Catheter Infections In Patients Research Articles

Frequency of Catheter Infections in Patients of Hemodialysis Despite Using Antibiotic Lock

Non-tunneled catheters are associated with many complications, including infections and thrombosis. Objective: To determine the frequency of catheter infections in patients of hemodialysis despite using antibiotic locks, in a Tertiary Care Hospital Karachi. Methods: It was a cross-sectional study conducted at the department of nephrology, Liaquat national hospital and medical college, Karachi, Pakistan from 18th October 2020 to 18th April 2021. Patients of age 20 to 70 years of either gender on hemodialysis through double lumen catheter– non-cuffed for > 2 weeks were included in the study. Brief history was taken from all the patients. Gentamicin lock solutions were administered in all patients. Catheter tip was sent to institutional laboratory for culture and sensitivity to reach the outcome i-e catheter related infection. Results: The mean age was 58.97 + 14.82 years. The catheter related blood stream infection was in 21 patients (17.5%). The most common organism was coagulase negative Staphylococci (CoNS) (5.9%), followed by Vancomycin-resistant Enterococcus (VRE) (4.2%), respectively. There was insignificant association observed between catheter related blood stream infection and age groups, gender, comorbids, duration of catheter insertion and hemodialysis, site of catheter infection and reasons of hemodialysis (p > 0.05). Conclusions: Catheter-related infections in patients of hemodialysis despite using antibiotic locks is frequent but it has been observed that gram negative infections have responded well to gentamicin lock solution, where as in our study most common organism responsible for infection is coagulase negative Staph. followed by VRE

Nursing Effect of Avoiding PICC Catheter Infection in Patients with Blood Diseases Complicated with Diabetes Mellitus

Nursing Effect of Avoiding PICC Catheter Infection in Patients with Blood Diseases Complicated with Diabetes Mellitus

Risk Factors Analysis and Nursing Countermeasures of Postoperative Central Venous Catheter Infection in Patients with Urinary Tumors

Risk Factors Analysis and Nursing Countermeasures of Postoperative Central Venous Catheter Infection in Patients with Urinary Tumors

Analysis of the relationship between serum amyloid protein A, procalcitonin, C-reactive protein, and peripherally inserted central catheter infection in patients with malignant tumor.

Compared with a central venous catheter, a peripherally inserted central catheter (PICC) has the advantages of less trauma and a lower risk of bleeding and bloodstream infection. However, patients with tumors are commonly immunocompromised and therefore susceptible to infection during the course of PICC indwelling. This study aimed to investigate the relationship between serum amyloid protein A (SAA), procalcitonin (PCT), C-reactive protein (CRP), and PICC infection in patients with malignant tumor. Patients with malignant tumor treated with PICC in Gansu Provincial Cancer Hospital from March 2017 to January 2020 were retrospectively investigated. The incidence of infection and the differences in SAA, PCT, CRP, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIG), interleukin-18 (IL-18), and interleukin-16 (IL-6) between the infected group and noninfected group were observed. The correlations of SAA, PCT, and CRP levels in different infection sites and infection degrees were analyzed. A total of 414 eligible patients were included with 93 in the infection group and 321 in the noninfection group. The overall incidence of infection was 22.4%. The levels of SAA, PCT and CRP in the infection group were significantly higher than those in the noninfection group (P<0.001). Compared with the non-infected group, the levels of PT, APTT, TT, IL-18 and IL-6 were significantly higher in the infected group (P<0.001). However, the level of FIG was significantly lower in the infected group (P<0.001). Compared with the local infection group, the levels of SAA, PCT, and CRP in the bloodstream infection group were significantly higher (P<0.001). Furthermore, the levels of SAA, PCT, and CRP were positively correlated with the degree of PICC catheter infection. In patients with malignant tumors, PICC catheter infection were associated with increased risk of bleeding and the levels of SAA, PCT, and CRP can be used as predictive diagnostic indexes for PICC catheter infection. Furthermore, these parameters were positively correlated with the degree of PICC catheter infection.

Risk factors of peripherally inserted central catheter infection in patients with lung cancer undergoing chemotherapy

Objective To study the risk factors of peripherally inserted central catheter (PICC) infection in patients with lung cancer undergoing chemotherapy. Methods Medical records of 285 PICC patients with lung cancer treated in our hospital from February 2015 to October 2018 were retrospectively analyzed. The incidence of infection during PICC was recorded and the risk factors associated with infection were analyzed. Results Among 285 patients, there were 33 cases of PICC infection, with the infection rate of 11.58%. Catheterization in summer, the working time of catheterization staff less than 5 years, the times of catheterization more than 2 times, and the catheter retention time more than 30 days, diabetes history were independent risk factors for PICC infection (P<0.05). Conclusion Catheterization in summer, the working time of catheterization staff less than 5 years, the times of catheterization more than 2 times, and the catheter retention time more than 30 days, diabetes history were independent risk factors for PICC infection in lung cancer patients treated with chemotherapy. Key words: Lung cancer; Chemotherapy; Peripherally inserted central catheter; Risk factors; Infection

Intestinal failure-associated liver disease in adult patients.

