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Ohara H. Growth and Control of Catheter-related Bloodstream Infection Causing Bacteria in Nutrient Solutions. YAKUGAKU ZASSHI 2022; 142:303-315. [DOI: 10.1248/yakushi.21-00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hiroshi Ohara
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University
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Saqui O, Fernandes G, Allard J. Central venous catheter infection in Canadian home parenteral nutrition patients: a 5-year multicenter retrospective study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S34-S42. [PMID: 32324464 DOI: 10.12968/bjon.2020.29.8.s34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
HIGHLIGHTS A lower central venous catheter (CVC) infection rate suggests an improvement in practice and education. CVC infection remains a complication that often requires significant health care resources. Use of tunneled CVC and patient education on catheter care reduces CVC infection rates. OBJECTIVES CVC infection is one of the most frequent, life-threatening complications in home parenteral nutrition (HPN) patients. Our objective was to conduct a 5-year retrospective chart review regarding CVC infections in 3 adult HPN programs. METHODS Data were collected from the Canadian HPN Registry and patient charts that include demography, infection diagnosis, blood cultures, and treatments. RESULTS Results are reported as median (range) ± standard error of mean or population frequency. Eighty-one charts were reviewed. Mean age was 51.98 ± 1.71 years. Short bowel syndrome (54.3%) was the primary diagnosis, with 36 months (range, 1324 months) median length of HPN therapy. Forty-seven subjects (58%) had infections over a 5-year period. Of these, there were 144 sepsis events. There was positive correlation (r=0.423; P<0.001) between number of infections and HPN duration. The median length of time the CVC was in place was 281 (range, 14-4380) days. There were 66.7% tunneled CVCs; 25.9% peripherally inserted central catheters (PICCs), and 7.4% implanted venous port. In this sample, there was no association between line infection and catheter type. Most patients presented with fever (58.3%) and chills (38.2%). Blood cultures were done (89.6%), and coagulase negative Staphylococcus was the resulting pathogen present in 25.7%. Patients with bloodstream infection were treated for 17.9 ± 1.2 days with combination antibiotics (22.2%). Overall, the CVC infection rate was 0.97 per 1000 catheter days. CONCLUSION We found the standard approach to infection prevention is comparable to reports in literature. However, a subset of patients with multiple CVC infections require education with an emphasis on preventive techniques in order to reduce the incidence of infection.
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Affiliation(s)
- Olivia Saqui
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - G Fernandes
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - J Allard
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Ohara H, Watanabe M, Takebayashi M, Abe S, Matsuzaki T, Hayasaka M. Bactericidal and Antiproliferative Effects of Peripheral Parenteral Nutrition Solutions with Sodium Bisulfite on Pathogenic Microorganisms in Catheter Lumens. Int J Med Sci 2020; 17:1833-1839. [PMID: 32714086 PMCID: PMC7378669 DOI: 10.7150/ijms.48829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
Catheter-related bloodstream infections (CRBSIs) due to pathogenic microorganisms pose a major threat to patients requiring parenteral nutrition (PN). Additives contained in medicines and foods have antiproliferative and bacteriostatic effects on pathogenic microorganisms. Therefore, PN solutions containing additives may also have an antibacterial effect. However, so far, there have been no reports on or observations of a PN solution with bactericidal activity. In this study, we assessed several nutrition solutions with antimicrobial activities and investigated their effects on pathogenic microorganisms colonizing catheter lumens. We selected the highly acidic Plas-Amino® (PA), which contains a large amount of sodium bisulfite as a preservative and potentially has an antimicrobial effect. In this study, we used the following pathogenic bacteria as the main causatives of CRBSIs: Staphylococcus aureus, Staphylococcus epidermidis, Bacillus cereus, Serratia marcescens, Pseudomonas aeruginosa, and Candida albicans. We then created a catheter lumen microorganism contamination model and evaluated the antibacterial effect of PA; we found that all bacteria in the control group grew significantly in the catheter lumen in a time-dependent manner at 48 and 72 h. On the other hand, we demonstrated that PA has bactericidal effects on S. aureus, S. epidermidis, B. cereus, S. marcescens, and P. aeruginosa in the catheter lumen and confirmed that it has a remarkable antiproliferative effect on C. albicans. Hence, we concluded that highly acidic PN solutions that contain a preservative like sodium bisulfite have bactericidal and growth inhibition effects on microorganisms in the catheter lumens of patients with CRBSIs and patients with totally implantable central venous access devices, in whom it is difficult to remove the catheter.
