Central Intravascular Catheters Research Articles

Risk of catheter-associated bloodstream infection by catheter type in a neonatal intensive care unit: a large cohort study of more than 1100 intravascular catheters

The aim of this study was to evaluate the risk of catheter-associated bloodstream infection (CABSI) among different catheter types using a large prospective database in the neonatal intensive care unit (NICU) of a tertiary care centre in Switzerland. We included all neonates admitted to the NICU with at least one central intravascular catheter inserted between January 2017 and December 2020. We used marginal Cox model to determine the risk of CABSI among different catheter types. A total of 574 neonates and 1103 intravascular catheters were included in the study: 581 venous umbilical catheters, 198 arterial umbilical catheters and 324 peripherally inserted central catheters (PICCs). We identified 17, four and four CABSIs in neonates with venous umbilical catheters, arterial umbilical catheters and PICCs, respectively. The risk of CABSI increased after two days of umbilical catheter maintenance. Using univariable Cox models, and adjusting for sex and gestational age, we observed a similar CABSI risk between venous and arterial umbilical catheters (HR 0.57; 95% CI 0.16e2.08). Birth weight was associated with CABSI, with higher weight being protective (HR 0.37, 95% CI 0.16e0.81). Strategies aimed at reducing umbilical catheter dwell time, particularly in low and very low birth weight neonates, may be effective in decreasing the incidence of CABSI in this population.

Leuconostoc lactis Bacteremia and Neutropenic Fever

Abstract The epidemiology of bacteremic infections in neutropenic patients has shifted from a previous majority involving gram-positive cocci to an increasing preponderance of gram-negative Enterobacteriaceae species and Pseudomonas aeruginosa. Recommended empiric antimicrobial treatment regimens include an antipseudomonal β-lactam or carbapenem agent while considering risk factors for the possibility of extended-spectrum β-lactamase– or carbapenemase-producing organisms. The addition of vancomycin is generally reserved for the chance of gram-positive cocci infection, principally in patients with central intravascular catheters or soft tissue infections. Persistent or breakthrough bacteremia despite receiving this glycopeptide drug should prompt the clinician to contemplate not only the possibility of vancomycin-resistant enterococci, but also other organisms that possess intrinsic resistance vancomycin, including Leuconostoc species.

Prognostic Value of Variations in Serum Biomarkers and Prognostic Scores Values Between Admission and Second Day in Intensive Care Unit Septic Patients.

ObjectiveTo determinate the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) changes during the first two days of admission to the ICU with sepsis and/or septic shock, and to compare it with changes in Acute Physiology And Chronic Health Evaluation II (APACHE-II) and Sepsis-related Organ Failure Assessment (SOFA) prognostic scores.MethodsA single-center prospective observational study was performed. Fifty consecutive patients admitted to the ICU, diagnosed of severe sepsis/septic shock were included. We considered risk factors for infection: diabetes mellitus, chronic obstructive pulmonary disease (COPD), previous antibiotic treatment, central intravascular catheter, bladder catheter, active neoplasia.ResultsMedian aged 67(52-75) years with median APACHE-II 19(14-25) points and SOFA scores 7(5-11) points on admission, and 28-day mortality of 42%. When we studied the relationship between mortality and the changes between the day of admission and the second day of the variables studied, we found that APACHE-II (p = 0.001) and SOFA (p = 0.002) between admission and second day raised significantly in no survivors, with no significant changes in CRP and PCT. Multivariate analysis showed that mortality was significantly associated to changes in SOFA score (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.18-3.86) and to the presence of one or more risk factors for infection (OR, 6.01; 95% CI, 1.01-35.78) but not with PCT changes. Mortality was also related to the variations between the day of admission and the fifth day on APACHE-II (p = 0.002), SOFA (p < 0.001) and PCT (p = 0.012).ConclusionsChanges in SOFA and APACHE-II scores between admission and second day in ICU septic patients are more sensitive mortality predictors than the observed changes in CRP and PCT values. Changes in PCT levels between the day of ICU admission and the fifth day are significantly related to mortality and may be useful as an additional marker in patient outcome.

The importance of microscopic examination of the lungs in decedents with sustained central intravascular catheters: a nine-case series.

