Catheter-related Sepsis Research Articles

Strategies to reduce morbidity following pleurectomy and decortication for malignant pleural mesothelioma.

Pleurectomy and decortication (PD) in malignant pleural mesothelioma has a high morbidity mostly associated with aspiration pneumonia (PNA), deep vein thrombosis (DVT), and foreign catheter sepsis. We instituted four strategies to reduce these complications and report our experience. This was a retrospective review of patients who underwent PD at the University of Pennsylvania between 2015 and 2022. Our patients underwent standard of care PD in addition to tracheostomy and gastrostomy/jejunostomy tube with therapeutic anticoagulation (AC) leading up to surgery. Measured outcomes were postoperative PNA, DVT, and sepsis. The predicted risk of those same outcomes had patients not undergone the interventions was calculated based on the American College of Surgeons (ACS) surgical risk calculator (SRC). A McNemar's test was used to determine whether the risk of having PNA, DVT and sepsis differed between the two subgroups. Fifty-five patients were included in the study. The mean age was 70 years (SD 6.2) with a mean of 21 (SD 19) pack-years of smoking. PNA, DVT, and catheter-related sepsis occurred in 12, four, and seven patients, respectively. Upon using the ACS SRC prediction model of the nonintervention group, PNA, DVT and catheter related sepsis was predicted to occur in 24 (paired data OR 5, 95% CI: 1.4-17.2; McNemar's test p = 0.008), 14 (paired data OR 3.5, 95% CI: 1.15-10.6; McNemar's test p = 0.03), and 17 (paired OR 3, 95% CI: 1.09-8.3; McNemar's test p = 0.04) patients, respectively. Patients undergoing tracheostomy creation, therapeutic AC at the time of diagnosis, and gastrostomy tube placement had a reduced risk of aspiration PNA, DVT, and catheter sepsis.

#5622 DIALYSING THE ELDERLY: IMPACT ON THE PATIENTS’ HEALTH-RELATED QUALITY OF LIFE OUTCOME

Abstract Background and Aims The number of elderly who suffers from end stage renal disease (ESRD) is increasing and hence the dialysis therapy rate. Although dialysis increases life span, the overall benefits to elderly patients is arguably unpredictable due to the multiple comorbidities and functional impairment. Health-related quality of life (HRQOL) has been an important key outcome in the decision-making yet to date, there is no available local data of the dialysis implications on the elderly. Therefore, we aim to study on the impact of dialysis initiation on HRQOL among elderly ESRD patients. Method This is a prospective, multi-centered study conducted from 2021 to 2022 among elderly patients (aged ≥65) who were initiated on maintenance dialysis therapy. Health-related quality of life (QOL) were assessed using Kidney Disease Quality of Life-36 (KDQOL-36) questionnaire within the first month of initiation (baseline) with a follow-up review performed after six months. Results The study included 29 patients with the oldest was 95 years old. 27 patients underwent haemodialysis (HD) and another 2 had peritoneal dialysis (PD). 12 (42%) of them required caregivers with 8 of them had limited mobilization. All of the patients had underlying comorbidities with 25 of them had 3 and more comorbidities. Majority of the patients (n=24) were diabetic with 13 of them had an underlying ischemic heart disease. Their mean baseline haemoglobin and albumin were 8.1 g/dL (±0.3) and 34.2 mmol/L (±1.3) respectively. Only 1 of the study patients was initiated HD via a fistula while the rest were using temporary catheter. At 6 months of follow-up, 5 of the patients died due to cardiovascular events, catheter-related sepsis and one of them resorted to palliative care due to exhausted conventional vascular access. 13 patients out of 22 remained on catheter for HD with 9 patients were still using temporary catheter. We observed improvement in all five domains of HRQOL assessed. The mean score of physical component summary was 33.00% (±10.58) at baseline and 41.22% (±9.54) after 6 months (P = .011). The mean scores for mental component at baseline and 6-month review were 45.53% (±14.78) and 52.95% (±10.57) respectively (p= 0.018). As for symptoms and problems domain, they initially scored 58.59% (±18.71) which increased to 76.61% (±16.05) after 6 months (P = .003). The scores for ‘burden of kidney disease’ and ‘effects of kidney disease’ domains were and 43.49% (±35.62) and 58.21% (±26.74) respectively at baseline with improvements to 58.85% (±31.81) (P = .026) and 76.04% (±24.65) (P = .008) after 6 months. Conclusion Our study showed that dialysis therapy results in significant overall improvement in HRQOL among elderly ESRD patients. The decision for dialysis among this group of patients is nonetheless a complex process with consideration made on individual basis followed by continuous evaluation of its effectiveness, incorporating HRQOL assessment tool in particular.

