Catheter-related Infections Research Articles

Catheter Exchange With Elongation of Tunnel (CEET) Procedure-A Novel Technique for Cuff Extrusion of Tunneled Dialysis Catheter: Surgical Experience and Early Outcomes.

Cuff extrusion of tunneled dialysis catheter (TDC) leads to catheter dysfunction, leading to loss of vascular access and the need for new catheter. Definitive management is to remove TDC and reinsert new catheter by new venous puncture and tunnel, which may not be possible in all cases. The study evaluated the surgical experience and early outcomes of a novel "Catheter Exchange with Elongation of Tunnel (CEET)" procedure for cuff extrusion. The retrospective study included all cases of hemodialysis with TDC with partial or complete cuff extrusion and excluded complete catheter dislodgement, tunnel infection, or any catheter related infection. All patients also underwent the CEET procedure under fluoroscopy guidance, and the clinical details and outcomes were analyzed. Eleven cases of TDC cuff extrusion underwent the CEET procedure of which three (27.2%) had previous and four (36.4%) had partial cuff extrusion, and seven cases (63.6%) had short tunnel length, which likely predisposed to cuff extrusion. CEET procedure was successful in 10 cases (success rate 90.1%) with desired position of catheter tip and good blood flow. Study population was divided into early and late cuff extrusion (≥1 month). Short tunnel length was associated with late extrusion (p = 0.05), whereas premature removal of TDC anchor sutures was associated with early cuff extrusion (p = 0.04). CEET procedure is a successful alternative technique for correction of cuff extrusion of TDC with good success rate. Premature removal of anchor sutures was associated with early cuff extrusion, whereas short tunnel length was associated with late cuff extrusion.

Unveiling the Intricacies: Exploring Stepwise Initiation of Peritoneal Dialysis in a Single-Center Setting

Background and Objectives: Chronic kidney disease (CKD) poses a significant global health challenge, necessitating effective renal replacement therapies. Peritoneal dialysis (PD) offers a patient-friendly, home-based alternative to hemodialysis. The Stepwise Initiation of Peritoneal Dialysis (SIPD) method, used in the SPD group and involving a gradual introduction of PD, presents a potential advantage over traditional protocols, yet the scientific literature on its efficacy and safety is limited. Materials and Methods: We conducted a retrospective analysis of 39 end-stage renal disease patients undergoing SIPD and 78 patients receiving conventional PD (CPD) at a single center from 1 January 2010 to 31 December 2023. Patients were matched for age and sex. Surgical techniques, early and late complications, infection rates, and catheter survival were evaluated. Data were analyzed using statistical methods, including the chi-square test, t-test, and negative binomial regression. Results: The mean break-in period was significantly more extended for the SPD group (176.05 ± 154.39 days) compared to the CPD group (26.87 ± 58.45 days). Early complications were similar between groups, but late complications, including peritonitis, were significantly higher in the CPD group. The SPD group experienced fewer infection events (28 vs. 80, p = 0.043). Median catheter survival times were 1486 days for SPD and 1774 days for CPD, with no statistical difference. Age was a significant factor in peritonitis incidence, increasing with age in both groups. Conclusions: Our study suggests that SPD may reduce the incidence of catheter-related infections and peritonitis compared to CPD. The extended break-in period in SPD could enhance tissue healing and reduce biofilm formation, thereby contributing to fewer infectious complications. Despite these findings, no significant difference in overall catheter survival was observed. Further multi-center studies with larger sample sizes are recommended to confirm these results and explore the economic impact of SPD vs. CPD.

Nutrition management of intestinal failure: From neonates to the elderly

Double enterostomies (DES) and necrotising enterocolitis (NEC) are prevalent in neonatal intensive care units (NICU), commonly resulting from surgical removal of diseased intestine. Sarcopenia prevalence is >40% in community dwelling elderly >65 yrs and is associated with poor nutritional status before/after abdominal surgery, with intestinal failure (IF) and high output stoma losses. Parenteral Nutrition (PN) is the standard of care for Type 2 IF patients with DES or enteroatmospheric fistulas (EAF), but risks catheter-related complications, infection, gut and hepatobiliary dysfunction. Chyme reinfusion therapy (CRT) is a recommended distal feeding technique that may minimise these risks.

