Catheter Days Research Articles

Catheter-Related Infections in Hemodialysis Patients: A Retrospective Study

Background: Catheter-related infection (CRI) is a serious complication among hemodialysis patients, associated with significant morbidity and mortality. This study investigated the incidence, predictors, presentation, and complications of CRI. Methods: This single-center, retrospective, observational study enrolled all eligible chronic hemodialysis patients with tunneled central venous catheters inserted between June 2016 and June 2019. Results: Over 3 years, 63 patients (59% men) with a total of 27,395 catheter days were included of these patients. The median age was 68 years (interquartile range [IQR]: 58,76), and median hemodialysis duration was 62 months (IQR: 16,101). A total of 30 episodes of clinical CRI occurred, resulting in an overall incidence rate of 1.1 per 1,000 catheter days. CRI was significantly associated with baseline anemia (adjusted hazard ratio [AHR]=3.29; 95% confidence interval [CI], 1.42–7.64; P=0.006) and the use of the femoral vein as opposed to internal jugular vein (AHR=3.23; 95% CI, 1.29–8.06; P=0.012). The incidence of catheter-related bacteremia was 0.91 per 1,000 catheter days, and the most commonly isolated organism was Staphylococcus aureus (26%). Recurrent infection developed in 9/27 (33.3%) episodes and was lower among catheter salvage with antibiotic lock and catheter removal compared to catheter salvage alone. Conclusions: Anemia and the use of the femoral instead of the internal jugular vein are associated with a higher incidence of CRI. Catheter-related blood stream infection was associated with increased mortality, recurrence rate, and resource utilization. Along with systemic antibiotics, catheter management such as catheter removal or antibiotic lock use may help reduce the recurrence rate.

Feasibility of Home Parenteral Nutrition in Patients with Intestinal Failure Due to Neuroendocrine Tumours: A Systematic Review.

Maintaining adequate nutritional status can be a challenge for patients with small bowel neuroendocrine tumours (NETs). Surgical resection could result in short bowel syndrome (SBS), whilst without surgical resection there is a considerable risk of ischemia or developing an inoperable malignant bowel obstruction (IMBO). SBS or IMBO are forms of intestinal failure (IF) which might require treatment with home parenteral nutrition (HPN). Limited data exist regarding the use of HPN in patients with small bowel neuroendocrine tumours, and it is not frequently considered as a possible treatment. A systematic review was performed regarding patients with small bowel NETs and IF to report on overall survival and HPN-related complications and create awareness for this treatment. Five articles regarding patients with small bowel NETs or a subgroup of patients with NETs could be identified, mainly case series with major concerns regarding bias. The studies included 60 patients (range 1-41). The overall survival time varied between 0.5 and 154 months on HPN. However, 58% of patients were alive 1 year after commencing HPN. The reported catheter-related bloodstream infection rate was 0.64-2 per 1000 catheter days. This systematic review demonstrates the feasibility of the use of HPN in patients with NETs and IF in expert centres with a reasonable 1-year survival rate and low complication rate. Further research is necessary to compare patients with NETs and IF with and without HPN and the effect of HPN on their quality of life.

The evaluation of Candida-related central line-related bloodstream infections in pediatric cancer patients: A pre- and post-intervention study.

The purpose of this study was to assess the efficacy of a central line maintenance bundle in preventing catheter-related (implanted venous access devices, port) Candida bloodstream infections. The study encompassed two distinct time periods, namely, pre-bundle and bundle. The number of catheter-related bloodstream infections (CRBSI) episodes per catheter days for each timeframe was determined. Upon implementation of the central line bundle, the rate of CRBSI reduced significantly from 4.27 per 1000 central line days in the pre-bundle period to 1.0 per 1000 central line days in the bundle period (p < .001). Using a central line bundle to avoid CRBSIs in pediatric cancer patients with ports led to a significant decrease in Candida species-related CRBSIs.