Comment on: Dialysis catheter-related sepsis resulted in infective endocarditis, septic pulmonary embolism and acute inferolateral STEMI: a case report.

Comment on: Dialysis catheter-related sepsis resulted in infective endocarditis, septic pulmonary embolism and acute inferolateral STEMI: a case report.

Scanning Electron Microscope Examination as an Alternative to Classical Microbiology in the Diagnostics of Catheter-Related Sepsis?

Central venous catheters are essential elements enabling the treatment of intensive care unit patients. However, these catheters are sometimes colonised by both bacteria and fungi, and thus, they may become a potential source of systemic infections-catheter-related bloodstream infections (CRBSI). The identification of the pathogen responsible for CRBSI is a time-consuming process. At the same time, the relationship between the quick identification of the pathogen and the implementation of targeted antibiotic therapy is of key importance for controlling the clinical symptoms of sepsis and septic shock in the patient. Quick diagnosis is of key importance to reduce morbidity and mortality in this group of patients. In our study, we attempted to create a catalogue of images of the most commonly cultured pathogens responsible for CRBSI. An FEI Quanta 250 FEG Scanning Electron Microscope (SEM) was used for measurements. SEM images obtained during the analysis were included in this study. Images of SEM are three-dimensional and comparable to the images seen with the human eye and are a tool used for research and measurement whenever it is necessary to analyse the state of the surface and assess its morphology. The method described in our study will not replace the current procedures recognised as the gold standard, i.e., pathogen culturing, determination of the count of microorganisms (CFU -colony forming units), and assessment of drug sensitivity. However, in some cases, the solution proposed in our study may aid the diagnosis of patients with suspected catheter-related bloodstream infections leading to sepsis and septic shock.

Secondary infections in critically ill patients with COVID-19: A retrospective single-center study.

Patients infected with COVID-19 admitted to the intensive care unit (ICU) may have a higher incidence of developing secondary infections. These infections can further deteriorate the hospital course and increase mortality. Therefore, the objectives of this study were to investigate the incidence, associated risk factors, outcomes, and pathogens associated with secondary bacterial infections in critically ill patients with COVID-19. All adult COVID-19 patients admitted to the intensive care unit requiring mechanical ventilation from October 1, 2020 until December 31, 2021 were screened for inclusion in the study. A total of 86 patients were screened and 65 who met the inclusion criteria were prospectively entered into a customized electronic database. The database was then retrospectively analyzed to investigate secondary bacterial infections. Of the 65 patients included, 41.54% acquired at least one of the studied secondary bacterial infections during the course of their ICU stay. The most common secondary infection (59.26%) seen was hospital-acquired pneumonia followed by acquired bacteremia of unknown origin (25.92%) and catheter-related sepsis (14.81%). Diabetes mellitus (P = <.001), cumulative dose of corticosteroids (P = 0.001), were associated with an increased risk of secondary bacterial infection. The most commonly isolated pathogen in patients with secondary pneumonia was Acinetobacter baumannii. Staphylococcus aureus was the most common organism associated with a bloodstream infection and catheter-related sepsis. The incidence of secondary bacterial infections was high in critically ill patients with COVID-19 and was associated with a longer duration of admission to the hospital and ICU and a higher mortality. Diabetes mellitus and cumulative dose of corticosteroids were associated with significantly increased risk of secondary bacterial infection.