Assessing Hemodialysis Catheter Insertion Practices Against CDC Guidelines: A Closed-Loop Audit at a Tertiary Hospital in Egypt.

Background Following evidence-based guidelines during hemodialysis catheter insertion procedures is key to lowering catheter-related bloodstream infections (CRBSI) and other complications. Our aim was to examine all aspects relevant to the insertion of hemodialysis catheters in the dialysis unit at Alexandria Main University Hospital,Alexandria, Egypt, in order to identify practices that could be contributing to high complication rates. Methods We used the CDC's Guidelines for the Prevention of Intravascular Catheter-Related Infections to define the criteria relevant to hemodialysis catheter insertion procedures. These criteria were made into a form to be used as the primary auditing tool. The form was then used to record catheterization procedures in the dialysis unit from March 2024 to July 2024. Eighty patients scheduled for hemodialysis catheter insertion were randomlyselected, 40 in the initial cycle of the audit, and 40 in the re-audit cycle. Percentage adherence to each criterion was then calculated for each audit cycle and compared. Results Overall, adherence to the criteria assessed showed significant improvements, with mean compliance increasing from 69% in the initial cycle to 90% in the second cycle. In addition, the rate of mechanical complications recorded decreased. Conclusion Our study emphasized the effectiveness of using closed-loop clinical audits to ensure continuous improvement of care delivered during hemodialysis catheter insertion procedures.

Impact of sterile gloving during proximal manipulation of central line catheter hub: the multicenter observational study CleanHandPROX

BackgroundPatients with central lines face an increased risk of developing bacteremia. Preventing late-onset catheter-related infections relies on implementing various measures during manipulations of the catheter hub of central lines (e.g., during connections, disconnections, blood withdrawals, pulsed rinses, or injections performed at the first connection after the central catheter). French guidelines include, among these measures, the requirement to put on sterile gloves immediately before proximal manipulation to help prevent contamination of the catheter hub during preparation. To our knowledge, no study has reported compliance with wearing sterile gloves during these manipulations, nor the impact of not wearing sterile gloves on the cleanliness of the fingers of healthcare workers (HCWs) just before manipulating the connectors.MethodsWe conducted a two-part study to assess compliance with sterile gloving and to provide direct microbiological evidence of bacterial contamination on HCWs’ hands immediately before the manipulation of central lines when sterile gloving is not used. First, the use of sterile gloves was observed during proximal manipulations of central lines using a standardized grid. Second, we examined the microbial flora present on the fingers of each observed HCW just before proximal manipulation.ResultsA total of 260 HCWs from 35 healthcare institutions were observed during proximal manipulation. The HCWs were distributed into three groups: 188 used sterile gloves (72%), 23 used nonsterile gloves (9%), and 49 did not wear gloves (19%). The swabbing of the fingertips revealed microbial cultures from 72 samples (28%). A total of 97 microorganisms were identified, all of which are well-recognized agents responsible for catheter-related bacteremia, predominantly coagulase-negative staphylococci (n = 36) and Bacillus sp. (n = 31). Fingertip contamination was lower for HCWs wearing sterile gloves (27/188; 14%) than for those wearing nonsterile gloves (12/23; 52%) or not wearing gloves (33/49; 67%) (p < 0.001). The contaminants were similar across the three groups.ConclusionsOur data support the positive impact of sterile gloving in ensuring clean fingertips during proximal manipulation of central lines, a key measure in preventing late-onset catheter-related bacteremia. The contamination of sterile gloves in one out of seven HCWs highlights the need for a clean care environment and minimal contact with the patient’s skin and surroundings during proximal manipulation.

