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Mazuel M, Moulier V, Bourrel AS, Guillier C, Tazi A, Jarreau PH, Chollat C. Systematic culture of central catheters and infections related to catheters in a neonatal intensive care unit: an observational study. Sci Rep 2024; 14:8647. [PMID: 38622221 PMCID: PMC11018835 DOI: 10.1038/s41598-024-59371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
Systematic culture of the tip of central lines is performed in many neonatal intensive care units (NICUs) to guide any subsequent antibiotic therapy. The clinical relevance of this procedure is debated, given the significant bacterial contamination during its removal. We aimed to describe infections related to catheters and assess the usefulness of central catheter systematic cultures for probabilistic antibiotic therapy in cases of suspicion of catheter-related infections in a NICU. A retrospective study in a NICU included all newborn patients hospitalized with a central catheter, between January 2018, and June 2019. The main outcome measures were bacterial catheter colonization, catheter-related infection rate, and simulation-based approach to antibiotic prescription. Three hundred and seventy-five newborns, with 634 central catheters were included. There were 273 (43%) catheters that were colonized by at least one microorganism. There were 183 cases of suspected sepsis, with 31 infections definitively related to the catheter. In our simulation antibiotic prescription approach, there was no significant difference in terms of the efficacy toward the microorganism(s) involved between the probabilistic antibiotic therapies proposed by the experts and those ultimately prescribed. Performing a catheter culture only if catheter-related infection is suspected could be an alternative to routine screening.
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Affiliation(s)
- Marie Mazuel
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, Paris, France
| | - Virginie Moulier
- University Department of Psychiatry, Centre d'Excellence Thérapeutique, Institut de Psychiatrie, Centre hospitalier du Rouvray, Sotteville-lès-Rouen, France
- Unité de Recherche Clinique, Etablissement Publique de Santé de Ville Evrard, 93332, Neuilly-sur-Marne, France
| | - Anne-Sophie Bourrel
- Department of Bacteriology, University Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Cyril Guillier
- Paediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Armand Trousseau University Hospital, Sorbonne Université, Paris, France
| | - Asmaa Tazi
- Department of Bacteriology, University Paris Cité, Assistance Publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Pierre-Henri Jarreau
- Service de Médecine et Réanimation Néonatales de Port-Royal, Hôpital Cochin, APHP centre - Université Paris Cité, Paris, France
| | - Clément Chollat
- Department of Neonatal Paediatrics, APHP, Service de Néonatologie, Sorbonne Université, Hôpital Armand Trousseau, 26 Av. du Dr Arnold Netter, 75012, Paris, France.
- Université Paris Cité, INSERM, NeuroDiderot, 75019, Paris, France.
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Larson-Nath C, Wendt L, Rahhal R. Catheter salvage from central line-related bloodstream infections in pediatric intestinal failure. J Pediatr Gastroenterol Nutr 2024; 78:918-926. [PMID: 38451061 DOI: 10.1002/jpn3.12175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/05/2024] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Patients with intestinal failure require central venous access which puts them at risk for central line-associated bloodstream infections (CLABSI). Maintaining vascular patency is critical for this population to receive nutrition support. When CLABSIs occur line salvage can help maintain vascular access. The aim of this study is to assess factors associated with safe and successful central venous catheter salvage. METHODS Retrospective cohort study of patients with intestinal failure at two tertiary care institutions between 2012 and 2020. The study examined the rates of attempted salvage, factors associated with successful salvage, and complications associated with salvage attempts. RESULTS Over the study period, 76 patients with intestinal failure were include while central venous access was in place. There were a total of 94 CLABSIs. Salvage was more likely to be attempted when patients were under the direct care of an intestinal rehabilitation service (95% vs. 68%, p = 0.04). The overall successful salvage rate was 91.6% (n = 77). Gram-positive, Gram-negative, and polymicrobial infections had successful salvage rates of 97%, 92%, and 94% respectively. The successful salvage rate for fungal infections was 40%. There was no difference in 30-day complication rates for hospital readmission, intensive care unit admission, and death between patients who underwent salvage attempt and those who did not. CONCLUSIONS Central line salvage can be safely attempted for many infections in patients with intestinal failure, leading to vascular access preservation.
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Affiliation(s)
- Catherine Larson-Nath
- Pediatric Gastroenterology, Hepatology, and Nutrition University of Minnesota, Minneapolis, Minnesota, USA
| | - Linder Wendt
- Institute for Clinical and Translational Science University of Iowa, Iowa City, Iowa, USA
| | - Riad Rahhal
- Pediatric Gastroenterology, Hepatology, and Nutrition University of Iowa, Iowa City, Iowa, USA
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Fiske HW, Roussel B, Winkler M, Hall B. A case report of lactobacillus bacteremia in a patient on chronic parenteral nutrition. Clin Nutr ESPEN 2024; 60:281-284. [PMID: 38479922 DOI: 10.1016/j.clnesp.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/03/2024] [Accepted: 02/16/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND AIMS Short bowel syndrome is a malabsorption disorder typically caused by the physical loss of a portion of the intestine, whereafter the body is unable to adequately absorb nutrients, fluids, and electrolytes. Many patients with short bowel syndrome are reliant on home parenteral nutrition through a tunneled or peripherally inserted central catheter to ensure sufficient hydration and nutrition. Central venous catheters are a nidus for bacteria, and patients are at risk for infections associated with high levels of morbidity and mortality. Lactobacillus is a ubiquitous microorganism that most frequently colonizes mucosal surfaces such as the gastrointestinal tract. Lactobacillus bacteremia is rare, with limited occurrence in current medical literature. METHODS Our patient is a 60-year-old female with a past medical history significant for multiple abdominal surgeries resulting in short bowel syndrome, with subsequent dependence on home parenteral nutrition via peripherally inserted central catheter. She had type III chronic intestinal failure, category D2, and stage 1 moderate malnutrition. She was originally admitted to the hospital for a presumed pulmonary embolism and was found to have a deep vein thrombosis in the setting of her peripherally inserted central catheter. On admission her abdominal exam was unremarkable, she denied abdominal pain, and her only gastrointestinal complaint was chronic stable diarrhea. During the hospitalization she developed severe left lower quadrant abdominal pain and noted decreased frequency of her bowel movements. A computed tomography scan of her abdomen revealed chronic stable intestinal distension and was concerning for obstruction. Clinically she remained without symptoms of acute obstruction or ileus. During the admission she became febrile, with blood cultures from her peripherally inserted central catheter and peripheral IV growing out gram negative rods determined to be lactobacillus bacteremia. The infectious disease team recommended removal of her peripherally inserted central catheter given their concern for a line infection. RESULTS The patient was treated with broad-spectrum antibiotics, did well clinically, and was ultimately discharged following reinsertion of her peripherally inserted central catheter after negative repeat blood cultures. Though she initially did well in the outpatient setting, she ultimately passed away ten months later after re-presenting to the hospital in septic shock, secondary to bowel ischemia and suspected fungemia of her peripherally inserted central catheter. CONCLUSIONS In this case report, we describe an unusual case of a patient with short bowel syndrome on chronic parenteral nutrition who developed catheter-associated lactobacillus bacteremia - the first reported case in an adult patient on parenteral nutrition.
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Affiliation(s)
- Hannah W Fiske
- Department of Internal Medicine, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Breton Roussel
- Division of Gastroenterology, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Marion Winkler
- Division of Surgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Benjamin Hall
- Division of Surgery, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
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Lotfinejad N, Januel JM, Tschudin-Sutter S, Schreiber PW, Grandbastien B, Damonti L, Lo Priore E, Scherrer A, Harbarth S, Catho G, Buetti N. Systematic scoping review of automated systems for the surveillance of healthcare-associated bloodstream infections related to intravascular catheters. Antimicrob Resist Infect Control 2024; 13:25. [PMID: 38419046 PMCID: PMC10903068 DOI: 10.1186/s13756-024-01380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Intravascular catheters are crucial devices in medical practice that increase the risk of healthcare-associated infections (HAIs), and related health-economic adverse outcomes. This scoping review aims to provide a comprehensive overview of published automated algorithms for surveillance of catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI). METHODS We performed a scoping review based on a systematic search of the literature in PubMed and EMBASE from 1 January 2000 to 31 December 2021. Studies were included if they evaluated predictive performance of automated surveillance algorithms for CLABSI/CRBSI detection and used manually collected surveillance data as reference. We assessed the design of the automated systems, including the definitions used to develop algorithms (CLABSI versus CRBSI), the datasets and denominators used, and the algorithms evaluated in each of the studies. RESULTS We screened 586 studies based on title and abstract, and 99 were assessed based on full text. Nine studies were included in the scoping review. Most studies were monocentric (n = 5), and they identified CLABSI (n = 7) as an outcome. The majority of the studies used administrative and microbiological data (n = 9) and five studies included the presence of a vascular central line in their automated system. Six studies explained the denominator they selected, five of which chose central line-days. The most common rules and steps used in the algorithms were categorized as hospital-acquired rules, infection rules (infection versus contamination), deduplication, episode grouping, secondary BSI rules (secondary versus primary BSI), and catheter-associated rules. CONCLUSION The automated surveillance systems that we identified were heterogeneous in terms of definitions, datasets and denominators used, with a combination of rules in each algorithm. Further guidelines and studies are needed to develop and implement algorithms to detect CLABSI/CRBSI, with standardized definitions, appropriate data sources and suitable denominators.
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Affiliation(s)
- Nasim Lotfinejad
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Jean-Marie Januel
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Peter W Schreiber
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Bruno Grandbastien
- Infection Prevention and Control Unit, Service of Infectious Disease, Lausanne University Hospital, Lausanne, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elia Lo Priore
- Department of Infectious Diseases and Hospital Epidemiology, EOC Regional Hospital of Lugano, Lugano, Switzerland
| | | | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gaud Catho
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Université Paris-Cité, INSERM, IAME UMR 1137 , Paris, 75018, France
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Khzam A, Saunier J, Guilbaud M, Herry JM, Dazzi A, Tortolano L, Carpentier L, Mignot A, Yagoubi N. Surface properties and bacterial adhesion on polyurethane central catheters: Impact of ethanol lock solution. Biomater Adv 2023; 146:213281. [PMID: 36634377 DOI: 10.1016/j.bioadv.2023.213281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/08/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
It was shown in the literature that ethanol locks have a positive effect on preventing catheter-related infections in patients with central venous catheters without causing any microbial resistance. However, ethanol is known to interact with polyurethanes. The consequences of this interaction on the catheter surface properties were studied as it can impact the biocompatibility of the material and the adhesion phenomena onto the surface. No physical and chemical degradation was put into evidence, but low molecular weight compounds such as additives were extracted from the catheter bulk or migrated and exudated onto its surface. Nevertheless, as far as bacterial adhesion is concerned, after the catheter was locked and the lock removed, the surface modifications promoted no adhesion.