Determine the microbial profile of catheter related sepsis in ICU

Background: Intravenous catheter-related blood stream infections (PVC-BSIs) are one of the common causes of death and illness in hospitals worldwide. Failure to practice adequate aseptic techniques is a leading cause of blood stream infections caused by catheters. The aim of this study to identify the microbiological makeup of catheter-related sepsis in the intensive care unit. Materials and methods: Participants comprised all intensive care unit (ICU) inpatients who had a peripheral venous catheter (PVC) implanted and who showed symptoms of septicemia within 48 hours after PVC implantation. Kirby-Brauer disc diffusion technique was used to test the antibiotic susceptibility of the bacterial isolates, as recommended by the CLSI. Results: Twenty percent of patients had identical bacterial growth in PVC tip cultures and blood cultures, suggesting peripheral venous catheter-related bloodstream infection (PVC- BSI), while twenty-five percent of patients were colonised and thirty percent of patients had bloodstream infections unrelated to the catheter. For one-quarter of patients, (25%) no organism development was identified. Among the 20 patients diagnosed with PVC-BSI, 8 (40%) were found to have infections caused by Staphylococcus aureus, 4 (20%) by Klebsiella species, 4 (20%) by CONS, 2 (10%) by Enterococcus species, and 1 (5%) by both Acinetobacter and Pseudomonas species.

S2840 Hepatic Tuberculoma Caused by Mycobacterium Fortuitum: A Rare Case Diagnosed by EUS-FNA

Introduction: Mycobacterium fortuitum is a type of nontuberculous mycobacteria belonging to a group classified as Rapidly Growing Mycobacteria (RGM), along with Mycobacterium abscessus and Mycobacterium chelonae. M. fortuitum is predominantly associated with skin, soft tissue, and surgical-wound infections. Catheter-related sepsis and disseminated disease can also occur. Isolated liver involvement by atypical mycobacterial infection is exceedingly rare. Here we describe a case of M. fortuitum presenting as an asymptomatic liver mass. Case Description/Methods: A 67-year-old male was referred for endoscopic ultrasound (EUS) to evaluate a gastric body subepithelial lesion (SEL) and a 3 cm incidental liver mass. He was asymptomatic. Percutaneous CT-guided biopsy was performed, but pathologic results were nondiagnostic. Patient was thus referred for EUS to evaluate the gastric SEL and determine if the liver mass represented metastasis. A 14 by 4 mm elongated intramural hypoechoic mass arising from the muscularis propia highly suggestive of a leiomyoma or GIST was identified. A heterogeneous mass with cystic spaces and echogenic foci in the left liver lobe measuring 27 by 20 mm was sampled using a 22g FNA needle. Pathology revealed granulomatous inflammation with necrosis. An AFB stain was positive for acid fast bacilli. PCR analysis of the specimen detected M. fortuitum DNA. Patient was treated with levofloxacin 750 mg daily plus trimethoprim and sulfamethoxazole (Septra DS) 800 mg - 160 mg twice daily. Follow-up contrast-enhanced MRI revealed complete resolution of liver lesion after 3 months of antibiotics. Discussion: Isolated liver involvement by nontuberculous mycobacteria is uncommon, usually asymptomatic, and its diagnosis can easily be missed or mistaken. We report the first case of a hepatic tuberculoma caused by M. fortuitum diagnosed by EUS-FNA. Precise and accurate recognition by a minimally invasive technique via EUS-FNA resulted in prompt treatment and resolution of the disease.

Molecular analysis of oxa-48 producing k. pneumoniae strains isolated from patients with catheter-associated sepsis.

K. pneumoniae is an important cause of hospital and community-acquired infections. In particular, carbapenem-resistant strains of K. pneumoniae spread globally, increasing the public health risk. This study aims to sequence and phylogenetically analyze K. pneumoniae strains isolated from blood cultures of patients in intensive care units in our hospital. In this study, blood samples were collected from patients with catheter-related sepsis. Culture, biochemical, antibiotic susceptibility, and molecular tests were performed as microbiological analyses. Twenty-four K. pneumoniae strains showing multidrug resistance by isolating 276 K. pneumoniae were included in the study. It was determined that they showed the highest resistance against Ampicillin, Amoxicillin/ Clavulanic Acid, Ceftazidime, and Ceftriaxone. The comparison determined that K. pneumoniae isolates from different countries isolated from blood cultures had closeness and distance in OXA-48. After multilocus sequence typing, all of our 24 K. pneumoniae isolates were determined to be ST11.

