Catheter-related Infections Research Articles

Chapter 10 - Early and late complications of hematopoietic stem cell transplantation

As autologous stem cell transplantation (ASCT) is increasingly frequent in some patients with multiple sclerosis (MS), the knowledge of its adverse effects is paramount. Early complications (within 30 from transplantation) are usually due to conditioning regimen and consequent neutropenia. They include infections and noninfectious complications, such as oral and intestinal mucositis, increases in liver enzymes, hemorrhagic cystitis, and worsening of neurologic symptoms. Infections in the early phase, particularly during neutropenia, are mainly of bacterial origin, such as bloodstream infections, pneumonia, central-venous catheter-related infections, urinary infections, and neutropenic typhlitis, followed by viral reactivations. Prophylaxis with acyclovir against reactivation of herpes simplex virus (HSV) and varicella-zoster virus (VZV) is recommended, while a preemptive strategy is used for cytomegalovirus (CMV) and Epstein-Barr virus (EBV) management. Fungal infections are infrequent and mainly caused by Candida, thus fluconazole prophylaxis is used in some centers. Late complications include secondary autoimmune diseases: hematologic, such as immune thrombocytopenic purpura, autoimmune hemolytic anemia, or acquired hemophilia, or nonhematologic, such as thyroiditis, rheumatoid arthritis, or Crohn's disease. Other late complications are endocrinopathies and gonadal dysfunction with possible consequences on fertility. Particularly in women over 32 years of age, the risk of infertility and premature ovarian insufficiency can be significant. Thus, reproductive counseling with fertility preservation techniques if required is mandatory before ASCT.

Patient preferences and willingness to pay for central venous access devices in breast cancer: A multicenter discrete choice experiment

BackgroundDespite being a significant management decision in clinical or nursing practice, there is limited understanding of the preferences regarding risks, benefits, costs, and other attributes of patients with breast cancer when selecting peripherally inserted central catheters or totally implanted ports. The objective of this study is to investigate the preferences of patients with breast cancer who require chemotherapy when selecting an optimal central venous access device. MethodsData on patients' preferences for central venous access devices were collected using a face-to-face discrete choice experiment from the oncology departments of three public hospitals in China representing the eastern (Zhejiang province), central (Henan province), and western (Sichuan province) regions. The study used six attributes to describe the preferences of breast cancer patients for central venous access devices, including out-of-pocket cost, limitations in activities of daily living, catheter maintenance frequency, risk of catheter-related thrombosis, risk of catheter-related infection, and size of incision. Data were analyzed using a conditional logit model and mixed logit model. The marginal willingness to pay (mWTP) was calculated by assessing the ratio of the preference for other attributes to the preference for out-of-pocket cost. ResultsA total of 573 respondents completed the survey. The discrete choice experiment results showed that respondents strongly preferred a central venous access device with a catheter maintenance frequency of one time a month (vs four times a month, β = 1.188, p < 0.001), the lower risk of catheter-related thrombosis (2 % vs 10 %, β = 1.068; p < 0.001) and lower risk of catheter-related infection (2 % vs 8 % risk: β = 0.824; p < 0.001). Respondents were willing to pay CNY ¥11,968.1 (US$1776.5) for a central venous access device with a catheter maintenance frequency of one time a month rather than four times a month, ¥10,753.6 (US$1596.2) for a central venous access device with 2 % thrombosis risk over one with 10 %, and ¥8302.0 (US$1232.3) for a central venous access device with 2 % infection risk over one with 8 %. Respondents with longer travel time to the hospital, younger than 50 years old, and with urban employee basic medical insurance were willing to pay more for an improvement in the attributes. ConclusionsThese findings suggest that patients with breast cancer were mainly concerned with the out-of-pocket cost, catheter maintenance frequency, risk of catheter-related thrombosis and risk of catheter-related infection when choosing a central venous access device for the delivery of chemotherapy. In clinical or nursing practice, when making central venous access device recommendation for young patients and those who live far from hospitals, totally implanted ports may be a preferable choice.

A Case of Central Venous Catheter-Related Candida parapsilosis Fungemia Evolved to Disseminated Infection in a Neutropenic Patient with Blast Crisis of Chronic Myeloid Leukemia.

Central venous catheter-related infections are of particular importance in onco-hematological patients. Candida parapsilosis is generally reported as a mild pathogen, however it is able to effectively colonize intravascular devices and potentially give rise to sustained fungemias. Here we report a case of invasive, potentially lethal C. parapsilosis disseminated infection in a neutropenic patient affected by chronic myeloid leukemia with blast crisis. We underline the importance of removing the central venous catheter as potential source of infection as soon as possible during the course of candidemia, and not replacing it with other polyurethan intravascular devices, which pose a risk for the maintenance of the fungemia despite the administration of the best antifungal therapy available.