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Affiliation(s)
- A Khzam
- Université Paris-Saclay, Faculté de pharmacie, Matériaux et Santé, 91400 Orsay, France
| | - J Saunier
- Université Paris-Saclay, Faculté de pharmacie, Matériaux et Santé, 91400 Orsay, France.
| | - M Guilbaud
- Université Paris-Saclay, INRAE, AgroParisTech, UMR SayFood, 91300 Massy, France
| | - J M Herry
- Université Paris-Saclay, INRAE, AgroParisTech, UMR SayFood, 91300 Massy, France
| | - A Dazzi
- Université Paris-Saclay, CNRS, Institut de Chimie Physique, 91405 Orsay, France
| | - L Tortolano
- Université Paris-Saclay, Faculté de pharmacie, Matériaux et Santé, 91400 Orsay, France; Department of Pharmacy, Henri Mondor Hospital, Créteil, France
| | | | | | - N Yagoubi
- Université Paris-Saclay, Faculté de pharmacie, Matériaux et Santé, 91400 Orsay, France
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Zhong C, Wang F, Zhou H, Liu J, Hu J, Chen Y. Bacteremia caused by accidental injection of Bacillus licheniformis microbiota modulator through the central venous catheter: A case report. Medicine (Baltimore) 2022; 101:e28719. [PMID: 35089241 PMCID: PMC8797554 DOI: 10.1097/md.0000000000028719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/11/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Bacillus licheniformis (B licheniformis) is a commonly used microbiota modulator. However, infections are rarely observed in immunocompetent hosts. PATIENT CONCERNS A 67-year-old woman who underwent esophagectomy experienced accidental injection of B licheniformis and presented with chills followed by hyperpyrexia. DIAGNOSIS The initial diagnosis was B licheniformis bacteremia. INTERVENTION Based on our experience, the patient first received levofloxacin and ornidazole. The application of levofloxacin was retained based on the antibiogram results. After discharge, the antibiotics were changed to vancomycin and levofloxacin, based on sensitivity tests, until two consecutive blood cultures were negative. OUTCOMES The patient recovered without any severe complications. LESSONS This is a rare report of the successful treatment of B licheniformis bacteremia caused by improper drug administration, which will provide a reference for the treatment of B licheniformis bacteremia.
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Affiliation(s)
- Chuan Zhong
- Department of Thoracic Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Fen Wang
- Clinical Laboratory, Suining Central Hospital, Suining, Sichuan, China
| | - Haining Zhou
- Department of Thoracic Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Jiarui Liu
- Clinical Laboratory, Suining Central Hospital, Suining, Sichuan, China
| | - Jiewei Hu
- Department of Thoracic Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Yongjun Chen
- Department of Gastroenterology, Suining Central Hospital, Suining, Sichuan, China
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Pai AB, McGuire MD, Davidge KN, Dean MC, Costello GM, Souza E, Mukherjee S, Heung M, Yevzlin AS, Yessayan LT. Lipoteichoic Acid as a Potential Noninvasive Biomarker of Biofilm in Dialysis Access. ASAIO J 2020; 66:960-965. [PMID: 32740359 DOI: 10.1097/mat.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tunneled central venous catheters (TCVCs) are colonized by Gram-positive organisms and form biofilm. Lipoteichoic acid (LTA) is a Gram-positive cell wall component that can be measured in serum. The purpose of this pilot study was to characterize LTA concentrations in hemodialysis (HD) patients with TCVCs compared to other access types and to evaluate biofilm morphology and microbiology in TCVCs removed by clinical decision. The study enrolled patients with TCVCs (18), grafts (19), and fistulas (18). Blood samples were collected before HD, at 30 minutes, 2 hours, and end of HD. Catheters removed by clinical decision were evaluated by scanning electron microscopy (SEM) for biofilm morphology, and portions of the catheter were cultured. LTA was detectable in all samples and concentrations increased significantly in all access types during HD (p < 0.05 for all comparisons). Patients with TCVCs that had a >30% increase in LTA concentration from baseline also had the greatest rate of increase (slope) compared to grafts and fistulas (p = 0.03 and p = 0.04, respectively). Catheters removed by clinical decision (n = 7) and examined by SEM had deposition of fibrin. Cultures revealed polymicrobial colonization. TCVCs had the highest rate of increase of LTA during HD. Further studies to determine the source of LTA in patients with AVG and AVF are warranted.
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Affiliation(s)
- Amy Barton Pai
- From the University of Michigan, College of Pharmacy, Ann Arbor, Michigan
| | | | - Karen N Davidge
- From the University of Michigan, College of Pharmacy, Ann Arbor, Michigan
| | - Michael C Dean
- From the University of Michigan, College of Pharmacy, Ann Arbor, Michigan
| | | | - Ernane Souza
- From the University of Michigan, College of Pharmacy, Ann Arbor, Michigan
| | | | - Michael Heung
- University of Michigan, Division of Nephrology, Ann Arbor, Michigan
| | | | - Lenar T Yessayan
- University of Michigan, Division of Nephrology, Ann Arbor, Michigan
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Rosenthal VD. Impact of needle-free connectors compared with 3-way stopcocks on catheter-related bloodstream infection rates: A meta-analysis. Am J Infect Control 2020; 48:281-284. [PMID: 31551122 DOI: 10.1016/j.ajic.2019.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Needle-free connectors (NFCs) were introduced to eliminate the use of needles in intravascular catheters, and their newest generations were designed to improve patient safety and reduce catheter-related bloodstream infection (CRBSI) risks. The aim of this meta-analysis was to compare NFCs with 3-way stopcocks (3WSCs) and their effects on CRBSI rates. METHODS A meta-analysis was conducted using a research protocol consistent with the PRISMA statement for reporting meta-analyses. The Cochrane Database of Systematic Reviews and MEDLINE were searched for relevant randomized studies published from January 2000 to September 2018. RESULTS We identified and selected for the meta-analysis 8 studies comparing CRBSI rates (according to the Centers for Disease Control and Prevention's National Healthcare Safety Network definition) associated with NFCs utilizing negative-displacement, neutral-displacement, or positive-displacement devices with rates for 3WSCs. Relative risk was 0.53 with a 95% CI of 0.28 to 1.00, and the relative difference was -0.018 with a 95% CI of -0.039 to 0.004. CONCLUSIONS CRBSI risk was statistically higher for 3WSCs compared to NFCs.
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Nahla KS, Manal IS, Gehan MA. Central line-related bloodstream infections and microbiological study in an Egyptian Ministry of Health Hospital. Afr Health Sci 2020; 20:158-167. [PMID: 33402904 PMCID: PMC7750073 DOI: 10.4314/ahs.v20i1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Central line-associated bloodstream infections continue to be one of the most important health problems in ICU. OBJECTIVES To identify the central line-related bloodstream infections and their microbiological characteristics Specific objectives to the identify the incidence, predisposing factors of central line-related bloodstream Infections and study the antibiotic sensitivity patterns of the isolated organisms. MATERIAL AND METHODS Patients' demographic, clinical data, central venous catheter related data,and blood culture specimen collection data were collected utilizing a descriptive exploratory design from a purposive sample of 120 ICU patients underwent insertion central venous catheter. RESULTS out of 120 central line catheters sent for culture from patients immediately and seven days after insertion., 13(10.83%) were positive seven days after insertion. Of the 13 infection cases, 10 cases were Staphylococcus epidermis and the others were Staphylococcus aureus. In addition, most infected patients were overweight and obese, diabetic, had sub-clavian route, and their length of hospital stayed more than7 days. CONCLUSION 10.83 % developed bacterial blood stream infection 7 days after insertion of central venous catheters, and most of bacterial isolates were Staphylococcus epidermis and were sensitive to Vancomycin and Amikain.
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Affiliation(s)
- Khalil Shaaban Nahla
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Cairo University, Egypt
| | - Ismaeel Sayed Manal
- Critical Care and Emergency Nursing Department, Faculty of Nursing, British University in Egypt
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Choksi A, Finnegan K, Etezadi V. Does systemic antibiotic prophylaxis prior to the placement of totally implantable venous access devices reduce early infection? A retrospective study of 1,485 cases at a large academic institution. Am J Infect Control 2020; 48:95-99. [PMID: 31439370 DOI: 10.1016/j.ajic.2019.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND To determine if ending the practice of administering prophylactic antibiotics prior to the placement of totally implantable venous access devices (TIVADs) is correlated with an increase in 30-day bloodstream infection-related TIVADs removals. METHODS The practice of administering prophylactic antibiotics prior to the placement of TIVADs ended in July 2013 at our institution. We compiled a list of patients who had TIVADs placed between July 2010 and July 2016 and cross-referenced this list to a list of patients who had TIVADs removed between July 2010 and August 2016 to evaluate the 30-day bloodstream infection-related TIVAD removals. Retrospective chart review of all patients was performed to collect demographic information, indication for placement, and type of antibiotic administered, if applicable. RESULTS Over the study period of 6 years, a total of 1,513 TIVADs were placed, of which 28 cases were excluded because of death within 30 days unrelated to TIVAD placement. Of the remaining 1,485 cases, 733 TIVADs were placed in 709 unique patients with prophylactic antibiotic treatment and 752 TIVADs were placed in 709 unique patients without treatment. A total of 8 patients were identified to have TIVADs removed within 30 days owing to infection, of which 4 patients were treated with prophylactic antibiotics. The odds of infection-related removals without prophylactic treatment compared with prophylactic treatment was 0.97 (95% confidence interval, 0.24-3.91; P = .97). CONCLUSIONS Ending the practice of administrating systemic antibiotic prophylaxis prior to the placement of TIVADs had no effect on the 30-day bloodstream infection-related TIVAD removals rate at our institution. We do not recommend the use of prophylactic antibiotics for the placement of TIVAD.
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Affiliation(s)
- Ankur Choksi
- Department of Vascular and Interventional Radiology, University of Maryland Medical System, Baltimore, MD
| | - Karen Finnegan
- Department of Vascular and Interventional Radiology, University of Maryland Medical System, Baltimore, MD
| | - Vahid Etezadi
- Department of Vascular and Interventional Radiology, University of Maryland Medical System, Baltimore, MD.
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Paioni P, Kuhn S, Strässle Y, Seifert B, Berger C. Risk factors for central line-associated bloodstream infections in children with tunneled central venous catheters. Am J Infect Control 2020; 48:33-39. [PMID: 31395289 DOI: 10.1016/j.ajic.2019.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) are among the most common complications of central venous catheters (CVCs). The aim of this study was to examine the epidemiology of CLABSIs in tunneled CVCs and analyze their risk factors in a general pediatric population. METHODS Children with a tunneled CVC inserted at the University Children's Hospital Zürich between January 2009 and December 2015 were eligible for the study. The influence of CVC dwell time on the risk of CLABSI was examined using life tables. Hazard ratios (HRs) for CLABSIs were analyzed using Cox regression for age and diagnosis with cluster robust standard errors. RESULTS Fifty-five CLABSIs were observed in 193 patients with 284 tunneled CVCs. Overall, CVCs in children with gastrointestinal disorders and in children 2 to 5 years of age showed the highest incidence rates of 6.06 and 5.85 CLABSIs per 1,000 catheter days, respectively, during the first 90 days after placement. Gastrointestinal disease (HR, 3.89; 95% CI, 2.19-6.90; P < .001) and age 2 to 5 years (HR, 2.48; 95% CI, 1.45-4.22; P = .001) were identified as independent risk factors for CLABSI. In children without gastrointestinal disease, tunneled CVCs showed an increasing risk of CLABSI after a dwell time of 90 days. CONCLUSIONS The need for tunneled CVCs requires the evaluation of targeted CLABSI prevention measures, especially in young children with underlying gastrointestinal disease.
