Catheter-related Bloodstream Infection Rates Research Articles

Home Parenteral Nutrition in Patients with Advanced Cancer: Quality Outcomes from a Centralized Model of Care Delivery.

Lack of expertise in home parenteral nutrition (HPN) management has been reported as a barrier to its initiation in patients with advanced cancer (AC), and there are limited data describing hospital readmissions and HPN-related complications. We aimed to assess a centralized approach for managing HPN in AC and evaluate associated outcomes, including hospital readmissions and HPN-related complications. This was a cohort study of adults with AC requiring palliative HPN between 2010–2018 at a tertiary intestinal failure (IF) center, primarily utilizing a centralized model of HPN oversight to discharge patients remotely from an oncology center to their homes over a wide geographic area. A total of 126 patients were included, with a median distance between the patient’s home and the IF center of 17.5 km (IQR 10.9–39.1; maximum 317.4 km). A total of 28 (22%) patients experienced at least one HPN-related complication, the most common being a central venous catheter (CVC) occlusion and electrolyte abnormalities. The catheter-related bloodstream infection (CRBSI) rate was 0.49/1000 catheter days. The CVC type, administration of concomitant chemotherapy via a distinct CVC lumen separate from PN, venting gastrostomy and distance between the patient’s home and the IF center were not associated with CRBSI or mechanical CVC complications. A total of 82 (65.1%) patients were readmitted while on HPN, but only 7 (8.5%) of these readmissions were HPN-related. A total of 44 (34.9%) patients died at home, 41 (32.5%) at a hospice and 41 (32.5%) in a hospital. In conclusion, this study demonstrates that a centralized approach to IF care can provide HPN to patients over a large geographical area while maintaining low HPN-related complications that are comparable to patients requiring HPN for benign conditions and low hospital readmission rates.

Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients?

BackgroundIn children in the ICU, catheter-related bloodstream infections (CRBSI) have also been linked to mortality, morbidity, and healthcare costs. Although CRBSI poses many potential risks, including the need to avoid femoral access, there is debate regarding whether jugular access is preferable to femoral access in adults. Study reports support both perspectives. There is no consensus in meta-analyses. Children have yet to be examined in depth. Based on compliance with the central line bundle check lists, we aim to determine CRBSI risk in pediatric intensive care units for patients with non-tunneled femoral and internal jugular venous access.MethodsA retrospective cohort study was conducted on patients with central venous catheters in the pediatric ICU of King Abdulaziz University Hospital between January 1st, 2017 and January 30th, 2018. For the post-match balance, we use a standardized mean difference of less than 0.1 after inverse probability treatment weighting for all baseline covariates, and then we draw causal conclusions. As a final step, the Rosenbaum sensitivity test was applied to see if any bias influenced the results.ResultsWe recorded 145 central lines and 1463 central line days with 49 femoral accesses (33.79%) and 96 internal jugular accesses (66.21%). CRBSI per 1000 central line days are 4.10, along with standardized infections of 3.16. CRBSI risk differed between non-tunneled femoral vein access and internal jugular vein access by 0.074 (− 0.021, 0.167), P-value 0.06, and relative risk was 4.67 (0.87–25.05). Using our model, the actual probability was 4.14% (0.01–0.074) and the counterfactual probability was 2.79% (− 0.006, 0.062). An unobserved confounding factor was not identified in the sensitivity analysis.ConclusionsSo long as the central line bundle is maintained, a femoral line does not increase the risk of CRBSI. Causation can be determined through propensity score weighting, as this is a trustworthy method of estimating causality. There is no better way to gain further insight in this regard than through the use of randomized, double-blinded, multicenter studies.