Novel Antibacterial Agents SAAP-148 and Halicin Combat Gram-Negative Bacteria Colonizing Catheters.

The antibiotic management of catheter-related infections (CRIs) often fails owing to the emergence of antimicrobial-resistant strains and/or biofilm/persister apparitions. Thus, we investigated the efficacy of two novel antimicrobial agents, i.e., the synthetic peptide SAAP-148 and the novel antibiotic halicin, against Gram-negative bacteria (GNB) colonizing catheters. The antibacterial, anti-biofilm, and anti-persister activities of both agents were evaluated against Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae strains. The enrolled strains were isolated from catheters and selected based on their resistance to at least three antibiotic classes and biofilm formation potential. Furthermore, the hemolysis and endotoxin neutralization abilities of these agents were explored. The bactericidal activity of both agents was reduced in urine and plasma as compared to buffered saline. In a dose-dependent manner, SAAP-148 and halicin reduced bacterial counts in 24 h preformed biofilms on silicone elastomer discs and eliminated persisters originating from antibiotic-exposed mature 7-day biofilms, with halicin being less effective than SAAP-148. Importantly, SAAP-148 and halicin acted synergistically on E. coli and K. pneumoniae biofilms but not on A. baumannii biofilms. The peptide, but not halicin, decreased the production of IL-12p40 upon exposure to UV-killed bacteria. This preliminary study showed that SAAP-148 and halicin alone/in combination are promising candidates to fight GNB colonizing catheters.

A population-based study on the incidence and aetiology of infectious complications in peritoneal dialysis in South Sweden

Background Peritonitis is a major cause of morbidity in peritoneal dialysis (PD) and an independent risk factor for elevated all-cause mortality. The aims of this study were to report the incidence, trend, aetiology, and antimicrobial susceptibility of PD-associated peritonitis and catheter-related infections in South Sweden between 2011–2020. Methods This population-based observational cohort study included all patients with PD between the years 2011–2020 in the county of Skåne. Data was accessed through the Swedish Renal Registry and the Department of Clinical Microbiology in Lund. Definitions issued by the International Society for Peritoneal Dialysis were implemented to assess PD-associated infections. Results Medical records of 675 paediatric and adult PD patients were eligible for inclusion. Of those, 208 (31%) were female and the median age was 67 years (range 0-91). The overall rate of PD-peritonitis was 0.38 episodes per year at risk. Out of 484 episodes of peritonitis, 61% (n = 295) were caused by Gram-positive bacteria. There were 289 occurrences of exit site infections, of which most (n = 152, 53%) were Gram-positive. Tunnel infections occurred in 16 episodes and were caused by S. aureus or P. aeruginosa. Among all isolates, 37 were of MRSE, four of ESBL-producing E. coli, and one of MRSA. Conclusion The crude rate of PD-peritonitis was stable during the study period. Gram-positive bacteria dominated the microbial aetiology, and antibiotic resistance was limited. It is important to monitor the aetiology, incidence, and resistance rates in PD-associated infections, to base empirical antibiotic regimens and facilitate prevention.

Retracted: Risk Factors of Catheter-Related Infection in Unplanned Extubation of Totally Implantable Venous-Accessportsin Tumor Patients

Retracted: Risk Factors of Catheter-Related Infection in Unplanned Extubation of Totally Implantable Venous-Accessportsin Tumor Patients

Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes.

Coronavirus disease 2019 (COVID-19) pandemic disrupted adherences to healthcare-associated infection (HAI) prevention protocols. Herein, we studied the characteristics of all HAIs occurring in critically ill COVID-19 patients. A retrospective, single-center cohort of critical COVID-19 patients during 2021. Microbiological samples were collected if HAI was suspected. We analyzed all factors that could potentially induce HAI, using septic shock and mortality as endpoints. Sixty-four among 161 included patients (39.7%) presented a total of 117 HAIs with an incidence density of 69.2 per 1,000 hospitalization days. Compared to the prior COVID-19 period (2013-2019), the identification of HAI increased in 2021. HAIs were classified into ventilator-associated pneumonia (VAP; n=38), bloodstream infection (n=32), urinary tract infection (n=24), catheter-related infection (n=12), and fungal infection (n=11). All HAIs occurred significantly earlier in the post-COVID-19 period (VAP: 6 vs. 10 days, P=0.045, in 2017 and 2021). Acinetobacter baumannii (39.5%) and Klebsiella pneumoniae (27%) were the most commonly isolated pathogens that exhibited a multidrug-resistant (MDR) profile, observed in 89% and 64.5%, respectively. The HAI factors were laboratory abnormalities (odds ratio [OR], 6.4; 95% confidence interval [CI], 2.3-26.0), cumulative steroid dose (OR, 1.9; 95% CI, 1.3-4.0), and invasive procedures (OR, 20.7; 95% CI, 5.3-64.0). HAI was an independent factor of mortality (OR, 8.5; P=0.004). During the COVID-19 era, the incidence of HAIs increased and MDR isolates remained frequent. A severe biological inflammatory syndrome, invasive devices, and elevated cumulative steroid dosages were related to HAIs. HAI was a significant death factor.

