Catheter-related Infections In Patients Research Articles

Australasian Malignant PLeural Effusion (AMPLE)-4 trial: study protocol for a multi-centre randomised trial of topical antibiotics prophylaxis for infections of indwelling pleural catheters

BackgroundMalignant pleural effusion (MPE) is a debilitating condition as it commonly causes disabling breathlessness and impairs quality of life (QoL). Indwelling pleural catheter (IPC) offers an effective alternative for the management of MPE. However, IPC-related infections remain a significant concern and there are currently no long-term strategies for their prevention. The Australasian Malignant PLeural Effusion (AMPLE)-4 trial is a multicentre randomised trial that evaluates the use of topical mupirocin prophylaxis (vs no mupirocin) to reduce catheter-related infections in patients with MPE treated with an IPC.MethodsA pragmatic, multi-centre, open-labelled, randomised trial. Eligible patients with MPE and an IPC will be randomised 1:1 to either regular topical mupirocin prophylaxis or no mupirocin (standard care). For the interventional arm, topical mupirocin will be applied around the IPC exit-site after each drainage, at least twice weekly. Weekly follow-up via phone calls or in person will be conducted for up to 6 months. The primary outcome is the percentage of patients who develop an IPC-related (pleural, skin, or tract) infection between the time of catheter insertion and end of follow-up period. Secondary outcomes include analyses of infection (types and episodes), hospitalisation days, health economics, adverse events, and survival. Subject to interim analyses, the trial will recruit up to 418 participants.DiscussionResults from this trial will determine the efficacy of mupirocin prophylaxis in patients who require IPC for MPE. It will provide data on infection rates, microbiology, and potentially infection pathways associated with IPC-related infections.Ethics and disseminationSir Charles Gairdner and Osborne Park Health Care Group Human Research Ethics Committee has approved the study (RGS0000005920). Results will be published in peer-reviewed journals and presented at scientific conferences.Trial registrationAustralia New Zealand Clinical Trial Registry ACTRN12623000253606. Registered on 9 March 2023.

Effects of Vancomycin Subtherapeutic Concentration on Staphylococcus aureus Isolated from Hemodialysis Patients with Low Serum Trough Concentrations.

Blood bactericidal activity and antimicrobial therapy are crucial against catheter-related infection in patients undergoing hemodialysis (HD). It is well-known that catheters colonized by biofilm-producing bacteria are a risk factor for bacteremia in HD-patients. Methicillin-resistant S. aureus bacteremia in HD-patients justify the use of vancomycin as empiric therapy. The recommended vancomycin target for therapeutic efficacy is a minimum serum concentration of 10µgmL-1 to avoid resistance. However, subtherapeutic concentrations of vancomycin have frequently occurred in HD-patients. Thus, we aim to investigate the effect of subtherapeutic vancomycin concentration on S. aureus growth, susceptibility to antimicrobials, resistance to whole blood activity, and biofilm formation. Seventeen S. aureus strains isolated from bacteremia in HD-patients and two reference strains were exposed to a vancomycin-gradient (0-10µgmL-1) for five consecutive days to mimic the dosing interval of vancomycin in HD-patients. After that, we observed the following: no effect on growth curve; decreased susceptibility to vancomycin and daptomycin; increased S. aureus survival to whole blood bactericidal action; and a strain-dependent biofilm production after drug exposure. In conclusion, our findings suggest that the subtherapeutic concentration of vancomycin decrease S. aureus susceptibility to vancomycin and daptomycin and increases its survival to whole blood bactericidal action.