The impact of shortening patient–doctor contact duration on early peritoneal dialysis-related infections

Early peritoneal dialysis (PD)-related infection is a severe complication. This study investigated the relationship between patient–doctor contact (PDC) duration and early PD-related infection. In the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) Korea, incident dialysis patients receiving PD were divided into two groups based on PDC duration (< 15 min versus ≥ 15 min), which was defined as the duration a nephrologist typically spends with a patient receiving PD during each visit according to the facility practice pattern. Early risks of PD-related infections, such as peritonitis and catheter-related infection (onset within 3 and 12 months of PD), were compared to the PDC duration using Cox regression. The study included 276 patients (184 [66.7%] in the shorter PDC group [< 15 min] and 92 [33.3%] in the longer PDC group [≥ 15 min]). The average age did not differ between the groups. The incidences of 3- and 12-month PD-related infections were significantly lower in the longer PDC group than in the shorter PDC group (3 months: 1.1% versus 9.8%, P = 0.007; 12 months: 9.8% versus 23.4%, P = 0.007). Longer PDC was independently associated with a lower risk of PD-related infections at 3 and 12 months (3 months: adjusted hazard ratio [aHR], 0.11; 95% confidence interval [CI], 0.02–0.85, P = 0.034; 12 months: aHR, 0.43; 95% CI 0.19–0.99, P = 0.048). Overall, a longer PDC duration was associated with a significantly lower risk of early PD-related infection.

The Association Between Hypoalbuminemia and Catheter-Related Infections in Hemodialysis Patients

Background: Catheter-related infections cause significant complications in patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD). Objectives: This study aimed to evaluate the association between serum albumin level and catheter-related infection in HD patients. Methods: This study included 210 HD patients with positive blood and catheter cultures and 210 without catheter infection. Mean albumin level, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were also checked as surrogate disease markers and compared between the two groups. Results: Staphylococcus aureus (38.6% of cases) and Staphylococcus epidermidis (27.6% of cases) were the most frequently detected bacteria. Erythrocyte sedimentation rate and CRP were significantly higher in the target group (P = 0.002 and P = 0.001, respectively). Conclusions: In this investigation, hypoalbuminemia did not emerge as an independent risk factor for access-related infections. S. aureus and S. epidermidis were the predominant bacteria responsible for catheter-related infections in HD patients.

Systematic review of ultrasound-guided central venous catheter placement-related complications in neonates and infants aged

Although ultrasound can be considered an assistant method, successful placement of a central venous catheter (CVC) in infants is still challenging. The incidence of CVC placement-related complications is still high. Therefore, this systematic review aimed to synthesize evidence to assess the effects of ultrasound-guided CVC placement on adverse outcomes in infants and neonates aged <12 months. PubMed, Ovid, EMBASE, and the Cochrane Library were searched to identify potentially relevant studies. The main outcome was the incidence of adverse events, which included inadvertent arterial puncture, hematoma, pneumothorax and hemothorax, catheter kinking, threading, and malpositioning problems, venous thrombosis, catheter-related infection, phlebitis, and cardiac tamponade. Eleven studies involving 2097 patients were included in the final analysis. The odds of inadvertent arterial puncture, and catheter kinking, threading, and malpositioning problems were lower in the ultrasound group than in the control group. No significant difference was detected in the incidence of hematoma or venous thrombosis between the control and ultrasound groups. Other complications, such as pneumothorax, hemothorax, phlebitis, and cardiac tamponade, rarely occurred. Ultrasound-guided CVC placement can improve the safety of punctures in neonates and infants. CVC punctures should be guided in real-time by ultrasound.

