Central Catheter-related Bloodstream Infection Research Articles

Research progress on the risk factors of peripherally inserted central catheter-related bloodstream infection in elderly patients with malignant tumors

Research progress on the risk factors of peripherally inserted central catheter-related bloodstream infection in elderly patients with malignant tumors

Central venous catheter-related bloodstream infections: Epidemiology and risk factors for hematogenous complications

BackgroundCentral catheter-related bloodstream infections (CRBIs) can lead to severe complications, including suppurative thrombophlebitis, endocarditis, and metastatic infections. While complications due to CRBIs caused by Staphylococcus aureus (SA) are well-known, there are limited data regarding CRBIs caused by other bacteria. MethodsThis 2-year retrospective single-center study of patients with CRBIs from a tertiary care hospital examined the hematogenous complications associated with CRBIs according to patient characteristics, central venous catheter (CVC) types, and causative bacteria. ResultsAll in all, 254 patients with confirmed CRBIs were included; 285 bacteria types were isolated, mainly Enterobacteriaceae (n = 94), coagulase-negative Staphylococci (CNS, n = 82), SA (n = 45), and non-fermenting Gram-negative bacteria (NGB, n = 45). Among the patients, 35 developed at least one hematogenous complication (14 %), including suppurative thrombophlebitis (n = 15), endocarditis (n = 7) and metastatic infections (n = 16). In multivariate analysis, hemodialysis, persistent bacteremia for at least 3 days, and CRBIs caused by SA were associated with increased risk for hematogenous complications, while previous curative anticoagulant treatment was associated with reduced risk. Diabetes, CVC maintenance, and hematogenous complications were associated with increased 3-month mortality. ConclusionA thorough investigation of hematogenous complications should be envisioned in patients with persistent bacteremia, particularly those with SA infections and those on hemodialysis.

Risk factors for the development of peripherally inserted central catheter-related bloodstream infection in neonates: Prospective cohort study

This study aimed to analyze the factors associated with catheter-related bloodstream infection (CRBSI) in newborns undergoing infusion therapy using a peripherally inserted central catheter (PICC). A prospective cohort of 281 newborns who underwent installation of 483 PICCs in a neonatal intensive care unit (NICU) was followed from catheter insertion until 72 h after removal. Risk factors were assessed by analyzing the association between variables using the chi-square test and relative risk (RR) using the Poisson regression model. The significance level was 5%. Most of the patients were preterm infants with inadequate weight, respiratory disorders, and heart disease, but these variables were not associated with CRBSI. There was a significant association between CRBSI and PICC insertion in the upper limbs of newborns who received infusion therapy in the NICU (RR = 2.84; 95% confidence interval 1.02–6.85).

Peripherally inserted central catheter-related bloodstream infections in patients with hematological malignancies: A retrospective 7-years single-center study

ObjectivesWe sought to investigate the nature and incidence of bloodstream infection complications and to identify the risk factors of central catheter-related bloodstream infections (CRBSI). MethodsDuring the study period, 291 consecutive patients with hematological malignancies who underwent PICC placement were retrospectively enrolled. We analyzed the covariates that were specified a priori for their association with CRBSI through multivariate Cox proportional hazards regression models. The association between each predictor and the related outcome was expressed using hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). ResultsOf 391 peripherally inserted central catheter (PICCs) were inserted in 291 patients for a total of 63,714 catheter days during 7 years, with an infection rate of 0.71/1,000 catheter days. Among the patients with hematological malignancies, those with acute leukemia were prone to CRBSI. Having previous bloodstream infection (BSI) (HR 18.139; 95% CI, 8.19-40.174; P < .0001), the number of PICCs insertions (HR 4.695; 95% CI, 1.842-11.967; P = .001) (twice), (HR 6.794; 95% CI, 1.909-24.181; P = .003) (≥3 times) were significantly associated with CRBSI. Not accompanied by chronic comorbidities (HR 0.34; 95% CI, 0.131-0.887; P = .028) and longer duration of PICC use (days) (HR 0.997; 95% CI, 0.994-0.999; P = .008) might be protective factors preventing CRBSI. ConclusionsOur finding suggests that previous BSI and a higher number of PICC insertions are associated with an increased risk of CRBSI. A lack of chronic comorbidities may help prevent CRBSI.