Percutaneous nephrostomy catheter-related infections in patients with gynaecological cancers: a multidisciplinary algorithmic approach

Percutaneous nephrostomy catheters (PCNs) are commonly utilized in patients with gynaecological cancers due to intrinsic or extrinsic urinary obstruction. Unfortunately, these foreign medical devices may be associated with several infectious complications, including: pyelonephritis, renal abscess, and bacteraemia, which may lead to further delay of life-saving cancer therapy. To evaluate the performance of our multidisciplinary algorithm for diagnosis and treatment of PCN-related infections (PCNIs) and identify risk factors for recurrent urinary device-related infections. Patients with gynaecological cancers having PCNIs were prospectively evaluated at our institution from July 2019 to September 2021. All patients were managed by our standardized algorithm and followed-up until reinfection or routine PCN exchange. Of 100 consecutive patients with PCNIs, 74 had adequate follow-up, and were analysed in three groups according to clinical outcome: reinfection with the same organism (26%), reinfection with a different organism (23%), and no reinfection (51%). Their median age was 54 years, and the most common cancers were cervical (65%), and ovarian (19%) with 53% being metastatic. The most frequently recovered micro-organisms were Pseudomonas (32%), Enterococcus (27%), and Escherichia (24%) species. The main risk factors for recurrent PCNI with the same organism were pelvic radiation therapy (P=0.032), pelvic fistulas (P=0.014), and a PCNI with the same pathogen within the previous year (P = 0.012). Our algorithm has allowed for accurate diagnosis, staging, and treatment of and identification of several key risk factors for recurrent PCNIs. These results may lead to further preventive measures for these infections.

Surface properties and bacterial adhesion on polyurethane central catheters: Impact of ethanol lock solution

It was shown in the literature that ethanol locks have a positive effect on preventing catheter-related infections in patients with central venous catheters without causing any microbial resistance. However, ethanol is known to interact with polyurethanes. The consequences of this interaction on the catheter surface properties were studied as it can impact the biocompatibility of the material and the adhesion phenomena onto the surface. No physical and chemical degradation was put into evidence, but low molecular weight compounds such as additives were extracted from the catheter bulk or migrated and exudated onto its surface. Nevertheless, as far as bacterial adhesion is concerned, after the catheter was locked and the lock removed, the surface modifications promoted no adhesion.

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

Evaluating risk factors for catheter-related infections in hemodialysis patients

Introduction: Catheter-related infection in the patients with end-stage renal disease (ESRD) is one of the leading causes of death. Identifying risk factors for infection, including patients’ iron profile, plays an important role in preventing this complication. Objectives: In this study, we aimed to determine the risk factors of catheter-related infections among the ESRD patients in Qazvin, Iran. Patients and Methods: In this observational study, 41 patients with hemodialysis venous catheter-related infection (case group) and 42 patients without catheter-related infection ( control group) in Qazvin educational and medical centers were studied. The definition of functional iron deficiency anemia included ferritin <500 ng/mL and serum iron/total iron-binding capacity (TIBC) <30%. The laboratory evaluation method was based on enzyme-linked immunosorbent assay method. Definition of catheter-related infection in this study consisted of two positive results of the three cultures from blue and red catheter lines and blood at the same time with the same microorganism. Results: In studying iron parameters, a significant difference between serum iron levels and transferrin saturation in the two groups was detected (P values of 0.0016 and 0.003, respectively). Both parameters were higher in the control group. The most common microorganism causing the infection was Staphylococcus aureus (43.9%) and most of the catheters used were of temporary internal jugular vein types. The most important risk factors in the incidence of catheter infection were diabetes mellitus (OR = 5.059) and high serum iron levels (OR = 1.053). Decreased transferrin saturation levels reduced the risk of infection (OR = 0.825). Conclusion: There was a relationship between iron profile and diabetes mellitus and the increased risk of catheter-related infections. To prevent infection, patients with ESRD undergoing hemodialysis with venous catheters, blood sugar and serum iron levels need to be monitored carefully and iron overdose should be prevented in these patients.

Clinical characteristics of catheter-related infection in patients with chronic renal failure End Stage Renal failure undergoing semi-permanent catheter placement during maintenance hemodialysis through tunnelled cuffed hemodialysis catheter.

