematology and Oncology, University of Munich, Munich, Germany
| | - O Penack
- Internal Medicine, Hematology, Oncology and Tumor Immunology, University Hospital Charité, Campus Virchow Klinikum, Berlin, Germany
| | - M Ruhnke
- Department of Hematology and Oncology, Paracelsus-Klinik, Osnabrück, Germany
| | - M Sandherr
- Hematology and Oncology Practice, Weilheim, Germany
| | - X Schiel
- Department of Hematology, Oncology and Palliative Care, Klinikum Harlaching, Munich, Germany
| | - J J Vehreschild
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany
| | - F Weissinger
- Department of Internal Medicine, Hematology, Oncology and Palliative Care, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany.
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De Egea V, Guembe M, Rodríguez-Borlado A, Pérez-Granda MJ, Sánchez-Carrillo C, Bouza E. Should non-bacteraemic patients with a colonized catheter receive antimicrobial therapy? Int J Infect Dis 2017; 62:72-76. [PMID: 28743533 DOI: 10.1016/j.ijid.2017.07.014] [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: 06/12/2017] [Revised: 07/04/2017] [Accepted: 07/16/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The impact of antimicrobial therapy on the outcomes of patients with colonized catheters and no bacteraemia has not been assessed. This study assessed whether targeted antibiotic therapy is related to a poor outcome in patients with positive cultures of blood drawn through a non-tunnelled central venous catheter (CVC) and without concomitant bacteraemia. METHODS This was a retrospective study involving adult patients with positive blood cultures drawn through a CVC and negative peripheral vein blood cultures. Patients were classified into two groups: those with clinical improvement and those with a poor outcome. These two groups were compared. The outcome was considered poor in the presence of one or more of the following: death, bacteraemia or other infection due to the same microorganism, and evidence of catheter-related bloodstream infection. RESULTS A total of 100 patients were included (31 with a poor outcome). The only independent predictors of a poor outcome were a McCabe and Jackson score of 1-2 and a median APACHE score of 5. No association was found between the use of targeted antimicrobial therapy and a poor outcome when its effect was adjusted for the rest of the variables. CONCLUSIONS This study showed that antimicrobial therapy was not associated with a poor outcome in non-bacteraemic patients with positive blood cultures drawn through a CVC.
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Affiliation(s)
- V De Egea
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
| | - M Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
| | - A Rodríguez-Borlado
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
| | - M J Pérez-Granda
- Red Española de Investigación en Patología Infecciosa (REIPI), RD06/0008/1025, Spain; Cardiac Surgery Postoperative Care Unit, H. G. U. Gregorio Marañón, Madrid, Spain.
| | - C Sánchez-Carrillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), RD06/0008/1025, Spain; Universidad Complutense, Madrid, Spain.
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23
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Cornely OA, Mellinghoff SC. [Fever in Cancer Patients]. Dtsch Med Wochenschr 2017; 142:961-968. [PMID: 28672418 DOI: 10.1055/s-0042-117248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Fever in cancer patients is a medical emergency until a severe infection has been ruled out. In case of neutropenia prompt diagnostic work-up should be paralleled by empiric antibiotic treatment. Underlying malignancy as well as treatments may impair immune response and thus pave the way for less virulent pathogens. So the spectrum of infections comprises both pathogens that cause disease in immunocompetent patients and a variety of rarer organisms. After collecting two pairs of blood cultures, broad-spectrum antibiotic treatment should commence within one to two hours. Depending on the individual patient's risk antimicrobial prophylaxis should be considered.