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Affiliation(s)
- Hiroshi Ohara
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan.,Department of Pharmacy, Ohu University Hospital, 31-1 Misumido, Tomitamachi-aza, Koriyama, Fukushima 963-8611, Japan
| | - Masanori Watanabe
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan
| | - Masamu Takebayashi
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan
| | - Saori Abe
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan
| | - Tetsuya Matsuzaki
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan
| | - Masataka Hayasaka
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan
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Omotani S, Tani K, Nagai K, Hatsuda Y, Mukai J, Myotoku M. Water Soluble Vitamins Enhance the Growth of Microorganisms in Peripheral Parenteral Nutrition Solutions. Int J Med Sci 2017; 14:1213-1219. [PMID: 29104477 PMCID: PMC5666554 DOI: 10.7150/ijms.21424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/21/2017] [Indexed: 11/16/2022] Open
Abstract
Peripheral parenteral nutrition (PPN) solutions contain amino acids, glucose, and electrolytes, with or without some water soluble vitamins. Peripheral venous catheters are one of the causes of catheter related blood stream infection (CRBSI), which requires infection control. In Japan, PPN solutions have rarely been prepared under aseptic conditions. However, in recent years, the necessity of adding vitamins to infusions has been reported. Therefore, we investigated the effects of water soluble vitamins on growth of microorganisms in PPN solutions. AMINOFLUID® (AF), BFLUID® (BF), PARESAFE® (PS) and PAREPLUS® (PP) PPN solutions were used. Water soluble vitamins contained in PP were also used. Causative microorganisms of CRBSI were used. Staphylococcus epidermidis decreased after 24 hours or 48 hours in all solutions. On the other hand, Escherichia coli, Serratia marcescens, Pseudomonas aeruginosa, Staphylococcus aureus and Candida albicans increased, especially in PP. When each water soluble vitamin was added to BF and PS, growth of S. aureus was greater in solutions that contained nicotinamide than in solutions that contained other vitamins. As for C. albicans, they grew in all test solutions. C. albicans grew especially well in solutions that contained biotin. When commercial amino acids and glucose solutions with electrolytes are administered, in particular those containing multivitamins or water soluble vitamins, efforts to control infection must be taken to prevent proliferation of microorganisms.
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Affiliation(s)
- Sachiko Omotani
- Laboratory of Practical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Osaka Ohtani University
| | - Katsuji Tani
- Laboratory of Environmental Science and Microbiology, Faculty of Pharmacy, Osaka Ohtani University
| | - Katsuhito Nagai
- Laboratory of Practical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Osaka Ohtani University
| | - Yasutoshi Hatsuda
- Laboratory of Practical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Osaka Ohtani University
| | - Junji Mukai
- Laboratory of Practical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Osaka Ohtani University
| | - Michiaki Myotoku
- Laboratory of Practical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Osaka Ohtani University
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Abstract
Patients who cannot ingest adequate calories to maintain body weight via their gastrointestinal tract may require parenteral nutrition (PN) at home. As with any therapy, the patient must be evaluated to determine if the home PN (HPN) is effective and the patient is free of complications. This review discusses specific items to monitor for HPN patients. Parameters to monitor can be divided into those used to determine effectiveness and those used to prevent complications of HPN. In addition, potential HPN-associated complications can be divided into those that occur with short- or long-term PN administration. Specific items to monitor are discussed within this framework.
