Catheter-associated Bloodstream Research Articles

October 2023 Critical Care Case of the Month: Multi-Drug Resistant K. pneumoniae

No abstract available. Article truncated after 150 words. History of Present Illness: A 75-year-old man presented from a skilled nursing facility with altered mental status and hypotension. He had a seven-year-long history of steroid-dependent myasthenia gravis, but had previously declined Covid vaccination, and subsequently experienced a severe case of COVID-19 pneumonia five months prior to admission. This resulted in chronic respiratory failure and renal failure for which he subsequently underwent tracheostomy, tunneled subclavian vein dialysis catheter placement and percutaneous endoscopic gastrostomy (PEG). He had resided in a skilled nursing facility since then, requiring four subsequent hospital readmissions for complications. These sequentially included septic shock due to a catheter associated blood stream infection, an intra-abdominal abscess due to PEG migration into the peritoneum resulting in fungal blood stream infection, recurrent intra-abdominal infection with multiple organisms, and bacterial pneumonia. Treatment of these infectious complications included replacement of the tunneled dialysis catheter and exploratory laparotomy with debridement of multiple abscesses. The …

Abstract #1407449: Successful Plasma Exchange and Thyroidectomy in Thyroid Storm

Thyroid storm is a severe manifestation of thyrotoxicosis that is defined by hyperthyroidism with multi-organ failure. Typical treatment revolves around decreasing thyroid hormone production and peripheral conversion of T4 to T3. TPE (Therapeutic Plasma Exchange) removes cytokines, antibodies, and thyroid hormones with their bound proteins, but this is mostly a transient option until medications take effect. TPE +/- thyroidectomy is not an ATA (American Thyroid Association) recommended practice but can be considered in individuals. Multiple case reports have been published showing successful resolution of storm with plasmapheresis and surgery if medical management failed or in cases of severe iodine-induced storms. Here, we present a patient in thyroid storm with history of untreated Graves complicated with iodine-induced disease. A 49-year-old male with untreated Graves disease was brought to the hospital after a motor vehicle accident. He underwent multiple contrasted CT studies and found to have several traumatic fractures requiring urgent surgical fixation. In the ER, he was in clinical heart failure with Atrial fibrillation with rapid response, which was treated with an amiodarone drip. He was later found to have suppressed TSH and elevated free thyroid hormones. Full medical treatment for thyroid storm including cholestyramine and steroids was started with initial biochemical improvement for 7 days; however, his thyroid function and clinical status began to deteriorate. During his ICU course, he had worsening Atrial Fibrillation, life-threatening Upper GI bleed with altered mental status which led to his intubation and eventual tracheostomy. We then decided to proceed with TPE and plans for urgent thyroidectomy. He underwent 5 sessions of TPE with nearly a 50% drop in hormones allowing him to be stable enough to undergo a successful total thyroidectomy without surgical complications. Although he did develop presumed catheter associated blood stream infection, it did resolve after antibiotics and central line removal. Soon after, he was discharged to inpatient rehab for ongoing physical therapy. There are currently no ATA guideline recommendations for TPE and thyroidectomy for thyroid storm. In our case, this approach appeared effective in relieving the life-threatening storm our patient presented in. Perhaps, the addition of TPE +/- thyroidectomy after medical treatment failure should be considered earlier for patients with life-threatening thyroid storm and at higher risks for decompensation.

Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care?

The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device. The midline catheter has had a resurgence in use because of the need for a long-term peripheral vascular access device not linked to central catheter-associated bloodstream infection risk. To review the characteristics of midline catheters, the benefits and risks of midline catheters, and current evidence regarding midline catheter use in critical care. Research related to midline catheters has greatly expanded the body of knowledge regarding vascular access device selection and midline catheter use. Although the quality and results of research on vascular access devices vary widely, a more accurate safety profile is emerging to illustrate how midline catheter use can support the goals of infusion therapy. Optimizing vascular access device selection requires recognition that every vascular access device can cause patient harm. Although the midline catheter appears to fill an important niche in infusion therapy, use of the midline catheter should be carefully evaluated. Midline catheters should not be used as a catheter-associated bloodstream infection prevention strategy, should be inserted to administer peripherally compatible solutions, and should be considered for short-term continuous vesicant therapy only in emergent situations until more definitive vascular access can be achieved.