The aim of this review is to give up-to-date information on intestinal failure-associated liver disease (IFALD) and how its investigation and management has evolved. Despite advances in treatment for patients with intestinal failure, IFALD remains a significant cause of mortality. Liver biopsy remains as the gold standard for the diagnosis of IFALD, but its invasive nature has prompted assessment of noninvasive techniques. Risk factors for IFALD are both nonnutritional (e.g. sepsis) and nutritional. Strict protocols for the prevention of central venous catheter infections in patients with intestinal failure are well established, as is the optimization of the constituents of parenteral nutrition. Further research comparing the available lipid emulsions has become available. Novel approaches at maximizing intestinal absorption are discussed including glucagon-like peptide-2 analogues, as well as surgical approaches. Although there are data on the novel investigative and therapeutic strategies for managing IFALD, further study is required to identify a suitable noninvasive technique for earlier diagnosis and then monitoring of IFALD. Further data are also required on the impact of novel therapies aimed at improving absorption and reducing parenteral nutrition load on IFALD occurrence and progression.

Micrococcus bacteremia in a patient with pulmonary hypertension and a long-term central venous catheter: Opportunity knocks, and an unexpected pathogen enters

© 2007 Elsevier 0196-4399/00 (see frontmatter) 173 Introduction Micrococcus species are grampositive cocci (GPC) that are most frequently recovered in blood cultures as phlebotomy-associated contaminants. However, they can be opportunistic pathogens on rare occasions. Our case highlights a previously reported association between Micrococcus spp. and catheter infections in patients with pulmonary arterial hypertension (PAH) who are being treated with epoprostenol (EPO) via central venous catheter (CVC). To enhance prompt recognition of clinically significant culture results, such cases benefit from good communication between the microbiology laboratory and the clinical team.

Micrococcus-Associated Central Venous Catheter Infection in Patients With Pulmonary Arterial Hypertension

To determine the incidence of catheter-related infection in patients with pulmonary arterial hypertension (PAH) receiving epoprostenol (EPO), and to note an etiologic role for Micrococcus spp, which is rarely reported as a pathogen in the medical literature. Observational study. Two PAH specialty treatment centers, Harbor-UCLA Medical Center (Torrance, CA), and the College of Physicians and Surgeons, Columbia University (New York, NY). A total of 192 patients with PAH receiving continuous therapy with IV EPO. From 1987 to 2000, 192 patients with PAH received infusions of EPO via central venous catheter. Catheter care included regular dressing changes with dry gauze using a sterile procedure, without the use of flushes. Patients were asked to report on known infections and treatments, and symptoms. All infections were verified by a telephone call to the patient, care provider, and microbiology laboratory whenever possible. There were 335,285 catheter days (mean +/- SD, 1,325 +/- 974 catheter days). There were 88 clinical catheter infections with 51 blood culture-positive infections, necessitating catheter removal in 38 instances. The following pathogens were isolated: Staphylococcus aureus (25); Micrococcus spp (14); mixed flora (3); coagulase-negative Staphylococcus spp (2); Corynebacterium spp (2); Serratia marcessens (1); Enterobacter spp (1); Pseudomonas aeruginosa (1); enterococci (1); and unidentified Gram-positive cocci (1). The catheter infection rate was 0.26 per 1,000 catheter days. The use of long-term therapy with continuous EPO appears to be associated with a low incidence of catheter-related infections. Micrococcus spp were the second most common etiologic agent. Caregivers managing patients with PAH must be aware of the risk of catheter infection, as it may contribute to the morbidity and mortality associated with the use of EPO. When isolated, Micrococcus spp should not be viewed as a contaminant, but rather as a true pathogen that may require therapeutic intervention.