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24
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Hashem AA, Abd El Fadeal NM, Shehata AS. In vitro activities of vancomycin and linezolid against biofilm-producing methicillin-resistant staphylococci species isolated from catheter-related bloodstream infections from an Egyptian tertiary hospital. J Med Microbiol 2017; 66:744-752. [DOI: 10.1099/jmm.0.000490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Asmaa A. Hashem
- Department of Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Noha M. Abd El Fadeal
- Department of Medical Biochemistry, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Atef S. Shehata
- Department of Microbiology and Immunology, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
- Department of Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Gominet M, Compain F, Beloin C, Lebeaux D. Central venous catheters and biofilms: where do we stand in 2017? APMIS 2017; 125:365-375. [PMID: 28407421 DOI: 10.1111/apm.12665] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/29/2016] [Indexed: 12/28/2022]
Abstract
The use of central venous catheters (CVC) is associated with a risk of microbial colonization and subsequent potentially severe infection. Microbial contamination of the catheter leads to the development of a microbial consortia associated with the CVC surface and embedded in an extracellular matrix, named biofilm. This biofilm provides bacterial cells the ability to survive antimicrobial agents and the host immune system and to disseminate to other sites of the body. The best preventive strategy is to avoid any unnecessary catheterization or to reduce indwelling duration when a CVC is required. Beside aseptic care and antibiotic-impregnated catheters (like minocycline/rifampin), preventive locks can be proposed in some cases, whereas non-biocidal approaches are under active research like anti-adhesive or competitive interactions strategies. When the diagnosis of catheter-related bloodstream infection (CRBSI) is suspected on clinical symptoms, it requires a microbiological confirmation by paired blood cultures in order to avoid unnecessary catheter removal. The treatment of CRBSI relies on catheter removal and systemic antimicrobials. However, antibiotic lock technique (ALT) can be used as an attempt to eradicate biofilm formed on the inside lumen of the catheter in case of uncomplicated long-term catheter-related BSI caused by coagulase-negative staphylococci (CoNS) or Enterobacteriaceae. Recently, promising strategies have been developed to improve biofilm eradication; they rely on matrix degradation or destabilization or the development of anti-persister compounds, targeting the most tolerant bacterial cells inside the biofilm. Understanding biofilm formation at the molecular level may help us to develop new approaches to prevent or treat these frequent infections.
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Affiliation(s)
- Marie Gominet
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Paris, France
| | - Fabrice Compain
- Université Paris Descartes, Paris, France.,Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Christophe Beloin
- Unité de Génétique des Biofilms, Département de Microbiologie, Institut Pasteur, Paris, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile de Microbiologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Paris, France
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:216-230. [DOI: 10.1007/s00103-016-2485-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Klastersky J, de Naurois J, Rolston K, Rapoport B, Maschmeyer G, Aapro M, Herrstedt J. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines. Ann Oncol 2016; 27:v111-v118. [PMID: 27664247 DOI: 10.1093/annonc/mdw325] [Citation(s) in RCA: 379] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- J Klastersky
- Institut Jules Bordet-Centre des Tumeurs de l'ULB, Brussels, Belgium
| | - J de Naurois
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - K Rolston
- M.D. Anderson Cancer Center, Houston, TX, USA
| | - B Rapoport
- Medical Oncology Centre of Rosebank, Johannesburg, South Africa
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst von Bergmann Hospital, Potsdam, Germany
| | - M Aapro
- Multidisciplinary Institute of Oncology, Clinique de Genolier, Genolier, Switzerland
| | - J Herrstedt
- Department of Oncology, Odense University Hospital (OUH), Odense, Denmark
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Clinical prognostic factors for time to positivity in cancer patients with bloodstream infections. Infection 2016; 44:583-8. [PMID: 27084368 DOI: 10.1007/s15010-016-0890-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Time to positivity (TTP) has been used in recent years as a simple and rapid method for the additional characterization of the degree of bacteremia. However, prognostic factors for TTP in cancer patients with bloodstream infections have rarely been studied. The aim of this study was to investigate the clinical factors for TTP involving various isolated organisms in cancer patients. METHODS We analyzed 386 episodes of bloodstream infections (BSIs) in patients with or without cancer during a 19 month period. Information on age, gender, tumor type, ICU stay, organisms, multidrug resistance (MDR), TTP and outcome was collected. Multivariate logistic regression analysis was performed. RESULTS The mean TTP of Enterobacteriaceae in patients with hepatocellular carcinoma, gastroenterological cancer, and lung cancer was shorter than in non-cancer patients (9.86 ± 3.22, 10.05 ± 3.47, 8.85 ± 2.78 vs 13.11 ± 5.37 h). The mean TTP of nonfermentative bacilli in patients with lung cancer (12.37 ± 5.96 h) and hematologic diseases (8.72 ± 4.21 h) was also shorter than in non-cancer patients (20.74 ± 2.46 h), and the mean TTP of Staphylococcus isolates was significantly different between non-cancer patients (22.06 ± 3.71 h) and hematologic disease patients (11.93 ± 5.44 h). The presence of a benign tumor was a significant prognostic factor for a long TTP only in the Staphylococci group (OR 0.076, 95 % CI 0.014-0.412), according to multivariate analysis. MDR (OR 2.178, 95 % CI 1.196-4.239) was an independent significant predictor in the Enterobacteriaceae group, with a short TTP, and it was also a significant clinical factor for a long TTP in nonfermentative bacilli and the Staphylococci group (OR 5.037, 95 % CI 1.065-23.82; OR 0.167, 95 % CI 0.059-0.474). CONCLUSION Time to positivity provides useful diagnostic and prognostic information for the differentiation of frequently isolated organisms. This information may help clinicians to use the correct antibiotics in a timely manner to treat cancer patients with BSIs based on clinical factor analysis.