Central Line Associated Bloodstream Infection in Neonatal Intensive Care Unit

Background Central-line–associated bloodstream infections (CLABSIs) are a major source of healthcare-associated infections in neonatal intensive care units (NICUs), and they are associated with increased morbidity, mortality. Aim To describe the epidemiology, demographic and, etiological characteristics of CLABSI at NICUs of Ain Shams University Hospitals. Patients and Methods Prospective observational study included 136 neonates with central venous catheters (CVCs) over period of 9 months, two blood cultures samples were taken from each patient thought to be infected based on clinical signs suggestive of infection (apnea, bradycardia, bad perfusion, temperature instability) and laboratory markers like Creactive protein (CRP) with one culture sample from CVC and the other from a peripheral vein, CLABSI was diagnosed according to Centers for Disease Control and Prevention (CDC) criteria. Results Twenty-three episodes of CLABSI were reported with a rate of 20.8 per 1000 catheter days. The mean gestational age and mean weight of CLABSI cases were 33.57±2.83 weeks and 1.97 ± 0.71 kg respectively. No statistically significant differences between CLABSI cases and others with no CLABSI as regards demographic characteristics. The use of invasive respiratory support was significantly associated with a high rate of CLABSI episodes. CLABSI was significantly associated with prolonged hospitalization with a mean of 18.78±9.10 days. Klebsiella was the most common isolated organism among CLABSI cases with a percentage of 52.1 %. The percentage of mortality was 56.5% among CLABSI cases Conclusions Evaluation of infection prevention programs is required to determine if specific strategies can be implemented to further reduce infection risk.

Feasibility Analysis of Ultrasound-Guided Placement of Tunneled Hemodialysis Catheters

Radiographic fluoroscopy is the current standard for placement of tunneled central venous catheters (CVCs) for hemodialysis. Radiographic fluoroscopy requires structural and personnel infrastructure and exposes the patient to ionizing radiation. Here, we investigate the feasibility of solely ultrasound-guided placement of tunneled central venous dialysis catheters (USCVCs). We evaluated prospectively collected single-center data regarding safety and catheter function of 134 consecutive patients who underwent USCVC implantation between 2020 and 2021. We used the inset guidewire to visualize the position of the catheter tip. In the case of inadequate visibility by ultrasound, we used intracardiac electrocardiography (ECG) recording or agitated saline. A total of 1844 catheter days were assessed. The optimal CVC position was defined as being within the upper right atrium (URA) and middle to deep right atrium. Of the 134 USCVCs, 87% were placed on the right side. The primary success rate for optimal tip position and catheter function was 98%. Of the USCVCs, 97% were placed solely by ultrasound. Regarding positioning, 6% were in the vena cava superior zone, 70% in the URA and 24% in the middle to deep right atrium, resulting in a rate of 94% with optimal positioning. Effective blood flow averaged 292 ± 39 ml/min. There were no immediate procedure-associated complications. Placement of CVC for hemodialysis solely by ultrasound is an effective alternative to fluoroscopy-assisted placement.

P29 Catheter-associated urinary tract infections, potential for diagnostic and antimicrobial stewardship

Abstract Background and Objectives Catheter-associated urinary tract infections (CAUTIs) are one of the most common healthcare-associated infections.1 Microbiological investigation of catheter specimens of urine (CSUs) results in a significant workload for microbiology laboratories. As bacteria cultured from CSUs often reflect colonization rather than infection, we must prudently interpret these culture results and judiciously prescribe antimicrobials in this setting. For these reasons, we felt it was important to assess if CAUTIs are being appropriately investigated and managed in our hospital. Methods We identified all the CSUs received in the microbiology laboratory from inpatients over a 7 day period in an 820-bed adult tertiary referral hospital. Once identified, a retrospective review of each patient’s clinical and drug charts was undertaken. The CDC definition of CAUTI was applied for the purpose of this audit.2 Results A total of 126 CSUs from 101 patients were included. The majority of patients (n=79, 78%) had a urinary catheter introduced during their hospital admission. At the time of CSU sampling, suspicion of infection was documented in only 47 patients. Only 9% of patients who had a CSU processed met the criteria for a CAUTI.2 Fifty-six percent of patients were commenced on antibiotics, despite only 31% returning a culture positive CSU sample. CSU results were documented in only 10% of patient charts. In cases where a CAUTI was suspected, it took an average of 6.75 days for the urinary catheter to be exchanged or removed. Four patients continued to receive an antibiotic despite the organism isolated being reported as resistant. Conclusions Overall, we noted that there was poor documentation of both urinary catheter status and of CSU results. Our audit revealed that several patients had multiple specimens processed within the 7 day period. Most patients had no clear indication for CSU sampling. From an antimicrobial stewardship perspective, there was unnecessary and inappropriate prescribing of antimicrobials. The results of this audit show that there is potential for both diagnostic and antimicrobial stewardship in the management of CAUTIs.