Risk-Adjusted Therapies Yield Equivalent Outcomes for Adolescents and Young Adults (AYAs) Treated for Newly Diagnosed T-Cell Acute Lymphoblastic Leukemia (T-ALL) on Children's Oncology Group (COG) Studies AALL0434 and AALL1231

Introduction Previous clinical trials have reported that adolescent and young adult (AYA) patients treated for T-cell acute lymphoblastic leukemia (T-ALL) have lower disease-free survival (DFS) and overall survival (OS) and increased toxicity as compared to younger patients. Results for the AYA cohort treated on two COG international phase 3 trials for T-ALL are reported here. Patients and Methods AALL0434 enrolled 1562 T-ALL patients (2007-2014) and AALL1231 enrolled 615 T-ALL patients (2014-2019) treated on augmented BFM (ABFM) regimens. AYA patients were defined as age ≥16 years of age (AALL0434: n=226; AALL1231: n = 107). Both studies allowed enrollment up to age 31 years. On AALL0434, participants were randomized to receive escalating dose methotrexate (CMTX) without leucovorin rescue + pegaspargase or high dose MTX (HDMTX) + leucovorin rescue. Intermediate and high-risk patients were randomized to receive or not receive six 5-day courses of nelarabine (Nel). Risk group assignments in AYA vs non-AYA patients can be found in Table 1. On AALL1231, participants were randomized to receive or not receive bortezomib in Induction and Delayed Intensification. Key differences between AALL0434 and AALL1231 ABFM backbones included the use of prednisone in induction in AALL0434 versus dexamethasone in AALL1231, and cranial radiation therapy in the majority of AALL0434 participants versus only in patients with central nervous system involvement in AALL1231. Results On AALL0434, the 4-year DFS for AYA was 81% compared to 84% for those &amp;lt;16 years old (P=0.5965), and OS was 88% and 90% respectively (P=0.3478). AYA patients randomized to CMTX (n=70) had a superior DFS compared to those randomized to HDMTX (n=72) with 4-year DFS 96% versus 78% respectively (P=0.0038). No disadvantage was seen among AYA subjects who received nelarabine versus those who did not, as shown by a 4-year DFS 85% versus 89%, respectively (N=54) (P=0.8116), albeit the sample size was small. On AALL1231, the 4-year EFS for AYA (n=107) was 82.7±3.9% compared to 82.2 ±1.7% for non-AYA (n=508) (P=0.727), and OS was 86.5 ±3.5% and 88.4 ±1.5% respectively (P=0.553). No difference in outcome was seen for AYA patients randomized to receive/not receive bortezomib. Combined outcome data for AALL0434 and AAL1231 demonstrates 4-year EFS for AYA (n=333) of 82.2+2.4% vs 83.9+0.9% for non-AYA (n=1844) (P=0.52) (Figure 1) and OS of 87.5+2.1% vs 90+0.8% respectively (P=0.19). Significant differences in patient characteristics in AALL0434 were higher initial white blood counts (P=0.0004) and higher risk group category (P=0.0002) for AYA patients. There were no significant differences in the AALL0434 AYA cohort compared to younger patients in CNS disease status, race, ethnicity, remission status at end of induction, or day 29 end of induction minimal residual disease (MRD). Toxicity rates were not significantly different in non-AYA vs AYA patients with the exception of upper respiratory infection (9.4% vs 1.8%; P=0.0001) and osteonecrosis (4.8% vs 17.7%; P&amp;lt;0.0001) in AALL0434. Rates of sepsis, catheter-related infection, and other infections were not significantly different between AYA and younger patients in AALL0434. Analysis of patient characteristics and toxicity rates in AALL1231, as well as analysis of the combined toxicity data for AALL0434 and AAL1231, are currently underway and will be presented at the meeting. Conclusion COG AALL0434 and AALL1231 show outstanding overall outcomes for AYA patients with no significant difference in survival between AYA and non-AYA patients on either study, despite differences in the ABFM backbones and the higher risk features seen among the AYA group in AALL0434. There were similar occurrences of therapy-related toxicities for AYA and non-AYA study participants on AALL0434. Despite small numbers, CMTX holds a survival advantage for AYA T-ALL patients, with no survival disadvantage seen among AYA T-ALL patients who received Nel. Bortezomib does not offer significant benefit for AYA T-ALL patients.