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See I, Freifeld AG, Magill SS. Causative Organisms and Associated Antimicrobial Resistance in Healthcare-Associated, Central Line-Associated Bloodstream Infections From Oncology Settings, 2009-2012. Clin Infect Dis 2016; 62:1203-9. [PMID: 26936664 DOI: 10.1093/cid/ciw113] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/19/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Recent antimicrobial resistance data are lacking from inpatient oncology settings to guide infection prophylaxis and treatment recommendations. We describe central line-associated bloodstream infection (CLABSI) pathogens and antimicrobial resistance patterns reported from oncology locations to the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN). METHODS CLABSI data reported to NHSN from 2009 to 2012 from adult inpatient oncology locations were compared to data from nononcology adult locations within the same hospitals. Pathogen profile, antimicrobial resistance rates, and CLABSI incidence rates per 1000 central line-days were calculated. CLABSI incidence rates were compared using Poisson regression. RESULTS During 2009-2012, 4654 CLABSIs were reported to NHSN from 299 adult oncology units. The most common organisms causing CLABSI in oncology locations were coagulase-negative staphylococci (16.9%), Escherichia coli (11.8%), and Enterococcus faecium (11.4%). Fluoroquinolone resistance was more common among E. coli CLABSI in oncology than nononcology locations (56.5% vs 41.5% of isolates tested; P < .0001) and increased significantly from 2009-2010 to 2011-2012 (49.5% vs 60.4%; P = .01). Furthermore, rates of CLABSI were significantly higher in oncology compared to nononcology locations for fluoroquinolone-resistant E. coli (rate ratio, 7.37; 95% confidence interval [CI], 6.20-8.76) and vancomycin-resistant E. faecium (rate ratio, 2.27, 95% CI, 2.03-2.53). However, resistance rates for some organisms, such as Klebsiella species and Pseudomonas aeruginosa, were lower in oncology than in nononcology locations. CONCLUSIONS Antimicrobial-resistant E. coli and E. faecium have become significant pathogens in oncology. Practices for antimicrobial prophylaxis and empiric antimicrobial therapy should be regularly assessed in conjunction with contemporary antimicrobial resistance data.
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Affiliation(s)
- Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison G Freifeld
- Infectious Diseases Section, University of Nebraska Medical Center, Omaha
| | - Shelley S Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Planes AM, Calleja R, Bernet A, Campins-Martí M, Almirante B, Pumarola T, Fernández-Hidalgo N. Evaluation of the usefulness of a quantitative blood culture in the diagnosis of catheter-related bloodstream infection: Comparative analysis of two periods (2002 and 2012). Enferm Infecc Microbiol Clin 2016; 34:484-9. [PMID: 26778796 DOI: 10.1016/j.eimc.2015.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/09/2015] [Accepted: 11/20/2015] [Indexed: 01/14/2023]
Abstract
INTRODUCTION A retrospective study was conducted to investigate the usefulness of systematic quantitative blood culture (QBC) in the diagnosis of catheter-related bloodstream infection (CRBSI) during two 1-year periods (2002 and 2012). METHODS The study included all QBC requests sent to the microbiology laboratory for suspected CRBSI in adults (≥18 years) with any type of intravascular catheter (IVC). Based on a ratio of ≥4:1CFU/mL of the same microorganism between IVC blood culture from any lumen and peripheral blood culture, 5 diagnostic groups were defined: confirmed or probable CRBSI, primary BSI, other focus of infection, and colonization. RESULTS In total, 4521 QBCs were evaluated; 24% positive in 2002 and 16% in 2012 (P<0.0001). There were 243 episodes of suspected CRBSI (101 in 2002 and 142 in 2012). Confirmed CRBSI episodes were higher in 2002 than 2012 (56% vs 34%) (P<0.0001), whereas colonization episodes were lower (18% vs 38%) (P=0.0006). Gram-positive cocci decrease in 2012 relative to 2002 (56% vs 79.7%) (P=0.022). Almost one-third (32%) of confirmed CRBSI would have been missed if blood from all catheter lumens had not been cultured. CONCLUSIONS QBC is a useful method for diagnosing CRBSI. Blood samples from all catheter lumens must be cultured to avoid missing around one-third of CRBSI diagnoses.