Staphylococcus haemolyticus meningitis and bacteremia in an allogenic stem cell transplant patient

Staphylococcus haemolyticus is a rare cause of bacterial meningitis and most commonly occurs as a nosocomial infection in patients’ post-neurosurgery. We report a patient post-allogenic stem cell transplant, with no prior history of neurosurgical procedures, who developed S. haemolyticus meningitis and bacteremia following central catheter-related bloodstream infection. The patient failed therapy with vancomycin and daptomycin but was successfully treated with a prolonged course of linezolid. We review the pharmacological management of coagulase negative Staphylococcus (CoNS) meningitis, with a focus on the pharmacokinetic properties of vancomycin, daptomycin and linezolid within the cerebrospinal fluid (CSF).

Effects of a Quality Improvement Program to Reduce Central Venous Catheter-Related Infections in Hemodialysis Patients

BackgroundCentral catheter infections are of concern in patients on hemodialysis because of the high risk of catheter-related bloodstream infections, sepsis, and death. Adequate nursing is critical for the prevention of such infections. This study aimed to use the PDCA (plan-do-check-act) method to reduce the incidence of central venous catheter infection using management in the maintenance of central venous catheter in patients on hemodialysis, compared with routine care. MethodsThis pilot study recruited patients on hemodialysis via central venous catheterization at the Blood Purification Center of Ruijin Hospital between November 2017 and November 2018. The patients were randomized to the routine and PDCA groups. All participants received routine nursing. The PDCA group received central venous catheter management by PDCA. The incidence of central venous catheterization-related infections, nursing satisfaction, and quality of life were compared between the two groups. ResultsA total of 122 participants were enrolled in each group. The incidence of central catheter-related bloodstream infection, as the primary outcome, was 0.8 and 8.8 cases per 1000 catheter days in the PDCA and routine groups, respectively (P < 0.001). In addition, as the secondary outcomes, the scores of nursing satisfaction (health guidance, nursing technology, and therapeutic effects) score and quality of life (physiological, psychological, social, and environmental status) were better in the PDCA group than in the routine group (all P < 0.01). ConclusionsThis pilot study suggests that the PDCA cycle model can effectively reduce the incidence of central venous catheter-related infections and improve satisfaction and quality of life in patients on hemodialysis.

Central Catheter-related Bloodstream Infection Rates in Children on Home Parenteral Nutrition.

Reliable venous access is prerequisite for patients receiving long-term parenteral nutrition (PN). Central venous catheters are, however, an important risk factor for the development of potentially lethal complications, including catheter-related bloodstream infection (CRBSI). We have retrospectively assessed the incidence of CRBSIs in children on long-term PN who were treated at the Children's Hospital Zagreb from January 2011 until January 2019 and the cost effectiveness of the use of taurolidine line locks in children at home PN (HPN). During this period 48 children received long-term PN and 24 children were discharged to HPN. The rate of CRBSI 1.15/1000 catheter days in total; 2.35/1000 days in the hospital; and 0.48/1000 days at home. If taurolidine line lock was used every day of PN for children on HPN total costs would exceed existing CRBSI treatment costs >5 times.

MON-127 CLINICO-MICROBIOLOGICAL PROFILE AND OUTCOMES OF CENTRAL CATHETER RELATED BLOOD STREAM INFECTIONS IN HEMODIALYSIS: A SINGLE CENTRE STUDY