209. Validation of a New Risk Stratification System-Based Management for Methicillin-Resistant Staphylococcus aureus Bacteremia: Analysis of a Multicenter Prospective Study

Abstract Background Distinguishing between complicated and uncomplicated Staphylococcus aureus bacteremia (SAB) is therapeutically essential. However, this distinction has limitations in reflecting the various manifestation of SAB. In the light of this, Koujizer et al. proposed a new risk stratification system for metastatic infection in SAB, which involves a stepwise approach to diagnosis and treatment. We tested this risk stratification system in methicillin-resistant SAB (MRSAB) patients. Methods We retrospectively analyzed data of a 3-year multicenter, prospective cohort of hospitalized patients with MRSAB. We classified the patients into three risk groups: low, indeterminate, and high, based on the new system and compared between-group management and outcomes, as well as microbiologic features. Results The demographic and baseline characteristics of patients are shown in Table 1. The most frequent source of MRSAB was central venous catheter-related infection (25.5%), followed by unknown origin (15.3%) and pneumonia (11.1%). Echocardiography was performed in 248 cases (65.3%). Of 380 patients with MRSAB, 6.3% were classified as low-, 7.6% as indeterminate-, and 86.1% as high-risk for metastatic infection (Figure 1). No metastatic infection occurred in the low-, 6.9% in the indeterminate-, and 17.7% in the high-risk groups (P=0.03) (Figure 2A). After an in-depth diagnostic work-up, patients were finally diagnosed as ‘without metastatic infection (6.3%)’, ‘with metastatic infection (15.8%)’, and ‘uncertain metastatic infection (77.9%)’. 30-day mortality increased markedly as the severity of diagnosis shifted from ‘without metastatic infection’ to ‘uncertain’ and ‘with metastatic infection’ (P=0.07) (Figure 2B). In multivariable analysis, independent factors associated with metastatic complications were suspicion of endocarditis in transthoracic echocardiography, clinical signs of metastatic infection, Pitt bacteremia score ≥4, and persistent bacteremia. Figure 1. Flowchart of risk stratification and final diagnosis Figure 2. Outcomes of metastatic infection and 30-day mortality. A, metastatic infection according to the risk stratification, B, 30-day mortality according to the final diagnosis Conclusion The new risk stratification system provides good discrimination in predicting metastatic complications, making it a reliable tool for guiding work-up and management of MRSAB. However, minimizing the number of ‘uncertain metastatic infection’ cases remains an area for improvement. Disclosures All Authors: No reported disclosures

2423. Central venous catheter tip colonization and associated bloodstream infection in severe burn patients

Abstract Background Because severe burn patients are at higher risk for catheter-related infections, routine changes of central venous catheters (CVCs) are commonly performed for them. However, there are limited information on pathogen colonization of the CVC tip and associated bloodstream infections (BSI) in burn patients. Methods In this study, medical records of severe burn patients, in whom routine CVC changes were performed every 7 days, were retrospectively reviewed. The results of CVC tip cultures and concurrently performed blood cultures were investigated. Results A total of 686 CVCs in 214 severe burn patients admitted to the burn intensive care unit were analyzed. A median of 2 CVCs (range: 1–15 CVCs) were inserted in each patient, and each CVC was maintained for a median of 8 days (range: 2–24 days). The median duration of catheterization was 17 days (range: 4–117 days). Of the 686 CVCs, 138 (20.1%) CVC tips were colonized by 150 pathogens (two pathogens in 12 CVCs), and 82 (59.4%) of them accompanied BSIs caused by the same pathogen. Non-flame burn (p &amp;lt; 0.001), higher total body surface area burn (p &amp;lt; 0.001), renal replacement therapy (p &amp;lt; 0.001), and femoral catheter (p &amp;lt; 0.001) were significantly associated with the development of catheter-related BSI in a multivariate analysis. Most cases of tip colonization (81.3%) and BSI (82.9%) were caused by Gram-negative bacteria: Acinetobacter baumannii and Klebsiella pneumoniae were most frequently identified. Conclusion Catheter-related BSI was accompanied in 12.0% of the changed CVCs: nine of ten CVCs might not require routine changing. Therefore, selective CVC changing at higher risk for catheter-related BSI seems to be appropriate rather than routine CVC changing in severe burn patients. Also, source control for burn wounds should be emphasized because most common pathogens of burn wound infection caused CVC tip colonization and BSI. Disclosures All Authors: No reported disclosures