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Affiliation(s)
- Anna Maria Planes
- Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Raquel Calleja
- Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Bernet
- Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Magda Campins-Martí
- Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benito Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomàs Pumarola
- Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Núria Fernández-Hidalgo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Tanaka H, Ambiru S, Kawaguchi T, Sugita Y, Kawajiri C, Nagao Y, Shimura T. Cessation of In-line Filters in Central Venous Catheters Does Not Significantly Influence the Incidence of Bloodstream Infections and Mortality in a Hospital Hematological Ward. Intern Med 2016; 55:1287-92. [PMID: 27181534 DOI: 10.2169/internalmedicine.55.6207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The use of intravenous in-line filters is effective for the mechanical removal of large particles, precipitates, bacteria, fungi, large lipid globules, and air. However, the routine use of in-line filters remains controversial. Many patients with hematological diseases frequently suffer from bloodstream infections (BSIs) with fatal outcomes. Methods The year before cessation of an in-line filter was defined as the "filter period" and the year after its cessation was defined as the "non-filter period." The number of central line-associated bloodstream infections (CLABSIs), which are defined through surveillance, the catheter utilization rate, the number of patient deaths within 7 days after removal of the central venous catheters (CVCs), and the overall survival rate following CVC insertion were measured. Results During both periods, 84 patients had a total of 140 CVCs with a total number of catheter days of 3,407. There were 10 CVCs with CLABSIs, and the overall CLABSI rate was 2.9/1,000 catheter days, including 4 CVCs with CLABSIs (2.5/1,000 catheter days) during the filter period and 6 CVCs with CLABSIs (3.3/1,000 catheter days) during the non-filter period. The CLABSI rate, catheter utilization rate, and mortality did not differ significantly between the two periods. The only independent variable that was found to be significantly associated with the development of CLABSIs was a neutrophil count of <500×10(6)/L (p<0.05). Conclusion Our study revealed that the cessation of in-line filters from CVCs does not significantly influence the incidence of BSIs and mortality in patients with hematological disease. To confirm our results, however, a large-scale randomized controlled study is warranted.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Hematology, Oami Municipal Hospital, Japan
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Naseh MH, Marashi SMA, Asgari E, Aghabarari M, Mahmudi E, Asadi M, Hatami S, Kalantar E. Bacteremia in Cancer Patients: A Two Center Experience of Isolates and Spectrum of Antibiotic Resistance Pattern. Jundishapur J Nat Pharm Prod 2015. [DOI: 10.17795/jjnpp-24358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus. Crit Rev Oncol Hematol 2015; 95:191-213. [PMID: 25818202 DOI: 10.1016/j.critrevonc.2015.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/25/2015] [Accepted: 03/05/2015] [Indexed: 12/31/2022] Open
Abstract
The reporting of infection/sepsis in chemo/radiation-treated head and neck cancer patients is sparse and the problem is underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met with the aim of reaching a consensus on a clinical definition and management of infections and sepsis. The Delphi appropriateness method was used for this consensus. External expert reviewers then evaluated the conclusions carefully according to their area of expertise. The paper contains seven clusters of statements about the clinical definition and management of infections and sepsis in head and neck cancer patients, which had a consensus. Furthermore, it offers a review of recent literature in these topics.
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Alp S, Akova M. Management of febrile neutropenia in the era of bacterial resistance. Ther Adv Infect Dis 2014; 1:37-43. [PMID: 25165543 DOI: 10.1177/2049936113475610] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Managing cancer patients with fever and neutropenia must be considered as a medical emergency since any delay in initiating appropriate empirical antibacterial therapy may result in high rates of mortality and morbidity. Emerging antibacterial resistance in bacterial pathogens infecting febrile neutropenic patients complicates management, and choosing the type of empirical antimicrobial therapy has become a challenge. To further complicate the decision process, not all neutropenic patients are in same category of susceptibility to develop severe infection. While low-risk patients may be treated with oral antibiotics in the outpatient setting, high-risk patients usually need to be admitted to hospital and receive parenteral broad-spectrum antibiotics until the neutrophil levels recover. These strategies have recently been addressed in two international guidelines from the Infectious Diseases Society of America (IDSA) and the European Conference on Infections in Leukaemia (ECIL). This review gives a brief overview of current antimicrobial resistance problems and their effects in febrile neutropenic cancer patients by summarizing the suggestions from the IDSA and ECIL guidelines.
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Affiliation(s)
- Sehnaz Alp
- Section of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Akova
- Section of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey
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Gahlot R, Nigam C, Kumar V, Yadav G, Anupurba S. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci 2014; 4:162-7. [PMID: 25024944 PMCID: PMC4093967 DOI: 10.4103/2229-5151.134184] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Central-venous-catheter-related bloodstream infections (CRBSIs) are an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. Consequences depend on associated organisms, underlying pre-morbid conditions, timeliness, and appropriateness of the treatment/interventions received. We have summarized risk factors, pathogenesis, etiology, diagnosis, and management of CRBSI in this review.