Indwelling intravascular catheters provide convenient access to healthcare personnel and also recreational intravenous drug users who inject suspensions of oral medications. A nine-case series of autopsies of clinically stable decedents with indwelling catheters and sudden death is herein presented. Pulmonary histologic findings were consistent with intravenous administration of oral medications in all cases. In eight, the mechanism of death was directly attributed to occlusive vascular embolization of foreign material, with or without contribution of acute drug toxicity. In one, the mechanism of death was solely attributed to acute drug toxicity. Acute, massive embolization of foreign material may explain sudden death by vascular obstruction, whereas chronic repeated injections lead to obliteration of the pulmonary vasculature, increased pulmonary vascular resistance, and cardiac failure. Therefore, a complete autopsy with histologic examination of the lungs and toxicology testing is recommended in patients with indwelling catheters to determine the cause and mechanism of death.

Study of microbial flora in indwelling catheter, drains, CIVP lines and endotracheal tubes

Background: The use of indwelling devices like Urinary catheter, Drain tubes, Central intravascular catheter, endotracheal tubes has become routine practice in the medical field. Localized or systematic infection are frequent complications associated with extensive use of these devices, requiring its removal or may even be associated with life threatening consequences. Materials and Methods: Microbiological study was carried out among all the indwelling device samples received from 20th April 2011 to 19th April 2012 at Clinical Microbiology Laboratory, Department of Pathology, Kathmandu Medical College Teaching Hospital. Results: Out of total 205 samples (125 Foley’s catheters, 31 drain tubes, 29 central intravascular catheter lines and 20 endotracheal tubes) received during this study period, 38.4% urinary catheters, 23.33% drain tubes, 6.9% central intravascular catheter lines and 40.0% endotracheal tubes were found to have significant growth. Escherichia coli and Klebsiella were found to be the commonest organisms. Conclusion: The infection rates of indwelling devices used for various reasons are found to be very high. These infections have increased the morbidity and mortality of the hospitalized patients and also increased the duration of hospital stay. Thus aseptic measurements during insertion of these devices periodic change of these devices may help to overcome these complications. DOI: http://dx.doi.org/10.3126/jpn.v3i6.8995 Journal of Pathology of Nepal (2013) Vol. 3, 469-471

Epidemiology, Risk Factors and Outcome of Candida parapsilosis Bloodstream Infection in Children

Candida parapsilosis constitutes a common Candida spp. isolated in children with candidemia. Few data exist on risk factors and outcome of candidemia caused by C. parapsilosis in pediatric patients. We conducted a retrospective analysis of demographic data, clinical features, therapeutic procedures and outcomes associated with Candida bloodstream infections (BSIs) that occurred at the Children's Hospital of Philadelphia between 1997 and 2009. Among 406 Candida BSIs, Candida albicans accounted for 198 (49%), C. parapsilosis for 99 (24%) and all other species for 109 (27%) episodes. There was no consistent change in the proportion of C. parapsilosis BSIs during the study. C. parapsilosis BSI was more frequent than non-parapsilosis Candida spp. at age ≤2 years as compared with older patients (62% versus 50%, odds ratio = 1.24, 95% confidence interval: 1.03-1.51, P = 0.038). Patients with C. parapsilosis were more likely to be mechanically ventilated within 48 hours of BSI (odds ratio = 1.38, 95% confidence interval: 1.01-1.85, P = 0.047). Presence of a urinary catheter a week before infection was a protective factor for developing candidemia due to C. parapsilosis spp. (P = 0.003). No significant differences were found between the 2 groups in the presence of central intravascular catheters, comorbidities and clinical or surgical procedures, previous administration of immunosuppressive or antifungal agents and mortality. C. parapsilosis is the second most frequent cause of candidemia after C. albicans. Although it is more frequent at the age of ≤2 years and is more likely associated with mechanical ventilation than other Candida spp., mortality does not significantly differ between those with and without C. parapsilosis candidemia.

Point prevalence and risk factors of hospital acquired infections in a cluster of university-affiliated hospitals in Shiraz, Iran

