Catheter-related Bacteremia In Patients Research Articles

Evaluation of catheter related bacteremia in patients with end stage renal disease on hemodialysis

Evaluation of catheter related bacteremia in patients with end stage renal disease on hemodialysis

Management of catheter related bacteremia in patients on home parenteral nutrition: a systematic review and meta-analysis

Rationale: Catheter-related bacteremia (CRB) is regarded as a life-threatening complication of home parenteral nutrition (HPN) support. Therefore optimal CRB management, preferably with salvage of the catheter, is required to secure vascular access in the long term. The aim of this review was to systematically evaluate the currently available literature for CRB treatments in adult patients on HPN support.

Distribution of virulence genes in bacteremic methicillin-resistant Staphylococcus aureus isolates from various sources.

Methicillin-resistant Staphylococcus aureus (MRSA) can encode proteins which directly bind bacteria to many tissues and medical devices or catheters to trigger pathogenesis. However, the relationship between genetic backgrounds and virulent factors in MRSA isolates remained incompletely understood yet. MRSA isolates were collected from blood cultures of patients with infective endocarditis, bone/joint infection, skin/soft tissue infection, or catheter-related bacteremia in hemodialysis at a tertiary medical center between 2005 and 2011. MRSA isolates were characterized by the methods of spa, multilocus sequence, and staphylococcal cassette chromosome mec (SCCmec) typing. Identification of virulence gene expression was measured by Power SYBR Green PCR Master Mix. Overall collected were 136 MRSA bacteremic isolates, including those from the cases of infective endocarditis (n=23), bone/joint infection (n=49), skin/soft tissue infection (n=20), or catheter-related bacteremia in patients with acute kidney injury or end-stage renal stage receiving hemodialysis (n=54). CC8-ST239-MRSA-SCCmec type III-spa type t037 was the most prevalent type observed in all of 136 MRSA bacteremic isolates. The prevalent genes in the group of infective endocarditis were clfA, clfB, fnbA, ebpS, eap, emp, sae, and eno; bone/joint infections clfA, emp, sae, and eno; skin/soft tissue infection eno; hemodialysis catheter-related bacteremia clfA and sae. The distribution of each gene was not statically different among four groups. A major MRSA lineage, CC8-ST239-MRSA-SCCmec type III-spa type t037, is noted among bacteremic MRSA isolates. No disease-specific virulent genes can be identified.

Successful prevention of tunneled central catheter infection by antibiotic lock therapy using cefazolin and gentamicin

Catheter-related bacteremia (CRB) is one of the various complications related to hemodialysis (HD). As a result of this high rate of infection, the antibiotic lock technique (ALT) has been recommended to prevent CRB. However, adverse effects of ALT such as increased emergence of strains resistant to antibiotics and increased mechanical dysfunction catheter were poorly evaluated. We prospectively evaluated the efficacy of catheter-restricted filling using an antibiotic lock solution in preventing CRB. A total of 233 HD patients requiring 325 new tunneled catheters while waiting for placement and maturation of an arteriovenous fistula or graft were enrolled in this study. Patients with a tunneled catheter were assigned to receive either an antibiotic-heparin lock solution (antibiotic group: cefazolin 10 mg/ml, gentamicin 5 mg/ml, heparin 1,000 U/ml) or a heparin lock solution (no-antibiotic group: heparin 1,000 U/ml) as a catheter lock solution during the interdialytic period. The present study aimed to assess the efficacy of ALT using cefazolin and gentamicin in reducing CRB in patients undergoing HD with tunneled central catheter and to identify its adverse effects. CRB developed in 32.4 % of patients in the no-antibiotic group and in 13.1 % of patients in the antibiotic group. CRB rates per 1,000 catheter-days were 0.57 in the antibiotic group versus 1.74 in the no-antibiotic group (p < 0.0001). Kaplan-Meier analysis also showed that mean CRB-free catheter survival was significantly higher in the antibiotic group than in the no-antibiotic group (log-rank statistic 17.62, p < 0.0001). There was statistically significant difference between the two groups in causative organisms of CRB, with predominance of negative culture in both groups, but this prevalence was higher in ALT group (57.9 vs 90.1 %, p < 0.0001), and the two groups also were different in prevalence of gram-positive bacteria as causing organisms (ALT group 21.05 vs = 0 % in control group, p < 0.0001). There was no statistically significant difference between the two groups in drug-resistant germs. There were statistically significant differences between the two groups in the catheter removal causes, with higher rate of infectious cause in control group (12.32 vs 2.22 %, p < 0.0001) and mechanical cause in ALT group (28.26 vs 37.78 %, p < 0.0001). The results suggest that ALT may be a beneficial means of reducing the CRB rate in HD patients with tunneled catheter, without association between ALT and emergence of strains resistant. However, mechanical complications were more prevalent in antibiotic group. Further studies are required to determine the optimal drug regimen, concentrations for ALT, and its adverse effects.