S1027 Short Bowel Syndrome Is Associated With Increased Morbidity and Health-Care Utilization but Not Mortality in Patients Hospitalized for Crohn’s Disease Flare: Analysis From National Inpatient Database

Introduction: Crohn’s disease is an inflammatory disorder of the gastrointestinal tract that can affect any part of the tract, ranging from the mouth to the perianal area. Depending on the location and severity of inflammation, small bowel resections might be necessary to control disease. Short Bowel Syndrome (SBS) is a common complication arising after extensive bowel resection, especially in medically refractory Crohn’s disease. These patients are at a high risk of adverse outcomes when hospitalized. The aim of this study was to analyze the impact of SBS for patients hospitalized for Crohn’s disease flare. Methods: All adult hospitalized patients from January 2016 to December 2019 in the nationwide inpatient sample (NIS) were captured. The sample population included all patients with a primary diagnosis of Crohn’s disease using ICD-10 codes (International Classification of Diseases, tenth edition). We then identified patients with a secondary diagnosis of SBS. The Crohn’s disease population was divided into patients with SBS (study group) and without SBS (control group). Linear regression was used for comparing continuous variables and Chi-square tests for categorical variables. Morbidity, mortality and healthcare utilization were analyzed using multivariate logistic and linear regression models where appropriate. Results: The sample size included 374,745 patients admitted for Crohn’s disease flare, of which 99.75% did not have underlying SBS while 0.25% did. Study group had a higher incidence of Hospital-acquired pneumonia (Adjusted OR (aOR) =2.93), Catheter related blood-stream infection (aOR=7.71) and Sepsis (aOR=2.99), all with p< 0.05 or less. There was also a higher risk of hyponatremia (aOR=1.79) and Iron-deficiency anemia (aOR=1.68) in the study group. No difference was noted in venous thromboembolism rates. The adjusted mean change in hospitalization charge was $44,359 and mean change in length of stay was 6.35 days in study group vs control. Mortality though was higher in SBS group, this lost significance following multivariate analysis. (Figure) Conclusion: SBS increases the risk of infections, electrolyte deficiency and anemia in patients admitted for Crohn’s disease flare but venous thromboembolism and mortality rates of both groups remains similar. This proves to be a huge burden on both the patients and the healthcare. The outcomes of patients with SBS could be greatly improved by more effective prevention of these complications, and treatment of high-risk Crohn’s patients more vigilantly. (Table) Table 1. - In-hospital outcomes Variables Crohn’s with no SBS* (Control) Crohn’s with SBS* (Study) p-value Hospital acquired pneumonia 0.78% 3.36% < 0.001 Adjusted odds ratio1=2.93 0.042 Catheter related blood-stream infection 0.1% 1.68% < 0.001 Adjusted odds ratio1=7.71 0.005 Sepsis 1.19%% 5.88% < 0.001 Adjusted odds ratio1=2.99 0.006 Septic shock 0.51% 2.52% 0.002 Adjusted odds ratio1 = 2.36 0.15 Hyponatremia 6.07% 16.81% < 0.001 Adjusted odds ratio1=1.79 0.02 Venous thrombo-embolism 0.77% 2.52% 0.02 Adjusted odds ratio1=1.84 0.29 Iron deficiency anemia 12.49% 31.09% < 0.001 Adjusted odds ratio1=1.68 0.045 Mean total hospitalization charge ($) $44,911 $100,203 < 0.001 Mean change in charges1 = $44,359 < 0.001 Mean length of stay (days) 4.78 12.53 < 0.001 Mean change in length of stay1 = 6.35 < 0.001 In-hospital mortality 0.2% 0.84% 0.11 Adjusted odds ratio1=2.44 0.39 *SBS- Short Bowel Syndrome 1Adjusted for Age, Sex, Race, income, hospital characteristics and Elixhauser score. Figure 1.: Graph 1.

Obligate aerobic, gram-positive, weak acid-fast, nonmotile bacilli, Tsukamurella tyrosinosolvens: Minireview of a rare opportunistic pathogen.