A retrospective study of subcutaneous anchor securement systems in oncology patients.

Maintaining optimal central venous catheter tip position requires reliable catheter securement. A vital decision about the choice of engineered securement device is often made by what is conveniently available in the insertion kit or default clinical routine. The importance of continuous securement for oncology patients prompted the need for an evaluation of securement options currently available. This study aimed to assess the effectiveness of two engineered securement devices to assist the oncology patient in reaching the end of their catheter need. A retrospective study was conducted to assess patients' ability to finish their therapy with one peripherally inserted central catheter. Implant and explant data for adult oncology patients was evaluated spanning 2007-2021. All patients received a PICC with either an adhesive securement device or a subcutaneous anchor securement system. Partial or complete dislodgement causing the unplanned removal of the PICC occurred at 12% for ASD and 0.4% for SASS (p < 0.0001). The probability of reaching the end of need with one PICC, regardless of the reason for premature removal, at 2 years for patients with an adhesive securement device was 68% (n = 944). For patients with a subcutaneous anchored securement device, it was over 95% (n = 8313). The difference in the probability of reaching the end of the need with one PICC between the two securement devices was calculated at (p < 0.0001). With over 9200 patients and more than a million catheter days, the results of this retrospective study demonstrate the SASS's superiority in assisting the patient to reach the end of need with a single PICC.

Effect of a Multifaceted Intervention on the Incidence of Hemodialysis Catheter Dysfunction in a National Stepped-Wedge Cluster Randomized Trial

Effective strategies to prevent hemodialysis (HD) catheter dysfunction are lacking and there is wide variation in practice. In this post hoc analysis of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a national (REDUCCTION) stepped-wedge cluster randomized trial, encompassing 37 Australian nephrology services, 6361 participants, and 9872 catheters, we investigated whether the trial intervention, which promoted a suite of evidence-based practices for HD catheter insertion and management, reduced the incidence of catheter dysfunction, which is defined by catheter removal due to inadequate dialysis blood flow. We also analyzed outcomes among tunneled cuffed catheters and sources of event variability. A total of 873 HD catheters were removed because of dysfunction over 1.12 million catheter days. The raw incidence was 0.91 events per 1000 catheter days during the baseline phase and 0.68 events per 1000 catheter days during the intervention phase. The service-wide incidence of catheter dysfunction was 33% lower during the intervention after adjustment for calendar time (incidence rate ratio= 0.67; 95% confidence interval [CI], 0.50-0.89; P= 0.006). Results were consistent among tunneled cuffed catheters (adjusted incidence rate ratio= 0.68; 95% CI, 0.49-0.94), which accounted for 75% of catheters (n= 7403), 97.4% of catheter exposure time and 88.2% of events (n= 770). Among tunneled catheters that survived for 6 months (21.5% of tunneled catheters), between 2% and 5% of the unexplained variation in the number of catheter dysfunction events was attributable to service-level differences, and 18% to 36% was attributable to patient-level differences. Multifaceted interventions that promote evidence-based catheter care may prevent dysfunction, and patient factors are an important source of variation in events.

National Healthcare-Associated Infections Report 2022 – Saudi Arabia

BackgroundSurveillance data are very essential for the effective use of available resources, the prioritization of infection control practices, and setting goals for intervention. The aim was to present the current rates of healthcare-associated infections (HAIs) and device utilization ratios (DUR) among the Saudi Ministry of health (MOH) hospitals. MethodsMOH analyzed the surveillance data collected from 106 MOH hospitals enrolled in the health electronic surveillance network (HESN) between January 2022 and December 2022. The surveillance methodology was similar to the methods of the US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) center for infection control. ResultsMore than one million device-days of surveillance were analyzed. The rate of central line associated bloodstream infection (CLABSI) was 2.57 per 1000 central lines days. The rate of catheter-associated urinary tract infection (CAUTI) was 1.08 per 1000 urinary catheter days. The rate of ventilator-associated events (VAE) was 4.21 per 1000 ventilator days. The average rate of pediatric/neonatal ventilator-associated pneumonia (VAP) was 1.53 per 1000 ventilator days. The average DURs were 0.33 for central line, 0.61 for urinary catheter, 0.44 for ventilator in adult patients, and 0.26 in ventilator in pediatric/neonatal patients. In 238632 months of surveillance, the rate of dialysis events (DE) was 0.97 per 100 patient-months. In 86324 surgeries monitored, the rate of surgical site infection (SSI) was 0.87 per 100 surgeries surveyed. ConclusionsThe current report can serve as a national benchmark for MOH hospitals and a regional benchmark for similar hospitals in the region.