Evidence-based standardized nutrition protocol can shorten the time to full enteral feeding in very preterm/very low birth weight infants

To investigate whether evidence-based standardized nutrition protocol can facilitate the establishment of full enteral nutrition and its effect on short-term clinical outcomes in very preterm/very low birth weight infants. A retrospective analysis was performed on the medical data of 312 preterm infants with a gestational age of ≤32 weeks or a birth weight of <1 500 g. The standardized nutrition protocol for preterm infants was implemented in May 2020; 160 infants who were treated from May 1, 2019 to April 30, 2020 were enrolled as the control group, and 152 infants who were treated from June 1, 2020 to May 31, 2021 were enrolled as the test group. The two groups were compared in terms of the time to full enteral feeding, the time to the start of enteral feeding, duration of parenteral nutrition, the time to recovery to birth weight, the duration of central venous catheterization, and the incidence rates of common complications in preterm infants. Compared with the control group, the test group had significantly shorter time to full enteral feeding, time to the start of enteral feeding, duration of parenteral nutrition, and duration of central venous catheterization and a significantly lower incidence rate of catheter-related bloodstream infection (P<0.05). There were no significant differences between the two groups in the mortality rate and the incidence rate of common complications in preterm infants including grade II-III necrotizing enterocolitis (P>0.05). Implementation of the standardized nutrition protocol can facilitate the establishment of full enteral feeding, shorten the duration of parenteral nutrition, and reduce catheter-related bloodstream infection in very preterm/very low birth weight infants, without increasing the risk of necrotizing enterocolitis.

HPN Standard of Care and Long-Term Outcomes of CIF Pediatric Patients: Twenty-Eight Years' Experience in a Reference Center.

Background and AimsChronic intestinal failure (CIF) therapy changed significantly in recent decades, and both survival and complication rates improved over time. International guidelines claim that early referral of long-term home parenteral nutrition (HPN) patients to an expert center with specific standards of care may positively affect long-term outcomes. Herein, we retrospectively analyse the long-term outcomes of a cohort of pediatric patients with CIF followed-up since our Pediatric Intestinal Failure Unit foundation, in 1989.MethodsData of the 120 children followed up at Pediatric Intestinal Failure Unit during the last 28 years were retrospectively collected. Patients' and HPN characteristics, as well as dependence, survival, and complication rates, were described.ResultsIncidence and prevalence of CIF increased during the study period particularly due to the increase of HPN for non-digestive disease (NDD) CIF (47.5% of the study sample). Catheter-related bloodstream infection (CRBSI) rate decreased over the study period: 0.33 episodes/1,000 catheters days before 2011 and 0.19 episodes/1,000 catheters days afterwards. Only 1 patient out of 12 died because of HPN complications. The survival rate of patients with PDD was 98.4% at 1 year from the beginning of HPN, 96.5% at 2 years, and 93.8% from the fifth year onwards. Concerning the dependence rate, 70.6% of patients were still on HPN 1 year after the start of HPN, 63.7% at 2 years, 52.4% at 5 years, and 40.8% from the 9th year onwards, with no significant difference according to the underlying intestinal pathology. The survival rate of NDD patients was 91.2% at 1 year from the beginning of HPN, 87.4% at 2 years, and 81.9% from the third year onwards. For what concerns the enteral autonomy, it was regained by 56.7% 1 year after the start of HPN, 74.5% at 2 years, and 95.0% in the 5th year.ConclusionsOur data confirmed the importance of appropriate standards of care and suggest that applying a specific set of standards and protocols may further improve patients' outcomes and survival. Indeed, both primary and non-digestive diseases HPN showed good outcomes.

Sodium Bicarbonate Locks May Be a Safe and Effective Alternative in Pediatric Intestinal Failure: A Pilot Study.

This was a retrospective study that compared outcomes in pediatric intestinal failure (IF) patients that were switched from ethanol lock therapy (ELT) to sodium bicarbonate lock therapy (SBLT). The primary outcome was rate of catheter-related blood stream infections (CRBSI). The secondary outcomes were number of hospitalizations, emergency room (ER) visits, central venous catheter (CVC)-related complications. In 4 patients, median rates of CRBSI were 2.77 (interquartile range [IQR] 0.6-5.6) on ELT versus 0 on SBLT per 1000 catheter days ( P = 0.17). The median rates of hospitalizations and ER visits for CVC-related complications were 6.1 (IQR 3.2-10.2) on ELT versus 0 on SBLT (IQR 0-0; P = 0.11) and 2.8 (IQR 2-3.6) on ELT versus 1.8 (IQR 0-3.7) on SBLT per 1000 catheter days ( P = 0.50), respectively. Rates of CVC-related complications were similar. No adverse events were reported. SBLT may be safe and effective for pediatric IF.