Objective:To analysis the relevant infections and risk factors of patients undergoing hemodialysis semi-permanent catheter (tunneled cuffed) placement during for maintenance hemodialysis.Methods:A total of 158 patients with chronic renal failure (CRF) End stage renal failure (ESRF) treated in our hospital from September 2018 to September 2021 were retrospectively analyzed. All the patients underwent semi-permanent catheter placement during maintenance hemodialysis. The occurrence of catheter-related infections in the patients were recorded. The patients with catheter-related infections were included in the infection group, and the others without infection in the non-infection group. The differences in hypertension, gender, diabetes, age, catheter indwelling time and dialysis time between the two groups were analyzed, and the distribution of pathogens in the patients with infections was analyzed.Results:The patients were followed up for 13 to 36 months, with an average of (22.18 ± 6.09) months. Among the 158 patients who underwent going semi-permanent catheter placement, 42 (26.58%) presented semi-permanent catheter-related infections, including four cases of catheter-related bacteremia, 16 cases of tunnel infection and 22 cases of catheter exit-site infection. Among total of 42 strains of pathogens were isolated from the 42 patients with catheter-related infections, including 243 strains of Gram-positive cocci were identified in 24/42(57.14%), and 163 strains of Gram-negative bacilli were identified 16/42(38.10%) and one starin of fungus was identified in 2/42 patients. Statistically significant differences were found in dialysis duration time, hypoalbuminemia, average mean age, diabetes and catheter indwelling time between patients with and without catheter-related infections (P < 0.05). Hypoalbuminemia, catheter indwelling time and diabetes were risk factors for catheter-related infections (P < 0.05).Conclusions:Patients with ESRF CRF are at risk and prone to catheter-related infections during hemodialysis using catheter, mainly tunnel infection and catheter exit-site infection. Gram-positive cocci are the main pathogens. Hypoalbuminemia, too long catheter indwelling time and diabetes are the risk factors for infections.

Risk Factors of Catheter-Related Infection in Patients Undergoing Hemodialysis Using Double Lumen Catheter at Dr. M. Djamil Hospital Padang

Background. Chronic kidney disease (CKD) is a terminal disease requiring hemodialysis. Hemodialysis requires vascular access using a double lumen catheter (DLC). However, the use of DLC may increase complications mainly infection, either infection of exit site or bloodstream. This study is aimed to seek risk factors contributing to the incidence of central catheter-related infections in CKD patients with DLC undergoing HD at Dr. M. Djamil Hospital, Padang.&#x0D; Methods. This study is a prospective study on patients undergoing HD at Dr. M. Djamil Hospital, Padang. This study using consecutive sampling technique. Data were analyzed using SPSS version 25.0.&#x0D; Results. This study involved 40 CKD patients undergoing HD. Majority of the samples had bloodstream infections (67.5%). Clinical manifestations of purulent secretion, duration of catheter used, and hypoalbuminemia had significant differences in the incidence of DLC infection based on bloodstream infection and exit site infection (p&lt;0.05). The most common bacterial found was Pseudomonas aeruginosa (22.5%) which was sensitive to ceftazidime, cefepime, meropenem, amikacin, gentamicin, ciprofloxacin.&#x0D; Conclusion. Factors contributing to the incidence of DLC-related infections at Dr. M. Djamil Hospital are duration of catheter use and hypoalbuminemia. Pseudomonas aeruginosa is the most common cause of DLC-related infections.

Eradication of Staphylococcus aureus colonization by chronic use of mupirocin in patients on home parenteral nutrition.