Does Bisphosphonate-Induced Osteonecrosis of the Jaw (BONJ) Preclude Intensive Chemotherapy? Oral and Infectious Toxicities Associated with Autotransplantation In Patients with BONJ.

AbstractAbstract 1314 Background:Bisphosphonate-induced osteonecrosis of the jaw (BONJ) is a recently recognized adverse reaction associated with intravenous bisphosphonate use. The incidence of BONJ is estimated to be between 5–15% of patients with multiple myeloma (MM) treated with biphosphonates. Relevant to this complication, areas of osteonecrosis can harbor bacteria with the potential to cause infection and bacteremia during prolonged periods of myelosuppression. Furthermore, it is unclear if BONJ can worsen mucositis associated with cytotoxic therapy or if intensive chemotherapy can impair the healing of osteonecrosis. Since autologous peripheral blood stem cell transplantation (APBSCT) is an integral part of the treatment of MM, it is important to determine toxicities associated with APBSCT in patients with BONJ. Study Purpose:To determine the oral and infectious toxicities associated with APBSCT in patients with multiple myeloma and BONJ. Method:This is a retrospective analysis of patients with MM and BONJ who underwent APBSCT between January 2005 and June 2010. All the patients were evaluated for dental clearance by local dentists prior to referral to our institution. Before transplantation, all the patients underwent another oral evaluation by our institution's dentist who specializes in oral and maxillofacial pathology and is experienced in the evaluation and care of transplant patients. Results:During the study period, 176 patients underwent APBSCT for MM at our institution. Ten male patients, or 6% of all patients, were diagnosed with BONJ prior to transplantation. The median age of patients with BONJ was 60 years (range, 39–70). BONJ developed a median of 444 days (range, 187–2194) after the initiation of treatment with bisphosphonates. Patients with BONJ received a median of 15 infusions of biphosphonates (range, 6–60) before the diagnosis of BONJ was established. Six patients received zoledronate, 3 received pamidronate and one received both. Eight of the 10 patients with BONJ were diagnosed by our dentist. Five patients received dental care by local dentists a median of 5 months (range 1–7) before they were seen at our facility where they were examined by our dentist. Two of the five patients had received extractions placing them at risk of developing BONJ. None of the patients received radiation to the jaw or had lytic lesions in the jaw area.The transplant conditioning regimen was similar for all patients: melphalan 100 mg/m2 daily for 2 days. Six patients developed neutropenic fever for a median of 4 days (range, 1–9). Bacteremia was diagnosed in 3 patients and 1 met criteria for catheter-related bacteremia (CRB) as defined by the Centers for Disease Control of the United States. The incidence of CRB in patients with BONJ appears similar to the 13% CRB observed at our institution during the study period. The organisms isolated from the blood were Pseudomonas aeruginosa, Corynebacterium species, Sphingomonas paucimobilis and Coagulase-negative staphylococcus, the last 2 were cultured from one patient. None of these organisms are predominantly found in the oral cavity but have been well described as pathogens in immunosuppressed hosts. Seven patients with BONJ developed mucositis posttransplantation but only one patient experienced grade 3 mucositis as defined by the Common Toxicity Criteria version 3. Of the remaining patients, 3 developed grade 1 and 3 developed grade 2 mucositis posttransplantation. Patients without BONJ had a similar frequency of mucositis: 31% of patients did not experience any mucositis, another 31% developed grade 1, 30% developed grade 2 and only 7% developed grade 3 mucositis. There was no treatment-related mortality within one year posttransplantation. So far, only 1 patient has died of progressive disease 13 months after APBSCT. Of interest, BONJ healed in nine patients posttransplantation with conservative management and 3 patients had bisphosphonates reintroduced with no recurrence of BONJ. Conclusion:Autologous stem cell transplantation can be performed safely in patients with BONJ. The incidence of oral and infectious toxicities observed in patients with BONJ appears similar to the incidence observed in patients without BONJ transplanted during the same period of time. BONJ was not recognized by most practitioners who referred patients for transplantation. Finally, BONJ healed in most patients after the transplant with conservative management. Disclosures:No relevant conflicts of interest to declare.