Central catheter related blood stream infections (CCRBSI) are serious infections in hemodialysis (HD) and are associated with significant morbidity and mortality. With frequent use of HD catheters and indiscriminate use of antibiotics, there is a rise in CCRBSI incidence with emergence of drug resistance. There is scarce data on incidence, clinical profile and course of CCRBSI in HD catheters. To study the clinical profile, microbiology, outcomes and factors associated with CCRBSI in HD catheters in a tertiary care centre. A prospective study was conducted from 01 Jan, 2017 to 30 Jun, 2018 in our hospital, in which all patients with HD catheters in jugular and subclavian veins were included. All catheters were inserted under USG guidance. Patients were grouped into tunneled catheters (TCC) or non-tunneled (NTCC). The details of patient demography, clinical, biochemical parameters and any immediate complications were recorded. The patients were followed for CCRBSI. Catheters were removed if any complication or when it is no longer required. In case of CCRBSI, catheter duration, microbiology and antibiotic sensitivity were recorded. Statistical analysis was performed using Strata 14. Study was approved by institutional review board. Of the total 461 HD catheters, 384 (83.3%) were NTCC and 77 (16.7) were TCC. The mean age of patients was 42.3 ± 15.0 years with 287 males (62.2%). 112 patients had diabetes (24.2%). 103 (22.3%) patients had previous history of CCRBSI. History of recent sepsis (other than catheter related) was present in 133 cases (28.85%). 49 (43.7%) of diabetic patients had CRBSI compared to 95 (27.2%) of non-diabetics. Complications were seen in 184 (39.91%) cases and 158 (34.2%) catheters were removed in view of various complications. CCRBSI was the commonest complication seen in 144 (31.2%) cases with an incidence of 6.12 per 1000 catheter days. It was 8.80 and 2.49 per 1000 catheter days in NTCC and TCC groups respectively. The median number of catheter days was 30 days (range, 1-120) for NTCC and 180 days (15-180) for TCC. The median number of catheter days for NTCC with complications was 42 days (range, 1-102) and was 22 days (range, 5-120) for NTCC removed electively. Thirty-four (23.6%) cases of CCRBSI were culture positive. The infection free survival at 30, 60, 90, 120 and 180 days for NTCC was 41.6, 7.1, 1.8, 0, 0% and for TCC 91.5, 86.4, 82.1, 75.4 and 39.2% respectively. The organisms causing CCRBSI were gram positive in 17 (Staphylococcus aureus in five, Staphylococcus epidermidis in three, other coagulase negative Staphylococcus in nine and gram negative in 12 (Klebsiella pneumoniae in five, E. coli in two and P. aeruginosa in five). On multivariate analysis, risk factors for CRBSI were presence of underlying systemic sepsis (OR=1.20, 95% CI 1.14 to 1.62, p 0.02), number of catheter days (OR=1.2, 95% CI 1.01 to 1.71, p 0.02) and diabetes (OR=1.22, 95% CI 0.92 to 1.81, p 0.005). CCRBSI were seen in 31.2% cases (6.12 per 1000 catheter days) and were significantly more common in non-tunneled catheter. Gram positive organisms were more common. Presence of underlying sepsis, diabetes and longer duration of catheter use predisposed to CCRBSI.

Impact of two bundles on central catheter-related bloodstream infection in critically ill patients.

ABSTRACTObjective:To evaluate the impact of the implementation of insertion and maintenance bundles on the rates of catheter-related bloodstream infection in an intensive care unit. Method:This is a quasi-experimental, before-and-after study with a non-equivalent control group. During a six-month period, insertion and maintenance bundles for the central venous catheters were implemented. Supervision guidelines were developed to assess compliance with the bundle and catheter characteristics. Results:A total of 444 central catheters corresponding to 390 patients were observed, of which 68.7% were inserted in the unit. The maintenance and insertion bundles reached 62.9% and 94.7% compliance, respectively, and 50.7% of the insertions were supervised. It was possible to observe a 54.5% decrease in the rate of central catheter infection (3.48 vs 1.52 x 1000 days/catheter, p<0.05) when compared with the control group. Conclusion:The simultaneous implementation of insertion and maintenance bundles has a positive impact on the reduction of catheter-related bloodstream infection; therefore it is an efficient alternative to improve the quality and safety of care in high complexity units.

Peripherally inserted central catheter-related bloodstream infection due to Tsukamurella pulmonis: a case report and literature review

BackgroundTsukamurella pulmonis is an aerobic gram-positive and rod-shaped organism that causes central catheter-related bloodstream infections in immunocompromised hosts. However, peripherally inserted central catheter (PICC)-related bloodstream infections due to this organism have not been reported.Case presentationWe describe a case of a 48-year-old man with acquired immunodeficiency syndrome and diffuse large B cell lymphoma who received five courses of chemotherapy including rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone via a PICC. Five days after the last chemotherapy course, he presented with a high fever and shaking chills. His absolute neutrophil count was 4200/μL. Cultures obtained from blood and PICC culture revealed T. pulmonis. The colony count of T. pulmonis grown from PICC culture was 103 colony-forming units. Therefore, he was diagnosed with T. pulmonis bacteremia resulting from PICC-related bloodstream infection. The patient’s condition improved and he became afebrile within 48 h after intravenous administration of cefozopran hydrochloride, which is a fourth generation cephalosporin.ConclusionsPICCs can be associated with T. pulmonis bacteremia, and fourth generation cephalosporins may be effective treatment.

Logistic Regression Analysis the Risk Factors of Peripherally Inserted Central Catheter Related Blood Stream Infection of Tumor Patients

Objective: Our object is to study risk factors of tumor patients’ PICC catheter-related blood stream infection. Method: a retrospective analysis of data of 586 PICC catheterized patients was implemented, a univariate analysis of general data and catheterizing data of tumor patients was then carried out, and data of single factors with statistical significance were incorporated into multi-factor Logistic regression model for analysis. Results: PICC catheter-related blood stream infection occurred to 16 patients, and occurrence rate was 2.73%. Multi-factor Logistic regression analysis results showed that number of puncturing times, positioning method and maintenance frequency were risk factors for tumor patients’ peripherally inserted central catheter catheter-related blood stream infection, and odds risk values were respectively 8.762, 9.253 and 10.324. Conclusion: for tumor patients implanted with peripherally inserted central catheters, using ECG positioning during strict sterile operation and catheterizing process to avoid repeated puncturing and increasing maintenance frequency could effectively reduce occurrence of PICC catheter-related blood stream infection.

