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Ngo Bell EC, Chapon V, Bessede E, Meriglier E, Issa N, Domblides C, Bonnet F, Vandenhende MA. Central venous catheter-related bloodstream infections: Epidemiology and risk factors for hematogenous complications. Infect Dis Now 2024; 54:104859. [PMID: 38309647 DOI: 10.1016/j.idnow.2024.104859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/08/2023] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Central catheter-related bloodstream infections (CRBIs) can lead to severe complications, including suppurative thrombophlebitis, endocarditis, and metastatic infections. While complications due to CRBIs caused by Staphylococcus aureus (SA) are well-known, there are limited data regarding CRBIs caused by other bacteria. METHODS This 2-year retrospective single-center study of patients with CRBIs from a tertiary care hospital examined the hematogenous complications associated with CRBIs according to patient characteristics, central venous catheter (CVC) types, and causative bacteria. RESULTS All in all, 254 patients with confirmed CRBIs were included; 285 bacteria types were isolated, mainly Enterobacteriaceae (n = 94), coagulase-negative Staphylococci (CNS, n = 82), SA (n = 45), and non-fermenting Gram-negative bacteria (NGB, n = 45). Among the patients, 35 developed at least one hematogenous complication (14 %), including suppurative thrombophlebitis (n = 15), endocarditis (n = 7) and metastatic infections (n = 16). In multivariate analysis, hemodialysis, persistent bacteremia for at least 3 days, and CRBIs caused by SA were associated with increased risk for hematogenous complications, while previous curative anticoagulant treatment was associated with reduced risk. Diabetes, CVC maintenance, and hematogenous complications were associated with increased 3-month mortality. CONCLUSION A thorough investigation of hematogenous complications should be envisioned in patients with persistent bacteremia, particularly those with SA infections and those on hemodialysis.
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Affiliation(s)
| | - Virginie Chapon
- Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, F-33000 Bordeaux, France.
| | - Emilie Bessede
- Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, Hôpital Pellegrin, F-33000 Bordeaux, France.
| | - Etienne Meriglier
- Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne, Hôpital Pellegrin, INSERM, Institut Bergonié, CIC-EC 1401, F-33000 Bordeaux, France.
| | - Nahema Issa
- Centre Hospitalier Universitaire de Bordeaux, Service de Réanimation médicale, Hôpital Saint-André, F-33000 Bordeaux, France.
| | - Charlotte Domblides
- Centre Hospitalier Universitaire de Bordeaux, Service d'Oncologie médicale, Hôpital Saint-André, F-33000 Bordeaux, France.
| | - Fabrice Bonnet
- Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, F-33000 Bordeaux, France; Université de Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France.
| | - Marie-Anne Vandenhende
- Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne, Hôpital Pellegrin, INSERM, Institut Bergonié, CIC-EC 1401, F-33000 Bordeaux, France; Université de Bordeaux, INSERM, Institut Bergonié, CIC-EC 1401, F-33000 Bordeaux, France.
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Silverstein DM, Trerotola SO, Clark T, James G, Ng W, Dwyer A, Florescu MC, Shingarev R, Ash SR. Clinical and Regulatory Considerations for Central Venous Catheters for Hemodialysis. Clin J Am Soc Nephrol 2018; 13:1924-1932. [PMID: 30309840 PMCID: PMC6302318 DOI: 10.2215/cjn.14251217] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Central venous catheters remain a vital option for access for patients receiving maintenance hemodialysis. There are many important and evolving clinical and regulatory considerations for all stakeholders for these devices. Innovation and transparent and comprehensive regulatory review of these devices is essential to stimulate innovation to help promote better outcomes for patients receiving maintenance hemodialysis. A workgroup that included representatives from academia, industry, and the US Food and Drug Administration was convened to identify the major design considerations and clinical and regulatory challenges of central venous catheters for hemodialysis. Our intent is to foster improved understanding of these devices and provide the foundation for strategies to foster innovation of these devices.