Outcomes of the First 54 Pediatric Patients on Long-Term Home Parenteral Nutrition from a Single Brazilian Center.

Objectives:Data on multidisciplinary programs dedicated to home parenteral nutrition (HPN) in Latin America are limited. This study describes the results of the first multidisciplinary pediatric intestinal rehabilitation program for HPN at a public tertiary hospital in Brazil.Methods:We retrospectively reviewed patients aged 0–18 years with intestinal failure (IF) who required parenteral nutrition (PN) for >60 days between January/2014 and December/2020.Results:Fifty-four patients were discharged on HPN (15 achieved enteral autonomy, 34 continued on HPN at the end of the study, 1 underwent intestinal transplantation, and 4 died). The median (IQR) age at the study endpoint of patients who achieved enteral autonomy was 14.1 (9.7–19) versus 34.7 (20.4–53.9) months in those who did not achieve enteral autonomy. Overall prevalence of catheter-related thrombosis was 66.7% and catheter-related bloodstream infection rate was 0.39/1000 catheter-days. Intestinal failure-associated liver disease (IFALD) was present in 24% of all patients; none of the patients who achieved enteral autonomy had IFALD. All patients showed significant improvement in anthropometric parameters during the HPN period. The sociodemographic characteristics of the patients’ family members were mothers less than 20 years old (7.5%), schooling time more than 10 years (55.5%), and household income between 1 and 3 times the minimum wage (64.8%). The 5-year survival rate for HPN is 90%, and 27.7% of patients achieve enteral autonomy.Conclusion:The treatment of pediatric patients with IF followed by a multidisciplinary pediatric intestinal rehabilitation program with HPN is feasible and safe in the Brazilian public health system.

The effectiveness of a dedicated central venous access care team to prevent catheter-related bloodstream infections

Background: Catheter-related bloodstream infection (CRBSI) rates remain high despite the use of an insertion bundle. We hypothesized that line care and maintenance by a dedicated team would help decrease CRBSI rates. This study was conducted in The Medical City (TMC), is a 526-bed, private, tertiary-care center in Pasig City, Philippines. Methods: All adult hospitalized patients from October 1, 2020, to October 31, 2021, with a newly inserted temporary central venous catheter (CVC) were eligible for inclusion. CRBSI rates before the intervention (October 2019 to March 2020) and after the intervention (April to October 2021) were compared. The intervention arm consisted of a dedicated central venous access team (CVAT) who provided education and performed daily line care and dressing changes per protocol. A series of χ2 and Wilcoxon rank-sum tests were performed to compare characteristics between exposure groups. Incidence rates of CRBSI before and after the intervention were compared using an incidence rate ratio approach. Results: In total, 209 CVCs were enrolled in the study, with 103 CVCs (49.28%) in the preintervention arm and 106 CVCs (50.72%) in the postintervention arm. Baseline patient characteristics were similar. CRBSIs were more frequent in the preintervention arm than the postintervention arm (39 of 103 vs 28 of 106; P = .08). The CRBSI incidence density rate was higher in the preintervention arm than the postintervention arm, but the difference was not statistically significant (37.46 per 1,000 patient days vs 25.97 per 1,000 patient days; P = .14). Median time to CRBSI was similar in both groups (9 vs 8 days). Conclusions: Baseline CRBSI rates were high and risk of infection increased by day 8 after line insertion. We detected a decreasing trend in rates of CRBSI with a dedicated CVAT, but multiple interventions are likely needed to influence overall rates.Funding: NoneDisclosures: None