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Kuwahara T, Kaneda S, Shimono K. Adding Biotin to Parenteral Nutrition Solutions Without Lipid Accelerates the Growth of Candida albicans. Int J Med Sci 2016; 13:724-9. [PMID: 27648003 PMCID: PMC5027192 DOI: 10.7150/ijms.15951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We have previously demonstrated that Candida albicans requires multivitamins (MVs) or lipid to increase rapidly in parenteral nutrition (PN) solutions. In this study, in detail, the effects of vitamins on the growth of C. albicans in PN solutions without lipid were investigated. METHODS In the 1st experiment, a commercial PN solution without lipid was supplemented with water-soluble vitamins (SVs: vitamins B1, B2, B6, B12 and C, folic acid, nicotinamide, biotin and panthenol), water-insoluble vitamins (IVs: vitamins A, D, E and K) or both (MVs). In the 2nd experiment, the test solutions were prepared by supplementing the PN solution with one of each or all of the SVs. In the 3rd experiment, another commercial peripheral PN (PPN) solution without lipid was supplemented with SVs, nicotinic acid, biotin or both nicotinic acid and biotin. In each of the experiments, a specified number of C. albicans organisms was added to each test solution, and all of the test solutions were allowed to stand at room temperature (23-26ºC). The number of C. albicans was counted at 0, 24, 48 and 72 hours after the addition of the organism. RESULTS In the 1st experiment, the C. albicans increased rapidly in the PN solution supplemented with the SVs, but increased slowly without the SVs, regardless of the addition of the IVs. In the 2nd experiment, the C. albicans increased rapidly in the PN solution supplemented with the SVs or biotin, but increased slowly with each of the other water-soluble vitamins. In the 3rd experiment, the C. albicans increased rapidly in the PPN solution supplemented with the SVs or biotin, but increased slowly with the addition of nicotinic acid. CONCLUSIONS These results suggested that adding MVs or SVs to PN solutions without lipid promotes the growth of C. albicans, and that this effect is mostly attributable to biotin.
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Affiliation(s)
- Takashi Kuwahara
- Naruto Research Institute, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 115 Tateiwa, Naruto, Tokushima 772-8601, Japan
| | - Shinya Kaneda
- Naruto Research Institute, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 115 Tateiwa, Naruto, Tokushima 772-8601, Japan
| | - Kazuyuki Shimono
- Naruto Research Institute, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 115 Tateiwa, Naruto, Tokushima 772-8601, Japan
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Safdar N, O’Horo JC, Ghufran A, Bearden A, Didier ME, Chateau D, Maki DG. Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis*. Crit Care Med 2014; 42:1703-13. [PMID: 24674924 PMCID: PMC4258905 DOI: 10.1097/ccm.0000000000000319] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter-related colonization and catheter-related bloodstream infection using meta-analysis. DATA SOURCES Multiple computerized database searches supplemented by manual searches including relevant conference proceedings. STUDY SELECTION Randomized controlled trials evaluating the efficacy of a chlorhexidine-impregnated dressing compared with conventional dressings for prevention of catheter colonization and catheter-related bloodstream infection. DATA EXTRACTION Data were extracted on patient and catheter characteristics and outcomes. DATA SYNTHESIS Nine randomized controlled trials met the inclusion criteria. Use of a chlorhexidine-impregnated dressing resulted in a reduced prevalence of catheter-related bloodstream infection (random effects relative risk, 0.60; 95% CI, 0.41-0.88, p = 0.009). The prevalence of catheter colonization was also markedly reduced in the chlorhexidine-impregnated dressing group (random effects relative risk, 0.52; 95% CI, 0.43-0.64; p < 0.001). There was significant benefit for prevention of catheter colonization and catheter-related bloodstream infection, including arterial catheters used for hemodynamic monitoring. Other than in low birth weight infants, adverse effects were rare and minor. CONCLUSIONS Our analysis shows that a chlorhexidine-impregnated dressing is beneficial in preventing catheter colonization and, more importantly, catheter-related bloodstream infection and warrants routine use in patients at high risk of catheter-related bloodstream infection and central venous catheter or arterial catheter colonization.