Influence of tracheostomy on the incidence of central venous catheter-related bacteremia

Although there are many studies on catheter-related infection, there are scarce data about the influence of tracheostomy in the incidence of central venous catheter-related bacteremia (CRB). In this cohort study, we found a higher incidence of CRB in patients with tracheostomy than without (11.25 vs. 1.43 per 1,000 catheter-days; odds ratio [OR] = 7.99; 95% confidence interval [CI] = 4.38-infinite; P < 0.001). Besides, we found a higher incidence of CRB in patients with tracheostomy using the jugular access compared to subclavian access (21.64 vs. 5.11 per 1,000 catheter-days; OR = 4.23; 95% CI = 1.44-infinite; P = 0.0097).

The Effectiveness of Antibiotic-Lock Therapy for the Prevention of Catheter-Related Bacteremia in Patients on Chronic Hemodialysis: Case Controlled Study in a Veteran Population

Central venous catheters (CVCs) are frequently used in patients with chronic renal failure who require long-term hemodialysis. CVCs are also known to be a major source of bloodstream infections. Though antibiotic-lock therapy (ALT) has previously been used to prevent and treat catheter-related infections, the use of ALT remains controversial due to the lack of large prospective randomized controlled trials. The purpose of this study was to evaluate the effectiveness of ALT in the prevention of catheter-related bacteremia (CRB) in a veteran population who required chronic hemodialysis. This was a retrospective, case-controlled study. All patients who underwent hemodialysis using a tunneled central catheter (TCC) from January 1, 2006 to October 8, 2008 were examined. Eleven patients who received ALT were compared with 15 case control subjects. The effectiveness of ALT for prevention of CRB was determined by the incidence of CRBs during the study period and catheter removal secondary to a CRB. A total of 10,961 catheter-days were calculated from 47 TCCs among 26 patients. The two groups had similar demographics and risk factors for CRBs. There were a total of 17 incidences of CRBs with a rate of 1.55 incidences/1,000 catheter-days. The rate of CRB was significantly lower in the ALT group (0.69 incidences/1,000 catheter-days) than the control group (2.54 incidences/1,000 catheter-days), p=0.041. The rate of catheters removal due to a CRB was also significantly less in the ALT group (0.5 catheter removed/1,000 catheter-days) than the control group (2.41 catheter removed/1,000 catheter-days), p=0.041. Seven out of 9 patients died in the control group secondary to CRBs. Three patients died in the ALT group; however none of these deaths were associated with CRB. Our study results revealed that ALT is an effective way to prevent catheter related bacteremia among veterans with central venous catheter for chronic hemodialysis.