Tsukamurella species are obligate aerobic, gram-positive, weak acid-fast, nonmotile bacilli. They are found in various environments, such as soil, water, sludge, and petroleum reservoir wastewater, and belong to the order Actinomycetales. In 2016, there was a reclassification of species within the genus Tsukamurella, merging the species Tsukamurella tyrosinosolvens (T. tyrosinosolvens) and Tsukamurella carboxydivorans. Tsukamurella species are clinically considered to be a rare opportunistic pathogen, because most reported cases have been related to bacteremia and intravascular prosthetic devices and immunosuppression. To date, it has been isolated only from human specimens, and has always been associated with clinical disease; human infections are very rare. Reported infections have included pneumonia, brain abscesses, catheter-related bloodstream infections, ocular infections, bacteremia, and sepsis presenting with septic pulmonary emboli in patients who are immunocompromised. To date, there is no commercially available test for identification. On the other hand, sequence-based identification, including matrix-assisted laser desorption ionization time-of-flight mass spectrometry, is an alternative method for identifying clinical isolates that are either slow growers or difficult to identify through biochemical profiling. The golden standards for diagnosis and optimal management still remain to be determined. However, newer molecular biological techniques can provide accurate identification, and contribute to the appropriate selection of definitive therapy for infections caused by this organism. Combinations of several antimicrobial agents have been proposed for treatment, though the length of treatment for infections has yet to be determined, and should be individualized according to clinical response. Immunocompromised patients often experience severe cases due to infection, and life-threatening T. tyrosinosolvens events associated with dissemination and/or failure of source control have occurred. Favorable prognoses can be achieved through earlier identification of the cause of infection, as well as successful management, including appropriate antibiotic therapy together with source control. Further analyses of similar cases are required to establish the most adequate diagnostic methods and treatment regimens for infections.

Secondary infection in COVID-19 critically ill patients: a retrospective single-center evaluation

BackgroundPatients infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2) can develop severe illness necessitating intensive care admission. Critically ill patients are susceptible for the development of secondary bacterial infections. Due to a combination of virus- and drug-induced immunosuppression, critically ill patients with corona virus disease 2019 (COVID-19) may even have a higher risk of developing a secondary infection. These secondary infections can aggravate the severity of illness and increase the risk of death. Further research on secondary infections in COVID-19 patients is essential. Therefore, the objective of this study was to investigate the incidence and associated risk factors of secondary bacterial infections and to identify the most common groups of pathogens in critically ill COVID-19 patients.MethodsThis mono-center, retrospective observational cohort study was performed at the intensive care unit (ICU) of the Jessa Hospital, Hasselt, Belgium. All adult COVID-19 patients admitted to the ICU from 13th March 2020 until 17th October 2020, were eligible for inclusion in the study. Data from the resulting 116 patients were prospectively entered into a customized database. The resulting database was retrospectively reviewed to investigate three types of secondary bacterial infections (secondary pneumonia, bloodstream infections of unknown origin, catheter-related sepsis).ResultsOf 94 included patients, 68% acquired at least one of the studied secondary bacterial infections during their ICU stay. Almost two thirds of patients (65.96%, n = 62) acquired a secondary pneumonia, whereas 29.79% (n = 28) acquired a bacteremia of unknown origin and a smaller proportion of patients (14.89%, n = 14) acquired a catheter-related sepsis. Male gender (P = 0.05), diabetes mellitus (P = 0.03) and the cumulative dose of corticosteroids (P = 0.004) were associated with increased risk of secondary bacterial infection. The most common pathogens detected in the cultures of patients with secondary pneumonia were Gram-negative bacilli. Bacteremia of unknown origin and catheter-related sepsis were mostly caused by Gram-positive cocci.ConclusionThis study confirms that the incidence of secondary bacterial infections is very high in critically ill COVID-19 patients. These patients are at highest risk of developing secondary pneumonia. Male gender, a history of diabetes mellitus and the administration of corticosteroids were associated with increased risk of secondary bacterial infection.

Foreign body abscess caused by a remaining piece of an umbilical arterial catheter in a 3-year old girl

Since the 1960s umbilical catheterization has been a common method for vascular access, both arterial [1] and venous [2], in the sick newborn. Increased utilization of this procedure has demonstrated a number of complications including catheter related sepsis [3], thrombotic and embolic events [5], hemorrhage [1], limb ischemia, dissection of vessels, hypertension, congestive heart failure, visceral gangrene, necrotizing enterocolitis and liver abscesses [4]. Abscesses caused by umbilical arterial catheters (UAC) however are very rare in comparison to other complications. Most of the complications were reported during or just after the removal of the umbilical arterial catheter. We would like to present this very uncommon case of a late onset abscess lateral to the bladder caused by a remaining piece of a transected UAC in a 3-year old girl.