Hospital-acquired infections (HAIs) are critical and mostly preventable complications that occur in hospitalized patients and lead to major health and economic burdens. Most of the information on HAI risk factors and the recommended preventive measures is based on data acquired from only a few countries. The aim of this point prevalence HAI study conducted in Shiraz, Iran, was to study the local epidemiology of HAIs and the major risk factors for acquiring HAIs in a Middle-Eastern region. The study employed four identical point prevalence surveys in eight university hospitals, each consisting of 60-700 beds. The study was conducted during all four season of 2008-2009. All of the patients admitted for ≥48h were studied, although the patients admitted to emergency wards were excluded. A standardized data collection form that included name, age, gender, presence or absence of HAI, administration of any antibiotics, insertion of a central line, use of an endotracheal tube, mechanical ventilation, and use of an urinary catheter was completed for each patient. The HAI definitions used in this study were based on the US National Nosocomial Infection Surveillance (NNIS) guidelines. Data from 3450 patients were prospectively collected and analyzed. The overall HAI prevalence was 9.4%. The most common HAIs were blood stream infections (2.5%), surgical site infections (2.4%), urinary tract infections (1.4%), and pneumonia (1.3%). A logistic regression analysis showed that the odds ratio OR for males rather than females acquiring infections was 1.56 (95% confidence interval [CI] 1.21-2.02). Other HAI risk factors included using a central intravascular catheter, adjusted OR of 3.86 (95% CI 2.38-6.26), and using an urinary catheter, adjusted OR of 3.06 (95% CI 2.19-4.28). Being admitted to an ICU was not an independent HAI risk factor. For all HAIs, the OR of acquiring infection was 3.24 (95% CI 2.34-4.47) in the patients with hospital stays longer than eight days. A high discrepancy between HAIs and antibiotic use was observed. Antibiotics were administered to 71% of the patients, but only 9.4% of the patients also had at least one documented infection. This point prevalence study showed that HAIs are frequent in Shiraz university hospitals, and that the proportion of patients receiving antibiotics is high. The results imply that more primary prevention efforts are necessary to address HAIs associated with using indwelling devices and to prevent surgical site infections.

Point prevalence and risk ractors of hospital acquired infections in a cluster of university affiliated hospitals in Shirz, Iran

Summary Background: Hospital-acquired infections (HAIs) are critical and mostly preventable complications that occur in hospitalized patients and lead to major health and economic burdens. Most of the information on HAI risk factors and the recommended preventive measures is based on data acquired from only a few countries. The aim of this point prevalence HAI study conducted in Shiraz, Iran, was to study the local epidemiology of HAIs and the major risk factors for acquiring HAIs in a Middle-Eastern region. Methods: The study employed four identical point prevalence surveys in eight university hospitals, each consisting of 60—700 beds. The study was conducted during all four season of 2008—2009. All of the patients admitted for ≥48 h were studied, although the patients admitted to emergency wards were excluded. A standardized data collection form that included name, age, gender, presence or absence of HAI, administration of any antibiotics, insertion of a central line, use of an endotracheal tube, mechanical ventilation, and use of an urinary catheter was completed for each patient. The HAI definitions used in this study were based on the US National Nosocomial Infection Surveillance (NNIS) guidelines. Results: Data from 3450 patients were prospectively collected and analyzed. The overall HAI prevalence was 9.4%. The most common HAIs were blood stream infections (2.5%), surgical site infections (2.4%), urinary tract infections (1.4%), and pneumonia (1.3%). A logistic regression analysis showed that the odds ratio OR for males rather than females acquiring infections was 1.56 (95% confidence interval [CI] 1.21—2.02). Other HAI risk factors included using a central intravascular catheter, adjusted OR of 3.86 (95% CI 2.38—6.26), and using an urinary catheter, adjusted OR

Multidrug-resistant Acinetobacter lwoffii infection in neonatal intensive care units

Multidrug-resistant Acinetobacter lwoffii infection in neonatal intensive care units Narongsak Nakwan1,2, Jeerawan Wannaro2, Narongwit Nakwan31Neonatal Intensive Care Unit, 2Department of Pediatrics, 3Department of Medicine, Hat Yai Medical Education Center, Hat Yai Hospital, Songkhla, ThailandAim: To describe the clinical, bacteriological features, and outcome of Acinetobacter lwoffii infection in the neonatal population.Method: We retrospectively reviewed the medical records of four neonatal cases of A. lwoffii infection admitted to the Hat Yai Hospital, January 2005 to December 2009.Results: Four cases (one in 2007, and three in 2008) were identified as having A. lwoffii infection. Of the four cases, three presented with late-onset infection (after 72 hours of age), while 1 presented with early-onset (within the first 72 hours of age). All cases were inserted with umbilical catheters, required positive pressure mechanical ventilation, and had been treated previously with antibiotic drugs at time of diagnosis. Antimicrobial susceptibility testing of seven isolates (three in blood, three in sputum, and one in cerebrospinal fluid) was performed using the disk diffusion method. The most tested isolates were susceptible to netilmicin, imipenem, cefoperazone/sulbactam, while most were simultaneously generally resistant to amikacin, gentamicin, ceftazidime, ceftriaxone, cefepime, ciprofloxacin, and clindamicin. The treatment of A. lwoffii infection in the four cases varied. Only one case was successfully treated with imipenem, while three cases died from severe ventilator-associated pneumonia, and severe sepsis.Conclusion: This study increases awareness of A. lwoffii infection in the neonatal population, particularly in premature infants with several risk factors for nosocomial infection, including central intravascular catheters and prolonged mechanical ventilation.Keywords: Acinetobacter lwoffii, Acinetobacter infection, newborn infant