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Affiliation(s)
- Nasia Safdar
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - John C. O’Horo
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - Aiman Ghufran
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - Allison Bearden
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - Maria Eugenia Didier
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - Dan Chateau
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - Dennis G. Maki
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
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Raheem SA, Deen OJ, Corrigan ML, Parekh N, Quintini C, Steiger E, Kirby DF. Bariatric Surgery Complications Leading to Small Bowel Transplant. JPEN J Parenter Enteral Nutr 2013; 38:513-7. [DOI: 10.1177/0148607113486808] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Omer J. Deen
- Center for Human Nutrition, The Cleveland Clinic, Cleveland, Ohio
| | | | - Neha Parekh
- Intestinal Rehabilitation and Transplant, Cleveland, Ohio
| | | | - Ezra Steiger
- Cleveland Clinic Lerner College of Medicine, Nutrition Support Team, Intestinal Rehab and Transplant Program, Cleveland, Ohio
| | - Donald F. Kirby
- Center for Human Nutrition, The Cleveland Clinic, Cleveland, Ohio
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Kuwahara T, Kaneda S, Shimono K, Inoue Y. Effects of lipid emulsion and multivitamins on the growth of microorganisms in peripheral parenteral nutrition solutions. Int J Med Sci 2013; 10:1079-84. [PMID: 23869182 PMCID: PMC3714382 DOI: 10.7150/ijms.6407] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/14/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Blood stream infections caused by Bacillus cereus or Serratia marcescens in patients receiving peripheral parenteral nutrition (PPN) have occasionally been reported in Japan, but these microorganisms are not major causes of blood stream infections in patients receiving total parenteral nutrition via a central venous catheter. In Japan, commercially available PPN solutions contain amino acids, glucose, and electrolytes, but not contain lipid emulsion (LE) and multivitamins (MV). In this study, the effects of LE and MV on the growth of microorganisms such as Bacillus cereus, Serratia marcescens, Staphylococcus aureus, and Candida albicans in PPN solutions were investigated. METHODS A commercial 3% amino acid and 7.5% glucose solution with electrolytes (AF) was used as the base solution to prepare test solutions (LAF, AFV, and LAFV) containing LE, MV, or both. Specifically, 20% LE was added to AF in a ratio of 1:9 to prepare LAF. MV was added to AF and LAF to prepare AFV and LAFV, respectively. A specified number of each microorganism was added to each 100 mL of AF, LAF, AFV, and LAFV in sterile plastic flasks, and all flasks were allowed to stand at room temperature. The number of colony forming units per mL of each microorganism was counted at 0, 24, and 48 hours after the addition of each microorganism. RESULTS Both Bacillus cereus and Serratia marcescens increased rapidly in AF as well as in LAF, AFV, and LAFV. Staphylococcus aureus did not increased in AF, but increased slightly in LAF and increased rapidly in AFV and LAFV. Candida albicans increased slightly in AF and increased rapidly in LAF, AFV, and LAFV. CONCLUSIONS The results suggest the followings: if microbial contamination occurs, 1) Bacillus cereus and Serratia marcescens can grow rapidly in PPN solutions consisting of amino acids, glucose and electrolytes; 2) Staphylococcus aureus cannot grow without LE and MV, but can grow rapidly with MV; 3) Candida albicans can grow slowly without LE and MV, and the addition of LE or MV accelerates its growth.
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Affiliation(s)
- Takashi Kuwahara
- 1. Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 115 Tateiwa, Naruto, Tokushima 772-8601, Japan.
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Ferreira MVF, Andrade DD, Ferreira AM. Controle de infecção relacionada a cateter venoso central impregnado com antissépticos: revisão integrativa. Rev Esc Enferm USP 2011; 45:1002-6. [DOI: 10.1590/s0080-62342011000400030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 11/18/2010] [Indexed: 11/22/2022] Open
Abstract
O uso de cateter venoso central é apontado como um dos principais fatores para infecção da corrente sanguínea. Objetiva-se, neste estudo, buscar evidências científicas sobre o controle de infecção relacionada ao cateter venoso central impregnado com antissépticos utilizado em pacientes adultos hospitalizados. Para seleção dos estudos, foram utilizadas as bases de dados LILACS, CINAHL e MEDLINE. Totalizaram-se nove artigos por meio da revisão integrativa da literatura. As publicações acerca da utilização de cateteres impregnados com antissépticos mostraram diferença estatisticamente significante quanto à redução da colonização microbiana. Entretanto, apenas um estudo demonstrou redução na ocorrência da infecção. Diante das análises dos estudos, há necessidade de pesquisas adicionais em diferentes populações de pacientes com a finalidade de efetuar generalizações.