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Affiliation(s)
- Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center, University Children's Hospital Zürich, Zürich, Switzerland.
| | - Sereina Kuhn
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center, University Children's Hospital Zürich, Zürich, Switzerland
| | - Yvonne Strässle
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center, University Children's Hospital Zürich, Zürich, Switzerland
| | - Burkhardt Seifert
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center, University Children's Hospital Zürich, Zürich, Switzerland
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Slater K, Cooke M, Scanlan E, Rickard CM. Hand hygiene and needleless connector decontamination for peripheral intravenous catheter care-time and motion observational study. Am J Infect Control 2019; 47:1017-1019. [PMID: 30850248 DOI: 10.1016/j.ajic.2019.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/27/2022]
Abstract
Good hand hygiene and "scrub the hub" practices are important to prevent bloodstream infections. This observational study (n = 108) found high compliance with "scrubbing the hub," although scrub time was shorter than the recommended duration (average 6.1 seconds). Compliance with hand hygiene before medication preparation (33%) and before medication administration (43%) showed room for improvement compared with postadministration (65%), the emergency setting and glove use were associated with poorer compliance (P < .01).
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Affiliation(s)
- Karen Slater
- Princess Alexandra Hospital, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia.
| | - Marie Cooke
- Alliance for Vascular Access Teaching & Research Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Emma Scanlan
- Princess Alexandra Hospital, Brisbane, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching & Research Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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13
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Damman J, Arias P, Kerner J, Zhang KY, Dehghan M, Krishnan G, Nespor C, Bensen R, Park KT. Procalcitonin as a Predictive Marker for Bacteremia in Children With a Central Line and Fever. Hosp Pediatr 2019; 9:434-439. [PMID: 31097470 PMCID: PMC6537123 DOI: 10.1542/hpeds.2018-0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Unnecessary use of antibiotics is an increasing problem. In this study, we sought to determine the diagnostic accuracy of procalcitonin in predicting bacteremia in children with a central line and fever, and we sought to determine optimal cutoff values to maximize sensitivity and specificity. This is the largest study to date in which procalcitonin is examined as a predictive marker of bacteremia in pediatric patients with a central line and fever. METHODS We conducted a retrospective cohort study of children aged 0 to 23 years with a central line and fever of 38°C who had procalcitonin and blood cultures drawn before initiation of antibiotics and had no other identified bacterial infection. Patients were also prospectively monitored via a custom-built electronic medical record dashboard for eligibility. RESULTS There were 523 patients and >2500 procalcitonin values reviewed for eligibility. Of these, 169 (47%) patients and 335 blood cultures with procalcitonin were included. There were 94 (28%) positive bacterial blood cultures and 241 (72%) negative bacterial blood cultures. In bacteremic cultures, the mean procalcitonin level was 9.96 ± 15.96 ng/mL, and the median procalcitonin level was 4.85 ng/mL (interquartile range 18.5). In nonbacteremic cultures, the mean procalcitonin level was 1.23 ± 10.37 ng/mL, and the median procalcitonin level was 0.3 ng/mL (interquartile range 0.7). A receiver operating characteristic analysis indicated a procalcitonin level of ≥0.6 ng/mL as the best cutoff point that produced a sensitivity of 85.6% and a specificity of 65.7% (area under the curve 0.85). CONCLUSIONS Procalcitonin is a sensitive biomarker in predicting bacteremia in children with a central line and fever.
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Affiliation(s)
- Jennifer Damman
- Lucile Packard Children's Hospital Stanford, Palo Alto, California; and
| | - Patricio Arias
- Lucile Packard Children's Hospital Stanford, Palo Alto, California; and
| | - John Kerner
- Lucile Packard Children's Hospital Stanford, Palo Alto, California; and
| | - Ke-You Zhang
- Lucile Packard Children's Hospital Stanford, Palo Alto, California; and
| | - Melody Dehghan
- Lucile Packard Children's Hospital Stanford, Palo Alto, California; and
| | | | - Colleen Nespor
- Lucile Packard Children's Hospital Stanford, Palo Alto, California; and
| | - Rachel Bensen
- Lucile Packard Children's Hospital Stanford, Palo Alto, California; and
| | - K T Park
- Lucile Packard Children's Hospital Stanford, Palo Alto, California; and
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14
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Dang FP, Li HJ, Tian JH. Comparative efficacy of 13 antimicrobial dressings and different securement devices in reducing catheter-related bloodstream infections: A Bayesian network meta-analysis. Medicine (Baltimore) 2019; 98:e14940. [PMID: 30946317 PMCID: PMC6455863 DOI: 10.1097/md.0000000000014940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial dressings for prevention of catheter-related blood infections (CRBSI) and rank these antimicrobial dressings for practical consideration. METHODS We searched the PubMed, Cochrane library, Embase, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared dressings for prevention of CRBSI. Two authors independently extracted data from each included RCT according to a predesigned Excel spreadsheet and assessed the methodological quality of included RCTs using the Cochrane risk of bias tool. Data was analyzed using the WinBUGS (V.1.4.3) and the Stata (V.15.0). RESULTS Finally, 35 RCTs involving 8494 patients and evaluating 13 dressings were included. Network meta-analysis showed that transparent dressing may be the best way to prevent CRBSI. Suture and bordered polyurethane dressing might have the lowest risk of CRBSI rate per 1000 catheter-days, and sutureless securement device might lead to the lowest incidence of catheter failure. CONCLUSIONS This network meta-analysis indicated that transparent dressings may be selected for the prevention of CRBSI in patients with central venous catheters, which is of importance in future research. Although evidence is scant, more attention should be paid to head-to-head comparisons of the most commonly used dressings in this field.
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Affiliation(s)
| | - Hui-Ju Li
- School of Nursing of Lanzhou University
| | - Jin-Hui Tian
- School of Nursing of Lanzhou University
- Key Laboratory of Clinical Translational Research and Evidence-based Medicine of Gansu Province, Lanzhou, Gansu, China
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15
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Jannestad B, Skudal HK, Bock AJ, Bøhme M, Nøstdahl T. A man in his fifties with fever and a swelling on the neck. Tidsskr Nor Laegeforen 2019; 139:18-0157. [PMID: 30808098 DOI: 10.4045/tidsskr.18.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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16
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Ikram S, Heikal A, Finke S, Hofgaard A, Rehman Y, Sabri AN, Økstad OA. Bacillus cereus biofilm formation on central venous catheters of hospitalised cardiac patients. Biofouling 2019; 35:204-216. [PMID: 30950292 DOI: 10.1080/08927014.2019.1586889] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 06/09/2023]
Abstract
Formation of bacterial biofilms is a risk with many in situ medical devices. Biofilm-forming Bacillus species are associated with potentially life-threatening catheter-related blood stream infections in immunocompromised patients. Here, bacteria were isolated from biofilm-like structures within the lumen of central venous catheters (CVCs) from two patients admitted to cardiac hospital wards. Isolates belonged to the Bacillus cereus group, exhibited strong biofilm formation propensity, and mapped phylogenetically close to the B. cereus emetic cluster. Together, whole genome sequencing and quantitative PCR confirmed that the isolates constituted the same strain and possessed a range of genes important for and up-regulated during biofilm formation. Antimicrobial susceptibility testing demonstrated resistance to trimethoprim-sulphamethoxazole, clindamycin, penicillin and ampicillin. Inspection of the genome revealed several chromosomal β-lactamase genes and a sulphonamide resistant variant of folP. This study clearly shows that B. cereus persisting in hospital ward environments may constitute a risk factor from repeated contamination of CVCs.
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Affiliation(s)
- Samman Ikram
- a Department of Microbiology & Molecular Genetics , University of the Punjab , Lahore , Pakistan
- b Centre for Integrative Microbial Evolution and Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy , University of Oslo , Oslo , Norway
| | - Adam Heikal
- b Centre for Integrative Microbial Evolution and Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy , University of Oslo , Oslo , Norway
| | - Sarah Finke
- b Centre for Integrative Microbial Evolution and Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy , University of Oslo , Oslo , Norway
| | - Antje Hofgaard
- c Department of Biosciences , University of Oslo , Oslo , Norway
| | - Yasir Rehman
- a Department of Microbiology & Molecular Genetics , University of the Punjab , Lahore , Pakistan
| | - Anjum Nasim Sabri
- a Department of Microbiology & Molecular Genetics , University of the Punjab , Lahore , Pakistan
| | - Ole Andreas Økstad
- b Centre for Integrative Microbial Evolution and Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy , University of Oslo , Oslo , Norway
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Katsuragawa F, Nagahama K, Naito S, Tsuura Y, Otani M, Koide T, Nishiyama S, Yanagi T, Nanamatsu A, Aki S, Aoyagi M, Tanaka H, Rai T, Uchida S. Ruptured infected aneurysm of the thoracic aorta associated with tunneled dialysis catheter-related methicillin-resistant Staphylococcus aureus bacteremia in a hemodialysis patient. CEN Case Rep 2018; 7:325-329. [PMID: 29987666 PMCID: PMC6181888 DOI: 10.1007/s13730-018-0352-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022] Open
Abstract
Patients with an indwelling tunneled dialysis catheter (TDC) for hemodialysis access are at a high risk of developing methicillin-resistant Staphylococcus aureus (MRSA) infection. MRSA bacteremia complications rarely include infected aneurysm. Here, we report the first case of an infected thoracic aneurysm associated with TDC-related MRSA bacteremia. An 86-year-old Japanese male with a TDC for hemodialysis access developed TDC-related MRSA bacteremia. Intravenous vancomycin was initiated, and the TDC was removed on day 3. Despite removal of the catheter and initiation of vancomycin treatment, MRSA bacteremia persisted. Chest computed tomography (CT) showed no aneurysm; however, calcification of the thoracic aorta was detected on admission. The patient subsequently developed hemosputum. CT revealed a thoracic aneurysm, which turned out to be caused by MRSA bacteremia. The patient eventually died because of the rupture of the infected aneurysm, as confirmed by autopsy. This report demonstrates TDC management in a patient with TDC-related MRSA bacteremia and the importance of investigating a metastatic infection to a calcified artery if bacteremia persists.
