Catheter Blood Cultures Research Articles

Surveillance of catheter-related infections: the supplementary role of the microbiology laboratory.

BackgroundThe burden of catheter-related infections (CRIs) in developing countries is severe. In South Africa, a standardised surveillance definition does not exist and the collection of catheter days is challenging. The aim of the study was to provide baseline data on the prevalence of CRIs and to describe the epidemiology of CRI events within a tertiary academic hospital.MethodsSurveillance was laboratory-based and conducted for a six month period. A microbiologically confirmed CRBSI (MC-CRBSI) event was defined as the isolation of the same microorganism from the catheter and concomitant blood cultures (BCs), within 48 h of catheter removal, which were not related to an infection at another site.ResultsA total of 508 catheters, removed from 332 patients, were processed by the laboratory, of which only 50% (253/508 removed from 143/332 patients) of the catheters were accompanied by BCs within 48 h. Sixty-five episodes of MC-CRBSI in 57 patients were detected, involving 71 catheters and 195 microbial isolates. The institutional prevalence rate was 3.7 episodes per 1 000 admissions and 5.8 episodes per 10 000 in-patient days. Catheter day data was collected in only six wards of the hospital. The pooled laboratory incidence was 10.1 MC-CRBSI episodes per 1 000 catheter days, whereas the hospital-based central line-associated bloodstream infection (CLABSI) rate was pooled at 5.7 episodes per 1 000 catheter days. The majority of patients had an underlying gastro-intestinal condition (33%; 19/56) with a non-tunnelled, triple-lumen central venous catheter, placed in the subclavian vein (38%; 27/71). The most predominant pathogen was methicillin-resistant Staphylococcus epidermidis (28%; 55/195), followed by extensively-drug resistant Acinetobacter baumannii (18%; 35/195).ConclusionsCatheter-related infection prevention and control efforts require urgent attention, not only to keep patients safe from preventable harm, but to prevent the spread of multidrug resistant microorganisms.

Profiling of the bacteria responsible for pyogenic liver abscess by 16S rRNA gene pyrosequencing.

Pyogenic liver abscess (PLA) is a severe disease with considerable mortality and is often polymicrobial. Understanding the pathogens that cause PLA is the basis for PLA treatment. Here, we profiled the bacterial composition in PLA fluid by pyrosequencing the 16S ribosomal RNA (rRNA) gene based on next-generation sequencing (NGS) technology to identify etiological agents of PLA and to provide information of their 16S rRNA sequences for application to DNA-based techniques in the hospital. Twenty patients with PLA who underwent percutaneous catheter drainage, abscess culture, and blood culture for isolates were included. Genomic DNAs from abscess fluids were subjected to polymerase chain reaction and pyrosequencing of the 16S rRNA gene with a 454 GS Junior System. The abscess and blood cultures were positive in nine (45%) and four (20%) patients, respectively. Pyrosequencing of 16S rRNA gene showed that 90% of the PLA fluid samples contained single or multiple genera of known bacteria such as Klebsiella, Fusobacterium, Streptococcus, Bacteroides, Prevotella, Peptostreptococcus, unassigned Enterobacteriaceae, and Dialister. Klebsiella was predominantly found in the PLA fluid samples. All samples that carried unassigned bacteria had 26.8% reads on average. We demonstrated that the occurrence of PLA was associated with eight known bacterial genera as well as unassigned bacteria and that 16S rRNA gene sequencing was more useful than conventional culture methods for accurate identification of bacterial pathogens from PLA.

Diagnostic accuracy of semi-quantitative and quantitative culture techniques for the diagnosis of catheter-related infections in newborns and molecular typing of isolated microorganisms.