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Affiliation(s)
- Rupam Gahlot
- Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Chaitanya Nigam
- Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Vikas Kumar
- Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Ghanshyam Yadav
- Department of Anaesthesia, Institute of Medical Science, Banaras Hindu University, Varanasi, India
| | - Shampa Anupurba
- Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi, India
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Diagnostic usefulness of differential time to positivity for catheter-related candidemia. J Clin Microbiol 2014; 52:2566-72. [PMID: 24829236 DOI: 10.1128/jcm.00605-14] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A differential time to positivity (DTP) of ≥ 120 min is useful for diagnosing catheter-related bacteremia, but data on diagnosing catheter-related candidemia (CRC) in this way are limited. We wished to evaluate the usefulness of the DTP for diagnosing CRC. All adult patients who had the same Candida species isolated from blood cultures drawn simultaneously from a central venous catheter (CVC) and a peripheral vein were included at a tertiary care hospital over an 18-month period. A total of 105 patients with candidemia who had positive simultaneous CVC and peripheral vein blood cultures were included in our study. Sixty-one patients (58%) had CRC (47 definite and 14 probable), and 38 (36%) had candidemia from another source (non-CRC). The remaining 6 patients (6%) with indeterminate candidemia were excluded from the final analysis. The overall sensitivity and specificity of a DTP of ≥ 120 min for diagnosing CRC were 85% (95% confidence interval [CI], 74% to 93%) and 82% (95% CI, 66% to 92%), respectively, and for neutropenic patients, they were 75% (95% CI, 19% to 99%) and 100% (95% CI, 75% to 100%), respectively. For Candida glabrata infections, the optimal DTP cutoff was ≥ 6 h, with a sensitivity of 63% (95% CI, 35% to 85%) and a specificity of 75% (95% CI, 35% to 97%). In summary, DTP is useful for diagnosing CRC, and a DTP of ≥ 120 min appears to be the optimal cutoff except for CRC caused by C. glabrata. For neutropenic patients, DTP may be useful as an adjunct test to rule in CRC and to decide whether a catheter should be removed.
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Blood culture differential time to positivity enables safe catheter retention in suspected catheter-related bloodstream infection: a randomized controlled trial. Med Intensiva 2014; 39:135-41. [PMID: 24661917 DOI: 10.1016/j.medin.2013.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/14/2013] [Accepted: 12/19/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the clinical usefulness and safety of the differential-time-to-positivity (DTP) method for managing the suspicion of catheter-related bloodstream infection (CR-BSI) in comparison with a standard method that includes catheter removal in critically ill patients. METHODS-DESIGN A prospective randomized study was carried out. SETTING A 16-bed clinical-surgical ICU (July 2007-February 2009). INTERVENTIONS Patients were randomly assigned to one of two groups at the time CR-BSI was suspected. In the standard group, a standard strategy requiring catheter withdrawal was used to confirm or rule out CR-BSI. In the DTP group, DTP without catheter withdrawal was used to confirm or rule out CR-BSI. MEASUREMENTS clinical and microbiological data, CR-BSI rates, unnecessary catheter removals, and complications due to new puncture or to delays in catheter removal. RESULTS Twenty-six patients were analyzed in each group. In the standard group, 6 of 37 suspected episodes of CR-BSI were confirmed and 5 colonizations were diagnosed. In the DTP group, 5 of 26 suspected episodes of CR-BSI were confirmed and four colonizations were diagnosed. In the standard group, all catheters (58/58, 100%) were removed at the time CR-BSA was suspected, whereas in the DTP group, only 13 catheters (13/41, 32%) were removed at diagnosis, and 10 due to persistent septic signs (10/41, 24%). In cases of confirmed CR-BSI, there were no differences between the two groups in the evolution of inflammatory parameters during the 48hours following the suspicion of CR-BSI. CONCLUSIONS In critically ill patients with suspected CR-BSI, the DTP method makes it possible to keep the central venous catheter in place safely.
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Hentrich M, Schalk E, Schmidt-Hieber M, Chaberny I, Mousset S, Buchheidt D, Ruhnke M, Penack O, Salwender H, Wolf HH, Christopeit M, Neumann S, Maschmeyer G, Karthaus M. Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management and prevention by the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology. Ann Oncol 2014; 25:936-47. [PMID: 24399078 DOI: 10.1093/annonc/mdt545] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cancer patients are at increased risk for central venous catheter-related infections (CRIs). Thus, a comprehensive, practical and evidence-based guideline on CRI in patients with malignancies is warranted. PATIENTS AND METHODS A panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) has developed a guideline on CRI in cancer patients. Literature searches of the PubMed, Medline and Cochrane databases were carried out and consensus discussions were held. RESULTS Recommendations on diagnosis, management and prevention of CRI in cancer patients are made, and the strength of the recommendation and the level of evidence are presented. CONCLUSION This guideline is an evidence-based approach to the diagnosis, management and prevention of CRI in cancer patients.