Phase IB part of LOC-R01, a LOC network non-comparative randomized phase IB/II study testing R-MPV in combination with escalating doses of lenalidomide or ibrutinib for newly diagnosed primary central nervous system lymphoma (PCNSL) patients

BackgroundResults of conventional induction chemotherapies in primary central nervous system lymphoma (PCNSL) need to be improved. Ibrutinib, a BTK inhibitor, and lenalidomide, an immunomodulatory drug, have shown promising results at relapse, supporting to further assess their individual use in combination with high-dose methotrexate-based chemotherapy.MethodsPatients with newly diagnosed PCNSL were randomized to receive four 28-day cycles of ibrutinib or lenalidomide in combination with R-MPV (rituximab, methotrexate, procarbazine, vincristine and prednisone) in a 3 + 3 design. Responders then received a consolidation with R-Cytarabine and an intensive chemotherapy with autologous stem cell transplantation. The objective of the phase IB study was to define the recommended phase II dose (RP2D) based on the dose-limiting toxicity (DLT) occurring during the first induction cycle.ResultsTwenty-six patients (median age 52) were randomized. Four DLTs were observed: one grade 5 aspergillosis and pneumocystosis, one grade 4 catheter-related infection and two grade 3 increased alanine aminotransferase levels. RP2D of ibrutinib and lenalidomide were 560 mg daily (D3-14 and D17-28) and 15 mg daily (D1-21) respectively, in combination with R-MPV. In both arms, the most frequent grade ≥3 treatment-related adverse events were hepatic cytolysis, neutropenia and infections. One grade 4 Lyell’s syndrome was reported at cycle 2 in the lenalidomide arm. After 4 induction cycles, the overall response rates were 76.9% and 83.3% in the lenalidomide and ibrutinib arm, respectively.ConclusionTargeted induction therapies combining lenalidomide or ibrutinib with R-MPV are feasible for first-line PCNSL. The safety profile is consistent with the known safety profiles of R-MPV and both targeted therapies. The phase II part of the study is ongoing.Trial registrationNCT04446962.

Central venous catheter-related infection: does insertion site still matter? A French multicentric cohort study.

We aim to evaluate the association between central venous catheter (CVC) insertion site and microbiological CVC complications in a nationwide cohort. This study was conducted using the healthcare-associated infection surveillance cohort "REA-REZO" involving 193 intensive care units (ICUs). All CVC inserted and removed during the same ICU stay between January 1st 2018 and December 31st 2022 were eligible but only those whose tips were sent for microbiological analysis were included. Primary objective was to describe CVC insertion sites and subsequent catheter-related bloodstream infection (CRBSI). Out of 126,997 CVCs, 71,314 were not sent for tip culture, and only 55,663 CVCs were included, (30,548 in internal jugular [IJ], 14,423 in femoral and 10,692 in subclavian [SC] sites). The incidence of CRBSI was 0.7 [0.6-0.8] in the IJ site, 0.7 [0.6-0.9] in the femoral site, and 0.6 [0.4-0.7] CRBSI per 1000 CVC days in the SC site (p = 0.248). The multivariable Poisson regression model showed no differences of CRBSI incidence rates between the three insertion sites. Microorganisms observed in CRBSI were coagulase-negative Staphylococci (27.9%), Enterobacterales (27.5%), non-fermenting Gram-negative Bacilli (10.4%), Candida sp. (16.9%), and Staphylococcus aureus (16.9%). Low CRBSI incidence rates were reported. CRBSI incidences rates were similar in the three insertion sites. Uncertainty remains due to potential selection bias since many CVCs had to be excluded.

A Study to Assess the Effectiveness of Informative Booklet Regarding Knowledge, Attitude and Practice Among Intensive Care Unit (ICU) Staff Nurses Regarding Prevention of Central Line Associated Blood Stream Infection (CLABSI)