143 Intestinal Failure: Epidemiology, Catheter Related Sepsis and Challenges

Abstract Background The aforementioned service provides specialist intestinal failure care to patients in Leicestershire and surrounding counties. Aim To study the epidemiology of IF cases referred to the service &amp; review outcomes particularly the indications and delivery of parenteral nutrition (PN). To review catheter-related sepsis (CRS) rates and identify areas for improvement. Method Service data from January 2016 to November 2017 was analysed retrospectively. Descriptive and inferential statistical analysis was carried out. Chi-square/ Fisher Exact tests were used to identify significance on categorical data and non-parametric settling was used for qualitative data analysis. Results 365 patients were referred to the service from January 2016 to November 2017. 58% patients had grade I intestinal failure. 34% and 24% referrals were made by the colorectal and hepato-pancreato-biliary (HPB) units respectively. Gut rest (27%) and bowel obstruction (25%) were the most common indications for nutritional support. Duration of PN requirements varied greatly, but most patients (39%) patients required it for up to 7 days. Single lumen PICC line (64%) and cephalic vein (54%) were the most commonly used catheter and site of vascular access respectively. Chronicity of IF and number of vascular catheters required to provide PN were significantly associated with rates of CRS. Conclusions CRS was found to be statistically significantly associated with chronic IF and number of vascular access catheters required to provide PN. Cost implication and morbidity of CRS could be analysed further to identify other ways to provide safer and cost-efficient parental nutrition for patients with intestinal failure.

Comparison of Macrophage Immune Responses and Metabolic Reprogramming in Smooth and Rough Variant Infections of Mycobacterium mucogenicum.

Mycobacterium mucogenicum (Mmuc), a rapidly growing nontuberculous mycobacterium (NTM), can infect humans (posttraumatic wound infections and catheter-related sepsis). Similar to other NTM species, Mmuc exhibits colony morphologies of rough (Mmuc-R) and smooth (Mmuc-S) types. Although there are several case reports on Mmuc infection, no experimental evidence supports that the R-type is more virulent. In addition, the immune response and metabolic reprogramming of Mmuc have not been studied on the basis of morphological characteristics. Thus, a standard ATCC Mmuc strain and two clinical strains were analyzed, and macrophages were generated from mouse bone marrow. Cytokines and cell death were measured by ELISA and FACS, respectively. Mitochondrial respiration and glycolytic changes were measured by XF seahorse. Higher numbers of intracellular bacteria were found in Mmuc-R-infected macrophages than in Mmuc-S-infected macrophages. Additionally, Mmuc-R induced higher levels of the cytokines TNF-α, IL-6, IL-12p40, and IL-10 and induced more BMDM necrotic death. Furthermore, our metabolic data showed marked glycolytic and respiratory differences between the control and each type of Mmuc infection, and changes in these parameters significantly promoted glucose metabolism, extracellular acidification, and oxygen consumption in BMDMs. In conclusion, at least in the strains we tested, Mmuc-R is more virulent, induces a stronger immune response, and shifts bioenergetic metabolism more extensively than the S-type. This study is the first to report differential immune responses and metabolic reprogramming after Mmuc infection and might provide a fundamental basis for additional studies on Mmuc pathogenesis.

Clinical presentation and management of leuconostoc bacteremia in patient with prolonged ICU stay: Case report

A 54 years old female came to emergency with the complaints of pain in abdomen, recurrent vomiting, abdominal distention and not able to pass flatus since two days. Patient was managed in intensive care unit and was empirically put on Meropenem and Targocid. She developed multiple episodes of loose motion, and stool culture was sent which was positive for Clostridium defficle. Therefore, patient was put on Vancomycin and Metrogyl. The blood cultures reported growth of Leuconostoc pseudomesenteroides. Infection with Leuconostoc may cause fever, intravenous catheter-related sepsis, bacteremia, abdominal pain, gastroenteritis, colitis or meningitis. To summarize this rare organism which is most commonly seen in immunocompromised patients, was isolated in a previously healthy individual, post Vancomycin therapy with prolonged ICU stays.