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Affiliation(s)
- M Hentrich
- Department of Hematology, Oncology and Palliative Care, Harlaching Hospital and Neuperlach Hospital, Munich
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Differential time to positivity is not predictive for central line-related Staphylococcus aureus bloodstream infection in routine clinical care. J Infect 2014; 68:58-61. [DOI: 10.1016/j.jinf.2013.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/18/2013] [Accepted: 08/05/2013] [Indexed: 11/20/2022]
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Wagner J, Schilcher G, Zollner-Schwetz I, Hoenigl M, Valentin T, Ribitsch W, Horina J, Rosenkranz AR, Grisold A, Unteregger M, Troppan K, Valentin A, Neumeister P, Krause R. Microbiological screening for earlier detection of central venous catheter-related bloodstream infections. Eur J Clin Invest 2013; 43:964-9. [PMID: 23848936 DOI: 10.1111/eci.12126] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 06/11/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Catheter-related bloodstream infections (CRBSIs) are currently detected with a reactive diagnostic policy, that is, application of tests to patients with clinically suspected CRBSI. The aim of our study was to evaluate whether CRBSIs could be anticipated in an earlier stage by microbiological screening using peptide nucleic acid fluorescence in situ hybridization (PNA FISH) with universal hybridization probes or acridine-orange leucocyte cytospin (AOLC) tests in haemodialysis and haematological patients with CVCs in situ compared with routine test. MATERIALS AND METHODS Peptide nucleic acid fluorescence in situ hybridization (PNA FISH) and AOLC tests using blood samples from both CVC lines in patients undergoing haemodialysis were performed three times a week and from one CVC line in haematological patients were performed daily. Results were compared with those obtained from routinely performed CRBSI diagnostic tests. RESULTS One hundred fifteen patients with 139 catheter periods were investigated. The mean observation time per catheter period was 25 days (IQR 13.5-43.5), resulting in 5615 CVC days with a total of 4839 tested blood samples. Five CRBSI cases were detected by routine measures resulting in a CRBSI rate of 0.9/1000 catheter days. Four of five CRBSIs could be anticipated by positive PNA FISH and AOLC tests 2-8 days before the diagnosis was established with routine measures. CONCLUSIONS The proactive anticipative strategy using microscopic examination of CVC blood samples to anticipate CRBSI in an earlier stage compared with routine measures is a new diagnostic approach in patients with CVCs and a high risk of developing CRBSI.
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Affiliation(s)
- Jasmin Wagner
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria
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Wiernik PH, Goldman JM, Dutcher JP, Kyle RA. Evaluation and Management of Bacterial and Fungal Infections Occurring in Patients with a Hematological Malignancy: A 2011 Update. NEOPLASTIC DISEASES OF THE BLOOD 2013. [PMCID: PMC7120157 DOI: 10.1007/978-1-4614-3764-2_52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with a hematological malignancy are a heterogeneous patient population who are afflicted with diseases that range from rapidly fatal acute leukemia to indolent lymphoma or chronic leukemia. Treatment options for these patients range from observation to hematopoietic stem cell transplantation (HSCT), but all patients are more susceptible to infection. The problem of infection is dynamic with continued shifts in pathogenic organisms and microbial susceptibilities, new treatment regimens that further diminish immune function, and patients receiving treatment who are now older and frailer. The classic patterns of immunodeficiency for patients with a hematological malignancy include: periods of profound neutropenia, increased iatrogenic risks (i.e., central vascular catheters), and cellular immune suppression that affects HSCT recipients, patients with lymphoid malignancies, and those receiving treatment with corticosteroids or agents like alemtuzumab [1–4]. Recent advances in antimicrobial drug development, new technology, clinical trial results, and further clinical experience have enhanced the database on which to make infection prophylaxis and treatment decisions. However, the practicing clinician must remember that the majority of basic infection management principles for patients who are neutropenic remain unchanged.