Background: Nurses in Intensive Care Units (ICU) have a vital role in reducing Central line associated blood stream infections (CLABSI) if they are well educated to use strategies to decrease Central line associated blood stream infections (CLABSI) rate which are based on the center for disease control and prevention guidelines (CDC) to improve patient’s outcomes. Health-care-associated infections are a huge concern in the intensive care units (ICUs) across the globe. Nearly 90% of catheter-related bloodstream infections are caused by central venous catheters (CVCs). Central venous catheters (CVC) are commonly inserted in critically ill patients and play an important role for hemodynamic monitoring and delivery of crucial treatments. Central line-associated bloodstream infection (CLABSI) is a laboratory confirmed bloodstream infection occurring in a patient with a CVC in place for &gt;48 hours that is not related to an infection at any other site. Preventing nosocomial infections pose a great challenge in ICU, because of the multi-drug resistant organisms treated with broad-spectrum antibiotics. Clinical practice guidelines from various organizations are available for prevention of vascular catheter related infections. The Institute for Healthcare Improvement has introduced a “central line bundle” that includes the five best evidence-based practices to prevent CLABSI. This bundle includes hand hygiene, maximal barrier precautions during catheter insertion, skin antisepsis with chlorhexidine, optimal selection of the catheter site, with avoidance of the femoral vein and a daily assessment of line necessity, including the removal of an unnecessary line. Of these components, “hand hygiene” (HH) is the most convenient and cost effective to follow. “Hand Hygiene” HH prevents the transmission of pathogens and is a universal strategy to prevent all nosocomial infections. The World Health Organization has proposed a multimodal strategy; which includes five elements called the “Five Moments for Hand Hygiene”, as an evidence-based approach to prevent hospital-acquired infections. The five moments include, before touching the patient, before performing any a clean/aseptic procedure, after exposure/risk of body fluid, after touching the patient and after touching the patient surroundings. Therefore, the researcher was curious to know the effectiveness of informative booklet regarding knowledge, attitude and practice of intensive care unit staff nurses regarding prevention of central line associated blood stream infection (CLABSI).

Comparison of complications and indwelling time in midline catheters versus central venous catheters: A systematic review and meta-analysis.

Central venous catheters and midline catheters are commonly used as medium- to long-term intravenous infusion tools in clinical nursing. However, there is currently no reliable conclusion on whether there are differences in complications and indwelling time between these two types of catheters. To investigate whether there are differences in the incidence of complications and indwelling time between the use of midline catheters and central venous catheters as intravenous infusion tools. A systematic search was conducted across various databases including Web of Science, PubMed, Embase, Cochrane Library, CINAHL, Wanfang and China National Knowledge Infrastructure. The selection of studies and assessment of their quality was carried out independently by two reviewers. Meta-analysis was conducted using the RevMan 5.3 software. Heterogeneity was evaluated, one of the pooled analyses was performed using the random-effect model, while the others used the fixed-effect model. Mean differences or odds ratios with corresponding 95% confidence intervals were calculated. Ten studies (1,554 participants) met the inclusion criteria. Meta-analysis showed that there was a statistically significant difference in the complication rates [OR = 0.36, 95% CI (0.18, 0.70), p = 0.003], incidence of catheter-related thrombosis [OR = 0.28, 95% CI (0.11, 0.71), I2= 0%,p = 0.007], catheter-related infection[OR = 0.36, 95% CI (0.16, 0.78), I2= 27%, p = 0.007] and catheter blockage [OR = 0.21, 95% CI (0.09, 0.51), I2= 18%, p = 0.0005] between midline catheters group and central venous catheters group. There was a statistically significant difference in the catheter indwelling time between the two groups [MD = 0.9, 95% CI (0.33, 1.46), I2= 0%, p = 0.002]. There was no significant difference in other complications such as phlebitis, catheter dislodgement and leakage between the two groups. Midline catheter was superior to central venous catheter in terms of the overall complication rates and incidence of catheter-related thrombosis, catheter blockage, catheter-related infection and indwelling time.

Midregional-proAdrenomedullin as a prognostic tool in sepsis and septic shock: A systematic review and meta-analysis.