Gangrenous Ischemic Colitis Due to Acute Promyelocytic Leukaemia, and Myelofibrosis in a 62-year-old Man Suffering from ESRD; Case Report

Introduction and importanceIschemic colitis, also rare, is the most common ischemic pathology of the digestive system. It usually affects the ageing population and those suffering from end-stage renal disease (ESRD), hypertension, and heart failure. Its incidence varies from 4.5 to 44 cases per 100,000 annually.Case presentationWe have reported a case of gangrenous colitis in a 62-year-old man suffering from acute promyelocytic leukaemia (APL) and myelofibrosis. He had hypertension and ESRD due to obstructive uropathy from seven years ago in his past medical history. His recurrent constitutional symptoms and persistent leukocytosis of more than 20,000 in μL was always treated as catheter-related infection or sepsis until acute abdomen emerged. The surgical team encountered a vast gangrenous right hemicolon. The leukocytosis did not resolve. Thus, the haematological investigations proved APL with myelofibrosis. The affected colon was free of leukemic infiltration.Clinical discussionHypoperfusion due to ESRD and hemodialysis accompanied with malignancy induced hypercoagulative state provided a context in which small vessels of the bowel were obstructed.ConclusionMalignancies are associated with thrombophilia, and colonic involvement is not always related to lymphatic infiltration in leukaemia patients.

Efficacy and safety of 1.5% aqueous olanexidine gluconate antiseptic solution compared to 1% alcoholic chlorhexidine for the prevention of intravenous catheter-related infections (Apollo study): a protocol for a randomised controlled trial

IntroductionChlorhexidine alcohol (1.0%–2.0%) is currently recommended as a skin disinfectant to be used prior to catheterisation for preventing catheter-related infections. However, chlorhexidine alcohol has various side effects and has little antibacterial effect on methicillin-resistant Staphylococcus aureus (MRSA). Therefore, MRSA remains a concern for catheter-related bloodstream infection (CRBSI) prevention. Olanedine, containing 1.5% olanexidine gluconate in aqueous solution, was developed in Japan in 2015 and is structurally similar to chlorhexidine. Olanexine has been used as a disinfectant against various gram-positive and gram-negative bacteria and MRSA. This study aims to compare the efficacy of 1.5% aqueous olanexidine gluconate and 1% chlorhexidine alcohol as skin antiseptics for the prevention of catheter-related infections.Methods and analysisThis Apollo study is an open-label, multicentre, non-inferiority, two-arm, parallel-group, randomised controlled trial conducted at 21 intensive care units (ICUs) and high-care units (HCUs) in Japan. All patients scheduled to be admitted to the ICU or HCU of a facility participating in this study, who require central venous catheter insertion are eligible. Eligible patients will be assigned to either the 1.5% aqueous olanexidine gluconate or 1% chlorhexidine alcohol group by randomisation in a ratio of 1:1 with stratification by centres. The antibacterial agents are to be used as a skin disinfectant before and during catheter placement. The primary endpoint is the proportion of catheter-related infections, defined as a composite of catheter-related sepsis without bacteraemia and CRBSI. A total of 1980 patients will be included in this study.Ethics and disseminationThis clinical trial was approved by the Institutional Review Board of Jichi Medical University and the ethics committees of the participating institutions. The study results will be disseminated through conferences, peer-reviewed publications and meetings with interested parties.Trial registration numberUniversity hospital Medical Information Network (registration ID: UMIN000042343). This registration includes all items in the WHO Trial Registration Data Set.Protocol versionThis protocol corresponds to the original protocol version 5.

Intestinal Failure: Epidemiology, Catheter-Related Sepsis and Challenges.

BackgroundThe Leicestershire intestinal failure team (LIFT) service provides specialist intestinal failure care to patients in Leicestershire and surrounding counties.AimsTo study the epidemiology of intestinal failure (IF) cases referred to the service and review outcomes particularly the indications and delivery of parenteral nutrition (PN). To review catheter-related sepsis (CRS) rates and identify areas for improvement.MethodsService data from January 2016 to November 2017 was analysed retrospectively. Descriptive and inferential statistical analysis was carried out. Chi-square/Fisher Exact tests were used to identify significance on categorical data and non-parametric settling was used for qualitative data analysis.ResultsA total of 365 patients were referred to the service from January 2016 to November 2017. 58% patients had grade I intestinal failure. 34% and 24% referrals were made by the colorectal and hepato-pancreato-biliary (HPB) units, respectively. Gut rest (27%) and small bowel obstruction (25%) were the most common indications for nutritional support. Duration of PN requirements varied greatly, but most patients (39%) required it for up to seven days. Single lumen PICC line (64%) and cephalic vein (54%) were the most commonly used catheter and site of vascular access, respectively. Chronicity of IF and number of vascular catheters required to provide PN were significantly associated with rates of CRS.ConclusionCRS was found to be statistically significantly associated with chronic IF and number of vascular access catheters required to provide PN. Cost implication and morbidity of CRS could be analysed further to identify other ways to provide safer and cost-efficient parental nutrition for patients with intestinal failure.