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MESH Headings
- Administration, Intravenous
- Aged, 80 and over
- Aneurysm, Infected/complications
- Aneurysm, Infected/diagnostic imaging
- Anti-Bacterial Agents/therapeutic use
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/microbiology
- Aorta, Thoracic/pathology
- Asian People/ethnology
- Bacteremia/complications
- Catheters, Indwelling/adverse effects
- Catheters, Indwelling/microbiology
- Central Venous Catheters/adverse effects
- Central Venous Catheters/microbiology
- Fatal Outcome
- Humans
- Male
- Methicillin-Resistant Staphylococcus aureus
- Renal Dialysis/adverse effects
- Rupture
- Staphylococcal Infections/complications
- Staphylococcal Infections/microbiology
- Tomography, X-Ray Computed
- Vancomycin/administration & dosage
- Vancomycin/therapeutic use
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Affiliation(s)
- Fumiko Katsuragawa
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Kiyotaka Nagahama
- Department of Pathology, Graduate School of Medical Sciences, Kyorin University, Mitaka, Japan
| | - Shotaro Naito
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yukio Tsuura
- Department of Pathology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Megumi Otani
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Takaaki Koide
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Sakino Nishiyama
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Tomoki Yanagi
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Azuma Nanamatsu
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Shota Aki
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Makoto Aoyagi
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Hiroyuki Tanaka
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Tatemitsu Rai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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18
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Abstract
Central-line-associated bloodstream infections (CLABSIs) are responsible for ∼1/3 of all deaths from healthcare-associated infections in the United States. Of these, multidrug-resistant organisms (MDROs) are responsible for 20% to 67%. However, whether catheter removal affects clinical outcomes for MDRO CLABSIs has not been studied. Our objective was to determine the relationship between failure to remove a central venous catheter (CVC) and 30-day all-cause mortality in patients with MDRO CLABSIs. We used a retrospective cohort from Barnes-Jewish Hospital (1/1/2009-10/1/2015) to study patients with a multidrug-resistant Staphylococcus aureus, Enterococcus species, Enterobacteriaceae, Acinetobacter species, or Pseudomonas aeruginosa CLABSI. Risk factors for 30-day mortality, including catheter removal, were assessed for association with 30-day mortality using Cox proportional hazards models. The CLABSIs were assessed prospectively at the time of occurrence by infection prevention specialists. A total of 430 patients met inclusion criteria, 173 (40.2%) with Enterococcus, 116 (27.0%) Enterobacteriaceae, 81 (18.8%) S aureus, 44 (10.2%) polymicrobial, 11 (2.6%) P aeruginosa, and 5 (1.2%) Acinetobacter CLABSIs. Removal of a CVC occurred in 50.2% of patients, of which 4.2% died by 30 days (n = 9). For patients whose CVC remained in place, 45.3% died (n = 97). Failure to remove a CVC was strongly associated with 30-day all-cause mortality with a hazard ratio of 13.5 (6.8-26.7), P < .001. Other risk factors for 30-day mortality included patient comorbidities (cardiovascular disease, congestive heart failure, cirrhosis), and being in an intensive care unit at the time of MDRO isolation. Failure to remove a CVC was strongly associated with 30-day all-cause mortality for patients with MDRO CLABSIs in this single center retrospective cohort. This suggests that patients presenting with MDRO CLABSIs should all undergo CVC removal.
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Affiliation(s)
- Jason P. Burnham
- Division of Infectious Diseases, Washington University School of Medicine
| | | | - Marin H. Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO
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19
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Calvo-Lon J, Landaverde DU, Ramos-Esquivel A, Villalobos-Vindas JM. Epidemiology and Outcomes of Bloodstream Infections in Patients With Solid Tumors in a Central American Population at Mexico Hospital, San Jose, Costa Rica. J Glob Oncol 2018; 4:1-6. [PMID: 29244630 PMCID: PMC6180768 DOI: 10.1200/jgo.17.00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Bloodstream infections (BSIs) are an important cause of mortality in patients with solid tumors. We conducted a retrospective study to evaluate the epidemiologic profile and mortality of patients with solid tumors who have BSIs and were admitted to Mexico Hospital. This is the first study in Costa Rica and Central America describing the current epidemiologic situation. METHODS We analyzed the infectious disease database for BSIs in patients with solid tumors admitted to Mexico Hospital from January 2012 to December 2014. Epidemiology and mortality were obtained according to microorganism, antibiotic sensitivity, tumor type, and presence of central venous catheter (CVC). Descriptive statistics were used. RESULTS A total of 164 BSIs were recorded, the median age was 58 years, 103 patients (63%) were males, and 128 cases of infection (78%) were the result of gram-negative bacilli (GNB). Klebsiella pneumoniae (21%), Escherichia coli (21%), and Pseudomonas aeruginosa (15%) were the most common microorganisms isolated. Gram-positive cocci (GPC) were found in 36 patients, with the most frequent microorganisms being Staphylococcus aureus (10%) and Staphyloccocus epidermidis (6%). With respect to tumor type, BSIs were more frequent in the GI tract (57%) followed by head and neck (9%) and genitourinary tract (8%). Regarding antibiotic susceptibility, only 17% (GNB) expressed extended-spectrum beta-lactamase and 12% (GPC) had methicillin resistance. Patients with CVCs (n = 59) were colonized mainly by GNB (78%). Overall the mortality rate at 30 days was about 30%. CONCLUSION GNB are the most frequent cause of BSIs in solid tumors and in patients with CVCs. GI cancers had more BSIs than other sites. Mortality and antibiotic sensitivity remained stable and acceptable during this observational period in this Latin American population.
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Affiliation(s)
- Jorge Calvo-Lon
- Jorge Calvo-Lon and Juan M.
Villalobos-Vindas, Mexico Hospital; Denis U. Landaverde,
Mexico Hospital and University of Costa Rica; and Allan
Ramos-Esquivel, San Juan de Dios Hospital and University of Costa
Rica, San Jose, Costa Rica
| | - Denis U. Landaverde
- Jorge Calvo-Lon and Juan M.
Villalobos-Vindas, Mexico Hospital; Denis U. Landaverde,
Mexico Hospital and University of Costa Rica; and Allan
Ramos-Esquivel, San Juan de Dios Hospital and University of Costa
Rica, San Jose, Costa Rica
| | - Allan Ramos-Esquivel
- Jorge Calvo-Lon and Juan M.
Villalobos-Vindas, Mexico Hospital; Denis U. Landaverde,
Mexico Hospital and University of Costa Rica; and Allan
Ramos-Esquivel, San Juan de Dios Hospital and University of Costa
Rica, San Jose, Costa Rica
| | - Juan M. Villalobos-Vindas
- Jorge Calvo-Lon and Juan M.
Villalobos-Vindas, Mexico Hospital; Denis U. Landaverde,
Mexico Hospital and University of Costa Rica; and Allan
Ramos-Esquivel, San Juan de Dios Hospital and University of Costa
Rica, San Jose, Costa Rica
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20
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Zhao T, Liu H, Han J. Ethanol lock is effective on reducing the incidence of tunneled catheter-related bloodstream infections in hemodialysis patients: a systematic review and meta-analysis. Int Urol Nephrol 2018; 50:1643-1652. [PMID: 29667048 DOI: 10.1007/s11255-018-1855-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/26/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this meta-analysis is to evaluate the effect of ethanol lock on the incidence of catheter-related bloodstream infection (CRBSI) in patients with central venous catheters. METHODS RCTs comparing ethanol lock with another solution lock for prevention of CRBSI were obtained by searching databases of PubMed, Embase, Web of Science and Cochrane Central Register of clinical trials for eligible randomized controlled trials (inception to December 2017). Two researchers separately selected the RCTs and assessed their quality. Data on patient characteristics and ethanol protocols were collected. The primary outcome was the incidence of CRBSI, and the secondary outcomes were catheter colonization, exit infection and thrombosis. RESULTS A total of 2575 patients with 3375 catheters from 7 eligible RCTs were included. Overall, ethanol lock significantly decreased the risk of CRBSI, with RR 0.54 (95% CI 0.38-0.78; I2 = 0%; p = 0.001); no obvious heterogeneity was observed in the fixed-effects model (I2 = 0%). Of note, subgroup analysis demonstrated that ethanol lock conferred significant benefit in studies with tunneled catheters (RR 0.46; 95% CI 0.30-0.72) but not in studies with untunneled catheters. Only two studies provided data regarding catheter colonization, and no significant difference was found (RR, 1.09; 95% CI, 0.87-1.38; I2 = 41%; p = 0.45). Moreover, pooled data did not show significant differences between ethanol and control groups with regard to the incidence of thrombosis (RR 1.05; 95% CI 0.91-1.22; I2 = 0%; p = 0.48). CONCLUSIONS Our meta-analysis suggests that ethanol lock is effective on reducing the incidence of CRBSI in hemodialysis patients with tunneled central venous catheters.
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Affiliation(s)
- Tingting Zhao
- Department of Critical Care Medicine, The First Hospital of Shanxi Medical University, No. 85 Jiefangnan Road, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Hong Liu
- Department of Critical Care Medicine, The First Hospital of Shanxi Medical University, No. 85 Jiefangnan Road, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Jibin Han
- Department of Critical Care Medicine, The First Hospital of Shanxi Medical University, No. 85 Jiefangnan Road, Taiyuan, 030001, Shanxi, People's Republic of China.
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21
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Nourian MM, Schwartz AL, Stevens A, Scaife ER, Bucher BT. Clearance of tunneled central venous catheter associated blood stream infections in children. J Pediatr Surg 2018; 53:1839-1842. [PMID: 29397962 PMCID: PMC6015769 DOI: 10.1016/j.jpedsurg.2017.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/28/2017] [Accepted: 12/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal time to reinsert central venous catheters (tCVC) after a documented central line associated blood stream infection (CLABSI) is unclear. The goal of this study is to identify risk factors for children who develop persistent bacteremia after tCVC removal due to CLABSI. METHODS We performed a retrospective cohort study from a tertiary children's hospital. Children who underwent removal of a tCVC due to CLABSI were included in our analysis. Our primary outcome was persistent bacteremia after tCVC removal defined by a persistently positive blood culture. Salient patient demographic and clinical factors were extracted from the medical record. RESULTS A total of 140 patients met inclusion criteria and 27 (19%) had a persistent CLABSI after removal of the tCVC. There were no significant differences between the patients who cleared their bacteremia and those who develop persistent bacteremia. The median (IQR) time to positive blood culture after tCVC removal was 2.7 days (1.7- 4.0). CONCLUSIONS We did not identify any patient risk factors distinguishing between a child who will clear a CLABSI versus develop a persistent CLABSI after tCVC removal. Blood stream infection clearance was rapid after tCVC removal, supporting a brief line holiday prior to tCVC reinsertion. LEVEL OF EVIDENCE Level III Retrospective Case-Control Study.