The effect of bundle plan on central catheter-related bloodstream infections: A regional hospital experience

The effect of bundle plan on central catheter-related bloodstream infections: A regional hospital experience

Analysis the effect of the comprehensive appraisal of clinical department to improve hand hygiene compliance

to confirm whether the physician is necessary to use the central conduit and piping indwelling reason), from time to time during the execution of a sense of tube division to conduct relevant external audit units and audit the results back to the unit. Results: Early intervention infection cases of bloodstream infection density 2.76 &, central catheter-related bloodstream infection rate was 1.92 &, the use of catheter infection began to establish the number of days on average 5.6 days, a total of 32 strains were isolated, including Gram-positive bacteria accounted for 31.3 %; Gram-negative bacteria accounted for 56.3%; mold accounted for 12.5%; intervention execution of bloodstream infection density 2.15 &, central catheter-related bloodstream infection rate was 1.79 &, the use of catheter infection began to establish the number of days on average 8.2 days, a total of there are 18 strains were isolated, and its species distribution Gram-positive bacteria, Gram-negative bacteria, mold half and 33.3%, 2% Chlorhexidine literature on Gram-positive bacteria and negative bacteria Jieyou inhibitory effect, the proportion of the difference between before and after the intervention, suggesting that patients in the intervention may be less borne bacteria infection Gram-negative bacteria as much. Conclusions: In this study, the combined execution and implementation of infection control measures really care can reduce bloodstream infection density (average decrease of 21.9%), central catheter-related bloodstream infection (average decrease of 6.5 percent), the implementation of infection control measures combined care, first needs the support of the hospital executives, cross-departmental communication to reach a consensus in order to effectively implement, explore medical evidence through empirical experience of implementation of the hospital and patient safety point of view, are supported by an integrated care can reduce hospital infection rates, it is worth actively promoting.

Dramatic increase of central venous catheter-related infections associated with a high turnover of the nursing team

This retrospective study evaluated the impact of new organization during the moving to a new university pediatric hospital on the incidence of central catheter-related blood stream infections (CRBSIs) among children on long-term parenteral nutrition. The study ran from April 2007 to March 2014, starting a year prior to reorganisation of the department of pediatric Hepato-Gastroenterology and Nutrition associated to moving the children to a new hospital in April 2008, and continuing for 6 years following the move. During this time, data from all children hospitalized in this department who received parenteral nutrition (PN) for more than 15 days were analysed. During this 7-years study, 183 children aged 4.6±0.5 years received prolonged PN. Intestinal diseases were the main aetiologies (89%), primarily short bowel syndrome (18.4%), Hirschsprung disease and CIPO (13.5%) and inflammatory bowel disease (13.8%). The mean durations of hospitalization and of PN during hospitalization were, respectively, 70±2.1 and 55.7±3.6 days. During the study period, 151 CRBSIs occurred in 77 children (42% of all patients), i.e. 14.8 septic episodes/1000PN days and 12.0 septic episodes/1000 CVC days. No patient died of a central venous catheter-related infection. However, following the move from the older hospital to the newer one, the rate of CRBSIs significantly doubled, from 3.9/1000 to 8.8/1000 CVC days (p=0.02). During the following 4 years, the incidence of CRBSIs tended to increase between the 2nd and the 5th year after the move: 11.3 (p=NS); 21.4 (p=0.01); 17.3 (p=NS), 20.3/1000 (p=NS) CVC days. We also observed that after evaluations by the Department of Infection Control, nurse training and stabilization of the nursing team, the incidence decreased significantly from 20.3 to 11.1/1000 CVC days during the 6th year after the move (p=0.01). Our results reveal the deleterious impact of the reorganization during the hospital moving on the CRBSI incidence rate, and the possible implication of inexperienced team of nurses.