Safety of mid-thigh exit site venous catheters in multidrug resistant colonized patients.

Venous catheters inserted in superficial femoral vein and with mid-thigh exit site have emerged as a feasible and safe technique for central or peripheral tip's venous access, especially in agitated, delirious patients. The spread of multidrug-resistant bacterial (MDR) strains is an emerging clinical problem and more and more patients are being colonized by these types of bacteria. The aim of this study is to evaluate the incidence of central line associated bloodstream infections (CLABSI) or catheter related bloodstream infections (CRBSI) in mid-thigh catheters in patients with positive rectal swabs to evaluate the safety of this procedure and the real infection risk. In this retrospective observational study, we analyzed data on patients with mid-tight catheters inserted from May 2021 to November 2022. All surveillance rectal swabs were recorded. In addition, to collect data on CLABSI and CRBSI, the results of all blood and catheter tip cultures performed during the hospital stay were acquired. Six hundred two patients were enrolled, 304 patients (50.5%) had a rectal swab; 128 (42.1%) swabs were positive for MDR. Nine CLABSI (only two in patients with a positive rectal swab) and three CRBSI were detected. No statistical difference in the absolute number of CLABSI and CRBSI and in the number of infections per 1000 catheter days emerged between the overall population and patients with positive rectal swabs (respectively p = 0.45 and p = 0.53). Similarly, no statistical difference in the number of CLABSI and CRBSI was found among patients with a negative swab and patients with a positive one (respectively p = 0.43 and p = 0.51). According to our data, cannulation of the superficial femoral vein represents a safe location in patients with positive rectal swabs.

Clinical efficacy of modified sacral fixation under Leonardo da Vinci robot laparoscopy for pelvic organ prolapse.

The aim of this study was to analyze the clinical efficacy of modified sacral fixation under Leonardo da Vinci robot laparoscopy for pelvic organ prolapse (POP). Sixty POP patients admitted to our hospital from January 2020 to December 2021 were picked and divided into Group A (laparoscopic Y-mesh, n = 20), Group B (laparoscopic sacrovaginal fixation, n = 20), and Group C (da Vinci robotic sacral fixation, n = 20). These three groups were compared in terms of the perioperative indexes, such as operation time, intraoperative blood loss, postoperative indwelling catheter days, anal exhaust time, postoperative hospitalization days, etc. The occurrence of short-term and long-term complications in the three groups was compared. The changes of the following index values in the POP quantification system (POP -Q) staging before and 1 year after surgery were recorded and compared among the three groups. It mainly includes the midline of the anterior vaginal wall at 3 cm from the hymenal margin (Aa), the farthest point of the anterior vaginal vault from point Aa (Ba), the farthest point of the ectocervix (C), the location of the posterior vaginal vault or rectal uterine trap (D), the midline of the posterior vaginal wall at 3 cm from the hymenal margin (Ap), and the reflection of the posterior vaginal vault at the farthest point from the Ap point (Bp) values. The changes in Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) were recorded and compared before and 1 year after the operation. The patients in Group C had significantly lower intraoperative bleeding, postoperative indwelling catheter days, anal exhaust time, and postoperative hospitalization days compared with those in Group A and Group B (p < 0.05). There existed no statistical difference in the incidence of short-term and long-term complications between Group B and Group C (p > 0.05), but both were much lower than Group A (p < 0.05). The differences in POP-Q staging, PFDI-20 scale, and PISQ-12 scale were not statistically significant among the three groups before surgery (p > 0.05), and the POP-Q staging Aa, Ba, C, D, Ap, and Bp values, PFDI-20 scale, and PISQ-12 scale were strongly improved in three groups after the surgery (p < 0.05). However, the POP-Q staging, PFDI-20 scale, and PISQ-12 scale among the three groups had no obvious difference after the surgery (p > 0.05). The efficacy of modified sacral fixation under Leonardo da Vinci robot laparoscopy for POP was comparable to that of laparoscopic Y-mesh treatment and laparoscopic sacral vaginal fixation. However, da Vinci's robotic sacral fixation had the advantages of less intraoperative bleeding and faster postoperative recovery, which helped patients recover quickly and improved their quality of life.