MO788: Ethanol Lock Solution for Prophylaxis of CRBSI of Non-Tunnelled Catheters in Haemodialysis Patients

Abstract BACKGROUND AND AIMS Prevention of catheter related blood stream infection (CRBSI) is a major challenge in hemodialysis (HD) patients. Efficacy of 70% ethanol as a catheter lock solution for the treatment of tunnelled cuff catheter's (TCC's) CRBSI is widely studied [1, 2]. Prophylactic use of ethanol lock was limited to small number of studies especially involving paediatric and home parenteral nutrition (HPN) patients [3] and studies in chronic HD patients with TCCs [4, 5]. But its role in prophylaxis of CRBSI for non-tunnelled catheter (NTC's) is less explored. METHOD We conducted a single centre prospective study from May 2019 to May 2020. A total of 62 patients of end-stage renal disease (ESRD) requiring NTC's for the initiation of HD in emergency or maintenance of HD while waiting for the creation or maturation of an already created arteriovenous fistula (AVF) or for TCC insertion were included. The study population was divided into two groups, Group A (n = 31) received 70% ethanol with heparin 2000 IU as a catheter lock solution. Group B (n = 31) received standard heparin 2000 IU as a catheter lock. RESULTS The primary endpoint of the study was the rate of CRBSI, in group A 6.5% (n = 2) it was significantly lower compared with group B 25.8% (n = 8), (P = 0.038) and when the CRBSI rate/1000 days was calculated, for group A it was 2.2/1000 catheter days and for group B it was 9.6/1000 catheter days (P = 0.04). The mean duration of catheter survival was not significantly different for group A (29.97 ± 6.7) days and group B (26.42 ± 8.04) days. CONCLUSION 70% ethanol lock along with heparin may be safe and effective as a catheter lock for prophylaxis of CRBSI.

Reduction in hemodialysis catheter-related bloodstream infections after implementation of a novel care program.

Catheter-related bloodstream infection (CRBSI) due to dialysis is the major factor causing morbidity and mortality factor for patients undergoing hemodialysis and is associated with additional costs for these patients. This study investigated the effect of a novel care program in terms of reducing CRBSIs for hemodialysis patients with nontunneled (temporary) catheters inserted in their femoral veins. This study included dialysis patients (inpatients and outpatients) from July 2018 to September 2019, covering two periods, pre-intervention (baseline period) and intervention with a novel care program (novel care period). The novel care program was initiated on December 1, 2018. The CRBSI rates (/1000 catheter-days) for the baseline and novel care periods were compared, and the characteristics of the pathogens were determined. Of a total of 72 patients, 33 were from the baseline period and 39 were from the novel care period. Patients in the baseline and novel care periods had the catheter inserted in their femoral veins for a median of 20 and 29 days, respectively. The CRBSI rate decreased by 82.63%, from 8.52/1000 catheter-days in the baseline period to 1.48/1000 catheter-days in the novel care period (p=0.036). The most common organisms involved in CRBSIs were coagulase-negative staphylococcus and Burkholderia cepacia (26% for both). The novel care program reduced the incidence of CRBSIs in patients with temporary catheters inserted in their femoral veins.

Comparison of Efficacy of 2% Chlorhexidine Gluconate-Alcohol and 10% Povidone-Iodine-Alcohol against Catheter-Related Bloodstream Infections and Bacterial Colonization at Central Venous Catheter Insertion Sites: A Prospective, Single-Center, Open-Label, Crossover Study.