Coagulase-negative staphylococci and endocarditis: reappraisal in the 21st century

include hemodialysis, peripheral catheters, and central intravascular catheters, as well as invasive procedures such as cardiac catheterization and prostate surgery. It is not surprising that the affected patient population is the elderly and those with comorbid illnesses. Thus, this study and others call attention to the clinical scenarios that are associated with this disease. This study is the first to show that the majority (63%) of patients with CoNS NVE had a vegetation size of < 1 cm. Vegetations this small are often detected only by transesophageal echocardiography and can be missed by transthoracic echocardiography12. This, in addition to the typically subacute clinical presentation of CoNS bloodstream infections, illustrates how CoNS NVE can be missed early in the course of disease. Thus a high degree of suspicion for CoNS NVE in the appropriate clinical setting is important and could potentially have an impact on patient outcomes. The poor outcomes reported in this study are similar to those reported in other studies of CoNS NVE3,8,9. Over one-half of patients suffered from congestive heart failure and approximately 1 in 4 patients died in the hospital. Interestingly, in this study by Haro et al, mortality was higher among patients whose symptoms evolved over fewer than 21 days (on univariate analysis). As suggested by the authors, these patients were likely diagnosed in the hospital setting or under close observation in outpatient clinical settings. Possible explanations for the higher mortality are a sicker patient population or perhaps a more virulent staphylococcal strain acquired in the hospital setting. Although it is impossible to determine based on the current data, the poor outcomes with CoNS NVE are likely due to a combination of host susceptibility and staphylococcal pathogenicity factors. The epidemiology of NVE has changed dramatically over the past few decades. Once predominated by viridans streptococci in the community setting, this disease is increasingly becoming a nosocomial infection due to S. aureus, with CoNS increasing in prevalence7,9. While simple catheter-related CoNS bloodstream infections are common and usually benign, CoNS NVE can be associated with surprisingly poor outcomes. Future efforts should focus on the pathogenesis and prevention of serious CoNS infections.

Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: results from a prospective randomized controlled trial

Exit-site and tunnel infections of tunnelled central intravascular catheters are a frequent source of morbidity among neutropenic patients and may necessitate catheter removal. They require antimicrobial therapy that increases healthcare costs and is associated with adverse drug reactions. A prospective randomized clinical trial was conducted among adult patients undergoing chemotherapy in a haematology unit. Tunnelled intravascular catheters were randomized to receive the control of a standard dressing regimen as recommended by the British Committee for Standards in Haematology, or to receive the intervention of a sustained-release chlorhexidine dressing. Follow-up data were available in 112 of 114 tunnelled intravascular catheters which were randomized. Exit-site or combined exit-site/tunnel infections occurred in 23 (43%) of 54 catheters in the control group, and five (9%) of 58 catheters in the intervention group [odds ratio (OR) for intervention group compared with control group =0.13, 95% confidence intervals (CI) 0.04-0.37, P<0.001]. More tunnelled intravascular catheters were prematurely removed from the control group than the intervention group for documented infections [20/54 (37%) vs 6/58 (10%), OR=0.20, 95%CI 0.53-0.07]. However, there was no difference in the numbers of tunnelled intravascular catheters removed for all proven and suspected intravascular catheter-related infections [21/54 (39%) vs 19/58 (33%)], or in the time to removal of catheters for any reason other than death or end of treatment for underlying disease. Thus chlorhexidine dressings reduced the incidence of exit-site/tunnel infections of indwelling tunnelled intravascular catheters without prolonging catheter survival in neutropenic patients, and could be considered as part of the routine management of indwelling tunnelled intravascular catheters among neutropenic patients.

