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Barakzai MD, Bozic D, Gupta S, Amirabadi A, Temple M, Chiramel GK, Parra D, Gasparetto A, Amaral JG. Fever at Time of Leukemia Diagnosis in Children: Predictor of Bloodstream Infection or Catheter Removal? J Vasc Interv Radiol 2024:S1051-0443(24)00126-X. [PMID: 38342222 DOI: 10.1016/j.jvir.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/13/2024] Open
Abstract
PURPOSE To assess the incidence of fever at diagnosis in children with leukemia and determine if fever at diagnosis is a predictor of bloodstream infection (BSI) or central venous access device (CVAD) removal due to infection either within the first 30 days or between 30 and 90 days after CVAD insertion. MATERIALS AND METHODS One hundred fifty-one patients with acute leukemia (July 1, 2018, to December 31, 2020) who underwent a CVAD insertion within 2 weeks of diagnosis were included. Patient data included demographic characteristics, fever at diagnosis, CVAD type, antibiotics before and/or on the day of CVAD insertion, BSI incidence, BSI rates per 1,000 catheter days, and need for catheter removal after CVAD insertion within 30 days and between 30 and 90 days. RESULTS Patients with fever at diagnosis had a significantly higher incidence of BSI within the first 30 days after CVAD insertion (17/23) than that among patients without fever (6/23) (P = .046) at diagnosis. No statistically significant difference was observed in the incidence of BSI between 30 and 90 days after CVAD insertion between patients with fever (5/11) and those without fever at diagnosis (6/11) (P = .519). Fever at diagnosis was not a predictor of CVAD removal within 30 days (9 patients required CVAD removal; 7/9 had fever and 2/9 had no fever) (P = .181) or between 30 and 90 days (4 patients required CVAD removal; 1/4 had fever and 3/4 had no fever at diagnosis) (P = .343) after insertion. CONCLUSIONS Fever at diagnosis in patients with leukemia is not a predictor of CVAD removal due to infection.
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Affiliation(s)
- Muhammad Danish Barakzai
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Dalia Bozic
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sumit Gupta
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Amirabadi
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Temple
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - George Koshy Chiramel
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Dimitri Parra
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Alessandro Gasparetto
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Joao Guilherme Amaral
- Division of Image-Guided Therapy, Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Valtin J, Behrens S, Ruland A, Schmieder F, Sonntag F, Renner LD, Maitz MF, Werner C. A New In Vitro Blood Flow Model for the Realistic Evaluation of Antimicrobial Surfaces. Adv Healthc Mater 2023; 12:e2301300. [PMID: 37498721 DOI: 10.1002/adhm.202301300] [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: 04/24/2023] [Revised: 06/13/2023] [Indexed: 07/29/2023]
Abstract
Device-associated bloodstream infections can cause serious medical problems and cost-intensive postinfection management, defining a need for more effective antimicrobial coatings. Newly developed coatings often show reduced bacterial colonization and high hemocompatibility in established in vitro tests, but fail in animal studies or clinical trials. The poor predictive power of these models is attributed to inadequate representation of in vivo conditions. Herein, a new single-pass blood flow model, with simultaneous incubation of the test surface with bacteria and freshly-drawn human blood, is presented. The flow model is validated by comparative analysis of a recently developed set of antiadhesive and contact-killing polymer coatings, and the corresponding uncoated polycarbonate surfaces. The results confirm the model's ability to differentiate the antimicrobial activities of the studied surfaces. Blood activation data correlate with bacterial surface coverage: low bacterial adhesion is associated with low inflammation and hemostasis. Shear stress correlates inversely with bacterial colonization, especially on antiadhesive surfaces. The introduced model is concluded to enable the evaluation of novel antimicrobial materials under in vivo-like conditions, capturing interactions between bacteria and biomaterials surfaces in the presence of key components of the ex vivo host response.