Optimization of Monitoring of Nosocomial Infections in Hospitals of the Republic of North Ossetia–Alania

Introduction: Optimization of epidemiological and microbiological monitoring of nosocomial infections at the regional level will contribute to limiting circulation and spread of pathogens and improving preventive measures on the territory of the Russian Federation. Objective: To determine directions of optimization of epidemiological and microbiological monitoring of healthcare-associated infections in surgery departments and intensive care units of hospitals of the Republic of North Ossetia – Alania. Materials and methods: We carried out a retrospective epidemiological analysis of the incidence of nosocomial infections and results of microbiological monitoring conducted in surgery departments and intensive care units of ten multidisciplinary hospitals of the Republic of North Ossetia – Alania in 2015–2019. We also examined data on evaluation of preventive measures, infection control, and compliance with criteria of internal quality control and safety in health care. Results: According to the results of routine surveillance and specially organized epidemiological and microbiological monitoring, the incidence rates of healthcare-associated infections were 0.85 and 26.4 per 1,000 inpatients in surgery departments and intensive care units of hospitals of the Republic of North Ossetia – Alania, respectively. The incidence rates of certain types of nosocomial infections were statistically different (p ≤ 0.05) depending on the type of monitoring (routine/optimized): surgical site infections – 15.9/132.8 per 1,000 surgeries, catheter-associated urinary tract infections – 8.5/69.4 per 1,000 catheter days, central line-associated bloodstream infections – 7.74/89.12 per 1,000 catheter days, and ventilator-associated pneumonia – 8.12/39.74 per 1,000 ventilator days. K. pneumoniae strains isolated from surgery and intensive care patients and exhibiting extreme resistance to antimicrobial drugs belong to sequence type 1082, possess a high pandemic potential, and are widespread in many countries. According to the results of assessing compliance with the criteria of internal quality control and safety of health care, only three of ten hospitals in the Republic of North Ossetia – Alania had the compliance rate ≥ 70 %. As for the readiness for infection prevention and control in surgery departments and intensive care units, 60 % of the hospitals demonstrated a basic level and 40 % – an intermediate level of measures taken. Conclusions: Optimization of approaches to tracing healthcare-associated infections in the hospitals of the Republic of North Ossetia – Alania helped establish that actual incidence rates of nosocomial infections were on the average 26.4 times higher than those officially registered based on the results of routine surveillance.

Complications and risk factors on midline catheters’ follow-up about non-ICU patients: study protocol for a multicentre observational study (the midDATA study)

IntroductionThe midline catheter (MC) is an increasingly popular device used commonly for patients with difficult venous access or those who require infusion for more than 6 days. Little is known...

Clinical Impacts and Risk Factors for Central Line-Associated Bloodstream Infection: A Systematic Review.

Background A central line-associated bloodstream infection (CLABSI) is defined as a primary bloodstream infection (BSI) in a patient that had a central line within the 48-hour period before the development of the BSI and is not bloodstream-related to an infection at another site. CLABSI is a common healthcare-associated infection and a significant cause of morbidity and mortality. Methods This systematic review included studies published within the past 13 years that examined risk factors and clinical impact variables associated with CLABSI, using the Centers for Disease Control (CDC)/National Healthcare Safety Network (NHSN) criteria for defining catheter-associated infection, and included participants of all ages. The terms "CLABSI," "central line-associated bloodstream infection," "risk factors," "predictors," "morbidity," "mortality," "healthcare costs," and "length of hospital stay" were used to find relevant publications on PubMed/Medline, Google Scholar, and Science Direct. The quality assessment of the included publications utilized the modified Newcastle-Ottawa scale (NOS) for observational studies. Results After the full-text screening, we identified 15 articles that met our inclusion and exclusion criteria. The majority of these studies were of good quality and had a low risk of bias based on our bias assessment. The studies included a total of 32,198 participants and covered a time period from 2010 to 2023. The mean age of the male patients included in the studies ranged from 0.1 months to 69.1 years. All of the included studies were either observational cohort studies, cross sectional studies, case-control studies, or case reports. The major study parameters/outcomes extracted were risk factors, CLABSI-associated mortality, hospital cost, length of hospital stay, and catheter days. With respect to predisposing factors, multilumen access catheters were identified as risk factors in three studies, use of more than one central venous catheter per case in four studies, hematologic malignancy in three studies, catheterization duration in four studies, surgical complexity in four studies, length of ICU stays in three studies, and parenteral nutrition in two studies. Conclusion The decision to place a venous device should be carefully considered by evaluating individual risk factors for the development of CLABSI. This is important due to the potential for severe clinical consequences and significant healthcare expenses associated with this complication.