Midregional-proAdrenomedullin (MR-proADM) has been recently proposed as a tool in patients with sepsis and septic shock. Our aim was to evaluate the prognostic role of MR-proADM in hospitalized patients with sepsis and septic shock. PRISMA guideline was followed. MEDLINE and EMBASE were searched up to June 2023. Primary outcome was mean difference in MR-proADM among survivors and nonsurvivors, secondary outcome mean difference in MR-proADM according to infection severity and type. Risk of bias was evaluated using Newcastle-Ottawa scale for observational studies and Cochrane tool for randomized trials. Pooled mean differences (MD) with corresponding 95% confidence intervals (CIs) were calculated in a random-effects model. Twenty-four studies included 6730 adult patients (1208 nonsurvivors and 5522 survivors) and three studies included 195 paediatric patients (30 nonsurvivors and 165 survivors). A total of 10, 4 and 13 studies included, respectively, patients with sepsis (3602 patients), septic shock (386 patients) and a mixed population (2937 patients). Twenty-one studies included patients with different source of infection, three with pneumonia and one with a catheter-related infection. Most studies (n = 12) had a follow-up of 28 days. In adult cohort, pooled mean difference between nonsurvivors and survivors of MR-proADM was 2.55 mmol/L (95% CI: 1.95-3.15) with higher values in patients with septic shock (4.25 mmol/L; 95% CI, 2.23-6.26 mmol/L) than in patients with sepsis (1.77 mmol/L; 95% CI: 1.11-2.44 mmol/L). In paediatric cohort, pooled mean difference was 3.11 mmol/L (95% CI: -0.02-6.24 mmol/L). Higher values of MR-proADM are detectable in nonsurvivors adult and paediatric-hospitalized patients with sepsis or septic shock.

Recent developments in preventing catheter-related infections based on biofilms: A comprehensive review.

Urinary and vascular catheters are among the most commonly used medical devices. However, infections caused by biofilm formation on the surface of catheters are a major cause of healthcare-associated infections. Traditional methods, such as using antimicrobials to prevent such infections, generally have short-term effects, and treatment is challenging owing to the emergence of antimicrobial-resistant bacteria. This review aims to evaluate the limitations of conventional catheter-related infection prevention efficacy, such as currently used antimicrobials, and analyze the efficacy and limitations of potential alternatives to prevent catheter-related infections that have not yet been commercialized, classified by the transition stages of biofilm formation. We intend to provide profound insights into the ideal technologies for preventing catheter-associated tract infections and present perspectives on future directions in this field.

CN7 Clinical characteristics of cancer patients with central venous catheter-related infections: Insights from a single centre study

CN7 Clinical characteristics of cancer patients with central venous catheter-related infections: Insights from a single centre study

Antibiotic Lock Therapy for Port Catheter-Related Infections of Children with Acute Leukemia.

Port catheters facilitate the administration of chemotherapy, antibiotics, blood products, fluid, and parenteral nutrition to pediatric patients with hematological malignancies. However, as its use has become widespread, local and systemic, catheter-related infections have emerged as important causes of morbidity and mortality. In our study, we aimed to evaluate the success of antibiotic lock therapy in port catheter-related infections of pediatric patients followed up with acute leukemia. Port catheter cultures taken from a total of 182 pediatric patients with acute lymphoblastic/myeloblastic leukemia who were followed up at Ankara City Hospital Pediatric Hematology Clinic between August 2019 and August 2023 were evaluated retrospectively. Bacterial growth was identified in 739 port catheter culture specimens of 182 patients. Closure or removal of the port was required in 91, and removal of the port catheters in 49 patients due to port catheter-related infections. Antibiotic lock therapy was started in 56 patients with bacterial growth in the port catheter. With antibiotic lock therapy, port catheter-related infections of 42 patients were eradicated, and their catheters began to be used again. As a result, the port catheter-related infections of 42 of 56 (75%) patients whose ports were closed and also received systemic antibiotic therapy were eradicated, and no infection recurrence was observed. Adding antibiotic lock therapy to systemic antibiotics in pediatric patients may be beneficial in terms of catheter salvage.

Reduction of peritoneal dialysis associated infections using a novel exit-site care practice.