Although in other groups Staphylococcus aureus eradication has proven to be an effective infection prevention measure, to our knowledge, no such studies have been performed in patients on home parenteral nutrition (HPN). The aim of this study was to investigate the efficacy of chronic nasal mupirocin use on S. aureus eradication and prevention of catheter related infections in patients on HPN. This was a cohort study with data collected from adult patients on HPN who were screened for S. aureus carriage. In case of carriage, the patient was instructed to apply mupirocin nasal ointment monthly. Outcomes were the percentage of successful S. aureus eradication and the effect on the incidence of catheter-related infections and development of mupirocin resistance. S. aureus nasal carriage was found in 54% of the patients. Eradication was successful in 66% (70 of 106) of patients treated with mupirocin. Overall S. aureus catheter-related infection rates decreased by 50% (P=0.02). The decrease was mostly due to a drop in central line-associated bloodstream infection (CLABSI) rates (0.26versus 0.1 per 1000 central venous catheter days; P=0.04). The overall CLABSI rates decreased as well (incidence ratio rate, 0.43; 95% confidence interval. 0.24-0.76; P < 0.01). Low-level mupirocin resistance was observed in four patients. Findings from the present study highlighted the potential usefulness of mupirocin ointment prophylaxis to establish S. aureus eradication in patients on HPN. However, awareness for the development of mupirocin resistance is prudent. Further research needs to be carried out to validate these findings.

Taurolock versus saline 5% on preventing infection and dysfunction of hemodialysis catheters; a randomized, double blind controlled clinical trial

Introduction: Despite the higher rate of morbidity and mortality, the use of central venous catheters has increased significantly compared to arteriovenous fistula. So far, no ideal organic solution has been identified for the prevention of thrombosis and catheter-related infection in patients undergoing hemodialysis. Objectives: This study aimed to evaluate the efficacy of Taurolock versus saline 5% on the prevention of catheter dysfunction and catheter-related infections. Patients and Methods: Seventy patients with chronic kidney disease, who requiring hemodialysis or those with permanent hemodialysis catheters referring to hemodialysis centers of Ahvaz, were selected and randomly divided into two groups, while 68 patients remained until the end of the study. In the first group, saline 5% was inserted into the lumen of catheter after each hemodialysis, and then catheter was blocked. In the second group, Taurolock solution (TauroLock™ -Hep 500®: Taurolidine; antimicrobial agent), citrate 4% and heparin (UI/mL) were used as antibiotics. Results: No significant difference between the catheter-related infection and positive blood culture in both saline and Taurolock groups was detected (2.94% versus 2.94%; P &gt;0.05). Moreover, the catheter-related dysfunction in the saline 5% group was 5% less than the Taurolock group (2.94% versus 11.76%, P = 0.365). Conclusion: The results showed that saline 5% is at least as effective as a Taurolock solution for prevention of infections and catheter dysfunction. Saline is an effective, inexpensive, safe and readily available in various settings. Therefore, it could be considered as a proper alternative solution for reduction of dialysis-related side effects and costs. Trial Registration: Registration of trial protocol has been approved in Iranian registry of controlled trials (identifier: IRCT20190304042918N1; https://en.irct.ir/trial/38055, ethical code# IR.AJUMS.REC.1397.412).

Ethanol locks for the prevention of catheter-related infection in patients with central venous catheter: A systematic review and meta-analysis of randomized controlled trials.

BackgroundThe widespread use of central venous catheters (CVCs) has exposed patients to a high risk of catheter-related infection (CRI), which is linked to substantial morbidity and mortality. Several strategies for preventing CRI, including ethanol lock prophylaxis, have been explored. This study aimed to provide a comprehensive summary of randomized controlled trials (RCTs) assessing the efficacy and safety of ethanol locks for preventing CRI in patients with CVC.MethodsWe searched six electronic databases, earlier relevant meta-analyses and the reference lists of the included studies for RCTs that assessed the effects of ethanol locks on CRI in patients with CVC versus a control group. Two authors independently assessed the methodological quality of the included studies using the Cochrane Risk of Bias tool and extracted relevant information according to a predesigned extraction form. Data were analyzed using the Cochrane Collaboration’s RevMan 5.3.ResultsNine studies involving 2451 patients were included. Although limited in power, the results of the meta-analysis indicated a positive effect of ethanol lock prophylaxis on reducing catheter-related bloodstream infection (CRBSI) compared to heparin alone [OR = 0.53, 95% CI 0.34, 0.82, P = 0.004]. The effects on other outcomes, such as exit site infection, catheter dysfunction, catheter removal, thrombosis and mortality, were not statistically significant (P > 0.05). Moreover, although the effect of ethanol on CRBSI was in the expected direction compared to 0.9% NaCl locks, this effect was not statistically significant (P > 0.05).ConclusionsThe present data indicate that ethanol lock prophylaxis is a potential candidate for the prevention of CRBSI in patients with CVC. However, more attention should be paid to the uniform ethanol lock procedure and toxic effects after long-term ethanol lock exposure.