Reducing Unnecessary Laboratory Utilization in the Medical ICU: A Fellow-Driven Quality Improvement Initiative.

OBJECTIVES:Overutilization of laboratory services is now recognized as harmful to patients and wasteful. In fact, the American Board of Internal Medicine’s Choosing Wisely campaign recommends against ordering routine testing that does not answer a clinical question. Per peer benchmarking, our institution as a whole occupied an extreme outlier position at the 100th percentile for laboratory utilization. We sought to address this problem starting in our medical ICUs with a quality improvement project.DESIGN:Quality improvement project using the design, measure, analyze, improve, and control process. The primary endpoint was a sustained reduction in laboratory utilization. Counterbalance metrics were also followed, and these included mortality, renal replacement therapy initiation rates, stat laboratory orders, and central catheter–associated blood stream infections.SETTING:The medical ICU at the Ohio State University Medical Center.PATIENTS:All patients admitted to the medical ICU from March 2019 to March 2020.INTERVENTIONS:Root causes were identified and addressed with the implementation of a wide range of interventions involving a multidisciplinary team led by trainee physicians.MEASUREMENTS AND MAIN RESULTS:There was a sustained 20% reduction in the number of tests performed per patient day, with no change in the counterbalance metrics.CONCLUSIONS:Trainees can affect positive change in the culture and processes at their institutions to safely reduce laboratory utilization.

Quality of care for peripheral intravenous catheters (PIVCs) in Nepal: a cross-sectional study on feasibility and inter-rater agreement of the Peripheral Intravenous Catheters-mini Questionnaire (PIVC-miniQ) in a tertiary care hospital

ObjectivesThere is a lack of data regarding the quality of peripheral intravenous catheter (PIVC)-related care from low-income and middle-income countries, even though the use of PIVCs may lead to local...

Skin Colonizers and Catheter Associated Blood Stream Infections in Incident Indian Dialysis Patients.

Introduction:Skin colonization is a risk factor for multi-drug resistant (MDR) catheter-associated bloodstream infections (CABSI). This study aimed to determine the prevalence and spectrum of skin colonizing MDR organisms in incident HD patients and their correlation with CABSI.Methods:This single-center prospective cohort study included consecutive adult incident HD patients who underwent tunneled or non-tunneled internal jugular vein HD catheter insertion between June 1, 2017 and October 31, 2017. Nasal, axillary, and exit site swabs were obtained prior to catheter insertion, at 14–21 days, and 28–35 days after catheter insertion.Results:Forty-three patients (69.7% male, 32.5% diabetic) were included and provided baseline swabs, while 29 and 10 patients respectively were available for follow-up swabs. MDR bacterial colonization, MRSA colonization, and MDR gram-negative colonization on the baseline set of swabs were seen in 76.7%, 69.7%, and 9.3% patients respectively. Of the 29 patients with at least two consecutive sets of swabs, 79.3% showed persistent colonization by MDR gram-positive organisms, most commonly by MRSA. Six patients developed a CABSI during the follow-up period (incidence rate 3.7 per 1000 patient days), 83.4% were gram negative, and in only one instance (16.6%) was the bacterial strain identical to that which had previously colonized the skin.Conclusions:Three-fourths of HD patients were colonized by MDR bacteria prior to HD initiation. Despite the majority being persistently colonized by MDR gram-positive organisms, CABSIs were predominantly gram negative.

Advantages and disadvantages of femoral port systems in hematоlogical patients with superior vena cava syndrome