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Affiliation(s)
- Juliane Valtin
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Stephan Behrens
- Fraunhofer Institute for Material and Beam Technology IWS, 01277, Dresden, Germany
| | - André Ruland
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Florian Schmieder
- Fraunhofer Institute for Material and Beam Technology IWS, 01277, Dresden, Germany
| | - Frank Sonntag
- Fraunhofer Institute for Material and Beam Technology IWS, 01277, Dresden, Germany
| | - Lars D Renner
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Manfred F Maitz
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Carsten Werner
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
- Technische Universität Dresden, Cluster of Excellence Physics of Life, Center for Regenerative Therapies Dresden and Faculty of Chemistry and Food Chemistry, 01307, Dresden, Germany
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Opoku-Asare B, Boima V, Ganu VJ, Aboagye E, Asafu-Adjaye O, Asare AA, Kyeremateng I, Kwakyi E, Agyei A, Sampane-Donkor E, Puplampu P. Catheter-Related Bloodstream Infections among patients on maintenance haemodialysis: a cross-sectional study at a tertiary hospital in Ghana. BMC Infect Dis 2023; 23:664. [PMID: 37805461 PMCID: PMC10559469 DOI: 10.1186/s12879-023-08581-6] [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: 05/01/2023] [Accepted: 09/04/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Catheter-Related Bloodstream Infections (CRBSIs) are notable complications among patients receiving maintenance haemodialysis. However, data on the prevalence of CRBSIs is lacking. This study was conducted to determine the prevalence and factors associated with CRBSIs among patients receiving haemodialysis in the renal unit of the largest tertiary hospital in Ghana. METHODS A hospital-based cross-sectional study was conducted on patients receiving maintenance haemodialysis via central venous catheters (CVC) between September 2021 and April 2022. Multivariate analysis using logistic regression was used to determine the risk factors that were predictive of CRBSI. Analysis was performed using SPSS version 23 and a p-value<0.05 was statistically significant. RESULTS The prevalence of CRBSI was 34.2% (52/152). Of these, more than half of them (53.9%(28/52)) had Possible CRBSI while 11.5% (6/52) had Definite CRBSI. Among the positive cultures, 62% (21/34) were from catheter sites whilst the rest were from peripheral blood. Gram-negative cultures made up 53% (18/34) of positive cultures with the rest being Gram positive cultures. Acinetobacter baumannii (33.3% (6/18)) was the commonest organism isolated among Gram-negative cultures whilst Coagulase negative Staphylococci (43.7% (7/16)) was the commonest organism isolated among Gram-positve cultures. Gram-negative bacilli were more predominant in this study making up 52.9% of the total bacteria cultured. Sex, duration of maintenance dialysis, underlying cause of End-stage kidney disease, mean corpuscular haemoglobin (MCH), neutrophil count and lymphocyte count were significantly predictive of CRBSI status (p<0.05). CONCLUSION There was a high prevalence of CRBSI among patients undergoing haemodialysis. The commonest causative agent was Coagulase negative Staphylococci, however there was a predominance of Gram-negative bacilli as compared to Gram positive cocci. There is a need to set up infection surveillance unit in the renal unit to track CRBSI and put in place measures to reduce these CRBSI.
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Affiliation(s)
| | - Vincent Boima
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana
| | | | - Elvis Aboagye
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | | | - Anita Ago Asare
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | | | - Edward Kwakyi
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Adwoa Agyei
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Eric Sampane-Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Peter Puplampu
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana.
- Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana.
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Weldetensae MK, Weledegebriel MG, Nigusse AT, Berhe E, Gebrearegay H. Catheter-Related Blood Stream Infections and Associated Factors Among Hemodialysis Patients in a Tertiary Care Hospital. Infect Drug Resist 2023; 16:3145-3156. [PMID: 37249964 PMCID: PMC10216862 DOI: 10.2147/idr.s409400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Non-tunneled central venous catheter remains the preferred vascular access at hemodialysis initiation in developing countries despite a high burden of infection complications. The goal of this study was to determine the burden, risk factors, and microbiological spectrum of catheter-related bloodstream infections at a tertiary care center in Ethiopia. Methods A retrospective cross-sectional study design was applied among patients who underwent central venous catheter insertion for hemodialysis between January 2016 and June 2022 with no native arteriovenous fistula and stayed more than 48 hours. Data were collected from the patient's registration book, patient charts, and microbiology registry and analyzed using SPSS 21. Binary logistic regression was applied to assess the relationship between the independent and outcome variables. P-values less than 0.05 with AOR and 95% CI were used as statistically significant variables. Results In this study, 353 patients were included. The mean age was 39±17.9 years and the average duration of catheter stay was 58 ±95 days. A hundred thirty-five (38.2%) CRBSIs were documented with an incidence rate of 7.74 episodes per 1000 catheter days. The causative microorganism was predominantly gram-negatives (57.6%). Duration of a catheter (AOR: 0.3; P < 0.001), previous CVC infection (AOR: 11.9; P < 0.001), high white blood cell count (AOR: 0.31; P<0.001), urban residence (AOR: 1.92; P<0.05), and low hemoglobin levels (AOR: 2.78; P < 0.05) were independently associated with catheter-related bloodstream infections. Conclusion In conclusion, the incidence of catheter-related bloodstream infection among patients on hemodialysis was high with gram-negative predominance. Early fistula must be planned to reduce the duration of temporary vascular access.
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Affiliation(s)
- Meskelu Kidu Weldetensae
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Afewerki Tesfahunegn Nigusse
- Department of Epidemiology, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Ephrem Berhe
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hailemariam Gebrearegay
- Department of Pediatric and Child health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Rastmanesh R. Microbial Repercussion on Hemodialysis Catheter-Related Bloodstream Infection Outcome: A 2-Year Retrospective Study: An Escape Mechanism Comment [Letter]. Infect Drug Resist 2021; 14:4361-4362. [PMID: 34707379 PMCID: PMC8542588 DOI: 10.2147/idr.s342637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Reza Rastmanesh
- Independent Researcher, Private Clinic, Tehran, Iran.,The Nutrition Society, London, UK.,American Physical Society, College Park, MD, USA
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