Central Venous Catheter Infections in Patients with Acute Leukemia

Background: Central venous catheters (CVCs) have become an essential tool for an appropriate management of patients with acute leukemia. Infectious complications are a major concern in patients treated for acute leukemia. Although CVC-related infections are considered to be a major source of infections during neutropenia (<500/µl), data regarding the incidence of CVC-related infections are rare in acute leukemia. Patients and Methods: We analyzed nontunneled CVCs in 58 patients with acute leukemia (22 men/36 women) in 119 chemotherapy cycles from April 1996 to January 1998 in a prospective trial. Proven CVC-related infection was defined as the isolation of the same organism from peripheral blood and CVC tip. CVC infection was suspected or possible when exit site inflammation and positive blood culture or organisms typical for CVC infection were observed. Results: Mean neutropenia/cycle was 16.3 days (SD 8.0). 178 CVCs with 2,576 CVC days (mean 14.5 days, SD 7.2 days) were used in 119 cycles. Fever occurred in 87 cycles (73%). Blood stream infection was proven in 31 out of 87 febrile episodes (26.1%) with 40 isolates (8 gram-negative, 31 gram-positive, 1 Candida spp.). Colonization of the CVC tip was observed in 24 CVC lines with 28 isolates (27 gram-positive, 1 gram-negative); however, proven CVC-related infections were observed in 5 episodes only, all with coagulase-negative staphylococci. In another 6 episodes, CVC-related infection was assumed (local inflammation and gram-positive blood culture). Six further episodes had typical blood isolates (4 coagulase-negative staphylococci, 1 Candida spp.) and were considered possible CVC-related infections. In none of the remaining afebrile 32 cycles was a CVC infection observed or suspected. Conclusion: Gram-positive organisms contributed to the majority of CVC-related infections (16 out 17 CVC infections); however, the overall incidence of CVC infections in acute leukemia patients was 6.5/1,000 CVC days only (1.9 proven/2.3 suspected/2.3 possible/1,000 CVC days).

Clinical Observation: Outpatient Intravenous Antibiotic Therapy for Catheter Infections in Patients on Home Parenteral Nutrition

Standard management of infectious complications in home parenteral nutrition (HPN) patients includes hospitalization and use of IV antibiotics (1 to 4 weeks). Outpatient IV antibiotic therapy (OPIVAT) has proven to be safe, practical and cost‐effective for a variety of infections. The aim of this retrospective review is to describe our experience with OPIVAT for suspected catheter‐related infections in patients receiving HPN. The records of all HPN patients in our program were reviewed. Since 1993, eleven adults and seven children received HPN for a total of 5420 and 1212 days respectively. During the follow‐up there were 21 febrile episodes in the adult patients, nine catheter‐related infections, and 12 non‐catheter‐related febrile episodes. All received initially empiric antibiotic treatment (Teicoplanin or Vancomycin plus Ceftriaxone). If the patient's general condition was good, the treatment was administered at home, otherwise he or she remained in the hospital until the results of the blood cultures were available. Most of the febrile episodes treated entirely at home corresponded to non‐catheter related infections. No patients developed complications related to infections. None of the patients with catheter‐related bloodstream infection who received OPIVAT needed to be admitted or readmitted to the hospital during the course of the treatment. It was only necessary to remove the catheter as an inpatient in one patient with a tunnel infection. In most of the HPN programs, if the patient presents fever and no infectious focus is found, admission is recommended. IV antibiotics are started until the results of blood cultures are available. Our findings suggest that, even in the presence of catheter‐related bloodstream infection, if the patient's general condition is good, antibiotic treatment can be safely administered at home.

Intraluminal antibiotic treatment of central venous catheter infection in patients receiving total parenteral nutrition

Intraluminal antibiotic treatment of central venous catheter infection in patients receiving total parenteral nutrition

Intraluminal Antibiotic Treatment of Central Venous Catheter Infections in Patients Receiving Parenteral Nutrition at Home

We carried out an open, uncontrolled, prospective study to evaluate intraluminal antibiotic therapy for bloodstream infections arising from subcutaneously tunneled central venous catheters in patients receiving parenteral nutrition therapy at home. Seven bacterial infections were treated with intraluminal antibiotics (mean duration, 8.6 days) sometimes accompanied by systemic antibiotics (mean duration, 2.1 days). All seven infections were cured. Two infections caused by Candida species were treated with intraluminal amphotericin B. Fungal infections was suppressed during treatment but later relapsed, as confirmed by pulsed field DNA electrophoresis typing of bloodstream isolates. The concentration of antibiotic was assayed in intraluminal fluid from catheters of patients receiving treatment with vancomycin or gentamicin. The concentration was initially approximately 5 mg/mL, and it remained at > or = 2.5 mg/mL throughout the period that the solution was locked in the catheter. Our findings show that intraluminal therapy is effective against selected bacterial infections and can suppress fungal infections in subcutaneously tunneled catheters.