Background. In the superior vena cava syndrome, vein catheterisation provides an alternative for vascular access. Few reports describe the usage of femoral ports.Aim. Description of pros and contras for femoral port installation in patients with haematological malignancies and the superior vena cava syndrome.Materials and methods. This prospective non-randomised, single-centre study included 163 haematological patients implanted 72 ports in superior vena cava, 35 — in inferior vena cava and inserted with 156 non-tunnelled femoral catheters. Catheterisation properties, complications, duration of use and reasons for port and catheter removal were registered.Results. No significant differences were observed between ports in superior and inferior vena cava as per the frequency of urokinase use in catheter dysfunction, catheter dislocation, catheter-associated bloodstream and pocket infections. Differences were revealed in the catheter-associated thrombosis rate, which was higher with femoral access (17.0 % or 0.9/1000 catheter days vs. 8.3 % or 0.2/1000 catheter days, p = 0.017). Ports in inferior vena cava had a lesser duration of use than in superior vena cava (p = 0.0001). Unlike femoral ports, non-tunnelled femoral catheters had higher rates of catheter-associated thrombosis (9/1000 vs. 0.9/1000 catheter days, p = 0.002) and infection (4.9/1000 vs. 0.3/1000 catheter days, p = 0.002). One lymphoma therapy course required one femoral port or 1 to 14 (median 3) non-tunnelled femoral catheters.Conclusion. Femoral port implantation is a necessary measure in patients with the superior vena cava syndrome. It has advantages in terms of catheterisation frequency, lower infectious and thrombotic complication rates compared to non-tunnelled femoral catheters.

A clinical study of patients with central venous catheter associated bloodstream infections in a tertiary care hospital

Background: Central venous access puts the patients at risk of iatrogenic complications and is associated with bloodstream infections. Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus and Methicillin Resistant Staphylococcus aureus (MRSA) are responsible for at least two-thirds of the infections followed by Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Enterococcus spp and Acinetobacter spp. Due to the scarcity of Central Venous Catheter associated Blood Stream Infections (CVC-BSI) data, this study was taken up in our tertiary care hospital. Aims: This study is aimed to study the profile of organisms causing CVC-BSI, assess their antimicrobial susceptibility, the clinical course and outcome.Methods: All subjects whose central venous catheter samples (n=84) were sent for culture and sensitivity during the study period were included in this prospective observational study. The study was done in the Department of Microbiology from July 2019 to December 2019. The catheter tips were streaked onto blood agar plate using Roll plate technique. After biochemical identification of the organisms, antimicrobial susceptibility testing was performed by modified Kirby-Bauer disc diffusion method as per the Clinical Laboratory Standard Institute (CLSI) guidelines. Results: Growth of pathogens was seen in 64.3% (n=54). The common organisms were Coagulase Negative Staphylococcus aureus (CONS) in 27.78% (n=15), Enterococcus spp, Klebsiella pneumoniae in 14.8% each (n=8) and Acinetobacter spp in 11.1% (n=6). Resistance was seen with amoxicillin + clavulanic acid, cefepime, ciprofloxacin and cefoperazone. The organisms were sensitive to levofloxacin, tetracycline and vancomycin.Conclusion: Aseptic precautions taken by the healthcare personnel will bring down the infections and curb the spread of multi-drug resistant hospital acquired infections.

Catheter Associated Blood Stream Infection Related to Chryseobacterium indologenes in a Case with Acute Renal Failure

Chryseobacterium indologenes (C.indologenes) formerly Flavobacterium indologenes is not generally known as infectious...

Prevalence and predictors of peripherally inserted central venous catheter associated bloodstream infections in cancer patients: A multicentre cohort study.

Despite increasing use, the exact prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PICC-CLABSI) in hospitalized patients with cancer are not elucidated.This retrospective cohort study included consecutive patients who underwent peripherally inserted central catheter (PICC) placement in 4 institutions (during 12 months in 3 hospitals and 10 months in 1 hospital). The prevalence of PICC-CLABSI was evaluated. The association between predictors and PICC-CLABSI were analyzed using Cox proportional hazards regression models and Kaplan-Meier survival analysis with log-rank tests.During the study period, 539 PICCs were inserted in 484 patients for a total of 10,841 catheter days. PICC-CLABSI occurred in 25 (5.2%) patients, with an infection rate of 2.31 per 1000 catheter days. PICC for chemotherapy (hazards ratio [HR] 11.421; 95% confidence interval (CI), 2.434–53.594; P = .019), double lumen catheter [HR 5.466; 95% CI, 1.257–23.773; P = .007], and PICC for antibiotic therapy [HR 2.854; 95% CI, 1.082–7.530; P = .019] were associated with PICC-CLABSI.PICC for chemotherapy or antibiotics, and number of catheter lumens are associated with increased risk of PICC-CLABSI in cancer patients. Careful assessment of these factors might help prevent PICC-CLABSI and improve cancer patients care.