Peritoneal dialysis (PD) related infections are a significant obstacle leading to PD discontinuation. Since catheter related infections (CRI), defined as exit site infections and/or tunnel infection, can progress to peritonitis, vigorous efforts are implemented in CRI prevention. Following an increased CRI rate in our institution, partially related to environmental organisms found in water distribution systems, we hypothesized that exit site care that includes prevention of water exposure-related pathogens may reduce CRI. In this prospective single center study, we compared a contemporary cohort consisting of PD patients who implemented the modified exit-site care protocol, mainly including water avoidance during shower with stoma bag usage and local Mupirocin ointment against a historical control group before the protocol implementation. The historical cohort was allowed water exposure and used local gentamicin ointment. The primary outcome was the development of a CRI. Secondary outcomes were PD associated peritonitis and infection related outcomes. There were 55 patients in contemporary cohort and 58 in historical group. The CRI rate was significantly lower in study group (0.11/episodes per patient year [EPP]) compared to control group (0.71 EPP), p < 0.001. A multivariate Cox regression analysis demonstrated a protective effect of being in the contemporary cohort compared to historical group (HR for first CRI = 12.0 95%CI: 4.0-35.7, p < 0.001). Peritonitis rate was significantly lower in contemporary cohort (0.19/EPP) compared to the historical group (0.40/EPP), p = 0.011. Transfer to hemodialysis was significantly lower in contemporary cohort than historical group (7.3% vs 31.0% in contemporary and historical group respectively, HR = 0.2, 95%CI; 0.05-0.6, p = 0.001). An exit site care protocol that includes water avoidance and local Mupirocin use reduced substantially both CRI and peritonitis rate in patients treated with PD.

Differential analysis of lipoprotein and glycoprotein profiles in bacterial infections and COVID-19 using proton nuclear magnetic resonance and machine learning

BackgroundWe scrutinized variations in the proton nuclear magnetic resonance (1H NMR) lipoprotein and glycoprotein profiles among hospitalized individuals with infectious diseases. MethodsWe obtained sera from 124 patients with COVID-19, 50 patients with catheter-related bacterial infections, and 50 healthy volunteers. Results were interpreted using machine learning. ResultsCOVID-19 patients had bigger and more abundant VLDL particles than the control group and higher VLDL-cholesterol and VLDL-triglyceride concentrations. Patients with bacterial infections showed similar trends, but differences often did not reach statistical significance. Both types of patients showed lower LDL-cholesterol concentrations than the controls. LDL were larger, and the number of particles was lower than that of the healthy individuals. HDL particles had decreased cholesterol and increased triglycerides. Small particles were reduced. Glycoproteins were increased in both groups of patients. All these alterations were more pronounced in COVID-19 patients than those with bacterial infections. The diagnostic accuracy of these profiles exceeded 90 % when distinguishing between healthy individuals and patients, and 85 % when differentiating between the two patient groups. ConclusionOur findings highlight the potential of 1H NMR analysis for lipoproteins and glycoproteins as infection biomarkers. Additionally, they reveal differences between viral and bacterial infections, shedding light on an area with promising clinical significance.

International treatment outcomes of neonates on extracorporeal membrane oxygenation (ECMO) with persistent pulmonary hypertension of the newborn (PPHN): a systematic review