PGI24 Complications and Healthcare Utilization in Adult Patients Receiving Parenteral Support for Intestinal Failure Associated with Short Bowel Syndrome

A multinational survey was conducted to assess treatment-related complications and healthcare utilization of patients with short bowel syndrome and intestinal failure (SBS-IF) receiving parenteral support (PS). This online, cross-sectional survey was conducted in adults from France, Germany, Italy, the UK, and the USA with a self-reported physician’s diagnosis of SBS-IF and receiving PS. Patients were recruited using patient advocacy organizations (PAOs), healthcare providers (HCPs), market research databases, online patient panels and social media. Participants were asked to report complications associated with PS treatment for SBS-IF and associated healthcare utilization in the past year. Data were summarized with descriptive statistics (mean ± SD, median [IQR], or percentage). Patients (N=181, aged 52.0±15.1 years, 56.9% women, and 47.0% with stoma) were recruited primarily from PAOs and HCPs (57% and 29%, respectively). Nearly one-third of patients (30.4%) reported no side effects or complications; 21.0% of patients reported liver damage or liver-related complications; line infections (17.1%) and catheter-related sepsis (15.5%) were also reported. Patients primarily saw gastroenterologists (84.5%) and dieticians or nutritionists (50.3%) for the management of SBS. In the past year patients had a mean of 1.5 (±3.1) hospital admissions (median, 1.0 [IQR, 0.0–2.0]) and 1.1 (±3.0) visits to emergency departments (median, 0.0 [IQR, 0.0–1.0]). Patients reported a mean of 9.2 (±12.4) procedures (median, 5.0 [IQR, 2.0–10.0]) and 0.7 (±1.8) surgeries (median 0.0 [IQR, 0.0–1.0]). Whilst 44.8% of patients reported no difficulties accessing care for SBS, 26.5% reported that it was hard to find an SBS specialist near them. Common complications of PS experienced by patients with SBS-IF were liver- and catheter-related. In the previous year, patients reported multiple procedures, at least one hospital admission and one emergency department visit. A quarter of patients reported that it was hard to find HCPs specializing in SBS locally.

Association of Nursing Practice Environment on reported adverse events in private management hospitals: A cross-sectional study.

To examine the relationships between nurses' perceptions of their practice environment, other working conditions and reported adverse events in two private management hospitals. Patient safety is influenced by knowledge, available resources and the context in which nursing care is provided. In this sense, it has been found that certain work environments (e.g., workload, nurse turnover level, patient-to-nurse ratio, nurse staffing, nurse manager ability) influence patient outcomes. The association between nursing practice environment and reported adverse events has not been explored in private management hospitals. A cross-sectional study. The STROBE was selected as the checklist in this study. A total of 219 nurses were included in the study. This study was conducted from June 2018-June 2019 in Spain. Data were collected through questionnaires focusing on work conditions, reported adverse events (falls, medication errors, catheter-related sepsis and pressure ulcer) and Practice Environment Scale of the Nursing Work Index. Binary logistic regression analysis was performed to determine the factors influencing the occurrence of errors. Nurses reported poor perception of the professional environment, and 62.1% reported having made at least one error in the previous year. Manager support and leadership and nurse-physician relations were the most favourable aspects of work environment. Medical-surgical units, rotating in the same shift and favourable work environment, were associated with more reporting of adverse events. The factors of nursing practice (hospital area workload, staff rotating and perception of work environment) associated with reporting adverse events can be worked upon from the organisation and provided an opportunity for safety culture improvement and safer healthcare services. Improving the nurse work environment may reduce adverse patient events in private management hospitals.