An Intervention Based Prevention of Catheter Associated Blood Stream Infection in Adult Critical Care Unit

An Intervention Based Prevention of Catheter Associated Blood Stream Infection in Adult Critical Care Unit

Prevention of Bloodstream Infections in Patients Undergoing Hemodialysis.

Bloodstream infections are an important cause of hospitalizations, morbidity, and mortality in patients receiving hemodialysis. Eliminating bloodstream infections in the hemodialysis setting has been the focus of the Centers for Disease Control and Prevention (CDC) Making Dialysis Safer for Patients Coalition and, more recently, the CDC's partnership with the American Society of Nephrology's Nephrologists Transforming Dialysis Safety Initiative. The majority of vascular access-associated bloodstream infections occur in patients dialyzing with central vein catheters. The CDC's core interventions for bloodstream infection prevention are the gold standard for catheter care in the hemodialysis setting and have been proven to be effective in reducing catheter-associated bloodstream infection. However, in the United States hemodialysis catheter-associated bloodstream infections continue to occur at unacceptable rates, possibly because of lapses in adherence to strict aseptic technique, or additional factors not addressed by the CDC's core interventions. There is a clear need for novel prophylactic therapies. This review highlights the recent advances and includes a discussion about the potential limitations and adverse effects associated with each option.

Central venous catheter associated blood stream infections (CVC-BSIs) in the non-intensive care settings: Epidemiology, microbiology and outcomes.

Most studies have examined central venous catheter associated blood stream infections (CVC-BSIs) in Intensive Care Units (ICUs) but information on CVC-BSIs in non-ICU settings is sparse. This study aimed to determine the burden, microbiologic patterns, and associations of CVC-BSIs in non-ICU settings in a tertiary regional centre, University Hospital Geelong (UHG), Victoria, Australia. A retrospective study was conducted in the UHG from October 2016 to April 2018. Based on the National Healthcare Safety Network definition, 23 CVC-BSIs occurred in non-ICU settings. Data analysed using SPSS-v25 with a P value<0.05 was deemed as significant. The incidence rate was 1.2 per 10,000 bed-days. The mean age of patients was 57.22±18 years. 43.5% of patients had Charlson index score of ≥5 and 78% received appropriate empiric antibiotics. The 90-day mortality rate was zero. In total, 26 microorganisms were isolated. Gram-negative bacilli were more common than Gram-positive cocci. The mean catheter duration was 45.22±8.99 days. Hickman lines contributed to 52.2% of BSIs. Within the first two weeks of line insertion, 53.84% of CVC-BSIs occurred with 76.92% of CVC-Gram-negative bacteraemia and 71.4% of BSIs were related to Hickman lines. Also, 69.2% of CVC-BSIs occurred within ≤4 weeks of line insertion including 84.6% of CVC-Gram-negative bacteraemia. CVC-BSIs constitute a significant burden on high risk patients in non-ICU settings, with Gram negative bacilli predominating. A prospective surveillance program for all patients with CVC in the non-ICU setting may improve CVC management processes and influence educational measures.

Catheter-associated bloodstream infections

Each year an estimated quarter million central venous catheters (CVCs) are inserted in the UK for monitoring, delivery of drugs or intravenous feeding and blood sampling in patients receiving critical care. CVCs are indispensable, but the reported rate of catheter associated bloodstream infection (CA-BSI) is high with an incidence varying between 0.46 and 26.5 per 1000 CVC days. CA-BSI is an important cause of adverse clinical outcome, with associated morbidity and mortality, and an additional increased economic cost to the National Health Service. Of any clinical specialty Paediatric Intensive Care Units (PICUs) have one of the highest rates of hospital acquired bloodstream infection (BSI), with an estimated 70% caused by CVCs.