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Affiliation(s)
- Maziar M Nourian
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
| | - Angelina L Schwartz
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Austin Stevens
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Eric R Scaife
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Brian T Bucher
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
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YE H, Zeng J, Qin W, Yang Z, Yang L, Wu Z, Du G. A totally implantable venous access port associated with bloodstream infection caused by Mycobacterium fortuitum: A case report. Medicine (Baltimore) 2018; 97:e11493. [PMID: 30024528 PMCID: PMC6086552 DOI: 10.1097/md.0000000000011493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Rapidly growing mycobacteria (RGM) are well-known causative agents of human infections, particularly in immunocompromised hosts. However, Mycobacterium fortuitum, a predominant organism, in catheter-associated infections, has rarely been documented in totally implantable venous access port (TVIAP)-associated bloodstream infections. PATIENT CONCERNS A 25-year-old woman with breast cancer presented to hospital with repeated fever for several days. The patient first refused to remove the TVIAP in her body, and had a relapse of M. fortuitum bacteraemia four months later. DIAGNOSES Bacteria isolated from patient's blood and TVIAP were identified as M. fortuitum by Matrix-assisted laser desorption/ionization-time of flight spectrometry and bacterial 16s rDNA sequencing. The patient was diagnosed as a TVIAP-associated bloodstream infection. INTERVENTIONS The TVIAP was eventually surgically removed, and M. fortuitum was found to have localized on the tip of the catheter. The patient was treated by anti-infection therapy. OUTCOMES The patient was treated with 4 weeks of intravenous amikacin and levofloxacin followed by 4 weeks of oral levofloxacin. No episodes of fever occurred during the follow-up to date. LESSONS RGM infections remain a challenging issue for TIVAPs. Accurate species identification, timely intravascular catheter removal and appropriate antibiotic therapy are recommended to ensure successful outcomes.
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Affiliation(s)
| | - Junshao Zeng
- Department of Oncology, Guigang City People's Hospital, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi, People's Republic of China
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23
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Ramadan MA, Hebbar G. A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait. Med Princ Pract 2018; 27:337-342. [PMID: 29301135 PMCID: PMC6170898 DOI: 10.1159/000486595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 01/04/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the difference in the rates of dialysis events stratified by vascular access type and to describe the microbiological profile and sensitivity patterns of positive blood cultures over a 3-year period. SUBJECTS AND METHODS The dialysis event data of 10,751 chronic hemodialysis patients collected from March 2013 to February 2016 at an outpatient dialysis unit in Kuwait were reviewed. The dialysis events studied were: intravenous (IV) antimicrobial use, a positive blood culture, and signs of inflammation at the vascular access site. Dialysis event rates were stratified by the type of vascular access used for the dialysis, i.e., fistula, graft, and tunneled/nontunneled central line. Rates were expressed per 100 patient-months. RESULTS The overall dialysis event rate was (10.7/100 patient-months). The rate of IV antimicrobial use was higher (12.53/100 patient-months) in patients with tunneled central lines than in all other vascular access types (10.29/100 patient-months). Positive blood culture and inflammation at the vascular access site were highest in patients with nontunneled central lines (1.65 and 1.54/100 patient-months, respectively) when compared to those with other types of vascular access. Gram-negative rod isolates were predominant in patients with central lines (n = 35; 46.67%); however, common skin commensals and gram-negative rods were also identified in patients with fistula or graft (n = 4; 44.45%). CONCLUSION Dialysis event rates were higher among patients with tunneled or nontunneled central lines than in patients with fistula or graft. Gram-negative rods were the most commonly isolated microbial group.
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Affiliation(s)
- Moustapha Ahmed Ramadan
- Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait
- Department of Community Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Gautam Hebbar
- Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait
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Brandt CF, Tribler S, Hvistendahl M, Naimi RM, Brøbech P, Staun M, Jeppesen PB. Home Parenteral Nutrition in Adult Patients With Chronic Intestinal Failure: Catheter-Related Complications Over 4 Decades at the Main Danish Tertiary Referral Center. JPEN J Parenter Enteral Nutr 2018; 42:95-103. [PMID: 29505150 DOI: 10.1177/0148607116678766] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/20/2016] [Indexed: 10/13/2023]
Abstract
BACKGROUND/AIMS Catheter-related complications (CRCs) cause mortality and morbidity in patients dependent on parenteral support at home (HPN) due to intestinal failure (IF). This study describes the incidences of CRCs in an adult IF cohort over 40 years. It illustrates the evolution and consequences of CRCs, their association to demographic characteristics, and potential risk factors in an effort to provide the rationale for preventive precautions to the relevant patients with IF at risk. METHODS All patients with IF discharged with HPN from 1970-2010 were included. Patient and treatment characteristics were extracted from the Copenhagen IF database. The incidences were given per 1000 central venous catheter (CVC) days. RESULTS The 1715 CRCs occurred in 70% of the 508 patients with IF (56% of the 2191 CVCs). The incidence of catheter-related bloodstream infections (CRBSIs) was 1.43. Higher age, HPN administration by community home nurses, and prior CRBSIs significantly raised the hazard for CRBSIs. In the 1970s, catheters were generally replaced following CRBSIs, whereas catheter salvage was the norm in the 2000s. The incidences of mechanical complications, tunnel infections, and catheter-related venous thromboses were 0.80, 0.25, and 0.11, respectively. The overall CRC incidence was 2.58, decreasing the first 3 decades but peaking in the last (2.84). The deaths related to CRCs were low (0.018). CONCLUSION Even in an experienced IF center of excellence, the incidence of CRCs increased over the 4 decades. This increase could be explained by the expansion of the indication of HPN to a more elderly and frail patient population.
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Affiliation(s)
| | - Siri Tribler
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mark Hvistendahl
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rahim M Naimi
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Brøbech
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Staun
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
| | - Palle Bekker Jeppesen
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Copenhagen, Denmark
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Ulrich RJ, Santhosh K, Mogle JA, Young VB, Rao K. Is Clostridium difficile infection a risk factor for subsequent bloodstream infection? Anaerobe 2017; 48:27-33. [PMID: 28669864 PMCID: PMC5711547 DOI: 10.1016/j.anaerobe.2017.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/22/2017] [Accepted: 06/29/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clostridium difficile infection (CDI) is a common nosocomial diarrheal illness increasingly associated with mortality in United States. The underlying factors and mechanisms behind the recent increases in morbidity from CDI have not been fully elucidated. Murine models suggest a mucosal barrier breakdown leads to bacterial translocation and subsequent bloodstream infection (BSI). This study tests the hypothesis that CDI is associated with subsequent BSI in humans. METHODS We conducted a retrospective cohort study on 1132 inpatients hospitalized >72 h with available stool test results for toxigenic C. difficile. The primary outcome was BSI following CDI. Secondary outcomes included 30-day mortality, colectomy, readmission, and ICU admission. Unadjusted and adjusted logistic regression models were developed. RESULTS CDI occurred in 570 of 1132 patients (50.4%). BSI occurred in 86 (7.6%) patients. Enterococcus (14%) and Klebsiella (14%) species were the most common organisms. Patients with BSI had higher comorbidity scores and were more likely to be male, on immunosuppression, critically ill, and have a central venous catheter in place. Of the patients with BSI, 36 (42%) had CDI. CDI was not associated with subsequent BSI (OR 0.69; 95% CI 0.44-1.08; P = 0.103) in unadjusted analysis. In multivariable modeling, CDI appeared protective against subsequent BSI (OR 0.57; 95% CI 0.34-0.96; P = 0.036). Interaction modeling suggests a complicated relationship among CDI, BSI, antibiotic exposure, and central venous catheter use. CONCLUSIONS In this cohort of inpatients that underwent testing for CDI, CDI was not a risk factor for developing subsequent BSI.
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Affiliation(s)
- Robert J Ulrich
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.
| | - Kavitha Santhosh
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA; Division of Infectious Diseases, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Jill A Mogle
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA; Division of Infectious Diseases, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Vincent B Young
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA; Division of Infectious Diseases, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA; Department of Microbiology and Immunology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Krishna Rao
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA; Division of Infectious Diseases, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Corbella M, Brandolini M, Cambieri P, Decembrino N, Pagani M, Bottazzi A, Muzzi A, Zecca M, Mariani B, Marone P. A catheter-related bloodstream infection caused by Chryseobacterium indologenes successfully treated with antibiotic-lock rescue therapy. New Microbiol 2017; 40:223-225. [PMID: 28675244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Abstract
We report the case of a catheter-related bloodstream infection caused by Chryseobacterium indologenes, an uncommon and multi-resistant pathogen, in a pediatric patient with a long-term vascular access device placed for chemotherapy treatment. The infection was successfully treated with ciprofloxacin antibiotic-lock therapy. This is the first report on successful salvage of a long-term device colonized by multi-resistant Chryseobacterium indologenes.
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Affiliation(s)
- Marta Corbella
- Servizio di Biometria ed Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- S.C. Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Micaela Brandolini
- S.C. Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Patrizia Cambieri
- S.C. Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nunzia Decembrino
- S.C. Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michele Pagani
- S.C. Anestesia e Rianimazione 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Bottazzi
- S.C. Anestesia e Rianimazione 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alba Muzzi
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Zecca
- S.C. Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Bianca Mariani
- S.C. Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piero Marone
- S.C. Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Velasquez Reyes DC, Bloomer M, Morphet J. Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review. Intensive Crit Care Nurs 2017; 43:12-22. [PMID: 28663107 DOI: 10.1016/j.iccn.2017.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/03/2017] [Accepted: 05/23/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND In adult Intensive Care Units, the complexity of patient treatment requirements make the use of central venous lines essential. Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters. AIM Identify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters. METHODS A systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE; CINAHL Plus; EMBASE; PubMed; Cochrane Library; Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion. RESULTS Nineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the 'On the CUSP: Stop Blood Stream Infections' national programme. CONCLUSIONS Central venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection.