BackgroundCatheter-related bloodstream infections (CR-BSIs) have become the most common cause of healthcare-associated bloodstream infections in neonatal intensive care units (ICUs). Microbiological evidence implicating catheters as the source of bloodstream infection is necessary to establish the diagnosis of CR-BSIs. Semi-quantitative culture is used to determine the presence of microorganisms on the external catheter surface, whereas quantitative culture also isolates microorganisms present inside the catheter. The main objective of this study was to determine the sensitivity and specificity of these two techniques for the diagnosis of CR-BSIs in newborns from a neonatal ICU. In addition, PFGE was used for similarity analysis of the microorganisms isolated from catheters and blood cultures.MethodsSemi-quantitative and quantitative methods were used for the culture of catheter tips obtained from newborns. Strains isolated from catheter tips and blood cultures which exhibited the same antimicrobial susceptibility profile were included in the study as positive cases of CR-BSI. PFGE of the microorganisms isolated from catheters and blood cultures was performed for similarity analysis and detection of clones in the ICU.ResultsA total of 584 catheter tips from 399 patients seen between November 2005 and June 2012 were analyzed. Twenty-nine cases of CR-BSI were confirmed. Coagulase-negative staphylococci (CoNS) were the most frequently isolated microorganisms, including S. epidermidis as the most prevalent species (65.5%), followed by S. haemolyticus (10.3%), yeasts (10.3%), K. pneumoniae (6.9%), S. aureus (3.4%), and E. coli (3.4%). The sensitivity of the semi-quantitative and quantitative techniques was 72.7% and 59.3%, respectively, and specificity was 95.7% and 94.4%. The diagnosis of CR-BSIs based on PFGE analysis of similarity between strains isolated from catheter tips and blood cultures showed 82.6% sensitivity and 100% specificity.ConclusionThe semi-quantitative culture method showed higher sensitivity and specificity for the diagnosis of CR-BSIs in newborns when compared to the quantitative technique. In addition, this method is easier to perform and shows better agreement with the gold standard, and should therefore be recommended for routine clinical laboratory use. PFGE may contribute to the control of CR-BSIs by identifying clusters of microorganisms in neonatal ICUs, providing a means of determining potential cross-infection between patients.

Bloodstream infection among patients on hemodialysis by arteriovenous fistula and graft

Arteriovenous (AV) graft or fistula is the major risk factor for bacteremia in hemodialysis (HD) patients. The present study was designed to evaluate the prevalence of risk factors for bloodstream infections (BSIs) among patients with AV graft or fistula for HD and to identify the microorganisms isolated from the bloodstream of patients. From May 2010 to May 2013, this retrospective study was performed. A questionnaire that included demographic and medical data was completed for each case. Also laboratory data, including catheter blood culture and peripheral blood cultures were collected for each case. The collected data were analyzed using SPSS software. A p value < 0.05 was considered significant. Overall, 106 cases received AV fistula and graft for HD in this study. Regarding the type of vascular access, 68 % had AV fistulas, 32 % had AV graft. A total of 49 episodes of BSIs were found in this study. These BSIs detected represent an incidence rate of 0.64/1,000 catheter days (0.65/1,000 catheter days in AV fistula and 0.64/1,000 catheter days in AV graft) and 2.56/1,000 dialysis sessions (2.49/1,000 dialysis sessions in AV fistula and 2.71/1,000 dialysis sessions in AV graft). Staphylococcus aureus was common pathogenic organism in BSIs. In the multivariable logistic regression model presence of diabetes mellitus, older age, low serum albumin level, and poor patient hygiene were all independently associated with occurrence of a BSI. Our data suggest that improved nutrition and hygiene and diabetes management in HD patients may decrease the incidence of bacteremia.

English

Acinetobacter plays an important role in the infection of patients admitted to hospitals.Acinetobacter are free living gram-negative coccobacilli that emerge as significant nosocomial pathogens in the hospital setting and are responsible for intermittent outbreaks in the intensive care unit. The aim of this study was to determine the risk factors and outcome of Acinetobacter infections in patients admitted into the intensive care unit of a tertiary center in Oyo State, Nigeria. A total of one hundred patients were recruited for the study, catheter specimen urine, tracheal aspirate and blood culture were collected aseptically from the patients. The specimens were cultured on blood and MacConkey and the organisms identified using Microbact 12E (0xoid). Fourteen (14%) of the 100 patients recruited into the study developed Acinetobacter infection. Chronic obstructive pulmonary disease, endotracheal intubation, and duration of endotracheal intubation were associated risk factors with only duration of endotracheal intubation specifically an 8 to 14 day period being an independent risk factor for Acinetobacter. Six of the patients died of the infection while the remaining eight were discharged from the ICU. The findings that chronic obstructive pulmonary disease and duration of endotracheal intubation being associated with Acinetobacter infection and the attendant mortality associated with the infection should draw attention to this seemingly silent epidemic in our Intensive Care Units so that effective surveillance protocols can be deployed to manage this infection whenever it rears its head. Key words: Acinetobacter, intensive care unit.