An effective antiseptic agent is an essential component of a central venous catheter (CVC) care bundle, to protect against catheter-related bloodstream infections (CRBSIs). We conducted a trial to compare the incidences of CRBSI and the growth of insertion site flora in patients with CVC using 2% chlorhexidine gluconate–alcohol (CHG) or 10% povidone-iodine–alcohol (PVI) in the CVC care bundle. Patients who were admitted to two medical intensive care units (ICUs) and had CVC placement for >48 h were enrolled. Using a two-way crossover design with two six-month interventions, the ICUs were assigned to use either CHG or PVI in their care bundles. A total of 446 catheters in 390 subjects were enrolled in the study. The detection rate of flora was greater in the PVI group on both day 7 (26.6% versus 6.3%, p < 0.001) and day 14 (43.2% versus 15.8%, p < 0.001). The incidence rate of CRBSI was higher in the PVI group compared to the CHG group (2.15 vs. 0 events per 1000-catheter-days, p = 0.001), although the significance was lost in the multivariate analysis. In conclusion, 2% CHG was superior to 10% PVI in the CVC care bundle in terms of the inhibition of skin flora growth at CVC insertion sites and was potentially associated with lower incidence rates of CRBSI.

Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections: REDUCCTION stepped wedge, cluster randomised trial

ObjectiveTo identify whether multifaceted interventions, or care bundles, reduce catheter related bloodstream infections (CRBSIs) from central venous catheters used for haemodialysis.DesignStepped wedge, cluster randomised design.Setting37 renal services across Australia.ParticipantsAll adults...

Meta-analysis of the efficacy of taurolidine in reducing catheter-related bloodstream infections for patients receiving parenteral nutrition.

BackgroundParenteral nutrition administered via central venous catheter is an established treatment option for people with intestinal failure. A serious complication of central venous catheters is the high risk of catheter‐related bloodstream infections (CRBSIs). Catheter‐locking solutions are one strategy for CRBSI prevention, with the solution taurolidine showing beneficial effects. The aim of this meta‐analysis was to identify and synthesize evidence to assess taurolidine efficacy against comparators for the prevention of CRBSI for people with intestinal failure receiving parenteral nutrition.MethodsSix health literature databases were searched for efficacy data of rate of CRBSI for taurolidine vs control among our study population; no study design limits were applied. Individual study data were presented for the number of CRBSIs and catheter days, and rate ratio. Overall data were synthesized as a pooled risk ratio, with subgroup analyses by study design, control type, and taurolidine solution.ResultsThirty‐four studies were included in the final analysis. At the individual level, all studies showed superior efficacy of taurolidine vs control for prevention of CRBSIs. When the data were synthesized, the pooled risk ratio was 0.49 (95% CI, 0.46–0.53; P ≤ 0.0001), indicating a 51% decreased risk of CRBSI through the use of taurolidine. Subgroup analysis showed no difference depending on study design (P = 0.23) or control type (P = 0.37) and a significant difference for taurolidine type (P = 0.0005).ConclusionTaurolidine showed superior efficacy over controls regardless of study design or comparator group. The results show that taurolidine provides effective CRBSI reduction for people with intestinal failure receiving parenteral nutrition.

Infections and colonisation of central venous catheters in patients admitted to intensive care units at two tertiary care hospitals

Introduction: Central venous catheters (CVC) are frequently used in modern health care systems. However, CVCs are likely to get colonised with microorganisms, resulting in catheter-related blood stream infections (CRBSI). This study investigated microorganisms causing CRBSI and CVC colonisation, their antibiotic resistance, and factors associated with CRBSI in patients in the intensive care units (ICU) at the Colombo North Teaching Hospital (CNTH) and Apeksha hospital, Sri Lanka. Methods: The study included 300 adult patients in ICUs with a CVC in-situ for &gt;48 hours. Blood taken through the CVC, peripheral blood and CVC tips were cultured. Microorganisms were identified and tested for antibiotic susceptibility. Demographic factors were recorded. Results: Seventeen patients (13.1%) developed CRBSI. The CRBSI rate was 13.3 per 1,000 catheter days in CNTH while it was 10 (5.9%) cases and 5.2 per 1,000 catheter days in Apeksha hospital. In CNTH, CVC colonisation was detected in 35 (26.9%). Coagulase negative staphylococci (CoNS) were the leading cause of both CRBSI (41%) and colonisation (58%). In Apeksha hospital, Klebsiella sp. (5/10) were the predominant pathogens that caused CRBSI. Eighty-nine CVCs (52.3%) were colonised by CoNS (58%). In CNTH, CRBSI was detected more in males (14/17) (p&lt;0.05). The majority of microorganisms that caused CRBSI and CVC colonisation in both hospitals showed resistance to commonly used antibiotics. Conclusion: The CRBSI rates and the incidences were higher in CNTH. CoNS was the most common cause of CRBSI in CNTH and Gram negative bacteria in Apeksha hospital. CVC colonisation with CoNS was common in both hospitals. Antibiotic resistance was high among bacteria causing CRBSI and colonisation.