Bacteremia due to Serratia rubidaea in intensive care unit: a case series

IntroductionBacteremia caused by Serratia rubidaea is seldom mentioned in comparison with other Enterobacteriaceae species. It primarily affects immunocompromised patients undergoing invasive procedures. Furthermore, the incidence, clinical features, and microbiological profile of this pathogen in the intensive care unit are rarely described.Case presentationWe present four North African case studies of bacteremia in four young female patients admitted to the intensive care unit for ketoacidosis with a history of diabetes mellitus. All four patients developed catheter-related infections complicated by deep vein thrombosis. The catheter site was femoral in all cases, and the main clinical manifestation was poorly tolerated fever. The pathogen was isolated in multiple peripheral blood cultures (> 4) for each patient, showing a similar profile in all cases: resistance to third-generation cephalosporins and sensitivity to aminoglycosides, piperacillin, fluoroquinolones, and folate-pathway inhibitors. Targeted treatment consisted of a combination of ciprofloxacin 400 mg twice per day and trimethoprim/sulfamethoxazole 400/80 mg thrice per day for all four cases. However, in one case, this regimen was switched to amikacin due to adverse effects. The outcomes were favorable in the majority of cases. The patients described in this study were 21, 66, 22, and 27-year-old North African women.ConclusionMost of the reported cases shared common risk factors and clinical aspects. Notably, a case of thrombosis complicating a catheter infection caused by Serratia rubidaea has not been previously reported in the literature. Furthermore, this bloodstream infection typically affects deeply immunocompromised patients. However, our four cases, admitted to the intensive care unit for ketoacidosis, only had a history of diabetes mellitus.

Frequency of Catheter-Related Bacterial Infection in End Stage Renal Disease Patients on Hemodialysis

Objective: To determine the frequency of catheter related bacterial infections among the patients on hemodialysis due to end stage renal disease.&#x0D; Study Design: Cross sectional study&#x0D; Place and Duration of Study: Department of Nephrology, Sharif Medical City Hospital, Lahore Pakistan, from 6 Months i.e.,Jun 2021 to Oct 2021.&#x0D; Methodology: After meeting the inclusion and exclusion criteria 171 patients were enrolled. Tips of the catheters were removed by the surgeon and transferred to laboratory in a sterile container, while at least two blood culture samples were taken before removing the catheter. Catheter related bacterial infections were noted.&#x0D; Results: In this study the most common catheter related bacterial infection in ESRD cases on hemodialysis was blood stream tunnel infection noted in 48.5% patients followed by, infective endocarditis noted in 28.1%, echo vegetation in 26.3% patients, tunnel infection in 25.1% and exit site infection in 23.4% patients.&#x0D; Conclusion: The most common catheter related bacterial infection in ESRD cases on hemodialysis was blood stream tunnel infection followed by, infective endocarditis, echo vegetation, tunnel infection and exit site infection patients.

Ventriculoperitoneal shunt for tuberculous meningitis-associated hydrocephalus: long-term outcomes and complications

BackgroundHydrocephalus is a frequent complication of tuberculous meningitis (TBM), and ventriculoperitoneal shunt (VPS) has been shown to improve short-term prognosis for patients with TBM-associated hydrocephalus. However, questions remain about long-term prognosis and shunt-related complications. This study aims to provide a comprehensive assessment of both long-term prognosis and shunt-related complications in patients with TBM-induced hydrocephalus who have undergone VPS treatment.MethodsThis retrospective study analyzed the clinical data of TBM patients with hydrocephalus treated with VPS at Peking Union Medical College Hospital between December 1999 and February 2023. Both short-term outcomes at discharge and long-term outcomes during follow-up were examined. Prognosis and shunt-related complications were assessed using the modified Rankin Scale (mRS) and the Activity of Daily Living (ADL) score to evaluate neurological function and autonomic living ability, respectively.ResultsA total of 14 patients with TBM-associated hydrocephalus were included in this study. Of these, 92.9% (13/14) exhibited favorable short-term outcomes, while 57.1% (8/14) showed positive long-term outcomes. Initial results indicated 6 complete recoveries (CR), 7 partial recoveries (PR), and 1 treatment failure. No catheter-related complications were observed initially. Long-term results included 4 CRs, 4 PRs, and 6 treatment failures. A variety of shunt surgery-related complications were noted, including three instances of catheter obstruction, one of incision infection, one of catheter-related infection, one of acute cerebral infarction, and one of transient peritoneal irritation accompanied by diarrhea.ConclusionsVPS appears to be an effective and well-tolerated treatment for TBM-associated hydrocephalus, efficiently alleviating acute intracranial hypertension. Nonetheless, continuous long-term monitoring and proactive management are essential to mitigate the risk of catheter-related complications.