Risk factors for catheter-related infections in patients receiving permanent dialysis catheter

BackgroundDue to rising vascular comorbidities of patients undergoing dialysis, the prevalence of permanent hemodialysis catheters as hemodialysis access is increasing. However, infection is a major complication of these catheters. Therefore, identification of potential predicting risk factors leading to early infection related complications is valuable, in particular the significance the CRP (C-reactive protein)-value is of interest.MethodsIn this retrospective study 151 permanent hemodialysis catheters implanted in 130 patients were examined. The following data were collected at the time of catheter implantation: CRP-value, history of catheter-related infection, microbiological status, immunosuppression and diabetes mellitus. The primary outcomes were recorded over the 3 months following the implantation: catheter-related infection, days of hospital stay and death. Catheter removal or revision, rehospitalization and use of antibiotics were identified as secondary outcomes.ResultsWe identified a total of 27 (17.9%) infections (systemic infection: 2.26 episodes/ 1000 catheter days, local infection: 0.6 episodes/ 1000 catheter days). The development of an infection was independent of the CRP-value (p = 0.66) as well as the presence of diabetes mellitus (p = 0.64) or immunosuppression (p = 0.71). Univariate analysis revealed that infection was more frequent in patients with MRSA-carriage (p < 0.001), in case of previous catheter-related infection (p < 0.05) and of bacteremia or bacteriuria in the period of 3 months before catheter implantation (p < 0.001). Catheter removal or revision (p = 0.002), rehospitalization (p = 0.001) and use of antibiotics (p = 0.02) were also more often observed in patients with MRSA-carriage.ConclusionsThe CRP-value at the time of implantation of a permanent hemodialysis catheter is not associated with the development of early catheter related infections, but an individual history of catheter-related infection, MRSA-carriage and bacteremia or bacteriuria in the period of 3 months prior to catheter implantation are significant risk factors.

Increased Incidence of Central Venous Catheter-Related Infection in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intra-Peritoneal Chemotherapy.

Background: Cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC) is a complex surgical intervention with associated risks. Central venous catheter (CVC) line sepsis is one of a number of potential morbidities. The aim of this study was to calculate the incidence of catheter-related infection (CRI) in a CRS and HIPEC patient population and to assess its influence on length of hospital stay. Methods: Data were collected on consecutive patients who underwent CRS HIPEC between August 2013 and October 2017. Data included patient demographics, timing of CVC insertion/removal, time spent in critical care, and CVC tip/blood culture results. Charts were reviewed for patients with both positive CVC culture and positive blood cultures to assess for evidence of catheter related infection and systemic inflammatory response syndrome (SIRS). Results: Data on 100 consecutive CRS HIPEC operations performed between August 2013 and October 2017 was analyzed. There were 11 CRIs in 100 CVCs, resulting in a CRI rate of 16.2 per 1,000 CVC days. Patients within the CRI group had a longer high-dependency unit (HDU) stay compared with the non-septic group (6 days vs. 4.07 days, p < 0.05). The CVC duration for the CRI and non-CRI group was 8.4 and 7.6 days, respectively (p = 0.12). The CRI group also had an increased total hospital length of stay (LOS; 20.8 days vs. 15.4 days, p < 0.05). On average, CRIs occurred eight days post-operative and four days post-HDU discharge. There was no association identified with longer CVC duration (p = 0.34). There has been an annual decline in CRI rates in CRS and HIPEC patients over the duration of the study period from 19.1 per 1,000 CVC days in 2016 to 8.2 per 1,000 CVC days in 2017. Conclusion: This is the first study to report on CRI rates in patients undergoing CRS and HIPEC. The CRI rate of 16.2 per 1,000 CVC days is higher than the overall national figure of 5.2 per 1,000 for CVC lines inserted in the operating room. Patients who developed line sepsis had longer HDU and longer overall hospital stay. Catheter-related infection was noted post-HDU discharge in all cases. Implementation of a CVC care bundle in the later years of the study period coincided with a reduction in CRI rates.