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Affiliation(s)
| | - Melissa Bloomer
- Deakin University, School of Nursing and Midwifery, PO Box 20000, Geelong, VIC, AUS 3217, Australia
| | - Julia Morphet
- Monash University, School of Nursing and Midwifery Peninsula campus, McMahons Road, Frankston VIC, 3199, Australia
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Rickard CM, Marsh NM, Webster J, Gavin NC, Chan RJ, McCarthy AL, Mollee P, Ullman AJ, Kleidon T, Chopra V, Zhang L, McGrail MR, Larsen E, Choudhury MA, Keogh S, Alexandrou E, McMillan DJ, Mervin MC, Paterson DL, Cooke M, Ray-Barruel G, Castillo MI, Hallahan A, Corley A, Geoffrey Playford E. Peripherally InSerted CEntral catheter dressing and securement in patients with cancer: the PISCES trial. Protocol for a 2x2 factorial, superiority randomised controlled trial. BMJ Open 2017; 7:e015291. [PMID: 28619777 PMCID: PMC5734285 DOI: 10.1136/bmjopen-2016-015291] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/23/2017] [Accepted: 03/31/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Around 30% of peripherally inserted central catheters (PICCs) fail from vascular, infectious or mechanical complications. Patients with cancer are at highest risk, and this increases morbidity, mortality and costs. Effective PICC dressing and securement may prevent PICC failure; however, no large randomised controlled trial (RCT) has compared alternative approaches. We designed this RCT to assess the clinical and cost-effectiveness of dressing and securements to prevent PICC failure. METHODS AND ANALYSIS Pragmatic, multicentre, 2×2 factorial, superiority RCT of (1) dressings (chlorhexidine gluconate disc (CHG) vs no disc) and (2) securements (integrated securement dressing (ISD) vs securement device (SED)). A qualitative evaluation using a knowledge translation framework is included. Recruitment of 1240 patients will occur over 3 years with allocation concealment until randomisation by a centralised service. For the dressing hypothesis, we hypothesise CHG discs will reduce catheter-associated bloodstream infection (CABSI) compared with no CHG disc. For the securement hypothesis, we hypothesise that ISD will reduce composite PICC failure (infection (CABSI/local infection), occlusion, dislodgement or thrombosis), compared with SED. SECONDARY OUTCOMES types of PICC failure; safety; costs; dressing/securement failure; dwell time; microbial colonisation; reversible PICC complications and consumer acceptability. Relative incidence rates of CABSI and PICC failure/100 devices and/1000 PICC days (with 95% CIs) will summarise treatment impact. Kaplan-Meier survival curves (and log rank Mantel-Haenszel test) will compare outcomes over time. Secondary end points will be compared between groups using parametric/non-parametric techniques; p values <0.05 will be considered to be statistically significant. ETHICS AND DISSEMINATION Ethical approval from Queensland Health (HREC/15/QRCH/241) and Griffith University (Ref. No. 2016/063). Results will be published. TRIAL REGISTRATION Trial registration number is: ACTRN12616000315415.
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Affiliation(s)
- Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole M Marsh
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Joan Webster
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Nicole C Gavin
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Raymond J Chan
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Alexandra L McCarthy
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Peter Mollee
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Lady Cilento Children’s Hospital, Brisbane, Australia
| | - Vineet Chopra
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Patient Safety Enhancement Program, University of Michigan Health System and VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Li Zhang
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Matthew R McGrail
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Rural Health, Monash University, Churchill, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Md Abu Choudhury
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| | - Samantha Keogh
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Evan Alexandrou
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Western Sydney University and Liverpool Hospital, Sydney, Australia
| | - David J McMillan
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Merehau Cindy Mervin
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - David L Paterson
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Royal Brisbane and Women’s Hospitals, Brisbane, Australia
| | - Maria Isabel Castillo
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Andrew Hallahan
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Lady Cilento Children’s Hospital, Brisbane, Australia
| | - Amanda Corley
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - E Geoffrey Playford
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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Brisbois EJ, Major TC, Goudie MJ, Meyerhoff ME, Bartlett RH, Handa H. Attenuation of thrombosis and bacterial infection using dual function nitric oxide releasing central venous catheters in a 9day rabbit model. Acta Biomater 2016; 44:304-12. [PMID: 27506125 PMCID: PMC5045795 DOI: 10.1016/j.actbio.2016.08.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/19/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED Two major problems with implanted catheters are clotting and infection. Nitric oxide (NO) is an endogenous vasodilator as well as natural inhibitor of platelet adhesion/activation and an antimicrobial agent, and NO-releasing polymers are expected to have similar properties. Here, NO-releasing central venous catheters (CVCs) are fabricated using Elast-eon™ E2As polymer with both diazeniumdiolated dibutylhexanediamine (DBHD/NONO) and poly(lactic-co-glycolic acid) (PLGA) additives, where the NO release can be modulated and optimized via the hydrolysis rate of the PLGA. It is observed that using a 10% w/w additive of a PLGA with ester end group provides the most controlled NO release from the CVCs over a 14d period. The optimized DBHD/NONO-based catheters are non-hemolytic (hemolytic index of 0%) and noncytotoxic (grade 0). After 9d of catheter implantation in the jugular veins of rabbits, the NO-releasing CVCs have a significantly reduced thrombus area (7 times smaller) and a 95% reduction in bacterial adhesion. These results show the promise of DBHD/NONO-based NO releasing materials as a solution to achieve extended NO release for longer term prevention of clotting and infection associated with intravascular catheters. STATEMENT OF SIGNIFICANCE Clotting and infection are significant complications associated with central venous catheters (CVCs). While nitric oxide (NO) releasing materials have been shown to reduce platelet activation and bacterial infection in vitro and in short-term animal models, longer-term success of NO-releasing materials to further study their clinical potential has not been extensively evaluated to date. In this study, we evaluate diazeniumdiolate based NO-releasing CVCs over a 9d period in a rabbit model. The explanted NO-releasing CVCs were found to have significantly reduced thrombus area and bacterial adhesion. These NO-releasing coatings can improve the hemocompatibility and bactericidal activity of intravascular catheters, as well as other medical devices (e.g., urinary catheters, vascular grafts).
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Affiliation(s)
- Elizabeth J Brisbois
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Terry C Major
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Marcus J Goudie
- Biological Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Mark E Meyerhoff
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
| | - Robert H Bartlett
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Hitesh Handa
- Biological Engineering, College of Engineering, University of Georgia, Athens, GA, USA.
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Kreutzkamp B. [In process]. Med Monatsschr Pharm 2016; 39:453. [PMID: 29979552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
BACKGROUND The central venous catheter (CVC) is a device used for many functions, including monitoring haemodynamic indicators and administering intravenous medications, fluids, blood products and parenteral nutrition. However, as a foreign object, it is susceptible to colonisation by micro-organisms, which may lead to catheter-related blood stream infection (BSI) and in turn, increased mortality, morbidities and health care costs. OBJECTIVES To assess the effects of skin antisepsis as part of CVC care for reducing catheter-related BSIs, catheter colonisation, and patient mortality and morbidities. SEARCH METHODS In May 2016 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations and Epub Ahead of Print); Ovid EMBASE and EBSCO CINAHL Plus. We also searched clinical trial registries for ongoing and unpublished studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) that assessed any type of skin antiseptic agent used either alone or in combination, compared with one or more other skin antiseptic agent(s), placebo or no skin antisepsis in patients with a CVC in place. DATA COLLECTION AND ANALYSIS Two authors independently assessed the studies for their eligibility, extracted data and assessed risk of bias. We expressed our results in terms of risk ratio (RR), absolute risk reduction (ARR) and number need to treat for an additional beneficial outcome (NNTB) for dichotomous data, and mean difference (MD) for continuous data, with 95% confidence intervals (CIs). MAIN RESULTS Thirteen studies were eligible for inclusion, but only 12 studies contributed data, with a total of 3446 CVCs assessed. The total number of participants enrolled was unclear as some studies did not provide such information. The participants were mainly adults admitted to intensive care units, haematology oncology units or general wards. Most studies assessed skin antisepsis prior to insertion and regularly thereafter during the in-dwelling period of the CVC, ranging from every 24 h to every 72 h. The methodological quality of the included studies was mixed due to wide variation in their risk of bias. Most trials did not adequately blind the participants or personnel, and four of the 12 studies had a high risk of bias for incomplete outcome data.Three studies compared different antisepsis regimens with no antisepsis. There was no clear evidence of a difference in all outcomes examined, including catheter-related BSI, septicaemia, catheter colonisation and number of patients who required systemic antibiotics for any of the three comparisons involving three different antisepsis regimens (aqueous povidone-iodine, aqueous chlorhexidine and alcohol compared with no skin antisepsis). However, there were great uncertainties in all estimates due to underpowered analyses and the overall very low quality of evidence presented.There were multiple head-to-head comparisons between different skin antiseptic agents, with different combinations of active substance and base solutions. The most frequent comparison was chlorhexidine solution versus povidone-iodine solution (any base). There was very low quality evidence (downgraded for risk of bias and imprecision) that chlorhexidine may reduce catheter-related BSI compared with povidone-iodine (RR of 0.64, 95% CI 0.41 to 0.99; ARR 2.30%, 95% CI 0.06 to 3.70%). This evidence came from four studies involving 1436 catheters. None of the individual subgroup comparisons of aqueous chlorhexidine versus aqueous povidone-iodine, alcoholic chlorhexidine versus aqueous povidone-iodine and alcoholic chlorhexidine versus alcoholic povidone-iodine showed clear differences for catheter-related BSI or mortality (and were generally underpowered). Mortality was only reported in a single study.There was very low quality evidence that skin antisepsis with chlorhexidine may also reduce catheter colonisation relative to povidone-iodine (RR of 0.68, 95% CI 0.56 to 0.84; ARR 8%, 95% CI 3% to 12%; ; five studies, 1533 catheters, downgraded for risk of bias, indirectness and inconsistency).Evaluations of other skin antiseptic agents were generally in single, small studies, many of which did not report the primary outcome of catheter-related BSI. Trials also poorly reported other outcomes, such as skin infections and adverse events. AUTHORS' CONCLUSIONS It is not clear whether cleaning the skin around CVC insertion sites with antiseptic reduces catheter related blood stream infection compared with no skin cleansing. Skin cleansing with chlorhexidine solution may reduce rates of CRBSI and catheter colonisation compared with cleaning with povidone iodine. These results are based on very low quality evidence, which means the true effects may be very different. Moreover these results may be influenced by the nature of the antiseptic solution (i.e. aqueous or alcohol-based). Further RCTs are needed to assess the effectiveness and safety of different skin antisepsis regimens in CVC care; these should measure and report critical clinical outcomes such as sepsis, catheter-related BSI and mortality.
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Affiliation(s)
- Nai Ming Lai
- Taylor's UniversitySchool of MedicineSubang JayaMalaysia
- Monash University MalaysiaSchool of PharmacySelangorMalaysia
| | - Nai An Lai
- Queen Elizabeth II Jubilee HospitalIntensive Care UnitCnr Troughton and Kessels RoadsCoopers PlainsQueenslandAustralia4108
| | - Elizabeth O'Riordan
- The University of Sydney and The Children's Hospital at WestmeadFaculty of Nursing and MidwiferySydneyNew South WalesAustralia2006
| | - Nathorn Chaiyakunapruk
- Monash University MalaysiaSchool of PharmacySelangorMalaysia
- Faculty of Pharmaceutical SciencesCenter of Pharmaceutical Outcomes Research, Department of Pharmacy PracticeNaresuan UniversityPhitsanulokThailand65000
- The University of QueenslandSchool of Population HealthBrisbaneQueenslandAustralia
| | - Jacqueline E Taylor
- Monash Medical Centre/Monash UniversityMonash Newborn246 Clayton RoadClaytonVictoriaAustralia3168
| | - Kenneth Tan
- Monash UniversityDepartment of Paediatrics246 Clayton RoadClaytonMelbourneVictoriaAustraliaVIC 3168
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Shenep MA, Tanner MR, Sun Y, Culley T, Hayden RT, Flynn PM, Tang L, Wolf J. Catheter-Related Complications in Children With Cancer Receiving Parenteral Nutrition: Change in Risk Is Moderated by Catheter Type. JPEN J Parenter Enteral Nutr 2016; 41:1063-1071. [PMID: 26743773 DOI: 10.1177/0148607115624087] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although central venous catheters (CVCs) are essential to pediatric cancer care, complications are common (eg, occlusion, central line-associated bloodstream infection [CLABSI]). Parenteral nutrition (PN) and external CVCs are associated with an increased complication risk, but their interaction is unknown. METHODS A retrospective matched cohort study of pediatric oncology patients who received PN through subcutaneous ports or external CVCs. Complication rates were compared between CVC types during PN and non-PN periods (log-negative binomial model). RESULTS Risk of CLABSI was higher during PN for children with ports (relative risk [RR] = 39.6; 95% confidence interval, 5.0-309) or external CVCs (RR = 2.9; 95% confidence interval, 1.1-7.4). This increased risk during PN was greater for ports than for external CVCs (ratio of relative risks = 13.6). Occlusion risk was higher during PN in both groups (RR = 10.0 for ports; RR = 2.0 for external CVCs), and the increase was significantly greater in ports (ratio of relative risks, 4.9). Overall, complication rates for ports were much lower than for external CVCs during the non-PN period but similar during the PN period. CONCLUSION Children with cancer who receive PN have increased risk of CLABSI and occlusion. The risk increase is greatest in children with ports: a 40- and 10-fold increase in infection risk and occlusion, respectively, resulting in similar complication rates during PN regardless of CVC type and negating the usual benefits of ports. Children with cancer who will require PN should have primary insertion of external CVCs where possible.