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Affiliation(s)
- Peter H. Wiernik
- Beth Israel Hospital, Cancer Center, St. Lukes-Roosevelt Hospital Center, 10th Avenue 1000, New York, 10019 New York USA
| | - John M. Goldman
- , Department of Hematology, Imperial College of London, Du Cane Road 150, London, W12 0NN United Kingdom
| | - Janice P. Dutcher
- Continuum Cancer Centers, Department of Medicine, St. Luke's-Roosevelt Hospital Center, 10th Avenue 1000, New York, 10019 New York USA
| | - Robert A. Kyle
- , Division of Hematology, Mayo Clinic, First Street SW. 200, Rochester, 55905 Minnesota USA
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Murray PR, Masur H. Current approaches to the diagnosis of bacterial and fungal bloodstream infections in the intensive care unit. Crit Care Med 2012; 40:3277-82. [PMID: 23034460 PMCID: PMC4201853 DOI: 10.1097/ccm.0b013e318270e771] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Healthcare systems spend considerable resources collecting and processing blood cultures for the detection of blood stream pathogens. The process is initiated with the collection of blood cultures that depend upon proper skin disinfection, collection of an adequate number of specimens and volume of blood, and prompt processing in a sensitive culture system. Complementing blood cultures and gaining in use are techniques such as nucleic acid amplification tests and mass spectroscopy that allow clinical laboratories to detect and identify organisms from blood cultures substantially faster than conventional systems. Furthermore, certain resistance mutations can be detected within hours of organism detection, thus providing valuable guidance to clinicians who strive to initiate the appropriate antimicrobial therapy as rapidly as possible, and who wish to discontinue unnecessary drugs expeditiously. Molecular and mass spectroscopy techniques are changing sepsis diagnosis rapidly and will provide far more specific information far more quickly, but the performance characteristics of these systems must be understood by intensivists who use such information to guide their patient management.
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Affiliation(s)
- Patrick R. Murray
- Worldwide Director, Scientific Affairs, Becton Dickinson Diagnostic Systems, Sparks, Maryland 21152; Former Chief, Microbiology, Department of Laboratory Medicine, Clinical Center, National Institutes of Health
| | - Henry Masur
- Chief, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
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Murray PR, Masur H. Current approaches to the diagnosis of bacterial and fungal bloodstream infections in the intensive care unit. Crit Care Med 2012. [PMID: 23034460 DOI: 10.1097/ccm.3270b3013e318270e318771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Healthcare systems spend considerable resources collecting and processing blood cultures for the detection of blood stream pathogens. The process is initiated with the collection of blood cultures that depend upon proper skin disinfection, collection of an adequate number of specimens and volume of blood, and prompt processing in a sensitive culture system. Complementing blood cultures and gaining in use are techniques such as nucleic acid amplification tests and mass spectroscopy that allow clinical laboratories to detect and identify organisms from blood cultures substantially faster than conventional systems. Furthermore, certain resistance mutations can be detected within hours of organism detection, thus providing valuable guidance to clinicians who strive to initiate the appropriate antimicrobial therapy as rapidly as possible, and who wish to discontinue unnecessary drugs expeditiously. Molecular and mass spectroscopy techniques are changing sepsis diagnosis rapidly and will provide far more specific information far more quickly, but the performance characteristics of these systems must be understood by intensivists who use such information to guide their patient management.
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Freeman JT, Elinder-Camburn A, McClymont C, Anderson DJ, Bilkey M, Williamson DA, Berkahn L, Roberts SA. Central line-associated bloodstream infections in adult hematology patients with febrile neutropenia: an evaluation of surveillance definitions using differential time to blood culture positivity. Infect Control Hosp Epidemiol 2012; 34:89-92. [PMID: 23221198 DOI: 10.1086/668431] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We used differential time to positivity between central and peripheral blood cultures to evaluate the positive predictive value (PPV) of the National Healthcare Safety Network central line-associated bloodstream infection (CLABSI) surveillance definition among hematology patients with febrile neutropenia. The PPV was 27.7%, which suggests that, when the definition is applied to this population, CLABSI rates will be substantially overestimated.
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Affiliation(s)
- Joshua T Freeman
- Department of Clinical Microbiology, Auckland District Healthboard, Auckland, New Zealand.