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Kuwahara T, Shimono K, Kaneda S, Tamura T, Ichihara M, Nakashima Y. Growth of microorganisms in total parenteral nutrition solutions containing lipid. Int J Med Sci 2010; 7:101-9. [PMID: 20567610 PMCID: PMC2880838 DOI: 10.7150/ijms.7.101] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 05/17/2010] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To identify the microorganisms that can grow rapidly in total parenteral nutrition (TPN) solutions, we investigated the growth of the major causes of catheter-related blood stream infection (Staphylococcus aureus, Serratia marcescens, Bacillus cereus, and Candida albicans) in TPN solutions containing lipid. METHODS The pH value of a TPN solution containing lipid (pH 6.0, containing 20 ppm of NaHSO(3)) was adjusted by the addition of HCl to 5.7, 5.4, or 4.9. The pH value of another TPN solution (pH5.5, containing 400 ppm of NaHSO(3)) was adjusted by the addition of NaOH to 5.9, 6.3, or 6.8. A specific number of each microorganism was added to 10 mL of each test solution and incubated at room temperature. The number of microorganisms was counted as colony forming units at 0, 24, and 48 hrs later. RESULTS C albicans increased similarly at any pH values in the TPN solution. The bacterial species also increased rapidly at pH6.0 in the solution containing 20 ppm of NaHSO(3), but growth was suppressed as the pH value was reduced, with growth halted at pH4.9. However, these bacterial species did not increase, even at pH5.9, in the other solution containing 400 ppm of NaHSO(3). CONCLUSIONS These results suggest that Candida species can grow rapidly in almost all TPN solutions regardless of the acidity, lipid, and NaHSO(3); also, some bacterial species may grow in TPN solutions containing lipid unless the pH value is 5.0 or less. Therefore, each TPN solution should be examined whether or not the bacterial species can proliferate.
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Affiliation(s)
- Takashi Kuwahara
- Preclinical Assessment Department, Otsuka Pharmaceutical Factory, Inc., Tokushima, Japan.
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Kuwahara T, Kaneda S, Shimono K, Inoue Y. Growth of microorganisms in total parenteral nutrition solutions without lipid. Int J Med Sci 2010; 7:43-7. [PMID: 20107529 PMCID: PMC2811814 DOI: 10.7150/ijms.7.43] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 01/21/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To identify the microorganisms that can grow rapidly in total parenteral nutrition (TPN) solutions, we investigated the growth of the major causes of catheter-related blood stream infection (Staphylococcus aureus, Serratia marcescens, Bacillus cereus, and Candida albicans) in TPN solutions without lipid. METHODS Experiment 1: A commercial TPN solution without lipid containing multivitamins (pH5.6) was used. A specific number of each test microorganism was added to each 10 mL of the TPN solution and incubated at room temperature. An aliquot of test solution was sampled and inoculated to SCD agar plates at 0, 24, and 48 hrs after the addition of the microorganisms. The number of microorganisms was counted as colony forming units. Experiment 2: The other 2 commercial TPN solutions without lipid (pH5.5) were supplemented with multivitamins. The pH values of the solutions were adjusted to about 6.0, 6.5, or 7.0 using 0.5 mol/L NaOH. The addition of microorganisms, incubation, and counting were performed in the same manner. RESULTS Experiment 1: S. aureus, S. marcescens, and B. cereus did not increase in the TPN solution without lipid containing multivitamins (pH5.6), but C. albicans increased rapidly. Experiment 2: The 3 bacterial species did not increase even at pH6.0, but increased at pH6.5 and increased rapidly at pH7.0 in both TPN solutions. C. albicans increased similarly at any pH. CONCLUSION These results suggest that bacterial species cannot grow in TPN solutions without lipid due to the acidity (pH5.6 or lower), but Candida species can grow regardless of the acidity.