Comparative study of blood cultures and catheter for the Candida yeasts of origin nosocomial

The incidence of nosocomial infections by fungi have increased in recent decades, and 80% are caused by Candida species. The aim of this study was to characterize Candida yeasts isolated from central venous catheter (CVC) and blood cultures of hospitalised patients. Approximately 65% of the infections result from the migration of microorganisms the microflora of the skin, from the insertion site of the catheter and are due to biofilm formation. The methodology employed was to identify CVC and blood culture samples using CHROMagar®, CANDIFAST® and the automated VITEK® 2 Compact. To assess biofilm formation, we used a Scanning Electron Microscopy EVO MA 10 (SEM). The yeasts were the second microorganism most prevalent (17%) on catheter tip and blood culture along with Klebsiella pneumoniae and Staphylococcus epidermidis. We investigated 10 samples and 73% were identified through automated methodology, being 26% of strains of Candida albicans, 13% C. parapsilosis and C. tropicalis, 6% de C. glabrata, C. pelliculosa and C. guilliermondii. When analyzing the percentage of agreement between the results obtained in the three methodologies used, 80% of the strains had 67% agreement. Using SEM technique all samples were positive for catheter biofilm formation, concluding that their presence may influence the catheter‐related candidemia and that there is no single ideal method for identifying these emerging fungi.

NOSOCOMIAL &lt;i&gt;ACINETOBACTER&lt;/i&gt; INFECTIONS IN INTENSIVE CARE UNIT

Acinetobacter plays an important role in the infection of patients admitted to hospitals. Acinetobacter are free living gram-negative coccobacilli that emerge as significant nosocomial pathogens in the hospital setting and are responsible for intermittent outbreaks in the Intensive Care Unit. The aim of this study was to determine the prevalence of Acinetobacter in patients admitted into the Intensive Care Unit and determine their role in infections in the ICU. A total of one hundred patients were recruited for the study, catheter specimen urine, tracheal aspirate and blood culture were collected aseptically from the patients. The specimens were cultured on blood and MacConkey and the organisms identified using Microbact 12E (0xoid). The Plasmid analysis was done using the TENS miniprep method. Fourteen (14%) of the 100 patients recruited into the study, developed Acinetobacter infection. Acinetobacter spp constituted 9% of the total number of isolates. Twelve (86%) of the isolates were recovered from tracheal aspirate, 1(7%) from urine and 1(7%) from blood. All of the isolates harbor plasmids of varying molecular sizes. Ten of the fourteen Acinetobacter were isolated at about the same period of time in the ICU with 6(42.7%) having plasmid size in the 23.1kb band and all showed similar pattern revealing that the isolates exhibit some relatedness. The clonal nature of the isolates suggest that strict infection control practices must be adopted in ICU, also an antibiotic policy must be developed for the ICU to prevent abuse of antibiotics that may lead to selection of resistant bacteria.