Adverse Events and Infectious Complications in the Critically Ill Treated by Plasma Exchange: A Five-Year Multicenter Cohort Study.

The aim of this study was to determine, in critically ill patients treated with therapeutic plasma exchange (TPE), the incidence of adverse events as well as the incidence of secondary infections and its predictive factors. A multicenter retrospective cohort study of an intensive care population treated with TPE to collect adverse events and infectious complications. The characteristics of patients who developed an infection after plasma exchange were compared with those of patients who did not. Four ICUs of French university hospitals. All adults admitted between January 1, 2015, and December 31, 2019, who received at least one plasma exchange session were included. None. A total of 711 TPE sessions were performed on 124 patients. The most frequent TPE indications were thrombotic microangiopathies (n = 32, 26%), myasthenia gravis (n = 25, 20%), and acute polyradiculoneuropathy (n = 12, 10%). Among the 124 patients, 22 (21%) developed arterial hypotension, 12 (12%) fever, and 9 (9%) electrolyte disturbance during TPE. Moreover, 60 (48%) presented at least one infectious complication: ventilator-associated pneumonia 42, pneumonia 13, bacteremia 18 (of which 6 catheter-related infections) viral reactivation 14. Independent risk factors for ICU-acquired infection were the ICU length of stay (24 vs. 7 d; hazard ratio [HR]: 1.09 [1.04-1.15], p < 0.001) and invasive mechanical ventilation (92% vs. 35%; HR: 16.2 [5.0-53.0], p < 0.001). In critically ill patients treated with TPE, adverse events occurring during the procedure remain moderately frequent and are mostly not life-threatening. Infectious complications, mainly ventilation-associated pneumonia, are frequent in this population. The need of mechanical ventilation and longer ICU stay is associated with an increased risk of infection.

Magnetic Soft Robot for Minimally Invasive Urethral Catheter Biofilm Eradication.

Catheter-related biofilm infection remains the main problem for millions of people annually, affecting morbidity, mortality, and quality of life. Despite the recent advances in the prevention of biofilm formation, alternative methods for biofilm prevention or eradication still should be found to avoid traumatic and expensive removal or catheter replacement. Soft magnetic robots have drawn significant interest in favor of remote control, fast response, and wide space for design. In this work, we demonstrated magnetic soft robots as a minimally invasive, safe, and effective approach to eliminate biofilm from urethral catheters (20 Fr or 5.1 mm in diameter). Seven designs of the robot were fabricated (size 4.5 × 15 mm), characterized, and tested in the presence of a rotating magnetic field. As a proof-of-concept, we demonstrated the superior efficiency of biofilm removal on the model of a urethral catheter using a magnetic robot, reaching full eradication for the octagram-shaped robot (velocity 2.88 ± 0.6 mm/s) at a 15 Hz frequency and a 10 mT amplitude. These findings are helpful for the treatment of biofilm-associated catheter contamination, which allows an increase in the catheter wearing time without frequent replacement and treatment of catheter-associated infections.

Personality traits and peritoneal dialysis patients’ prognosis

Objective Peritoneal dialysis (PD) requires high patient conscientiousness. Therefore, we aimed to investigate the relationship between conscientiousness score and prognosis in PD patients. Methods The ten-item Big Five Personality Inventory’s Chinese version was used to assess the conscientiousness score. Basic clinical information, prior medical history, hematological examination results, the occurrence of the first peritonitis and catheter-related infection, the start of hemodialysis, and the time of renal transplantation were collected. The patients were split into two groups, high and low conscientiousness groups, based on the mean value of the conscientiousness score. The differences in prognostic indicators were compared between groups, and the association between conscientiousness score and prognostic indicators in PD patients was assessed. Results Enrolled PD patients were divided into low conscientiousness group 103 and high conscientiousness group 98. There were significant differences in serum albumin (p = 0.021) and iPTH (p = 0.045) between the two groups. Multivariate Cox regression analysis identified conscientiousness score as an independent risk factor for the development of first peritonitis (HR = 0.558, 95% CI 0.400–0.779, p = 0.001) and first catheter-related infection (HR = 0.544, 95% CI 0.308–0.962, p = 0.036) in PD patients. Conscientiousness score (HR = 2.377, 95% CI 1.109–5.095, p = 0.026) was independently associated with renal transplantation. Conclusion Conscientiousness personality is closely related to the prognosis of PD patients.