Mechanical Complications in Central Lines Using Taurolidine Versus Ethanol Lock Therapy in Children With Intestinal Failure.

Ethanol lock therapy (ELT) is effective in reducing rates of catheter-related-bloodstream infections (CRBSI) in the pediatric intestinal failure (IF) population; however, ELT may increase the risk of line occlusion and breakage, significantly impacting preservation of vascular access. During a period of ethanol shortage, Health Canada temporarily approved the use of taurolidine lock therapy (TLT) in pediatric iF patients previously utilizing ELT. This provided a unique opportunity to directly compare rates of central venous catheter (CVC) complications, including CRBSi, breaks, occlusions, repairs and replacements in patients who utilized both ELT and TLT. A retrospective study of pediatric IF patients managed by three Western Canadian intestinal rehabilitation programs was performed. Event rates in patients who used both ELT and TLT during the study period were compared using Poisson regression analysis. In 13 patients with 10,187 catheter days (CDs), TLT (vs ELT) had lower rates of CVC breaks (1.11 vs 5.19/1000 CDs, P < 0.001), occlusions (0.83 vs 4.06/1000 CDs, P = 0.01) and repairs (1.94 vs 5.64/1000 CDs, P = 0.01). There was no difference in CRBSI rates (0.83 vs 2.03/1000 CDs, P = 0.25) or rates of CVC replacements due to mechanical events (0.28 vs 1.81/1000 CDs, P = 0.08). Although there was no difference in CRBSI rates, TLT was associated with lower rates of mechanical complications compared to ELT in this study. Taurolidine may be a suitable alternative to ethanol in preventing CRBSI and may be associated with improved preservation of central lines in children with IF.

Use of Ethanol Lock for Primary Prevention of Catheter Related Blood Stream Infection in Pediatric Surgical Patients

Background: Catheter related blood stream infection (CRBSI) is one of the most serious complications of the central venous catheterization and can lead to severe sepsis, catheter loss, and death. The ethanol lock (EL) is now widely used as a second line therapy and secondary prevention of CRBSI especially in patients with intestinal failure. Objective: The present study’s objective was to evaluate the effectiveness of EL as the primary prevention of CRBSI in pediatric surgical patients. Materials and Methods: The present study was an experimental study that used EL in all pediatric surgical patients with central venous catheter (CVC) hospitalized between February 2020 and January 2021.The EL was done by indwelling the CVC with 70% ethanol for at least four hours per day, then the ethanol was aspirated from the catheter before routine using of the catheter. Data collection included demographics, catheter days, complication of CVC, and EL were collected. Statistical analysis was done using SPSS statistics program. Results: All 13 patients enrolled in the present study had intestinal failure or other gastrointestinal conditions that required a long-term CVC. The results showed no CRBSI in all patients. After using the EL for 1,930 catheter days, the incidence rate of CRBSI was 0 per 1,000 catheter days. The EL group was 1.29 times more likely not to develop CRBSI (RR 1.29, 95% CI 1.10 to 1.52). The authors’ CRBSI rates have declined from 3.84 per 1,000 catheter days in 2019 to 0 per 1,000 catheter days after using EL. One patient had central line removal due to mechanical breakage of the line while returning home. Conclusion: EL prevents CRBSI effectively in pediatric surgical patients especially in tunneled catheter usage. Keywords: Ethanol lock; Catheter related blood stream infection; Central venous catheter

Risk factors for peripherally inserted central catheterization-associated bloodstream infection in neonates.