Role of Peripherally Inserted Central Catheters in Home Parenteral Nutrition

Home parenteral nutrition (HPN) has become a common therapy, with tunneled central venous catheters (CVCs) being preferred for its administration. Peripherally inserted central catheters (PICCs) are not currently recommended for long-term HPN, although evidence to support this statement is scarce. The authors aimed to evaluate the outcomes of HPN, focusing on CVC-related complications. All patients attended at the authors' center for HPN from 2007-2011 were prospectively included. HPN composition aimed at 20-35 kcal/kg/d, 3-6 g/kg/d of glucose, 1.0 g/kg/d of amino acids, and <1 g/kg/d of lipids. HPN was infused in an intermittent schedule, mostly at night. Catheter-related bloodstream infections (CRBSIs) were confirmed with positive semi-quantitative or quantitative culture of the catheter or simultaneous differential blood cultures drawn through the CVC and peripheral vein. Seventy-two patients received HPN, with 79 implanted CVCs (48 PICCs, 10 Hickman, and 21 ports). Mean catheter-days were 129.1 for PICCs, 98.5 for Hickman, and 67.7 for ports (P = .685). When analyzing CRBSIs, ports had 44, Hickman had 20, and PICC had 0 episodes per 1000 catheter-days (P = .078). Only PICCs showed less incidence of CRBSIs vs ports (P = .043). Multivariate logistic regression, correcting by catheter-days, patients' age and sex, underlying disease, and type of catheter, showed that only catheter-days (P = .031) was a predictor for CRBSIs (P = .007, Nagelkerke R= = 0.246). PICCs are similar in terms of catheter-related complications to other CVCs for the administration of HPN, especially for oncology patients with HPN lasting <6 months.

Analysis of factors related to infection of intravascular indwelling catheter and preventive countermeasures

Objective To explore the factors related to infections of intravenous catheter as well as preventive measures.Methods In 598 cases of patients with central venous catheterization,indwelling time,location,bacteriology were monitored among 130 patients with suspected venous catheter infection.Results Indwelling catheter lasts for 3 days at least,70 days at most.For 77 out of toual cases,microbiology culture of catheter tip and blood culture were positive,accounting for 12.88％.Detected pathogens were 151 in total.Gram-negative bacteria were 48 (31.79％),gram-positive bacteria were 78(50.65％),fungal were 25 (16.56％).Among these,the most common pathogens were Staphylococcus epidermidis,Staphylococcus aureus,Candida and Acinetobacter,most of the bacteria had a high degree of drug resistance.The choice of position:infection rate of subclavian vein and basilic vein was lower than that of the superclavian vein and internal jugular vein,infection rate of catheterization time ≤ 13d was lower than that of ≥ 14d.Conclusions The choice of subclavian vein and basilic vein,standardization of puncture technical,strict catheter care,shortening of catheterization time and improvement of the general condition of patients can reduce catheter-reiated infections.The rational use of antibiotics is a critical measure to reduce vascular catheter infections of patients. Key words: Intavascular; Indwelling catheter; Infection; Countermeasure

Vascular Catheter Tip Cultures for Suspected Catheter-Related Blood Stream Infection in the Intensive Care Unit: A Tradition Whose Time Has Passed?

Catheter-related blood stream infections (CR-BSIs) are estimated to occur in 80,000 patients in intensive care units (ICUs) each year in the United States. We sought to determine the clinical utility of vascular catheter cultures in critically ill patients with suspected CR-BSI. We reviewed retrospectively all positive (≥15 colony forming units/roll) vascular catheter tip cultures (CTCs) documented over a four-year period in the ICUs of two hospitals. A CR-BSI was defined as matching positive blood and catheter cultures. The time interval between catheter removal and blood culture was recorded. A total of 1,391 CTCs were obtained, of which 468 (34%) were positive and 143 (31% of the positive cultures) were associated with a diagnosis of CR-BSI. In 133 of these 143 cases (93%), the positive blood culture was obtained before or within 24 h after catheter removal and dictated antibiotic therapy. In only 10 of 143 cases (7%) did catheter removal and culture significantly (>1 day) precede the positive blood culture. In 55% of the CR-BSI cases, the catheter was removed empirically and close to the time of blood culture (-1.3±19.0 h). In the remaining 45%, the catheter was removed clinically (after a blood culture was positive), and this action was more remote in time (23.6±19.4 h; p<0.001 vs. empiric removal). Total microbiology laboratory costs for the CTCs were $75,300, and 600 microbiology technician hours were required. In an ICU patient population, only about one-third of vascular catheter cultures were positive, and only about one-third of the positive CTCs were associated with CR-BSI. Ninety-three percent of all CR-BSIs were identified by bacteremia either before or coinciding with catheter removal, and the results of the blood culture dictated antimicrobial therapy. Because CTCs rarely changed therapy, they may not be appropriate in the management of suspected CR-BSI in the ICU setting.