Effect of different disinfectants on preventing asymptomatic bacteriuria and catheter-related urinary tract infection: a network meta-analysis

ObjectiveTo analyze the effect of different types of disinfectants for perineum and urethral meatus cleaning in preventing catheter-associated asymptomatic bacteriuria and catheter-associated urinary tract infection (CAUTI).MethodsChinese and English databases were searched to collect randomized controlled trials (RCTs) of different disinfectants for perineum and urethral meatus cleaning to prevent CAUTI, and the positive rates of urine culture with different cleaning methods were contrasted by network meta-analysis.ResultsA total of 18 RCTs were included in this study to analyze the effect of 10 disinfectants in preventing CAUTI. The disinfectants were 0.1% chlorhexidine (CHG), 0.5% CHG, 2% CHG, 0.1% benzalkonium bromide (DBDAB), 0.05% iodophor, 0.5% iodophor, acidic oxidizing potential water (EOW), normal saline (NS), Shehuang lotion, and sterile water. Meta-analysis showed that the positive rates of urine culture in the 0.5% CHG cluster, EOW cluster, 0.5% iodophor cluster, and Shehuang lotion cluster were remarkably lower than that in the 0.1% DBDAB cluster (P &amp;lt; 0.05). The positive rate of urine culture in the 0.5% CHG cluster was remarkably lower than that in the 0.05% iodophor cluster (P &amp;lt; 0.05), whereas the positive rates of urine culture in the 0.5% CHG cluster, 0.5% iodophor cluster, Shehuang lotion cluster, and EOW were remarkably lower than that in the normal saline cluster (P &amp;lt; 0.05). The positive rate of urine culture in the 0.5% CHG cluster and EOW cluster were remarkably lower than those in the sterile water cluster (P &amp;lt; 0.05). The results of the area under the cumulative ranking probability plot (SUCRA) analysis showed that the probability ranking of the preventive effect of different disinfectants was as follows: 0.5% CHG &amp;gt; Shehuang lotion &amp;gt; EOW &amp;gt; 0.5% Iodophor &amp;gt; 2% CHG &amp;gt; 0.1% CHG &amp;gt; 0.05% Iodophor &amp;gt; Sterile Water &amp;gt; 0.1% DBDAB &amp;gt; Saline. Conclusion0.5% CHG, Shehuang lotion, EOW, and 0.5% iodophor can be used to clean the perineum and urethral meatus in patients with indwelling catheters.Systematic review registrationChinese Clinical Trial Registry (ChiCTR), identifier ChiCTR2100052260.

Intraventricular Lavage vs External Ventricular Drainage for Intraventricular Hemorrhage

Intraventricular lavage has been proposed as a minimally invasive method to evacuate intraventricular hemorrhage. There is little evidence to support its use. To evaluate the safety and potential efficacy of intraventricular lavage treatment of intraventricular hemorrhage. This single-blinded, controlled, investigator-initiated 1:1 randomized clinical trial was conducted at Aarhus University Hospital and Odense University Hospital in Denmark from January 13, 2022, to November 24, 2022. Follow-up duration was 90 days. The trial was set to include 58 patients with intraventricular hemorrhage. Prespecified interim analysis was performed for the first 20 participants. Data were analyzed from February to April 2023. Participants were randomized to receive either intraventricular lavage or standard drainage. The main outcome was risk of catheter occlusions. Additional safety outcomes were catheter-related infections and procedure time, length of stay at the intensive care unit, duration of treatment, and 30-day mortality. The main outcome of the prespecified interim analysis was risk of severe adverse events. Efficacy outcomes were hematoma clearance, functional outcome, overall survival, and shunt dependency. A total of 21 participants (median [IQR] age, 67 [59-82] years; 14 [66%] male) were enrolled, with 11 participants randomized to intraventricular lavage and 10 participants randomized to standard drainage; 20 participants (95%) had secondary intraventricular hemorrhage. The median (IQR) Graeb score was 9 (5-11), and the median (IQR) Glasgow Coma Scale score was 6.5 (4-8). The study was terminated early due to a significantly increased risk of severe adverse events associated with intraventricular lavage at interim analysis (risk difference for control vs intervention, 0.43; 95% CI, 0.06-0.81; P = .04; incidence rate ratio for control vs intervention, 6.0; 95% CI, 1.38-26.1; P = .01). The rate of catheter occlusion was higher for intraventricular lavage compared with drainage (6 of 16 patients [38%] vs 2 of 13 patients [7%]; hazard ratio, 4.4 [95% CI, 0.6-31.2]; P = .14), which met the prespecified α = .20 level. Median (IQR) procedure time for catheter placement was 53.5 (33-75) minutes for intraventricular lavage vs 12 (4-20) minutes for control (P < .001). This randomized clinical trial of intraventricular lavage vs standard drainage found that intraventricular lavage was encumbered with a significantly increased number of severe adverse events. Caution is recommended when using the device to ensure patient safety. ClinicalTrials.gov Identifier: NCT05204849.

