Comparative risk of bloodstream infection in hospitalized patients receiving intravenous medication by open, point-of-care, or closed delivery systems

A prospective study of epidemiology characteristics and outcomes of bloodstream infections in older patients

OBJECTIVE

This study aimed to investigate the characteristics of bloodstream infections (BSIs) in older patients and describe the differences between community-acquired, hospital-acquired and health care-associated BSIs.

METHODS

A prospective observational study was conducted at the University Hospital of Heraklion, Crete, Greece. Epidemiology, clinical characteristics and outcomes of BSIs were recorded.

RESULTS

During a four-year period, 113 BSIs were recorded. Of them, 42% occurred in male patients; patients' mean age was 80 years. BSIs were community-acquired in 76% of patients, hospital-acquired in 12% and health care-associated in 12%. The most commonly isolated bacteria were E coli and K pneumoniae. Thirty-day mortality from detection of BSIs was 27%. Patients with fever, without septic shock and with appropriate empirical treatment were less likely to die.

CONCLUSION

Community-acquired, health care-associated and hospital-acquired BSIs had different presentation, microbiology and outcomes. Older patients had a high mortality. The absence of fever, inappropriate empirical treatment and septic shock were independent mortality predictors.

Comparing the risk of bloodstream infections by type of parenteral nutrition preparation method: A large retrospective, observational study

BACKGROUND AND AIMS

Complications such as blood stream infections (BSI) have been observed with the administration of parenteral nutrition (PN). Prior published studies reported the incidence of BSI for inpatient hospitalizations by comparing patients treated with custom compounded parenteral nutrition to those treated with premixed multichamber bag (MCB) formulations. Previous publications grouped patients treated with MCBs into a single category and no distinction was made between patients receiving only a MCB and those receiving a MCB supplemented with manual additions. This Study aims to assess differences in risk of blood stream infection, cost, and clinical outcomes among patients receiving multichamber bag parenteral nutrition products only (MCB-only), MCB with additions (MCB-addition), and compounded (COM) PN products using seven years of Premier Healthcare Data from 688 hospitals in the United States of America.

METHODS

Adult inpatients who were discharged between 01/01/2008 and 12/31/2014, had a hospital length of stay ≥3 days and received PN during the index hospitalization were analyzed. PN preparation method was determined by billing charge descriptions. BSI was defined as having primary or secondary ICD-9 diagnosis codes of 038.x (septicemia), 995.91 (sepsis), 995.92 (severe sepsis), and 790.7 (bacteremia). Multivariable regression models were used to assess effect of PN preparation on patient outcomes, adjusting for confounders.

RESULTS

84,564 patients were analyzed (MCB-only: 6.3%; MCB-addition: 14.8%; COM: 78.9%). Multivariable analysis indicated that compared to COM group, MCB-addition group had similar risk of BSI (7.0% vs. 6.8%, P > 0.05) and a 2.7% lower average total hospitalization cost ($28,072 vs. $28,861, P < 0.05) but had a higher PN treatment cost ($1135 vs. $1,031, P < 0.05) and a higher percentage of being discharged to rehabilitation or other acute care facilities (39.4% vs. 31.1%, P < 0.05). MCB-only group had lower risk of BSI and hospitalization cost.

CONCLUSIONS

In the U.S., compounded PN is the most commonly used in clinical practice followed by MCB with additions. MCB-addition group had similar BSI risk with COM. The slightly lower overall cost in MCB-addition group may be offset by higher post-hospitalization care cost to providers and payers under bundled payment methods in the U.S.

Air contamination in the sclerosing foam for the treatment of varicose veins

BACKGROUND

Fluids and drugs formulated for intravenous infusion may potentially promote the growth of microorganisms that can cause infections. The aim of this study is to test the sterility of sclerosing foam.

METHODS

Polidocanol was used for the production of the foam. The Tessari method was used in order to generate the foam. The preparation was carried out both in the operating theater and in an outpatient room. A validation test with microorganisms was also performed.

RESULTS

The measurements showed no evident growth of microorganisms and in the validation tests the foam appeared to even display bacteriostatic and/or bactericide properties.

CONCLUSIONS

Sclerosing foam seems to be safe from a microbiological point of view.