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Affiliation(s)
- Melissa A Shenep
- 1 Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Mary R Tanner
- 1 Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yilun Sun
- 2 Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tina Culley
- 1 Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Randall T Hayden
- 3 Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Patricia M Flynn
- 1 Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Li Tang
- 2 Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Joshua Wolf
- 1 Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
- 4 Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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Takahashi N, Shinjoh M, Tomita H, Fujino A, Sugita K, Katohno Y, Kuroda T, Kikuchi K. Catheter-related blood stream infection caused by Dermacoccus barathri, representing the first case of Dermacoccus infection in humans. J Infect Chemother 2015; 21:613-6. [PMID: 26044303 DOI: 10.1016/j.jiac.2015.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 11/18/2022]
Abstract
A 7-year-old boy undergoing home parenteral nutrition with totally implantable central venous access device for chronic intestinal pseudo-obstruction experienced repeated episodes of fever with a temperature above 39.0 °C despite the antibiotic treatment. The fever was considered to be catheter-related blood stream infections, as no other etiology could be justified. Repeated blood culture tests revealed negative after 1-week incubation, whereas some samples of blood collected from the central venous catheter yielded positive and gram-positive rods were detected. These bacteria were detected repeatedly, then the central venous access device was removed with consideration for the possibility of this bacteria being a pathogen. Thereafter, the fever did not recur and the blood culture tests were negative. The causative agent was identified as Dermacoccus barathri based on the 16S rRNA gene sequence and phylogenetic analysis of 6118-bp concatenated sequences of 4 housekeeping genes. Genus Dermacoccus are one form of Actinomycetes isolated from human skin and water, but human infection with Dermacoccus spp. has not been previously reported and the pathogenicity of the bacteria remains unclear. To our knowledge, this is the first reported case of Dermacoccus infection in humans.
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Affiliation(s)
- Nobuhiro Takahashi
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Hirofumi Tomita
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Akihiro Fujino
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kayoko Sugita
- Center for Infectious Diseases and Infection Control, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yasuhiro Katohno
- Central Clinical Laboratory, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Ken Kikuchi
- Department of Infection Control Science, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Department of Infectious Diseases, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
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Mekni MA, Achour W, Ben Hassen A. New Robbins device to evaluate antimicrobial activity against bacterial biofilms on central venous catheters. Tunis Med 2015; 93:153-157. [PMID: 26367403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Layouts of biomedical devices were tightly related with the emergence of Staphylococcus epidermidis as a major cause of nosocomial infections because of its ability to form biofilm on the biomaterial surfaces. This fact led researchers to develop in-vitro models to simulate what is really happening during biofilm formation process in order to have a better understanding of this phenomena and then to control it and to resolve the associated problems. The aim of this paper was to develop a homemade dynamic device based on instruments used in clinical practice, easy to mount, with low coast and with no sophisticated features. METHODS used to evaluate this dispositive were hydrodynamic calculation and enumeration of bacterial cells on petri dishes and with real time polymerase chain reaction during simulation of Staphylococcus epidermidis biofilm eradication with daptomycin. RESULTS With hydrodynamic calculation, Reynolds number was estimated to be 26.62 corresponding to a perfect laminar flux giving suitable dynamic growth environment for such experiment. Data recovered from cell enumeration with the two methods showed that bacterial colonization of the tested catheter segment was significantly reduced after 24 and 48h of treatment with daptomycin (P<0.01) reflecting a considerable reliability of this device. CONCLUSION the simple dispositive developed in this work has shown acceptable hydrodynamic proprieties and good reliability making research on biofilm easy to reach.
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Emergency department hand hygiene, catheter placement remain IC challenges. Hosp Peer Rev 2014; 39:142-3. [PMID: 25513699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Pérez Granda MJ, Guembe M, Cruces R, Martín-Rabadán P, Bouza E. Colonization of stickers used for the identification of intravenous lines: results from an in vitro study. Am J Infect Control 2014; 42:1161-4. [PMID: 25444263 DOI: 10.1016/j.ajic.2014.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clear differentiation of arterial and intravenous (IV) lines is a safety strategy recommended by the World Health Organization, and signaling stickers attached to IV lines are implemented in many institutions. However, the risk of colonization of the stickers' surface has not been evaluated. Our objective was to assess the colonization rate of stickers used for IV lines identification in an in vitro model using 3 different contamination degrees. METHODS A set of 30 stickers used for IV lines identification were exposed to low, medium, and high contamination degrees for up to 15 days. Twice a day, a single manipulator vigorously touched the surface of the stickers simulating the daily handling. Surface cultures of all stickers were performed daily. The microorganisms recovered were counted and identified by phenotypic characteristics. RESULTS Colonization occurred after 5 days in low and medium manipulation models and after 3 days in the high manipulation model. Nonadhesive sticker sides were associated with greater significant numbers of colony forming units when manipulation was performed without gloves. CONCLUSION Stickers used for the identification of IV lines may become potential reservoirs of catheter colonization. Clinical studies to validate these data and design policies of stickers' changes are required.
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Affiliation(s)
- María Jesús Pérez Granda
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Raquel Cruces
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Martín-Rabadán
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Emilio Bouza
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Cao RL. Unexplained seizures after intestinal surgery. Pediatr Neurol 2014; 51:587-8. [PMID: 25179525 DOI: 10.1016/j.pediatrneurol.2014.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 06/04/2014] [Accepted: 06/07/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Ri-Liang Cao
- Department of Pediatric Surgery, Guangdong Women and Children Hospital, Guangzhou, P.R. China.
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Jamal MA, Rosenblatt J, Jiang Y, Hachem R, Chaftari AM, Raad II. Prevention of transmission of multidrug-resistant organisms during catheter exchange using antimicrobial catheters. Antimicrob Agents Chemother 2014; 58:5291-6. [PMID: 24957841 PMCID: PMC4135861 DOI: 10.1128/aac.02886-14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/17/2014] [Indexed: 11/20/2022] Open
Abstract
Exchanging a central venous catheter (CVC) over a guide wire for a fresh uncoated CVC in the presence of bacteremia can result in cross-infection of the newly exchanged CVC. A recent retrospective clinical study showed that exchanging a catheter over a guide wire in the presence of bacteremia using an antimicrobial minocycline-rifampin (M/R) catheter may improve outcomes. To expand on this, we developed an in vitro cross-contamination model of exchange to evaluate the efficacy of different antimicrobial CVCs in preventing cross-contamination of multidrug-resistant organisms during exchange. Uncoated CVCs were allowed to form biofilm by methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans. After 24 h, the biofilm-colonized CVCs were placed in a glass tube containing bovine calf serum plus Mueller-Hinton broth, and each catheter was exchanged over a guide wire for a fresh uncoated or an M/R-, chlorhexidine-silver sulfadiazine (CHX/SS)-, or chlorhexidine-M/R (CHX-M/R)-coated CVC. Cross-contamination of exchanged catheters was enumerated by sonication and quantitative plating methods. The exchange of M/R CVCs completely prevented cross-contamination by MRSA biofilms compared to control exchanged CVCs (P<0.0001). Exchange with CHX/SS CVCs reduced but did not completely prevent cross-contamination by MRSA (P=0.005). Exchange with CHX-M/R CVCs completely prevented cross-contamination by MRSA, P. aeruginosa, and C. albicans biofilms (P<0.0001). Furthermore, CHX-M/R CVCs were superior to M/R CVCs against P. aeruginosa and C. albicans (P=0.003) and were superior to CHX/SS CVCs against MRSA and P. aeruginosa (P=0.01). In conclusion, exchange with the novel CHX-M/R CVC was the only exchange effective in completely and concurrently preventing cross-contamination from bacteria and Candida.
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Affiliation(s)
- Mohamed A Jamal
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Joel Rosenblatt
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ann-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Abstract
Catheter related bloodstream infections (CR-BSIs) can lead to a number of serious conditions for the patient, including death. There is much recent evidence both in the UK and abroad which identifies the sources of CR-BSIs, yet they continue to occur. This article seeks to review some of the current evidence in relation to the prevention of CR-BSIs at insertion point.
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Lee MR, Chang SA, Choi SH, Lee GY, Kim EK, Peck KR, Park SW. Clinical features of right-sided infective endocarditis occurring in non-drug users. J Korean Med Sci 2014; 29:776-81. [PMID: 24932077 PMCID: PMC4055809 DOI: 10.3346/jkms.2014.29.6.776] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 04/01/2014] [Indexed: 01/30/2023] Open
Abstract
Right-sided infective endocarditis (RIE) occurs predominantly in intravenous drug users in western countries, and it has a relatively good prognosis. Clinical features and prognosis of RIE occurring in non-drug users are not well known. We investigated the clinical findings of RIE in non-drug users. We retrospectively reviewed 345 cases diagnosed with IE. Cases with RIE or left-sided infective endocarditis (LIE) defined by the vegetation site were included and cases having no vegetation or both-side vegetation were excluded. Clinical findings and in-hospital outcome of RIE were compared to those of LIE. Among the 245 cases, 39 (16%) cases had RIE and 206 (84%) cases had LIE. RIE patients were younger (40 ± 19 yr vs 50 ± 18 yr, P=0.004), and had a higher incidence of congenital heart disease (CHD) (36% vs 13%, P<0.001) and central venous catheter (CVC) (21% vs 4%, P=0.001) compared to LIE patients. A large vegetation was more common in RIE (33% vs 9%, P<0.001). Staphylococcus aureus was the most common cause of RIE, while Streptococcus viridans were the most common cause of LIE. In-hospital mortality and cardiac surgery were not different between the two groups. CHD and use of CVC were common in non-drug users with RIE. The short-term clinical outcome of RIE is not different from that of LIE.