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Affiliation(s)
- Takashi Kuwahara
- Preclinical Assessment Department, Otsuka Pharmaceutical Factory, Inc., 115 Tateiwa, Naruto, Tokushima 772-8601, Japan.
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Abstract
Catheter-related bloodstream infection (CRBSI) is the most common complication related to peripherally inserted central catheters in the neonatal intensive care unit. CRBSIs are responsible for many morbidities and mortalities occurring in special care nurseries. However, these vascular access devices are an essential aspect of neonatal care and therefore are indispensable. To minimize CRBSI incidences and improve patient outcomes, objectives must be established to focus on the prevention of these potentially life-threatening infections. This article identifies the interventions incorporated by our facility to prevent nosocomial bloodstream infections.
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Edwards JF, Lassala AL, Spencer TE. Staphylococcus-associated abortions in ewes with long-term central venous catheterization. Vet Pathol 2008; 45:881-8. [PMID: 18984790 DOI: 10.1354/vp.45-6-881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Forty-two ewes had an intravenous catheter sewn in place in a prepared area over the jugular vein and beginning at 60 days of gestation received an infusion 3 times daily. The infusion consisted of sterile saline or sterile saline containing arginine. Twenty-six ewes in both control and treatment groups aborted between 81 days of gestation and term. Fetuses from 16 ewes that aborted were examined. Most were autolyzed or had early mummification. Macroscopic placentitis and noncollapsing lungs were noted. Large numbers of coagulase-positive Staphylococcus were isolated from fetal abomasal content, lungs, brains, or placentas. Histologically, suppurative placentitis with necrosis and pulmonary aspiration of meconium and amniotic debris often with suppurative bronchopneumonia were observed in abortuses. Four ewes euthanized and examined after abortion had suppurative endometritis. Three ewes had severe, chronic, jugular thrombophlebitis from which coagulase-positive Staphylococcus was isolated. The fourth ewe had mild phlebitis, and Staphylococcus aureus was isolated from both the catheter and the blood. Catheter-associated staphylococcal abortion was diagnosed.
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Affiliation(s)
- J F Edwards
- Department of Veterinary Pathobiology, Texas A&M University, College Station, TX 77843-4067, USA.
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15
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Abstract
Neonates are one of the highest risk groups of hospitalized patients for sepsis. There is a wide variation in the incidence and microbial causes of late-onset neonatal sepsis, owing to differences in both patient populations and standards of care in the individual neonatal units. Stratification according to risk factors is required to allow the meaningful comparison of infection rates between units. Knowledge of risk factors is also important in order to target interventions on high-risk aspects of neonatal care. Few independent risk factors for late-onset sepsis have been identified, the most common being birth gestational age and parenteral nutrition. Further work is required to validate that these observations can be generalized, and that they could, therefore, be used to stratify infection rates in multicenter surveillance schemes.
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Affiliation(s)
- James W Gray
- Birmingham Children’s Hospital, Department of Microbiology, Steelhouse Lane, Birmingham, B4 6NH, UK
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Richardson D. Vascular Access Nursing Practice, Standards of Care, and Strategies to Prevent Infection: A Review of Skin Cleansing Agents and Dressing Materials (Part I of a 3-Part Series). ACTA ACUST UNITED AC 2006. [DOI: 10.2309/java.11-4-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
This three-part series of articles (parts 2 and 3 will be published in the Spring and Summer 2007 journal issues, respectively) will include information appropriate for the novice and the expert vascular access nurse. The series will include primers on vascular access devices, along with review of skin cleansing agents, dressing materials, catheter flush solutions, and injection caps. The focus of the article series will be the issue of catheter-related bloodstream infection, practice, technologies developed to prevent or decrease infections, current standards, and guidelines and preventive strategies.
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