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Gowardman JR, Jeffries P, Lassig-Smith M, Stuart J, Jarrett P, Deans R, McGrail M, George NM, Nimmo GR, Rickard CM. A comparative assessment of two conservative methods for the diagnosis of catheter-related infection in critically ill patients. Intensive Care Med 2012; 39:109-16. [PMID: 23011530 DOI: 10.1007/s00134-012-2689-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 08/06/2012] [Indexed: 01/29/2023]
Abstract
PURPOSE To assess the utility of two in situ techniques, differential time to positivity (DTP) and semiquantitative superficial cultures (SQSC) for diagnosing catheter-related bloodstream infection (CR-BSI) in critically ill adults. METHODS This was a prospective cohort study in patients with suspected CR-BSI arising from a short-term arterial catheter (AC) or a central venous catheter (CVC). On suspicion of CR-BSI, devices were removed. Blood, skin, catheter tip and hub cultures were taken. Infection rates were compared against the diagnosis of CR-BSI using matched tip and blood cultures. RESULTS Of 120 episodes of clinically suspected CR-BSI in 101 patients examined, 9 (7.5 %) were confirmed as CR-BSI. Validity values (95 % CI) for the diagnosis of CR-BSI arising from both AC and CVC for DTP were: sensitivity 44 % (15-77 %), specificity 98 % (93-100 %), positive predictive value (PPV) 67 % (24-94 %), negative predictive value (NPV) 96 % (90-98 %), positive likelihood ratio (LR+) 25 (5-117), negative likelihood ratio (LR-) 0.6 (0.3-1.0), diagnostic odds ratio (DOR) 44 (7-258), and accuracy 94 % (92-98 %). Validity values (95 % CI) for SQSC were: sensitivity 78 % (41-96 %), specificity 60 % (50-69 %), PPV 14 % (6-26 %), NPV 97 % (89-99 %), LR+ 1.9 (1.0-2.3), LR- 0.4 (0.1-1.3), DOR 5.1 (1.1-19), and accuracy 61 % (51-69 %). DTP combined with SQSC improved sensitivity and NPV to 100 % whilst the DOR increased to 25.8 (95 % CI 3-454). CONCLUSIONS CR-BSI can be ruled out by undertaking DTP and SQSC concurrently for both ACs and CVCs with 100 % sensitivity and NPV.
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Affiliation(s)
- John R Gowardman
- Intensive Care Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
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Antimicrobial therapy of febrile complications after high-dose chemotherapy and autologous hematopoietic stem cell transplantation--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol 2012; 91:1161-74. [PMID: 22638755 DOI: 10.1007/s00277-012-1456-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 03/16/2012] [Indexed: 01/29/2023]
Abstract
More than 18,000 autolgous transplantation were performed in Europe in the year 2009. It as a routine procedure in experienced centres. Even if there is a low mortality rate, infections are a major issue after transplantation, occurring in more than 60 % of the patients. In this review we discuss all aspects of infections after autologous stem transplantation, including epidemiology, diagnostics, therapeutic algorithms, prophylaxis and supportive therapy.
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Lorente L. [Conservative methods for diagnosing catheter-associated bacteremia]. Med Intensiva 2012; 36:163-8. [PMID: 22386333 DOI: 10.1016/j.medin.2011.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 12/25/2011] [Indexed: 11/18/2022]
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Arendrup MC, Bille J, Dannaoui E, Ruhnke M, Heussel CP, Kibbler C. ECIL-3 classical diagnostic procedures for the diagnosis of invasive fungal diseases in patients with leukaemia. Bone Marrow Transplant 2012; 47:1030-45. [DOI: 10.1038/bmt.2011.246] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Differential time to positivity (DTTP) for the diagnosis of catheter-related bloodstream infection: do we need to obtain one or more peripheral vein blood cultures? Eur J Clin Microbiol Infect Dis 2011; 31:1367-72. [PMID: 22015990 DOI: 10.1007/s10096-011-1451-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 10/07/2011] [Indexed: 12/22/2022]
Abstract
The ideal number of blood samples to be obtained from peripheral veins (PVs) when differential time to positivity (DTTP) is being performed is an unresolved issue and most institutions obtain a single set. Our objective was to assess the number of proven central line-associated bloodstream infection (CLABSI) episodes that would have been recovered if blood had been cultured from one or two PVs. We performed a retrospective study in patients with proven CLABSI in which catheter lumens and two or more PV blood cultures were taken simultaneously. We calculated the number of episodes that would have been recovered if the culture of one or more PV blood cultures had been artificially eliminated. During a period of 4 years, we collected 60 episodes of proven CLABSI. Overall, if one PV culture had been eliminated in patients with two or three PV blood cultures, we would have documented 91.8% (p=0.362) and 96.9% (p>0.999) of episodes, respectively. If we had eliminated two PV blood cultures in patients with three PV blood cultures, 90.8% (p>0.999) of episodes would have been documented. When performing the DTTP technique to confirm CLABSI, a single paired PV blood culture was not associated with a significant number of missed CLABSI episodes.
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Tomlinson D, Mermel LA, Ethier MC, Matlow A, Gillmeister B, Sung L. Defining Bloodstream Infections Related to Central Venous Catheters in Patients With Cancer: A Systematic Review. Clin Infect Dis 2011; 53:697-710. [DOI: 10.1093/cid/cir523] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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