Outcomes from the first dedicated diagnostic and interventional nephrology (DIN) service in a UK renal unit

Background: We report the clinical outcomes, operational and training model from the first diagnostic and interventional nephrology (DIN) department in a UK renal unit. Methods: Patient outcomes were evaluated for an array of diagnostic and therapeutic interventional procedures performed at the DIN unit, SDIN (the Sunderland Diagnostic and Intervention Unit), within the first year of its establishment. Data was retrospectively collected for the period beginning 1st October 2019 to 1st October 2020 for patients who underwent the following procedures: ultrasound guided renal biopsy, Tunnelled Dialysis Catheter (TDC) insertion and exchange, Peritoneal Dialysis (PD) catheter insertion/exchange, and Areteriovenous Fistula (AVF) Point of Care Ultrasound (POCUS). These figures were compared to the cohort from the one-year period pre-SDIN, between the 1st October 2018 and 31st September 2019. All results are expressed as mean and percentages unless otherwise specified. Results: Renal Biopsy: 104 biopsies were performed with an improvement in median waiting time from 12 to 7 days with 98.4% being diagnostic. Tunnelled Dialysis Catheters: 99 TDCs were inserted or exchanged with the catheters remaining in place for a mean duration of 156 days. We report an incidence of 2 infections per 1000 catheter days within the 90-day observation period. Peritoneal dialysis catheters: 16 PD catheters were inserted and they remained in place for an average of 153 days. Eleven (69%) catheters had no complications within the 28-day observation period, 3 (19%) catheters required manipulation. AVF POCUS: 279 AVF POCUS scans were performed during the SDIN period. The waiting time from referral to scan was reduced from a mean of 35 days to 2 days. Conclusions: A comprehensive DIN service leads to significant improvements in training, service and patient outcomes and would be an ideal model for wider adaptation across the UK renal units.

Surgical treatment of benign prostatic hyperplasia: Thulium enucleation versus single-port transvesical robotic simple prostatectomy.

The objective of this work is to compare our outcomes using thulium laser enucleation of prostate (ThuLEP) to the single-port robot-assisted simple prostatectomy (SP RASP) in the surgical management of benign prostatic hyperplasia (BPH). A retrospective cohort study was conducted from January 2017 through December 2021 of men who underwent SP RASP and ThuLEP performed by a single surgeon with an enucleation experience of >300 cases and extensive robotic experience. The primary outcome was changed in International Prostate Symptom Score (IPSS) postoperatively. Secondary outcomes were operative time, length of stay (LOS), change in post-void residuals (PVR), de novo stress- or urge-urinary incontinence (SUI, UUI), and rate of complications. One hundred two patients underwent surgery during the study period: 33 RASP and 69 ThuLEP. There was no difference in preoperative characteristics, including age and body mass index, between both groups. Changes in IPSS scores postoperatively were not significant between SP RASP versus ThuLEP (-17 vs. -14, p = 0.2956). SP RASP had a longer operative time (180 vs. 90 min, p < 0.0001). There was no difference in LOS (0 vs. 0days, p = 0.2904). There was no difference in change in PVR (-96 vs. -91 mL, p = 0.8504). SP RASP patients had significantly less postoperative SUI than ThuLEP (0 vs. 13 patients, p = 0.0083), while there was no difference in UUI between both groups (4 vs. 2 patients, p = 0.0843). There was no difference in 30-day complication rate (21.2% vs. 21.7%, p = 0.9517), although there were three ThuLEP patients with Clavien-Dindo Class III or higher complication. There was no difference in change in IPSS scores between the two groups. ThuLEP is associated with shorter postoperative catheter days and decreased operative times. Hospital LOS was equivalent. SP RASP demonstrates significantly improved continence rates. Though SP RASP is within the initial learning curve at our institution, early results demonstrate the role for this modality alongside ThuLEP in the treatment of large gland BPH.

Disease Recurrence and Long-term Outcomes Following the Development of Intestinal Failure in Crohn's Disease: Over 20 Years of Experience from a National Reference Centre.