The Effectiveness of Personal Hygiene Practices on Non-Cuffed Central Vein Catheter-Related Infection in Patients Undergoing Hemodialysis: A Randomized Controlled Trial.

Infection of the internal jugular vein (IJV) catheter continues to be a common cause of death in patients with end-stage renal disease undergoing hemodialysis (HD). The present study aimed to evaluate the effectiveness of personal hygiene on the incidence of IJV catheter-related bloodstream infection (CRBSI). A randomized, controlled, parallel, and non-inferiority trial was conducted on patients initiated on maintenance HD via right IJV catheter. Patients were randomly allocated to control and intervention group via computer-generated random table. Intervention package for the intervention group included hand washing (2–4 hourly and whenever visibly dirty), feet washing (12 hourly), and axillary shave (at any point during the study, no hair growth in axilla). Patients were provided with a pamphlet and reinforced to continue package till IJV catheter was in situ. Patients were followed up twice a week for one month from the date of catheter insertion for the incidence of CRBSI. The primary outcome of the study was percentage of patients free from CRBSI. On intention-to-treat analysis, the percentage of patients without CRBSI was 53.7% and 29.3% in the intervention and control arm, respectively [P = 0.04; 25.12% (1.43–45.28%)]. Positive blood cultures were higher in control (73.3%) as compared to the intervention group (28.6%) (P = 0.19). Personal hygiene interventions are an effective method to reduce the incidence of CRBSIs among population undergoing maintenance HD via non-cuffed IJV catheter.

Catheter related infections in patients with acute type ii intestinal failure admitted to a national centre: Incidence and outcomes

Rationale: The long-term maintenance of central venous catheter access is vital in the management of IF, with meticulous catheter care and salvage of infected catheters being of prime importance. There is little, if any, data on the occurrence of CVC-related infection in patients with type 2 IF managed on a dedicated IF unit (IFU) and no data on the salvage outcomes in this setting.

Catheter-related infections in patients with acute type II intestinal failure admitted to a national centre: Incidence and outcomes