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Affiliation(s)
- Douglas M. Silverstein
- Center for Devices and Radiological Health, Division of Reproductive, Gastro-Renal, and Urological Devices, Renal Devices Branch, US Food and Drug Administration, Silver Spring, Maryland
| | - Scott O. Trerotola
- Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy Clark
- Interventional Radiology, Penn-Presbyterian Medical Center, Hospitals of the University of Pennsylvania, , Philadelphia, Pennsylvania
| | - Garth James
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana
| | - Wing Ng
- Regulatory Affairs and Patient Recovery, Cardinal Health, Inc., Dublin, Ohio
| | - Amy Dwyer
- Internal Medicine and Interventional Nephrology, University of Louisville, Louisville, Kentucky
| | - Marius C. Florescu
- Internal Medicine and Nephrology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Roman Shingarev
- Internal Medicine and Nephrology, University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | - Stephen R. Ash
- Indiana University Health Arnett Hospital, Lafayette, Indiana
- HemoCleanse Technologies, LLC, Lafayette, Indiana; and
- Ash Access Technology, Inc., Lafayette, Indiana
| | - on behalf of the Kidney Health Initiative HDF Workgroup
- Center for Devices and Radiological Health, Division of Reproductive, Gastro-Renal, and Urological Devices, Renal Devices Branch, US Food and Drug Administration, Silver Spring, Maryland
- Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Interventional Radiology, Penn-Presbyterian Medical Center, Hospitals of the University of Pennsylvania, , Philadelphia, Pennsylvania
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana
- Regulatory Affairs and Patient Recovery, Cardinal Health, Inc., Dublin, Ohio
- Internal Medicine and Interventional Nephrology, University of Louisville, Louisville, Kentucky
- Internal Medicine and Nephrology, University of Nebraska Medical Center, Omaha, Nebraska
- Internal Medicine and Nephrology, University of Alabama at Birmingham Medical Center, Birmingham, Alabama
- Indiana University Health Arnett Hospital, Lafayette, Indiana
- HemoCleanse Technologies, LLC, Lafayette, Indiana; and
- Ash Access Technology, Inc., Lafayette, Indiana
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Gnass M, Gielish C, Acosta-Gnass S. Incidence of nosocomial hemodialysis-associated bloodstream infections at a county teaching hospital. Am J Infect Control 2014; 42:182-4. [PMID: 24485373 DOI: 10.1016/j.ajic.2013.08.014] [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: 06/28/2013] [Revised: 08/25/2013] [Accepted: 08/25/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infections are an important cause of morbidity and mortality in patients undergoing hemodialysis. Limited information is to be found regarding nosocomial hemodialysis-associated bloodstream infections (HABSI). METHODS We sought to determine the rate of nosocomial HABSI and its associated risk factors at Riverside County Regional Medical Center. Inpatients who received hemodialysis during 2011 and 2012 were included, and outcomes were recorded along with risk factors. Data was analyzed with SPSS Inc software. RESULTS A total of 619 patients was included. Fourteen HABSI were detected, with a rate of 3.33/1,000 hemodialysis sessions and 1.03/1,000 patient-days. An association was detected between HABSI and vascular access type (highest risk with nontunneled catheters), length of hospital stay, number of hemodialysis sessions, and hemoglobin A1c level. A correlation was also noted between HABSI because of MRSA and colonization of nares with MRSA. A predominance of staphylococci infections was detected. CONCLUSION The rate of HABSI observed at Riverside County Regional Medical Center was lower than similar studies (2.5 per 1,000 patient-days and 3.95 per 1,000 hemodialysis sessions). The most important risk factors were determined to be nontunneled catheters, hemoglobin A1c greater than 7%, and nares colonization for HABSI because of MRSA. Infection prevention efforts in the inpatient hemodialysis population should focus on control of hyperglycemia and decolonization of nares from MRSA.
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De Paula DHG, Tura BR, Lamas CDC. Adverse events related to intravenous antibiotic therapy: a prospective observational study in the treatment of infective endocarditis. BMJ Open 2012; 2:bmjopen-2012-001189. [PMID: 23103604 PMCID: PMC3534239 DOI: 10.1136/bmjopen-2012-001189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The goal of this prospective observational study was to identify adverse events (AEs) related to the use of intravenous access sites used for infective endocarditis (IE) treatment in a tertiary care hospital. DESIGN This is an observational, analytical and prospective study on AEs resulting from the use of intravenous access sites in patients under antimicrobial treatment for IE. Patients enrolled in the International Collaboration on Endocarditis (ICE) study had their peripheral, short-term central catheters (CVC) and peripherally inserted central catheters (PICC) monitored for AEs. SETTING Tertiary care hospital for cardiac surgery in Rio de Janeiro, Brazil. PATIENTS Patients over 14 years of age, hospitalised in 2009 and 2010 with possible or definite criteria for IE by the modified Duke criteria were included. MAIN OUTCOME MEASURES AEs related to intravenous catheters: erythema and infiltration, fever, obstruction, externalisation and blood stream infection. RESULTS Thirty-seven episodes of IE in 35 patients were studied. Mean patient age was 44.32±15.2 years; 22 (63%) were men. The number of vascular catheters studied were 253, 148 of which were peripheral, 85 CVC (21 of which for haemodialysis) and 20 PICC. The most frequent AEs were 'erythema' and 'infiltration' for peripheral catheters, 'fever' for CVCs and 'obstruction' and 'externalisation' for PICCs. The number of catheter-days was 360 for peripheral catheters, 1.156 for CVC and 420 for PICC. Kaplan-Meier curves for CVC and PICC showed statistical difference for obstruction (p<0.001) in PICCs. More bacteraemia occurred in CVC compared with PICC. CONCLUSIONS The choice of intravenous access sites is critical in the treatment of IE. Close observation for AEs and stricter implementation of infection control measures and better manipulation of catheters are suggested.
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Affiliation(s)
| | - Bernardo Rangel Tura
- Department of Biostatistics and Bioinformatics, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Cristiane da Cruz Lamas
- Professor of Infectious Diseases, Unigranrio, Rio de Janeiro, Infection Control Committee, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
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