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Affiliation(s)
- Mi-Rae Lee
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sung-A Chang
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Hee Choi
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga-Yeon Lee
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Kyoung Kim
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyong-Ran Peck
- Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shime N. [Role of anesthesiologist in prevention of perioperative infection]. Masui 2014; 63:269-277. [PMID: 24724436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Perioprative infection has a significant impact on outcome of surgical patients. Anesthesiologists have roles in reducing infection by application of appropriate prophylactic measures. Hand hygiene is a prerequisite when contacting patients in the operating room. Bundled-preventive approaches should be applied during insertion of intravascular lines, specifically central venous lines. Application of appropriate skin preparation and/or dressings with antiseptics is important. Appropriate selection of antimicrobials depending on surgeries and patients' background, and avoidance of periopeative hypothermia are significant preventive measures for surgical wound infection. To reduce postoperative pneumonia including ventilator-associated pneumonia, avoidance of aspiration during intubation process or mechanical ventilation is necessary. Tracheal tube with a subglottic secretion drainage port might be applied in patients anticipated to receive longer period of postoperative mechanical ventilation and to have a greater risk of postoperative pneumonia.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tyczkowska-Sieroń E, Bartoszko-Tyczkowska A, Gaszyński W. [Fungal infections in patients of an intensive care unit analyzed on the example of the Lodz Medical University Hospital No 1 in the period of 2002-2012]. Med Dosw Mikrobiol 2014; 66:29-36. [PMID: 25007511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The objective of this study was to analyze the fungal infections in patients of an intensive care unit (ICU) in a long period (2002-2012) on the example of the Lodz Medical University Hospital No 1. This analysis was focused on the study of the effect of antimicrobial therapy on the level of these infections. METHODS A total of 291 strains of fungi were isolated from blood, tips of central intravenous catheters, lower respiratory tract, urine, wounds, pressure sores, and cerebrospinal fluid of 3177 patients. An automatic system Bactec 9050, Yeast ID Phoenix BD panels and E-tests (BioMerieux) were used for the fungi analysis. RESULTS The studies were mainly concentrated on the Candida infections, distinguishing cases caused by C. albicans and C. non-albicans pathogens. Changes in the number of these infections in consecutive years have been associated with epidemiological and therapeutic activities in the ICU. Particularly, relationships between the number of infections and the use ofceftazidime were discussed. A statistically significant positive correlation of the count of Candida infections and the ceftazidime consumption was found in the period to 2006. In the later years, the correlation was destroyed as a result of other important therapeutic factors (eg, immunosuppressive drugs). CONCLUSIONS It has been found that the number of Candida infections in the ICU depends on the consumption of antimicrobial drugs. This conclusion is based on quantitative example of ceftazidime. Only close cooperation between the ICU and microbiologists is able to provide a reduction in nosocomial fungal infections.
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Zheng X, Fang X, Cai X. Two episodes of anaphylaxis caused by a chlorhexidine sulfadiazine-coated central venous catheter. Chin Med J (Engl) 2014; 127:2395-2397. [PMID: 24931265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Xing Zheng
- Department of Anesthesia, Sir Run Run Shaw Hospital (Affiliated with Zhejiang University), Hangzhou, Zhejiang 310016, China
| | - Xiao Fang
- Department of Anesthesia, Sir Run Run Shaw Hospital (Affiliated with Zhejiang University), Hangzhou, Zhejiang 310016, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital (Affiliated with Zhejiang University), Hangzhou, Zhejiang 310016, China.
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Schilcher G, Schlagenhauf A, Schneditz D, Scharnagl H, Ribitsch W, Krause R, Rosenkranz AR, Stojakovic T, Horina JH. Ethanol causes protein precipitation--new safety issues for catheter locking techniques. PLoS One 2013; 8:e84869. [PMID: 24391979 PMCID: PMC3877335 DOI: 10.1371/journal.pone.0084869] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 11/19/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The ethanol lock technique has shown great potential to eradicate organisms in biofilms and to treat or prevent central venous catheter related infections. Following instillation of ethanol lock solution, however, the inherent density gradient between blood and ethanol causes gravity induced seepage of ethanol out of the catheter and blood influx into the catheter. Plasma proteins so are exposed to highly concentrated ethanol, which is a classic agent for protein precipitation. We aimed to investigate the precipitating effect of ethanol locks on plasma proteins as a possible cause for reported catheter occlusions. METHODS Plasma samples were exposed in-vitro to ethanol (concentrations ranging from 7 to 70 v/v%) and heparin lock solutions. In catheter studies designed to mimic different in-vivo situations, the catheter tip was placed in a plasma reservoir and the material contained within the catheter was analyzed after ethanol lock instillation. The samples underwent standardized investigation for protein precipitation. RESULTS Protein precipitation was observed in plasma samples containing ethanol solutions above a concentration of 28%, as well as in material retrieved from vertically positioned femoral catheters and jugular (subclavian) catheters simulating recumbent or head down tilt body positions. Precipitates could not be re-dissolved by dilution with plasma, urokinase or alteplase. Plasma samples containing heparin lock solutions showed no signs of precipitation. CONCLUSIONS Our in-vitro results demonstrate that ethanol locks may be associated with plasma protein precipitation in central venous catheters. This phenomenon could be related to occlusion of vascular access devices locked with ethanol, as has been reported. Concerns should be raised regarding possible complications upon injection or spontaneous gravity induced leakage of such irreversibly precipitated protein particles into the systemic circulation. We suggest limiting the maximum advisable concentration of ethanol to 28 v/v% in catheter lock solutions.
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Affiliation(s)
- Gernot Schilcher
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Axel Schlagenhauf
- Department of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Schneditz
- Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Werner Ribitsch
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander R. Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Joerg H. Horina
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Green JV, Orsborn KI, Zhang M, Tan QKG, Greis KD, Porollo A, Andes DR, Long Lu J, Hostetter MK. Heparin-binding motifs and biofilm formation by Candida albicans. J Infect Dis 2013; 208:1695-704. [PMID: 23904295 PMCID: PMC4038792 DOI: 10.1093/infdis/jit391] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/30/2013] [Indexed: 01/02/2023] Open
Abstract
Candida albicans is a leading pathogen in infections of central venous catheters, which are frequently infused with heparin. Binding of C. albicans to medically relevant concentrations of soluble and plate-bound heparin was demonstrable by confocal microscopy and enzyme-linked immunosorbent assay (ELISA). A sequence-based search identified 34 C. albicans surface proteins containing ≥1 match to linear heparin-binding motifs. The virulence factor Int1 contained the most putative heparin-binding motifs (n = 5); peptides encompassing 2 of 5 motifs bound to heparin-Sepharose. Alanine substitution of lysine residues K805/K806 in 804QKKHQIHK811 (motif 1 of Int1) markedly attenuated biofilm formation in central venous catheters in rats, whereas alanine substitution of K1595/R1596 in 1593FKKRFFKL1600 (motif 4 of Int1) did not impair biofilm formation. Affinity-purified immunoglobulin G (IgG) recognizing motif 1 abolished biofilm formation in central venous catheters; preimmune IgG had no effect. After heparin treatment of C. albicans, soluble peptides from multiple C. albicans surface proteins were detected, such as Eno1, Pgk1, Tdh3, and Ssa1/2 but not Int1, suggesting that heparin changes candidal surface structures and may modify some antigens critical for immune recognition. These studies define a new mechanism of biofilm formation for C. albicans and a novel strategy for inhibiting catheter-associated biofilms.
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García-Rodríguez JF, Álvarez-Díaz H, Vilariño-Maneiro L, Lorenzo-García MV, Cantón-Blanco A, Ordoñez-Barrosa P, Mariño-Callejo AI, Sesma-Sánchez P. Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit. BMC Infect Dis 2013; 13:445. [PMID: 24063563 PMCID: PMC3849631 DOI: 10.1186/1471-2334-13-445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 09/20/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Outside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. The aim of this study was to investigate the epidemiology and the impact of a multifaceted "bundle" approach in controlling CVC-ABSIs outside ICU. METHODS From 1991 we performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year. On november 2008, an education programme was instituted for care of catheter lines: reinforcing instructions in aseptic insertion technique, after care and hand-washing; in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in litres. From January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80% of cases. RESULTS Prevalence of use of CVC and parenteral nutrition was similar throughout the study. We followed-up 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9% decrease. The infection rates achieved were lower in Internal Medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in last three years, showing a 63.1% decrease. In 2009, the estimated CVC-ABSIs incidence rate was significantly lower in the Internal Medicine ward compared to the Surgery ward: rate ratio (RR) = 0.14, 95%CI: 0.03-0.60), and within the Internal Medicine ward, the estimated CVC-ABSIs incidence rate was significantly lower in 2009 compared to 2008 (RR = 0.20, 95%CI: 0.04-0.91). CONCLUSION The rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact.
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Affiliation(s)
- José Francisco García-Rodríguez
- Infectious Diseases Unit, Internal Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain
- C/ San Amaro 10-12, 6° Derecha, 15403, Ferrol, La Coruña, Spain
| | - Hortensia Álvarez-Díaz
- Infectious Diseases Unit, Internal Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain
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Ramos RT, Leite GM, Martinez HV, Sibin KC, Germano A, Svidzinski T. [Clinical and epidemiological characteristics of patients with central venous catheter colonized by yeasts]. ACTA MEDICA PORT 2011; 24 Suppl 2:257-262. [PMID: 22849910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Among others complications due central venous catheters (CVCs), the blood infection (BI) deserves particular attention. The purposes of this study were to analyze the clinical and epidemiological characteristics of adult patients using CVC; to know the yeast colonization index; and to link it to risk factors for BI. Yeasts were investigated in 156 CVCs removed from 91 patients of the Regional University Hospital of Maringá from February to August, 2008. Yeast colonization was detected in 10.89% of the catheters, which were removed from 15 patients, three of them had a fatal hospital yeast infection due to catheter. There was a preponderance of male subjects; median age was 66 years and the mean hospitalization time was 15 days, greater than that of the non-colonized (p = 0.003). The mortality rate was significantly greater in this group than among those with non-colonized catheters (p = 0.01). Total parenteral nutrition and hemodialysis were the risk factors significantly more frequent in this group (p = 0.002 and 0.001, respectively). The most frequently found yeast was Candida parapsilosis. Among the colonized catheters those of double-lumen for infusion predominated and the site of insertion was the right subclavian vein. In conclusion the colonization by yeasts rate of CVC was 10.89% and 20% of them resulted in infection. These results add to higher mortality in patients who CVC was colonized by yeasts deserve attention considering the increasing of the hospital fungal infections.
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Affiliation(s)
- Rosana T Ramos
- Serviços de Clínica Médica, Farmácia Hospitalar, Departamento de Análises, Clínicas Hospital Universitário Regional de Maringá, Brasil
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