BackgroundPPHN is a common cause of neonatal respiratory failure and is still a serious condition and associated with high mortality.ObjectivesTo compare the demographic variables, clinical characteristics, and treatment outcomes in neonates with PHHN who underwent ECMO and survived compared to neonates with PHHN who underwent ECMO and died.MethodsWe adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature for studies on the development of PPHN in neonates who underwent ECMO, published from January 1, 2010 to May 31, 2023, with English language restriction.ResultsOf the 5689 papers that were identified, 134 articles were included in the systematic review. Studies involving 1814 neonates with PPHN who were placed on ECMO were analyzed (1218 survived and 594 died). Neonates in the PPHN group who died had lower proportion of normal spontaneous vaginal delivery (6.4% vs 1.8%; p value > 0.05) and lower Apgar scores at 1 min and 5 min [i.e., low Apgar score: 1.5% vs 0.5%, moderately abnormal Apgar score: 10.3% vs 1.2% and reassuring Apgar score: 4% vs 2.3%; p value = 0.039] compared to those who survived. Neonates who had PPHN and died had higher proportion of medical comorbidities such as omphalocele (0.7% vs 4.7%), systemic hypotension (1% vs 2.5%), infection with Herpes simplex virus (0.4% vs 2.2%) or Bordetella pertussis (0.7% vs 2%); p = 0.042. Neonates with PPHN in the death group were more likely to present due to congenital diaphragmatic hernia (25.5% vs 47.3%), neonatal respiratory distress syndrome (4.2% vs 13.5%), meconium aspiration syndrome (8% vs 12.1%), pneumonia (1.6% vs 8.4%), sepsis (1.5% vs 8.2%) and alveolar capillary dysplasia with misalignment of pulmonary veins (0.1% vs 4.4%); p = 0.019. Neonates with PPHN who died needed a longer median time of mechanical ventilation (15 days, IQR 10 to 27 vs. 10 days, IQR 7 to 28; p = 0.024) and ECMO use (9.2 days, IQR 3.9 to 13.5 vs. 6 days, IQR 3 to 12.5; p = 0.033), and a shorter median duration of hospital stay (23 days, IQR 12.5 to 46 vs. 58.5 days, IQR 28.2 to 60.7; p = 0.000) compared to the neonates with PPHN who survived. ECMO-related complications such as chylothorax (1% vs 2.7%), intracranial bleeding (1.2% vs 1.7%) and catheter-related infections (0% vs 0.3%) were more frequent in the group of neonates with PPHN who died (p = 0.031).ConclusionECMO in the neonates with PPHN who failed supportive cardiorespiratory care and conventional therapies has been successfully utilized with a neonatal survival rate of 67.1%. Mortality in neonates with PPHN who underwent ECMO was highest in cases born via the caesarean delivery mode or neonates who had lower Apgar scores at birth. Fatality rate in neonates with PPHN who underwent ECMO was the highest in patients with higher rate of specific medical comorbidities (omphalocele, systemic hypotension and infection with Herpes simplex virus or Bordetella pertussis) or cases who had PPHN due to higher rate of specific etiologies (congenital diaphragmatic hernia, neonatal respiratory distress syndrome and meconium aspiration syndrome). Neonates with PPHN who died may need a longer time of mechanical ventilation and ECMO use and a shorter duration of hospital stay; and may experience higher frequency of ECMO-related complications (chylothorax, intracranial bleeding and catheter-related infections) in comparison with the neonates with PPHN who survived.

Isolation of Staphylococcus pseudintermedius in Immunocompromised Patients from a Single Center in Spain: A Zoonotic Pathogen from Companion Animals.

Staphylococcus pseudintermedius, a commensal opportunistic bacterium predominantly residing in the skin of companion animals, particularly dogs, has the potential to induce skin and soft tissue infections in pets, and zoonotic infections, including catheter-related complications. This study documents four cases of S. pseudintermedius infection or colonization in patients who had close contact with dogs or cats. Identification of the bacterial species was performed using MALDI-TOF mass spectrometry, and antibiotic susceptibility was determined using microdilution assay. DNA was sequenced using Nanopore technology followed by in silico analysis. Three isolates were multidrug resistant, including resistance to methicillin, with one belonging to the prevalent European lineage ST551, and the other two were attributed to a novel multilocus sequence type, ST2672. The remaining isolate was attributed to the novel multilocus sequence type ST2673 and was methicillin susceptible. All four isolates exhibited an array of virulence factors that contributed to colonization, damage to host immune cells, and biofilm formation. All the ST551 isolates included in the comparative analysis displayed clonality within the European continent. The importance of describing zoonotic infections associated with S. pseudintermedius resides in the scarcity of available scientific literature, further accentuated by its heightened resistance profile and potential complications, particularly in the context of catheter-related infections.