The Use of Rifampicin‐Miconazole–Impregnated Catheters Reduces the Incidence of Femoral and Jugular Catheter‐Related Bacteremia

The guidelines of the Centers for Disease Control and Prevention do not recommend the use of an antimicrobial- or antiseptic-impregnated catheter for short-term use. In previous studies, we have found a higher incidence of central venous catheter-related bacteremia among patients with femoral and central jugular accesses than among patients with other venous accesses. The objective of our study was to determine the incidence of central venous catheter-related bacteremia associated with rifampicin-miconazole-impregnated catheters and standard catheters in patients with femoral and central jugular venous accesses. This was a cohort study, conducted in the 24-bed polyvalent medical-surgical intensive care unit of a university hospital. We included patients who were admitted to the intensive care unit from 1 June 2006 through 30 September 2007 and who underwent femoral or central jugular venous catheterization. We inserted 184 femoral (73 rifampicin-miconazole-impregnated catheters and 111 standard catheters) and 241 central jugular venous catheters (114 rifampicin-miconazole-impregnated catheters and 127 standard catheters). We found a lower rate of central venous catheter-related bacteremia associated with rifampicin-miconazole-impregnated catheters than with standard catheters among patients with femoral access (0 vs. 8.62 cases per 1000 catheter-days; odds ratio, 0.13; 95% confidence interval, 0.00-0.86; P = .03) and among patients with central internal jugular access (0 vs. 4.93 cases per 1000 catheter-days; odds ratio, 0.13; 95% confidence interval, 0.00-0.93; P = .04). Rifampicin-minonazole-impregnated catheters are associated with a statistically significant reduction in the incidence of catheter-related bacteremia in patients with short-term catheter use at the central jugular and femoral sites.

Gram-Negative Intravascular Catheter-Related Bacteremia in Patients With Spinal Cord Injury

Hussain R, Cevallos ME, Darouiche RO, Trautner BW. Gram-negative intravascular catheter-related bacteremia in patients with spinal cord injury. Objective To determine whether the prevalence of gram-negative catheter-related bloodstream infection (CRBSI) is higher in patients with spinal cord injury (SCI) than in patients without SCI. Design Retrospective chart review from August 1998 to August 2006. Setting A Veterans Affairs medical center, which serves as a tertiary care medical center to over 500 veterans with SCI and is the primary source of health care for veterans in southeast Texas. Participants All hospitalized patients who had an International Classification of Diseases, Ninth Revision, code for bacteremia associated with their hospital stay. Interventions Not applicable. Main Outcome Measure The proportion of CRBSI caused by gram-negative organisms in the SCI patients to the proportion of CRBSI caused by gram-negative organisms in the non-SCI patients. Results Eight (42%) of 19 episodes of CRBSI in the SCI were caused by a gram-negative organism as compared with 4 (11%) of 36 infections in the non-SCI group ( P<.01). Factors associated with having a gram-negative organism rather than a gram-positive organism as the causative agent of CRBSI were SCI, femoral catheter site, prolonged hospitalization, decubitus ulcer, and urinary catheter. Conclusions In our medical center, patients with SCI who develop CRBSI are more likely to have an infection with a gram-negative organism than are patients without SCI. This knowledge may guide initial empirical therapy of suspected bloodstream infection.

Risk Factors for the Infections Caused by Temporary Double-Lumen Hemodialysis Catheters

Temporary hemodialysis catheters are important devices used in dialysis practice but may be the source of infection in hemodialysis patients. We investigated the infectious complications in 70 hemodialysis patients using 113 hemodialysis catheters. The frequency of catheter-related bacteremia was 23.9%, of which Staphylococci were the most frequently growing organism (96.3%). Exit-site infection was observed in one patient. No cases were lost due to the infectious complications. The risk for the development of catheter-related bacteremia was increased after the 24th day of catheterization and after the second venous puncture. There was a positive correlation between hypoalbuminemia and bacteremia. Internal jugular venous catheterization and hypoalbuminemia were determined as risk factors for the development of catheter-related bacteremia. The risk factors for catheter-related bacteremia in patients with hemodialysis catheter should be determined and modified in order to decrease infectious complications.