Intestinal failure [IF] is a recognised complication of Crohn's disease [CD]. The aim of this study was to identify factors predicting the development and recurrence of CD in patients with IF [CD-IF], and their long-term outcomes. This was a cohort study of adults with CD-IF admitted to a national UK IF reference centre between 2000 and 2021. Patients were followed from discharge with home parenteral nutrition [HPN] until death or February 28, 2021. In all, 124 patients were included; 47 [37.9%] changed disease location and 55 [44.4%] changed disease behaviour between CD and CD-IF diagnosis, with increased upper gastrointestinal involvement [4.0% vs 22.6% patients], p <0.001. Following IF diagnosis, 29/124 [23.4%] patients commenced CD prophylactic medical therapy; 18 [62.1%] had a history of stricturing or penetrating small bowel disease; and nine [31.0%] had ileocolonic phenotype brought back into continuity. The cumulative incidence of disease recurrence was 2.4% at 1 year, 16.3% at 5 years and 27.2% at 10 years; colon-in-continuity and prophylactic treatment were associated with an increased likelihood of disease recurrence. Catheter-related bloodstream infection [CRBSI] rate was 0.32 episodes/1000 catheter days, with no association between medical therapy and CRBSI rate. This is the largest series reporting disease behaviour and long-term outcomes in CD-IF and the first describing prophylactic therapy use. The incidence of disease recurrence was low. Immunosuppressive therapy appears to be safe in HPN-dependent patients with no increased risk of CRBSI. The management of CD-IF needs to be tailored to the patient's surgical disease history alongside disease phenotype.

Peripherally Inserted Central Venous Catheter (PICC) Related Bloodstream Infection in Cancer Patients Treated with Chemotherapy Compared with Noncancer Patients: A Propensity-Score-Matched Analysis.

The use of peripherally inserted central catheters (PICCs) has increased in cancer patients. This study aimed to compare the incidence of PICC-related bloodstream infections (PICCR-BSIs) in cancer patients treated with chemotherapy and in noncancer patients. We performed a secondary analysis from a retrospective, single-center, observational cohort. The PICCR-BSI incidence rates in cancer and noncancer patients were compared after 1:1 propensity-score matching. Then, the factors associated with PICCR-BSI were assessed in a Cox model. Among the 721 PICCs (627 patients) included in the analysis, 240 were placed in cancer patients for chemotherapy and 481 in noncancer patients. After propensity-score matching, the PICCR-BSI incidence rate was 2.6 per 1000 catheter days in cancer patients and 1.0 per 1000 catheter days in noncancer patients (p < 0.05). However, after adjusting for variables resulting in an imbalance between groups after propensity-score matching, only the number of PICC lumens was independently associated with PICCR-BSI (adjusted hazard ratio 1.81, 95% confidence interval: 1.01-3.22; p = 0.04). In conclusion, the incidence rate of PICCR-BSI is higher in cancer patients treated with chemotherapy than in noncancer patients, but our results also highlight the importance of limiting the number of PICC lumens in such patients.

#5134 THE REDS/MEWS SCALE USED FOR ASSESSMENT OF ESKD PATIENTS DIALYSED WITH CENTRAL CATHETER MAY REDUCE A NUMBER OF INFECTIVE ACCESS-RELATED COMPLICATIONS

Abstract Background and Aims Central tunnelled catheter (CVC)-related infections are a leading cause of catheter lost and being the source of significant morbidity and mortality of end stage kidneys disease (ESKD) patients. The study aimed to evaluate the impact of the implementation of the own REDS/MEWS scale for combined assessment of ESKD patients dialysed with the CTC on the frequency of infective complication. Method A group of 52 ESKD patients dialysed through a CTC were evaluated, pre dialysis on every session, using the REDS/MEWS scale for 24 months years and results as well as follow up of participants were compared with a two years period of time before the tool was introduced. Results Two-years cumulative incidence of CTC exit site infection (ESI) has dropped significantly (log-rank p &amp;lt; 0.001) from 0.87 episode per 1000 catheter days (52.3%, CI95 [34.2%; 67.3%]) in time before REDS/MEWS was used to 0.28 episode per 1000 catheter days (19.3%, CI95 [7.3%; 30.1%]) in REDS/MEWS time. There were also significantly less episodes of ESI complicated with catheter related blood stream infection (CRBSI) requiring CTC removal (0.8 episode per 1000 catheter days; 20.6%, CI95 [8.4%; 33.2%] vs. 0.4 episode per 1000 catheter days; 5.4%, CI95 [1.1; 8.7%]; log-rank p = 0.05, in pre – REDS and REDS time respectively). There was no serious complications as infective endocarditis, vertebral discs abscess among patients due to early detection and treatment of possible CTC related infection. Conclusion The REDS/MEWS scale appears to be a simple, cost-effective tool reducing frequency of the CTC related infective complication and the type of vascular access loss.