Impact of morbidity and mortality conferences on patient outcome

Introduction Despite decades of morbidity and mortality conference (MMC) research studies, there is still limited evaluation of their effect on healthcare outcome, especially in ICUs. Aim The aim of this study was to explore the effectiveness of goal-directed multidisciplinary MMCs on mortality and adverse event rates. Patients and methods A 4-year retrospective study was conducting in two ICUs for evaluating a systematized MMCs with a clear goal of improving local care through case discussion, analysis, brainstorming, and clear recommendations or action plans in a multidisciplinary meeting involving all related caregivers in a blame-free environment. This study included four phases: preintervention (January 2012–April 2013), intervention (May–June 2013), postintervention (July 2013–October 2014), and washout period (November 2014–December 2015, after MMC stoppage). A period prevalence study of ICU-acquired adverse events was done in March 2013, December 2013, and March 2015, in addition to monthly ventilator-associated pneumonia, catheter-associated blood stream), and catheter-associated urinary tract infection rates. Results A total of 5308 patients were included in this study, of which 1396 (26.3%) died. During the intervention and postintervention phases, 18 MMCs were held, which discussed 49 cases (38; 77.6% from ICU3 and 11; 22.4% from ICU1), reviewed other causes of death and unit performance indicators, and made 96 recommendations (85% accomplished in ICU3 vs. 55% in ICU1). All-cause combined and ICU3 mortality rates decreased after MMC implementation and then increased after MMC stoppage, with nonsignificant differences between the three groups regarding age, Acute Physiological and Chronic Health Evaluation II score, or primary diagnosis. Unexpected cardiac arrest (ICU3) and unplanned extubation (ICU1) decreased significantly with MMC and then increased significantly after MMC, whereas ICU-acquired gastrointestinal bleeding, deep vein thrombosis, and pneumothorax did not differ significantly across the three phases. Ventilator-associated pneumonia (ICU3), blood stream infection (ICU1), and urinary tract infection decreased significantly with MMC without significant change after MMC stoppage. Conclusion Goal-oriented multidisciplinary MMC reduced adverse events and probably mortality rate in medical/surgical ICU. Discrepancies between both units emphasized the need for continuous monitoring and tailoring of MMC system in case selection and recommendation implementation.

PP34 Costs Of Healthcare-Associated Infections In Latin America

IntroductionHealthcare-associated infections (HAI) are among the most common preventable health adverse event, associated with significant burden globally. Limited data on HAI costs in lower and middle-income countries is available. The aim of this study is to assess the cost, additional length-of-stay (LOS) and extra-mortality of HAI in the Latin American and Caribbean (LAC) Region.MethodsWe searched Medline/PubMed, Embase, Web of Science, Lilacs, Cochrane, National Health Service Economic Evaluation Database, Centre for Reviews and Dissemination, EconLit, and gray literature published in any language without restriction of date till July 2017. We included observational studies addressing the outcomes of interest, in which hospitalized patients with HAI are compared to those without HAI. The following study designs were included: quasi-experimental, controlled before-after, prospective and retrospective comparative cohort, case-control, and cross-sectional studies. We considered the following HAI-sites: surgical site infections (SSI), catheter-associated urinary-tract infections (CA-UTI), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infection (CLA-BSI), as well as cross-infection (CI). Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Reported costs were converted to USD considering official exchange rates.ResultsWe identified 4,339 citations. After removing duplicates, a total of 3,029 citations were screened for eligibility. A total of 87 studies from 17 countries were included. The majority (27.4 percent) reported on VAP, followed by CLA-BSI (21.2 percent), SSI (16.4 percent), and CA-UTI (14.4 percent). Most studies (46.7 percent) reported on incremental LOS, with an average of 14.8 days (range 0.9-49 days). Costs were reported by 25 percent of studies, with average incremental costs of USD 3,460 (range 49-12,155). Average extra-mortality of 15.6 percent (range -2.8-45.2 percent) was reported by 12.6 percent of studies.ConclusionsAvailable evidence from the LAC Region reports significant economic burden of HAI. This information will be useful for cost-effectiveness analysis of interventions aimed at reducing HAI economic and health burden.

Sustained Reduction of Catheter Associated Bloodstream Infections with Enhancement of Catheter Bundle by Chlorhexidine Dressings