Epidural catheter infection in patients receiving long-term pain control

Epidural catheter infection in patients receiving long-term pain control

Reduced Intravascular Catheter Infection by Antibiotic Bonding

We report a prospective, randomized, controlled clinical trial to evaluate the efficacy of antibiotic-bonded catheters in reducing the incidence of intravascular catheter-related infections. Ninety-three central venous catheters and 85 arterial catheters were studied in the surgical intensive care unit. Study catheters were pretreated with the cationic surfactant tridodecylmethylammonium chloride. The anionic antibiotic, cefazolin, was bonded before insertion of the catheters by immersing them in a 50-mg/mL solution. Fourteen percent of the 81 catheters in the control group were infected, compared with 2% of the 97 antibiotic-bonded catheters. Staphylococcus epidermidis was the most common organism obtained. There was no significant difference in the number of colonized or clinically inflamed catheter insertion sites. None of the 100 antibiotic immersion solutions yielded anything on microbiologic culture. We conclude that antibiotic bonding is an efficient, safe, and cost-effective method of reducing intravascular catheter infection in patients who are in intensive care units.

Antibiotic therapy of catheter infections in patients receiving home parenteral nutrition

Fifty-eight episodes of catheter-related sepsis in 21 patients receiving home parenteral nutrition were retrospectively studied. Of 81 organisms isolated from the blood, 59% were Gram-positive cocci, 25% were Gram-negative bacilli, and 16% were yeast. Attempts to treat bacterial infections at home with antibiotic therapy while the catheter remained in place were made; fungal isolation resulted in immediate hospitalization and catheter removal. Gram-negative infections more often resulted in eventual hospitalization (92%) and catheter removal (50%) than Gram-positive infections (57% hospitalization and 23% catheter removal). Empiric therapy with 1 g of cefazolin intravenously every 12 hr was successful in only 33% of episodes caused by coagulase-negative staphylococci, whereas vancomycin was successful in 62%. Sensitivity testing was not a reliable guide for antibiotic choice for treatment of these infections. Cefazolin, 1 g, intravenously every 12 hr was successful in only 25% of Gram-negative episodes treated empirically with this regimen. We conclude that our home parenteral nutrition patients should be hospitalized for a few days upon presentation with a catheter infection for clinical evaluation and aggressive antibiotic therapy. Vancomycin is the preferred drug for treatment of catheter-related infections caused by coagulase-negative staphylococcus.

Infections associated with hickman catheters in patients with acquired immunodeficiency syndrome

purpose: Hickman catheters are frequently used as convenient long-term venous access in patients with acquired immunodeficiency syndrome (AIDS). These patients seem to be at increased risk for bacterial infections of intravenous devices. The aim of our study was to determine the frequency of Hickman catheter infection in patients with AIDS as compared with that in other patients. patients and methods: We analyzed the records of 69 patients who underwent 71 consecutive Hickman catheter placements during a one-year study period. results: Forty-six Hickman catheters were inserted in 44 patients with AIDS, and 25 Hickman catheters were placed in 25 other patients. There were 18 infections: 16 occurred in patients with AIDS, and two developed in the control group (p <0.05). The 16 infections in AIDS were as follows: five exit site, five septicemias, two tunnel, one septic phlebitis, and three probable Hickman catheter-related. Staphylococcus aureus was responsible for 14 cases (87%); Staphylococcus epidermidis was responsible for four cases (25%). Mean onset of infection was 32 days, but seven patients were diagnosed in the first eight days after Hickman catheter insertion. Fever occurred in all patients with early infection, leukopenia was present only in three; infusion of parenteral nutrition did not increase the risk. Two early infections were fatal. The rate of Hickman catheter infection in patients with AIDS was 0.47 per 100 catheter days, as compared with 0.09 in the control group. conclusion: Our findings underscore the need for using Hickman catheters only when absolutely indicated in patients with AIDS, since the risk of serious infectious complications appears to be high.

Hickman catheter infections in patients with malignancies.

The infectious complications associated with implantation of 1,088 Hickman catheters (HCs) in 992 patients reported in 18 published series are presented (including data on 129 previously unreported HCs from our own institution). HCs allow reliable long-term venous access (mean, 92.4 days) with low complication and infection rates (0.30 and 0.14 cases per 100 catheter days, respectively). Exit site infections were the most common form of infection encountered (45.5%), followed by septicemia alone (30.8%), tunnel infections (20.3%), and septic thrombophlebitis (3.5%). Staphylococcus epidermidis (54.1%) and S. aureus (20.0%) were the most common pathogens responsible for catheter infections. HC infections were associated with a low mortality rate (maximum rate of 0.5%). Risk factor analysis of 129 HCs demonstrated that catheter thrombosis was the major risk factor associated with development of catheter infection. Presence of fever, distant infection, neutropenia or antibiotic administration on the day of catheter insertion was not significantly associated with HC infection in this series (although there was a trend suggesting an increased risk of infection of HCs inserted during febrile episodes). Based on observations at our institution and from a review of the literature, tentative recommendations for management of the various types of HC infections are outlined.