Catheter-Related Vancomycin-ResistantEnterococcus FaeciumBacteremia: Clinical and Molecular Epidemiology

To study the clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium organisms causing catheter-related bacteremia in patients with cancer. Retrospective case-control study. University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas. Case-patients were patients with cancer who had catheter-related vancomycin-resistant E. faecium bacteremia and control-patients were patients with cancer and vancomycin-resistant E. faecium gastrointestinal colonization without infection. Ten case-patients with catheter-related vancomycin-resistant E. faecium bacteremia were compared with 30 control-patients with gastrointestinal colonization by vancomycin-resistant E. faecium. Patients with catheter-related vancomycin-resistant E. faecium bacteremia were more likely to have required mechanical ventilation (P < .01), received total parenteral nutrition (P < .01), and had polyurethane catheters (P < .01) inserted in the femoral vein (P = .01). With the use of pulsed-field gel electrophoresis, 4 of the 10 catheter-related vancomycin-resistant E. faecium bacteremia isolates were genetically indistinguishable, whereas only 2 of the 30 control vancomycin-resistant E. faecium isolates displayed this same DNA pattern (P = .03). This study suggests that catheter-related vancomycin-resistant E. faecium bacteremia occurs more frequently in patients who receive total parenteral nutrition, mechanical ventilation, and femoral catheters.

Differential time to positivity: a useful method for diagnosing catheter-related bloodstream infections.

Catheter-related bloodstream infections are associated with recognized morbidity and mortality, especially in critically ill patients. Accurate diagnosis of such infections results in proper management of patients and in reducing unnecessary removal of catheters. To evaluate differential time to positivity as a method for diagnosing catheter-related bacteremias caused by both short-term and long-term use of central venous catheters. Prospective study design. M.D. Anderson Cancer Center, Houston, Texas, a tertiary care cancer center. All patients, between September 1999 and November 2000, who had the same organism isolated from blood cultures drawn simultaneously through the central venous catheter and the peripheral vein. Time necessary for the blood cultures from the central venous catheter and the peripheral vein to become positive, as well as other relevant patient information. 191 bloodstream infections with positive simultaneous central venous catheter and peripheral vein blood cultures were included. One hundred eight patients had catheter-related bacteremias, and 83 had non-catheter-related bacteremias. Catheter-related bacteremias were more frequently caused by staphylococci and less likely to be associated with underlying hematologic malignant conditions, neutropenia, and longer duration of hospitalization. As a diagnostic tool for catheter-related bacteremia (using a composite definition reference standard according to the Infectious Diseases Society of America guidelines), differential time to positivity of 120 minutes or more was associated with 81% sensitivity and 92% specificity for short-term catheters and 93% sensitivity and 75% specificity for long-term catheters. Differential time to positivity of 120 minutes or more is highly sensitive and specific for catheter-related bacteremia in patients who have short- and long-term catheters.

Catheter-Related Bacteremia in Patients Undergoing Hemodialysis

Letters1 April 1998Catheter-Related Bacteremia in Patients Undergoing HemodialysisKieren A. Marr, MD, Daniel J. Sexton, MD, and Kathryn B. Kirkland, MDKieren A. Marr, MDUniversity of Washington; Seattle, WA 98195Duke University Medical Center; Durham, NC 27705Search for more papers by this author, Daniel J. Sexton, MDUniversity of Washington; Seattle, WA 98195Duke University Medical Center; Durham, NC 27705Search for more papers by this author, and Kathryn B. Kirkland, MDUniversity of Washington; Seattle, WA 98195Duke University Medical Center; Durham, NC 27705Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-7-199804010-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:All of the patients in our study met the clinical case definition of catheter-related bloodstream infection suggested by the Centers for Disease Control and Prevention: isolation of the same microorganism from blood cultures obtained by venipuncture and drawn from the catheter in a patient with signs of sepsis and no source of bloodstream infection other than the catheter [1]. The Centers for Disease Control and Prevention guidelines further state that defervescence after removal of the catheter is indirect evidence of catheter-related infection in the absence of laboratory confirmation. Laboratory confirmation (which can be done by quantitative culture of ...