PP195-SUN THE EFFECT OF OSMOLARITY ON THE GROWTH OF E. COLI AND E. DURANS IN PARENTERAL NUTRITION CONTAINING LIPID

Rationale: The use of the femoral vein for parenteral nutrition (PN) is relatively contraindicated, because of common believe it’s associated with a high risk of contamination at the exit site at the groin, leading to sepsis and a high risk of venous thrombosis. When veins of upper part of the body became occluded, the femoral access is the first choice for long term PN, but such situation is now recognised as indication for intestinal transplantation. The aim was to evaluate safety of modified femoral venous access for HPN. Methods: 20 from 962 HPN patients suffered from intestinal failure presented complete occlusion of upper vena cava on admission (n = 8) or during HPN (n = 12 ), confirmed by phlebography and/or CT scan. 6.6 F Broviac catheter tunnelised to abdominal wall up for over 15 20 cm and then reversed, putting the cuff 5 cm down and exit site 2 cm lower, was inserted under fluoroscopy through femoral vein into right atrium. Exit site infection and central catheter related blood stream infection (CRBSI) rate was retrospectively analysed and compared with observed in the same patients when tunnelised upper vein access was used before occlusion of upper veins or after theirs recanalization. Results: HPN was provided for total of 31 206 days through femoral and 20422 days through subclavian or jugular vein. The CRBSI rate was 1.66/1000 HPN days for upper access and 0.27/1000 HPN days for femoral vein and exit site infection 0.09/1000 HPN days for both. Thrombosis of both femoral veins has occurred in 2 patients, upper veins recanalised after 3 12 years in 4 patients. Conclusion: Modified femoral access is safe. The risk of thrombosis is low with systemic anticoagulation. The reason for lower complications rate may be due to better catheter care performance with growing experience but also due to easier handling by the patients.

Bench-to-bedside review: Challenges of diagnosis, care and prevention of central catheter-related bloodstream infections in children

Central venous catheters (CVCs) are indispensable in modern pediatric medicine. CVCs provide secure vascular access, but are associated with a risk of severe complications, in particular bloodstream infection. We provide a review of the recent literature about the diagnostic and therapeutic challenges of catheter-related bloodstream infection (CRBSI) in children and its prevention. Variations in blood sampling and limitations in blood culturing interfere with accurate and timely diagnosis of CRBSI. Although novel molecular testing methods appear promising in overcoming some of the present diagnostic limitations of conventional blood sampling in children, they still need to solidly prove their accuracy and reliability in clinical practice. Standardized practices of catheter insertion and care remain the cornerstone of CRBSI prevention although their implementation in daily practice may be difficult. Technology such as CVC impregnation or catheter locking with antimicrobial substances has been shown less effective than anticipated. Despite encouraging results in CRBSI prevention among adults, the goal of zero infection in children is still not in range. More high-quality research is needed in the field of prevention, accurate and reliable diagnostic measures and effective treatment of CRBSI in children.

中心静脈カテーテル関連血流感染症の予防

中心静脈カテーテル関連血流感染症の予防

Central Venous Catheter-related Blood Stream Infections in Children Undergoing Hematopoietic Stem Cell Transplant for Primary Immunodeficiency and Other Nonmalignant Disorders

A single-center experience of catheter-related blood stream infections in children undergoing hematopoietic stem cell transplant for primary immunodeficiency is described. The rate of definite central venous catheter infections was 5.31/1000 line days. Staphylococcus epidermidis was the most commonly identified organism. Teicoplanin resistance occurred in 17% of S. epidermidis infections. The central catheter was removed in 21% of infections.

Clinical Efficacy Evaluation of Multi-parameter Real-time Polymerase Chain Reaction for the Central Venous Catheter-related Blood Stream Infection

Clinical Efficacy Evaluation of Multi-parameter Real-time Polymerase Chain Reaction for the Central Venous Catheter-related Blood Stream Infection

Central vascular catheter-related blood stream infections: incidence, associated pathogens and antibiotic sensitivity patterns at a tertiary care hospital in Sri Lanka

From February to November 2006, 100 central venous catheters (CVCs) were collected from patients admitted consecutively to the medical and surgical intensive care units (ICUs) of Colombo South Teaching Hospital (CSTH), who had temperature >38°C. Before removal of the venous catheter, two blood culture samples were collected, one through the central venous line and the other from a peripheral vein. Ethical committee approval and informed consent were obtained before collecting samples. Catheter tips were processed according to a quantitative technique known as the sonication method. The distal 4cm of the catheter tip was placed in brain heart infusion broth followed by sonication and then vortexing. The number of colony forming units (cfu) was determined by serial dilution. The threshold for a significant count was ≥103 cfu/ml. Blood cultures were processed according to guidelines issued by the College of Microbiologists of Sri Lanka. The organisms were then identified by routine microbiological techniques using API strips.