To study the features of catheter-related bloodstream infection (CRBSI) or central line-associated bloodstream infection (CLABSI) after peripherally inserted central catheterization (PICC) in neonates admitted to the neonatal intensive care unit (NICU) and the risk factors for CRBSI or CLABSI. A retrospective analysis was performed on the medical data of the neonates who were treated and required PICC in the NICU of the Children's Hospital, Zhejiang University School of Medicine from June 1, 2018 to May 1, 2020. The catheterization-related data were collected, including placement time, insertion site, removal time, and antimicrobial lock of PICC. The multivariate logistic regression model was used to investigate the risk factors for CRBSI or CLABSI in the neonates. A total of 446 neonates were enrolled, with a mean gestational age of (30.8±4.0) weeks, a mean birth weight of (1 580±810) g, a median age of 9 days, and a median duration of PICC of 18 days. The incidence rates of CLABSI and CRBSI were 5.6 and 1.46 per 1 000 catheter days, respectively. Common pathogens for CLABSI caused by PICC included Staphylococcus epidermidis (n=19) and Klebsiella pneumoniae (n=11), and those for CRBSI caused by PICC included Klebsiella pneumoniae (n=6). The risk of CLABSI caused by PICC increased significantly with prolonged durations of PICC and antibiotic use, and the PICC-related infection probability at head and neck was significantly lower than that in the upper and low limbs (P<0.05), while the above conditions were more obvious in neonates with a birth weight of <1 500 g. The risk of CRBSI caused by PICC decreased with the increase in gestational age (P<0.05). CRBSI and CLABSI remain serious issues in NICU nosocomial infection. The identification of the risk factors for CRBSI and CLABSI provides a basis for improving the quality of clinical care and management.

Hemodialysis Catheter-Related Infections: Incidence in Temporary Catheters locked with Vancomycin and Heparin vs. Heparin-only

Background: The increasing incidence of end stage renal disease (ESRD) patients initiating hemodialysis (HD) through a temporary HD catheter has caused the rise in catheter related infections and associated morbidity and mortality. An antibiotic lock solution (ALS) for the prevention of catheter-related bacteraemia is a promising strategy. The present randomized control study has evaluated the efficacy and safety of vancomycin as an ALS in 54 patients who required temporary double lumen catheters for HD.&#x0D; Methods: The patients were randomized to receive either (A) an ALS (vancomycin 5 mg/ml + heparin 5000 IU/ml) – group A; or (B) unfractionated heparin (5000 IU/ml) alone as a catheter lock control – group B. The study duration was of three months and was conducted at the Department of Nephrology, PIMS, Islamabad.&#x0D; Results: The primary endpoint of the study was catheter related blood stream infection (CRBSI). The vancomycin group (A) had one episode of infection (CRBSI rate = 1.23/1000 days) compared with six episodes in the heparin-locked control group (B) (CRBSI rate = 8.55/1000 days). Mean catheter survival was significantly (p&lt;0.05) more in group A (30.48 ± 5.7days) compared to group B (26 ± 6.5 days). No thrombotic episodes or side effects were recorded.&#x0D; Conclusion: Vancomycin appeared to be a safe and effective ALS, preventing CRBSI and increasing survival of catheter in HD patients.

Postoperative Rather Than Preoperative Neutropenia Is Associated With Early Catheter-related Bloodstream Infections in Newly Diagnosed Pediatric Cancer Patients.