The management of intestinal failure (IF) requires safe and sustained delivery of parenteral nutrition (PN). The long-term maintenance of central venous catheter (CVC) access is therefore vital, with meticulous catheter care and salvage of infected CVCs being of prime importance. CVC-related infection and loss of intravenous access are important causes of morbidity and mortality in IF. Avoidance, prompt recognition and appropriate management of CVC-related infections are crucial components of IF care. However, there are few, if any, data on the occurrence of CVC-related infections in patients with acute, type 2, IF managed on a dedicated IF unit and no data on the salvage outcomes of infected CVCs in this group of patients. This is a retrospective observational study conducted between January 2011 and July 2017. All patients with acute, type 2 IF newly admitted to a national U.K. IF unit (IFU) during these dates were included. All patients admitted to the unit with a CVC in place underwent immediate 'screening' paired central and peripheral blood cultures on arrival before the CVC was used for any infusate. A prospectively maintained database was used to record all confirmed catheter-related blood stream infections (BSI)/colonisations, demographic and clinical data. Diagnosis of catheter-related BSI/colonisation was based on quantitative and qualitative analysis of paired central and peripheral blood cultures. A standardized 10-14-day catheter salvage treatment protocol involving antibiotic and urokinase CVC locks and systemic antibiotic administration was used to salvage any infected or colonised CVCs, as appropriate. The CVC was not used for PN until successful salvage had been confirmed by negative blood cultures drawn 48h after antibiotic completion. The development of a subsequent catheter-related BSI was recorded for all patients, both during the remaining in-patient stay on the IFU and after discharge home on PN. Of the 509 patients with type 2 IF admitted to the IFU during the study period, 341 (54% female; mean age 54.6 (range 16-86 years)) had an indwelling CVC that had been placed in the referring hospital. Surgical complications and mesenteric ischaemia were the most common underlying disease aetiologies. Sixty-five of 341 (19.1%) patients had an infected/colonised CVC on the initial screening set of blood cultures. A successful CVC salvage rate of 91% was achieved in this cohort after antibiotic therapy. The subsequent in-patient catheter-related BSI rate for those admitted with a CVC (n=341) on the IFU was 0.042 per 1000 catheter days, over a total of 23,548 in-patient catheter days. Two hundred and seventy nine of 341 patients were discharged on home PN (HPN); with a subsequent catheter-related BSI rate on HPN of 0.22 per 1000 catheter days (mean duration of HPN=778 catheter days (range:)) over a follow-up period of 216,944 out-patient catheter days. There was no increased risk of HPN-related catheter-related BSI (p=0.09) or mortality (p=0.4) in those admitted with an infected CVC. This is the first study to report catheter-related BSI/colonisation rates and salvage outcomes in patients with type 2 IF newly admitted to a dedicated IF Unit. We report that nearly one-fifth of all patients were referred with evidence of a catheter related BSI/colonisation; despite this, successful catheter salvage is possible and, with stringent CVC care, an extremely low subsequent catheter related BSI rates can be achieved and maintained during in-patient stay on a dedicated IF Unit and after discharge on HPN. These data provide novel evidence to support ESPEN recommendations that patients with type 2 IF are managed on a dedicated IF Unit.

Risk factors for catheter-related infections in patients on hemodialysis

Background/Aim. Catheter-related infections are a significant morbidity and mortality cause in patients on hemodialysis. The objective of this study was to determine the incidence, to analyze risk factors and to identify etiological causes of catheter-related infections in these patients. Methods. The study was carried out at the Clinic for Nephrology and Clinical Immunology of the Clinical Centre of Vojvodina, from August, 2012 to May, 2015. One hundred and thirteen patients on chronic hemodialysis participated in the study. The risk factors of catheterrelated infections in the infected patients were to those in the control group, as follows: demographic and laboratory parameters, co-morbidities and the use of immunosuppressive therapy, the length of hemodialysis treatment, urgent catheter placement, the position and placement difficulties, the number of insertions and catheter maneuvering, the existence of permanent vascular access in maturation or without a vascular access in the course of catheter positioning, catheter life, surgical procedures (? 30 days from catheter placing), the length of hospitalization and isolated infection causes. Results. One hundred and ninety-seven catheters were placed in 113 patients, among which 182 of them temporary. The total number of catheter days was 17.842, the incidence of infections was 3.53/1,000 catheter days. During the monitoring period, 63 catheter-related infections were diagnosed, 54 (85.7%) with temporary and 9 (14.3%) with permanent catheters. Multivariate logistic regression analysis (with border values/ levels determined by receiver operating characteristic ? ROC analysis) determined independent predictors of catheter-related infections in the following order: hemoglobin levels &lt; 95 g/l (p &lt; 0.001) and albumin levels &lt; 33 g/l (p = 0.041), catheter duration of &gt; 90 days (p = 0.004), &gt; 2/day catheter maneuvering (p = 0.011) and the duration of hospitalization of &gt; 15 days (p = 0.003). The main pathogen was Staphylococcus spp. Coagulase negative. Conclusion. Intensifying of prevention measures and infection control would significantly reduce the frequency of catheter-related infections and the number of hospitalizations. The timely creation of a native arteriovenous fistula would decrease the use of hemodialysis catheters.

Central venous catheter-related infections in patients receiving short-term hemodialysis therapy: incidence, associated factors, and microbiological aspects.