An Interactive E-learning Platform-Based Training to Improve Intensive Care Professionals' Knowledge Regarding Central Venous Catheter-Related Infections.

Introduction The presence of a central venous catheter (CVC) leads to a high risk for blood infections, which are associated with increases in morbidity, mortality, and costs. This study aims to assess intensive care unit (ICU) nurses' and physicians' knowledge regarding the Centers for Disease Control and Prevention (CDC) guidelines for preventing CVC-related infections before and after an interactive distance education delivered through the e-learning platform Teleprometheus. Materials and methods The study was conducted among 85 nurses and physicians in Nicosia's General Hospital Intensive Care Unit (NGH-ICU) and high dependency unit (HDU). A validated questionnaire was used to assess nurses' and physicians' knowledge. Results Prior to the online interactive distance education, the mean total knowledge score was x̄ = 4.8 (SD = 2.46), while after, the mean total knowledge score increased to x̄ = 8.9 (SD = 2.38) (p<0.001). ICU physicians had a higher mean total knowledge score (x̄ = 10.20) than ICU nurses (x̄ = 8.75) after the intervention. There was no correlation between years of experience in the ICU and the level of knowledge (r = 0.048). The interactive distance education was positively evaluated by the participants, through a questionnaire, specially designed for this study. Discussion The most important findings were that (a) the level of knowledge of the participants improved with a statistically significant difference after the completion of the e-course, (b) the level of knowledge of the participants, after the completion of the e-course, was much higher from other studies, (c) there was no correlation between the years of experience of ICU health professionals and their level of knowledge, and (d) the interactive distance e-course was positively evaluated and satisfied the participants. Conclusion The current study demonstrates that in high-intensity work environments, such as ICUs, adopting e-learning approaches seems morenecessary than ever.

Modified Single Port Laparoscopic Peritoneal Dialysis Catheter Insertion - Initial Experience and Outcome from a Tertiary Care Centre

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are emerging as a major health related issues in developing countries. The increasing numbers require rapid adaptation of existing health-care policies. The number of patients requiring renal care is only bound to increase in coming years with the increasing incidence and prevalence of diabetes. Continuous ambulatory peritoneal dialysis (CAPD) catheter placement is performed on end-stage renal disease (ESRD) patients. There is abundant literature regarding post-operative outcomes and re-operative rates following CAPD. We report our initial experience of modified single port laparoscopic technique of placing CAPD catheters using a single port through the Palmer’s point and discuss our surgical outcomes. Methods: This was a retrospective review (2019-2020) of patients undergoing CAPD catheter placement at SMVD Narayana Superspecialty Hospital. Outcome analysis focused on patient related outcomes, including early (&lt; 30 days) versus late (≥ 30 days) complication and re-operation rates. Results: A total of 30 patients with ESRD, (mean ASA score = 3.3) were included in the study who underwent modified single port laparoscopic (n = 30) CAPD catheter placement (mean follow-up = 180 days). The total complication rate with the procedure was 43%, with re-operation rate of 20%. CAPD catheter non-function occurred in 06 patients (20% of total). CAPD catheter migrations occurred in 03 patients (10% of total). CAPD catheter related infections occurred in 05 patients (16% of total), and 02 required re-operation; 03 patients were treated successfully with culture directed antibiotics. There were 2 deaths during the study period, one due to peritonitis and other due to underlying cardiac disease. There was no surgical mortality in the study group. Conclusion: Although CAPD catheter placement in patients with ESRD are technically un-complicated to accomplish, long term results suggest as many as one in three patients will struggle with some form of catheter malfunction or infection. Our modified technique and the results have led to changes in our CAPD catheter placement technique, as well as the post-operative patient care algorithm.