Double-Blind Prospective Randomized Study Comparing Topical Mupirocin and Placebo for the Prevention of Infection Associated with Central Venous Catheters

To compare the incidence of exit site colonization, local catheter-related infection and catheter-related bacteremia in patients randomized to receive either topical 2% mupirocin or placebo at the catheter exit site. Patients requiring central venous catheters for more than three days were randomized to receive in a double-blind fashion either topical mupirocin or an identical placebo at the exit site three times weekly at the time of dressing change. Insertion, site care and removal of catheters were standardized. Serial semiquantitataive cultures of the skin at the catheter insertion site were performed using a sterile 25 cm(2) template. The distal and proximal catheter segments were cultured using a standardized semiquantitative technique, and any suspect catheter-related bacteremia was investigated with two sets of peripheral blood cultures, a 10 mL sample of infusate and clinical assessment. Both univariate and multivariate analyses were conducted on individual risk factors to determine factors that might influence the outcomes of local or systemic catheter-related infection. Local catheter-related infection (defined as more than 15 colony forming units [cfu] on culture of the proximal or distal catheter segment) occurred in six of 57 (10.5%) in the mupirocin group versus 18 of 69 (26%) in the placebo group (P<0.05) for the distal catheter segments and in one of 40 (2.5%) versus 13 of 47 (27.6%) for the proximal segments in the mupirocin and placebo groups (P<0.006), respectively. Catheter-related bacteremia occurred in one of 57 (1.8%) of the mupirocin group but in five of 69 (7.2%) of the placebo group (P=0.15). Stepwise logistic regression revealed that cutaneous colonization at the insertion site of at least 10(3) cfu/mL/25 cm(2) (OR 2.6; CI 1.0 to 6.9) and the use of placebo (OR 3.3; CI 1.2 to 9.0) were significant factors predicting local catheter-related infection; whereas mupirocin was associated with reciprocal protective effect (OR 0.3; 95% CI 0.1 to 0.8). These findings suggest that patients receiving topical mupirocin at the exit site for long term central venous catheters have significantly less local catheter-related infection, and there is a trend towards less catheter-related bacteremia.

Catheter-Related Infections Caused by the Mycobacterium fortuitum Complex: 15 Cases and Review

Fifteen cancer patients have developed catheter-related infections caused by the Mycobacterium fortuitum complex (M. fortuitum and Mycobacterium chelonae) at M. D. Anderson Cancer Center since 1978. Eleven patients had bacteremia and four had catheter site infections. Nine infections were caused by M. fortuitum and six by M. chelonae. All four bacteremic patients whose catheters were initially removed and who were treated with antibiotics recovered, whereas for all of the seven bacteremic patients whose catheters remained in place, the infection relapsed or treatment failed. Six (86%) of the latter group ultimately responded to additional antibiotic therapy when the catheter was removed. Successful treatment of local catheter infections was accomplished by catheter removal alone or in combination with antibiotic therapy. Fourteen additional cases have been reported, and eight (57%) of these patients also had underlying cancer. Patients with septicemia or an infection at the catheter insertion site responded to catheter removal and appropriate antibiotics. Patients with infection in the catheter tunnel (tunnel infection) responded only after surgical excision of the tissue surrounding the infected tunnel. M. fortuitum complex is a cause of catheter-related bacteremia in patients with cancer. Appropriate treatment consists of antibiotic therapy and catheter removal. Tunnel infections usually also require surgical excision.

Evaluation of culture techniques for identification of catheter-related infection in hemodialysis patients

A prospective study was conducted over eight months to evaluate the usefulness of two culture techniques using different catheter parts for detection of bacterial colonization or catheter-related bacteremia in patients with jugular or subclavian hemodialysis catheters. A combination of semiquantitative culture of the external surface and quantitative culture of the intraluminal surface of the intradermal catheter segment provided the best means of detecting catheter colonization. For detection of catheter-related bacteremia, this combination had 100% sensitivity and a positive predictive value similar to the actual rate of catheter-related bacteremia.