Bloodstream infections are the second most common cause of death among patients on hemodialysis. This study aimed to evaluate the incidence of and risk factors associated with central venous catheter-related infections in patients undergoing hemodialysis, and to identify and characterize the type and antimicrobial susceptibility profiles of the primary microorganisms isolated during one year of follow-up. A prospective cohort study was conducted in 2014 in a hemodialysis referral center. We included 200 outpatients with acute kidney injury who had no permanent venous access. A nurse assessed the patients for signs of infection three times per week during dressing changes. The clinicopathologic characteristics of patients with and without local or systemic infection were compared. Fifty-five episodes of catheter-related infections occurred in 43 (22%) patients; 38 (69%) were bloodstream infections and 17 (31%) were local infections. Thirty-two (75%) patients with infection had femoral vein catheter placement. In total, 6,240 hemodialysis sessions were performed; the rates of primary bloodstream and local infection were 6.1 and 2.7 episodes per 1,000 patients on daily dialysis, respectively. In the univariate analysis, diabetes was significantly associated with the development of infection, while level of education, ethnicity, age, and sex were not. Gram-negative bacteria were primarily isolated from blood culture specimens (55% of samples). Of the Gram-negative isolates, 56% were resistant to the carbapenems. We identified a high incidence of catheter-related infections caused by resistant microorganisms in patients undergoing hemodialysis via central venous catheters.

Incidence of infection associated with central venous catheter and related risk factors in patients on total parenteral nutrition in a third level hospital

Abstract Background Central venous catheters are devices used for therapeutic, diagnostic, and monitoring purposes. Complications associated with central venous catheter use include those related to their insertion, rupture and displacement of the catheter, occlusion, thrombosis, and infection. Of these the latter is important due to the high morbidity and mortality it causes in the patients, and total parenteral nutrition increases the risk. The aim of this study is determine the incidence and risk factors associated with catheter-related infection in patients on parenteral nutrition. Material and methods A retrospective, observational, and cross-sectional study was conducted, by analysing patients on total parenteral nutrition who developed a catheter-related infection in a 6-month period. Multiple variables were studied, looking for significance. A statistically significant relationship was considered with a p Results The study consisted of 85 patients, of whom 52% were women and 48% men. The median age was 54 years. The most frequent diagnosis was enterocutaneous fistula. Catheter associated infection was present in 19% of patients. The most frequent microorganisms found were Staphyloccocus sp. (44%) and Candida sp . (25%). Median time between central venous catheter insertion and infection was 78±64 days. There was a significance between days with a central venous catheters and infection development ( p = 0.014). Infection developed in 81% of patients on whom surgery was performed ( p Conclusion It was found that patients with a longer use of a central venous catheter ( p = 0.014) and those who were operated on in conjunction with total parenteral nutrition ( p

Complications catheter-related infections in patients on hemodialysis (septic infections of patients on hemodialysis)

Introduction: Hemodialysis catheters are used for quick establishing of an adequate vascular approach, when urgent hemodialysis is indicated in time of maturation of artery-vein fistula and in patients in whom all other vascular approach have been exhausted. Although the placement of the catheter provides the necessary vascular access, carries a risk of both local-infection exit site of a catheter, as well as systemic complications, including catheter-related infection, septic thrombophlebitis, endocarditis, and other metastatic infections such as lung abscess and brain, osteomyelitis and endophthalmitis. Cases series: We have presented a retrospective series of 5 cases of hemodialysis patients hospitalized at the Clinic of Nephrology and Clinical Immunology, of the Clinical Center of Vojvodina in the period of 2010 to 2017, which have developed different complications of catheter-related infections. Three patients diagnosed with spondylodiscitis and endocarditis in two. In one patient with native valve endocarditis, due to the appearance of other complications, there was a death, while the other patients had an adequate response to therapy. Conclusion: Early recognition of potential complications of catheter-related infections to more successful treatment of these patients.