#3349 METICULOUS CATHETER CARE CAN REDUCE CATHETER-RELATED BLOODSTREAM INFECTIONS SIGNIFICANTLY IN HAEMODIALYSIS PATIENTS – A 5-YEAR SINGLE CENTRE STUDY

Abstract Background and Aims The use of central venous catheters as hemodialysis (HD) vascular access is a leading contributor to a high rate of bloodstream infection. Our dialysis unit in China has followed the China National Infection Control Policy for HD unit as well as developed its own specific dialysis catheter care protocol using the Centre for Disease Control and Prevention (CDC) guidelines as a template. By doing so, our HD unit has achieved a tunneled dialysis catheter (TDC)- related bloodstream infection rate of 0.0229 per 1000 catheter days in the past 5 years. This report, aims to share our experience with the other units. Method We have undertaken a retrospective analysis to determine our catheter-related bloodstream infection (CRBSI) rate. The local Ethics and Research Committee has approved the conduct of the retrospective study. In this study, the definition of a CRBSI is taken from Kidney Disease Outcomes Quality Initiative (KDOQI) Vascular Access-2019 update as 1) clinical manifestations (fever &amp;gt; 37.5°C or rigors or presence of clinical signs of infection); 2) confirmation of bacteremia (blood cultures growing the same organism from the dialysis catheter and a peripheral vein), with either positive semiquantitative (&amp;gt;15CFU/catheter segment), or quantitative (&amp;gt;102 CFU/catheter segment), differential period of catheter culture versus peripheral blood culture (BC) positivity of 2 hours; 3) exclusion of another source of infection. Information including patient demographics, causes of kidney failure, and duration of TDC was obtained. Results The Covidien Palindrome chronic catheters have been used in the majority of our patients during the study period. All tunneled dialysis catheters were placed by the nephrologists under radiological guidance in the Hospital's sterile Digital Subtraction Angiography (DSA) Suite. In the study period (2017-2021), an average of 235 prevalent patients were receiving dialysis in the HD unit. A total of 212 tunneled dialysis catheters have been inserted and managed according to our local dialysis access pathway and catheter care protocol. The TDC days have been calculated by adding all the catheter days until the catheters have been removed or the patients have been transferred out of our HD unit. There was a total of 43,585 catheter days. The average waiting time for arteriovenous fistula (AVF) surgery was two weeks. The mean duration of TDC use was 107.8±14.8 days, range 1-1827 days. The incidence of confirmed tunneled CRBSI was 0.0229/ 1000 catheter days. Conclusion Our local catheter care protocol is similar to the CDC's “scrub-the-hub” protocol. 2% chlorhexidine with 70% alcohol has been used for the scrubbing and disinfection but we have a few additional steps. In our practice, great attention is given to the cleansing of the clamps. 1) Prior to removal of the caps, the clamps are opened and the surroundings are cleaned and disinfected thoroughly. 2) Two nurses are assigned to connect the bloodlines to the hubs, hence the risk of hub contamination is reduced. 3) The point of connection between the hubs and the bloodlines is protected with a gauze dressing in 3 layers during the entire duration of the dialysis. We believe our success with a very low rate of CRBSI has been the result of strict adherence to 1) good and general hygiene, 2) a well-designed dialysis catheter care protocol, 3) good use of a vascular access nurse, 4) short-duration of TDC days, and 5) short waiting time for AVF. Limitations: We may have underestimated the true rate of CRBSI because of the inherent nature of the diagnostic criteria as mentioned above. Although it is unlikely that a blood culture would have been missed before intravenous antibiotics under our hospital's stringent antibiotics stewardship and continuous audit, it is still possible in theory. Finally, a small number of patients has been transferred out to other HD units due to their change of residence, hence the follow up data might be incomplete. However, such patients are very few in number and the long follow up of this study strengthens our findings and conclusion.