NOSOCOMIAL &lt;I&gt;ACINETOBACTER&lt;/I&gt; INFECTIONS IN A TERTIARY FACILITY

Acinetobacter plays an important role in the infection of patients admitted to hospitals. Acinetobacter are free living gram-negative coccobacilli that emerge as significant nosocomial pathogens in the hospital setting and are responsible for intermittent outbreaks in the Intensive Care Unit. The aim of this study was to determine the prevalence of Acinetobacter in patients admitted into the Intensive Care Unit and determine their role in infections in the ICU. A total of one hundred patients were recruited for the study, catheter specimen urine, tracheal aspirate and blood culture were collected aseptically from the patients. The specimens were cultured on blood and MacConkey and the organisms identified using Microbact 12E (0xoid). The Plasmid analysis was done using the TENS miniprep method. Fourteen (14%) of the 100 patients recruited into the study, developed Acinetobacter infection. Acinetobacter spp constituted 9% of the total number of isolates. Twelve (86%) of the isolates were recovered from tracheal aspirate, 1(7%) from urine and 1(7%) from blood. All of the isolates harbor plasmids of varying molecular sizes. Ten of the fourteen Acinetobacter were isolated at about the same period of time in the ICU with 6(42.7%) having plasmid size in the 23.1kb band and all showed similar pattern revealing that the isolates exhibit some relatedness. The clonal nature of the isolates suggest that strict infection control practices must be adopted in ICU, also an antibiotic policy must be developed for the ICU to prevent abuse of antibiotics that may lead to selection of resistant bacteria.

What Has Kept the Antibiotic Miracle Alive?

Being a germ isn't easy. Bacteria need tightly scripted genomes orchestrating precise functions to compete in a crowded microbial world. A lone strain may infect a sterile site in a bigger organism and escape competition, but it may then attract a lethal host response and antibiotic therapy.The strain of Enterococcus faecalis described by Arias et al. in this issue of the Journal 1 escaped the competing bacteria of its usual bowel habitat by infecting a patient's hemodialysis catheter site. It alone kept growing from catheter tips and blood cultures despite catheter removals and reinsertions.2 Susceptibility tests showed that the initial . . .

Development of subsequent bloodstream infection in patients with positive Hickman catheter blood cultures and negative peripheral blood cultures

There are limited data on the incidence of subsequent bloodstream infection (BSI) and the effect of systemic antibiotics in patients who had positive catheter-drawn blood cultures (CBC) and negative peripheral blood cultures (PBC). We retrospectively reviewed all paired blood cultures from patients with Hickman catheter in the hematology–oncology ward between January 1997 and December 2008. There were 112 episodes with positive CBC and negative PBC. Nine episodes (8.0%; 95% CI, 3.0–13.1%) led to subsequent BSI within 28 days. Subsequent BSI developed in 6 of 31 episodes (19%) where empiric antibiotics were inappropriate but in 3 of 81 episodes (4%) where empiric antibiotics were appropriate (P = 0.01). Subsequent candidemia (50%, 2 of 4) was more common than subsequent bacteremia (6%, 7 of 108) (P = 0.03). In conclusion, for patients with positive CBC and negative PBC, the overall incidence of subsequent BSI was 8.0%, and inappropriate empiric antibiotics was associated with subsequent BSI.

Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention

In this study, we aimed to determine the utility of a multiple system intervention to reduce catheter-related bloodstream infections (CR-BSI) in our intensive care unit (ICU). A prospective cohort study was undertaken in the medical and surgical ICU at a university hospital. We applied five measures: educational sessions about inserting and maintaining central venous catheters, skin cleaning with chlorhexidine, a checklist during catheter insertion, subclavian vein insertion and avoiding femoral insertion whenever possible, and removing unnecessary catheters. We determined the rate of CR-BSI per 1,000 catheter-days during the intervention (March to December 2007) and compared it with the rate during the same period in 2006 in which we applied only conventional preventive measures. CR-BSI was defined as the recovery of the same organism (same species, same antibiotic susceptibility profile) from catheter tip and blood cultures. We registered 4,289 patient-days and 3,572 catheter-days in the control period and 4,174 patient-days and 3,296 catheter-days in the intervention period. No significant differences in the number of patients with central venous catheters during the two periods were observed: catheters were used in 81.5% of patients during the control period and in 80.6% of patients during the intervention period. During the control period, 24 CR-BSI were diagnosed (6.7/1,000 catheter-days); during the intervention period, 8 CR-BSI were diagnosed (2.4/1,000 catheter-days) (relative risk 0.36; 95% confidence interval [CI] 0.16 to 0.80; p = 0.015). Nurses interrupted the procedure to correct at least one aspect when completing the checklist in 17.7% of insertions. In conclusion, a multiple system intervention applying evidence-based measures reduced the incidence of CR-BSI in our ICU.

OC-084 The targeted use of Taurolock® to reduce central venous catheter sepsis in a home parenteral nutrition cohort

Introduction Taurolock® (Bio-Implant HealthCare, Winsen, Germany) is an anti-microbial agent (taurolidine) with anticoagulant properties (citrate). There is evidence that Taurolock® is beneficial in reducing catheter-related blood stream infections (CRBSI) in haemodialysis patients, but there are fewer data regarding benefit in home parenteral nutrition (HPN) patients.12 At St Mark9s Intestinal Failure Unit Taurolock® is prescribed for patients with greater than three CRBSI in a 12-month period. The primary aim was to determine the incidence of CRBSI prior and subsequent to Taurolock® use. The secondary aim was to establish cost benefit from Taurolock® prescription. Methods Retrospective audit using St Mark9s Intestinal Failure (IF) Database. ::::CRBSI and Taurolock® prescription recorded on IF database. CRBSI defined as positive central venous catheter blood cultures with fever±rigors. Simple cost analysis calculated at £8340 per hospital treatment for CRBSI (10 day in-patient admission) and Taurolock costing £11 per day. Results All 16 patients (male 56.3%, mean age 44.8 years (range 23–73)) prescribed Taurolock® were selected. In the pre-treatment group mean duration from first CRBSI episode to Taurolock® prescription was 602±317 days. This pre-treatment group had a mean 9.8±6.5 CRBSI rate per 1000 catheter days. The treatment group (mean duration 557±269 days) had a mean 3.3±3.4 CVC related sepsis rate per 1000 catheter days. There was a significant difference (p Conclusion Taurolock® significantly decreases CRBSI rate in HPN patients. These results are in keeping with a Canadian group that managed to decrease CRBSI following treatment in seven patients. (2) Taurolock® prescription generates considerable cost savings in this cohort of patients.

Deposits on the intraluminal surface and bacterial growth in central venous catheters

Central venous catheter (CVC) tip and blood cultures are generally used to diagnose a catheter-related infection. Such methodology does not confirm the presence of bacterial colonisation on parts of CVCs other than the CVC tip. In order to assess the extent of bacterial colonisation, 10 catheters were examined in detail from patients admitted to intensive care unit. Swabs from the lumen at several sites (hub, indwelling and non-indwelling) were cultured and the intraluminal surface of the device subjected to scanning electron microscopy (SEM). Bacteria were detected on five out of 10 catheters (50%), and bacterial contamination of CVCs was common in the hub area of the device. Deposits (crystallisation) that differed from bacterial colonisation or biofilm were observed on the intraluminal surface of used CVCs. SEM showed bacteria firmly anchored to the deposits. Experimental flow studies demonstrated that deposits were more likely to appear after exposure to solutions such as total parenteral nutrition rather than distilled water. These deposits facilitated bacterial colonisation 30 times more than CVCs free from deposits.