BACKGROUND Prospective randomized controlled studies have demonstrated that addition of chlorhexidine (CHG) dressings reduce the rate of catheter (central venous and arterial) associated bloodstream infections (CABSI). However, studies confirming their impact in a real world setting are lacking. METHODS We conducted a real world evidence study evaluating the impact of incrementally introducing chlorhexidine dressings (sponge or gel) in addition to an ongoing catheter bundle on the rates of CABSI, expressed as incidence density rates per 1000 catheter-days measured as part of a surveillance program. Poisson regression models were used to compare infections rates over time. Both dressings were used simultaneously during one of the five study periods. FINDINGS From 2006 to 2014, 18 286 patients were admitted (91 292 ICU-days and 155 242 catheter-days). We recorded 111 CABSI. We observed a significant decrease of CABSI rates from 1.48 (95%CI: 1¬·09-2·01) without CHG-dressings to 0·69 (95%CI: 0·43-1·09) and 0·23 (95%CI: 0·11-0·48) episodes per 1000 catheter-days when CHG-sponge and CHG-gel dressings were used (p=0·0007; p<0·001). The rates were lower for CHG-gel compared to CHG-sponge dressings when comparing different study periods and when both dressings were used simultaneously. This difference did not reach statistical significance due to the low number of infections. INTERPRETATION The addition of chlorhexidine dressings to all CVC and arterial lines to an ongoing catheter bundle resulted in a significantly sustained seven-year reduction of all catheter-associated bloodstream infections. This large real world evidence study further supports the current recommendations for the systematic use of CHG-dressings on all catheters of ICU patients. Funding: Partially supported by an unrestricted research grant from 3M. Declaration of Interest: PE and CJ served in the speaker bureau of 3M and of Ethicon, manufacturer of the disinfectant dressings used during the intervention. PE received an unrestricted research grant to support the analysis of the data. BE from 3M performed the statistical work. SFB from 3M provided writing assistance and language editing. Part of the data were provided to 3M and to the FDA in March 2017. The authors declared no other conflicts of interest. Ethical Approval: As the interventions were included in the measures targeted at improvement of the quality of care, with products with a patent for use in patients in Switzerland, the commission cantonale d’ethique de la recherche sur l’etre humain and the institutional review board approved the study and waived the need for informed consent.

Abstract P-466: INTRAVENOUS DRUG ADMINISTRATION IN THE PICU- ARE APPROPRIATE LINES USED?

Aims & Objectives: Most PICU patients require insertion of peripheral and/or central intravenous (IV) lines which are used for administering drugs or taking blood samples. It is the role of the nurse to manage the administration of drugs or sampling of lines. As part of quality improvement for reducing Catheter Associated Blood Stream Infections (CABSI) an audit was undertaken of the intravenous lines in situ and which lines were used to administer drugs. Methods Paper audit forms were completed by bedside nurses over a 24-hour period, to record the activity around intravenous line breaches. Patient details, feeding information, total number and type of lines in situ were recorded. Results From April to June 2017, 100 PICU patients were included in the audit. Intravenous drug boluses were administered 694 times. Of these 66% (460/694) were administered via a central venous line. 80% of patients had between one and nine line breaches during the 24-hours. Two patients had 26 line breaches in a 24- hour period. 23% of drug boluses could have been administered peripherally. 9% of patient were tolerating enteral feeding but receiving no oral medications. Conclusions Despite evidence recommending that breaches to central venous lines should be minimised to reduce CABSIs, the local culture was to preferentially use that route for drug administration. Targeted education is required to reduce un-necessary breaches to central venous lines, and early removal when possible. Peripheral venous access or enteral routes should be utilised more readily.

Clearance of tunneled central venous catheter associated blood stream infections in children

BackgroundThe 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. MethodsWe 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. ResultsA 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). ConclusionsWe 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 EvidenceLevel III Retrospective Case-Control Study

Treatment of Vancomycin-Resistant Enterococci: Focus on Daptomycin.

Vancomycin-resistant Enterococci (VRE) infections are problematic due to limited availability of anti-VRE agents and their potential for adverse effects and drug interactions. This review focuses on the role of daptomycin in treating VRE infections by summarizing key points of relevant clinical studies. Higher doses of daptomycin (≥6mg/kg), as compared to standard doses, were found to be safe in terms of creatinine phosphokinase elevation and associated with successful infection outcomes and microbiological clearance. High doses are especially important in treatment of infections involving elevated daptomycin minimum inhibitory concentration (MIC) values (3-4μg/mL). Daptomycin, especially in higher doses, has been shown to be an effective and safe VRE agent for a variety of serious infection types, such as catheter-associated bloodstream and intra-abdominal infections, and for different populations including oncology. Infections involving higher daptomycin MIC values were associated with previous daptomycin use and prosthetic devices.