The relationship of early catheter-related bloodstream infections (CRBSIs) with perioperative neutropenia and antibiotic prophylaxis is not well established. We sought to evaluate perioperative factors associated with early CRBSIs in newly diagnosed pediatric cancer patients, particularly hematologic indices and antibiotic use. We retrospectively reviewed national registry records of newly diagnosed pediatric cancer patients with port-a-caths inserted using standardized perioperative protocols where only antibiotic use was not regulated. Thirty-day postoperative CRBSI incidence was correlated with preoperative factors using logistic regression and with postoperative blood counts using linear trend analysis. Among 243 patients, 17 CRBSIs (7.0%) occurred at median 14 (range, 8-28) postoperative days. Early CRBSIs were significantly associated with cancer type [acute myeloid leukemia and other leukemias (AML/OLs) vs. solid tumors and lymphomas (STLs): odds ratio (OR), 5.09; P = 0.0036; acute lymphoblastic leukemia vs. STL: OR 0.83; P = 0.0446] but not preoperative antibiotics, absolute neutrophil counts and white blood cell counts. Thirty-day postoperative absolute neutrophil counts and white blood cell trends differed significantly between patients with acute lymphoblastic leukemia and STLs (OR 0.83, P < 0.05) and between AML/OLs and STLs (OR 5.09, P < 0.005), with AML/OL patients having the most protracted neutropenia during this period. Contrary to common belief, low preoperative absolute neutrophil counts and lack of preoperative antibiotics were not associated with higher early CRBSI rates. Instead, AML/OL patients, particularly those with prolonged neutropenia during the first 30 postoperative days, were at increased risk. Our findings do not support the use of empirical preoperative antibiotics and instead identify prolonged postoperative neutropenia as a major contributing factor for early CRBSI.

The use of parenteral nutrition is not associated with an increased incidence of catheter-related bloodstream infection (CRBSI) in hospital setting

Rationale: Catheter-related bloodstream infection (CRBSI) is a complication of great impact in patients using Parenteral Nutritional (PN). Historically, PN is considered a risk factor that increases CRBSI rates. However, strict adherence to systematic protocols established by the Nutritional Support Team (NST) can contribute to controlling infections. Therefore, our objective is to evaluate the CRBSI incidence in PN and non-PN patients in a high complexity hospital in Brazil simultaneously, and compare both results.

Microbial Repercussion on Hemodialysis Catheter-Related Bloodstream Infection Outcome: A 2-Year Retrospective Study.

BackgroundAlbeit growing technical advances in the design of hemodialysis catheters, intravascular catheter-related bloodstream infection (CRBSI) still represents an utmost clinical challenge to the health-care workers (HCWs). Data regarding the influence of the culprit organism on the scenario of CRBSI in the literature are extremely lacking. Thereby, this research was carried out.MethodsWe undertook a retrospective cohort study over an interval of 2 years, involving patients who underwent regular hemodialysis via catheters in the Renal Dialysis Unit (RDU) of Dr. Soliman Fakeeh Hospital (DSFH), Jeddah, Kingdom of Saudi Arabia (KSA). The study enrolled 139 patients (56.8% females and 43.2% males), with mean age of 60.79 ± 11.45 years.ResultsThe aggregate rate of CRBSI was 5.1/1000 catheter days. Amongst the 139 study candidates confirmed of having CRBSI, while 69.8% of CRBSIs were ascribed to Gram-positive cocci, about one-third of the infectious episodes were secondary to Gram-negative bacilli. Interestingly, fever was the most common presentation of S. aureus CRBSI compared to CoNS and Gram-negative bacilli CRBSIs (20.9% versus 12.9% versus 6.5%, p= 0.0001), whereas CRBSIs due to CoNS were presented mainly with rigors (19.4%). Of note, CRBSIs caused by Gram-negative bacilli had a tendency to manifest with unusual symptoms such as vomiting or hypotension. Besides, they were more prone to involve hospitalization or ICU admission. In this study, no mortality was attributed to CRBSIs.ConclusionOur study disclosed that the illicit organism has a repercussion on the clinical presentation as well as the fate of CRBSI among hemodialysis patients. This highlights the worth of identifying the infected cases in a periodic manner, to avoid the occurrence of devastating complications. A large body of work from various hemodialysis centers should take place in the near future so as to provide more insight in this perspective.