Central venous catheter-related bloodstream infection and Cryptococcus neoformans

This is the first case reported of central venous catheter-related fungemia due to C. neoformans. A patient with chronic renal failure developed a fungemia during the treatment of a dialysis-associated bacteremia. Cryptococcus neoformans grew in the catheter tip and blood culture. We addressed questions about this catheter-related fungemia.

Utilidade da cultura da ponta de cateter no diagnóstico de infecção neonatal

OBJETIVO: Determinar o número de unidades formadoras de colônias que melhor correlaciona com a infecção relacionada a cateter em recém-nascidos. MÉTODOS: Este foi um estudo prospectivo de culturas semiquantitativas de pontas de cateteres de recém-nascidos da unidade neonatal da Faculdade de Medicina de Botucatu. Os microrganismos isolados de cateteres e hemoculturas periféricas foram identificados e submetidos ao teste de sensibilidade a drogas. O ponto de corte ótimo foi determinado pela curva receiver operating characteristic (ROC). RESULTADOS: Foram estudados 85 cateteres de 63 recém-nascidos. A espécie Staphylococcus epidermidis foi prevalente (75%) nos cateteres. Dos 11 episódios de infecção diagnosticados, oito (72,7%) foram associados aos estafilococos coagulase-negativa, dos quais seis pertenciam à espécie S. epidermidis. Pela curva ROC, o ponto de corte ótimo para o diagnóstico de infecção relacionada a cateter foi 122 unidades formadoras de colônias. CONCLUSÃO: O ponto de corte 122 unidades formadoras de colônias melhor se correlacionou com o diagnóstico de infecção relacionada a cateter em recém-nascidos.

Avaliação do tipo de curativo utilizado em cateter venoso central para hemodiálise

OBJETIVOS: Avaliar a efetividade de dois tipos de curativos utilizados em cateter venoso central (CVC) em pacientes submetidos à hemodiálise; identificar a taxa de infecção no local de saída e de bacteremia comparando o curativo com gaze e micropore em relação ao filme transparente. MÉTODOS: Foi realizado um ensaio clínico randomizado controlado abrangendo 66 pacientes, sendo 33 nos grupos 1 e 2, respectivamente. No Grupo 1 o curativo utilizado foi gaze e micropore e no Grupo 2 filme transparente. Foram coletados os dados sócio demográficos, clínicos e os relacionados às infecções. Os 66 pacientes permaneceram no estudo até a indicação de retirada do cateter que ocorreu nos episódios de infecção quando foram realizadas culturas de óstio e da ponta do CVC e hemocultura quando indicado. RESULTADOS: Não houve diferença estatística significante quanto ao tipo de curativo e as variáveis estudadas. Os CVC posicionados a 90º em relação a pele apresentaram maior taxa de infecção por S. aureus. CONCLUSÃO: O uso do filme transparente não proporcionou redução de infecção, porém a análise qualitativa deste tipo de curativo teve melhor aceitação pelos pacientes e profissionais da Unidade de Diálise de um Hospital Universitário.

Usefulness of catheter tip culture in the diagnosis of neonatal infections

To determine the number of colony-forming units (CFU) that best correlates with catheter-related infections (CRI) in newborns. This was a prospective study of semiquantitative cultures of catheter tips obtained from newborns in the neonatal unit at Faculdade de Medicina de Botucatu, state of São Paulo, Brazil. The microorganisms isolated from catheter and peripheral blood cultures were identified and submitted to a drug susceptibility test. The optimal cutoff point was determined by the receiver operating characteristic (ROC) curve. A total of 85 catheters obtained from 63 newborns were studied. Staphylococcus epidermidis was the predominant species in the catheters (75%). Eight of 11 (72.7%) CRI episodes were associated with coagulase-negative staphylococci, six of which were of the S. epidermidis type. ROC curve analysis indicated that the optimal cutoff point for the diagnosis of CRI was 122 CFU. The cutoff point of 122 CFU correlated best with the diagnosis of CRI in newborns.