Prevalance of and risk factors for hospital-acquired infections in Slovenia—results of the first national survey, 2001

A one-day survey was conducted in all (19) Slovenian acute-care hospitals in October 2001 to estimate the prevalence of all types of hospital-acquired infections (HAIs) and to identify predominant micro-organisms and risk factors. Among 6695 patients surveyed, the prevalence of patients with at least one HAI was 4.6%. The prevalence of urinary tract infections was highest (1.2%), followed by pneumonia (1.0%), surgical wound infection (0.7%), and bloodstream infection (0.3%). In intensive care units (ICUs) the prevalence of patients with at least one HAI was 26.9% and the ratio of episodes of HAI per number of patients was 33.3%. One or more pathogens were identified in 55.8% of HAIs episodes. Among these, the most frequently single isolated micro-organisms were Staphylococcus aureus (18.2%) and Escherichia coli (10.2%). Risk factors for HAI included central intravascular catheter (adjusted odds ratio (OR) 3.2; 95% confidence intervals (CI) 2.1–4.9), peripheral intravascular catheter (adjusted OR 1.7; 95% CI 1.2–2.4), urinary catheter (adjuster OR 2.4; 95% CI 1.6–3.4), and hospitalization in ICUs (adjusted OR 2.5; 95% CI 1.4–4.3). The results provide the first national estimates for Slovenia.

Infective endocarditis in the Western Cape Province of South Africa: a three-year prospective study.

The last 50 years have seen major changes in the epidemiology of infective endocarditis (IE). To evaluate local patient characteristics, risk factors, clinical sequelae, microbiology, morbidity and mortality in patients with definite IE. Prospective observational study. Over a three-year period, patients referred with probable IE were prospectively enrolled. All received a standardized diagnostic evaluation. Epidemiological data were documented; underlying risk factors for IE were sought. Initial evaluation and follow-up (to 6 months) included the documentation of vascular or immunological phenomena, morbidity and mortality. Of 92 patients referred with probable IE, 47 had definite IE. These patients had a mean age of 37.7 years with a male predominance (1.6:1). Rheumatic heart disease was present in 36 (76.6%). Eight had prosthetic valves. Three had congenital heart disease, mitral valve prolapse or multiple central intravascular catheters, respectively. All denied the use of intravenous recreational drugs and only one tested seropositive for HIV. Renal involvement (59.6%) and clubbing (29.8%) were commonly observed. The 6-month mortality rate was 35.6%, while 44.7% needed valvular replacement. An aetiological diagnosis was made in 21, with viridans streptococci the most common isolate. Infective endocarditis in the Western Cape of South Africa is a disease of younger adults, with a male predominance. Rheumatic heart disease is the major predisposing factor. Degenerative heart disease and intravenous drug abuse are not important risk factors. Our data do not support the notion that HIV infection is an independent risk factor for IE. Local mortality rates are much higher than recent international figures, as is the proportion of 'culture-negative' IE.

Prevalence of nosocomial infections in neonatal intensive care unit patients: Results from the first national point-prevalence survey

Objectives: Patients admitted to neonatal intensive care units (NICUs) are at high risk of nosocomial infection. We conducted a national multicenter assessment of nosocomial infections in NICUs to determine the prevalence of infections, describe associated risk factors, and help focus prevention efforts. Study design: We conducted a point prevalence survey of nosocomial infections in 29 Pediatric Prevention Network NICUs. Patients present on the survey date were included. Data were collected on underlying diagnoses, therapeutic interventions/treatments, infections, and outcomes. Results: Of the 827 patients surveyed, 94 (11.4%) had 116 NICU-acquired infections: bloodstream (52.6%), lower respiratory tract (12.9%), ear-nose-throat (8.6%), or urinary tract infections (8.6%). Infants with infections were of significantly lower birth weight (median 1006 g [range 441 to 4460 g] vs 1589 g [range 326 to 5480 g]; P < .001) and had longer median durations of stay than those without infections (88 days [range 8 to 279 days] vs 32 days [range 1 to 483 days]; P < .001). Most common pathogens were coagulase-negative staphylococci and enterococci. Patients with central intravascular catheters (relative risk = 3.81, CI 2.32-6.25; P < .001) or receiving total parenteral nutrition (relative risk = 5.72, CI 3.45-9.49; P < .001) were at greater risk of bloodstream infection. Conclusions: This study documents the high prevalence of nosocomial infections in patients in NICUs and the urgent need for more effective prevention interventions. (J Pediatr 2001;139:821–7)

Candidal and bacterial bloodstream infections in premature neonates: a case-control study

Nosocomial bloodstream infections (BSI) in premature neonates are an important cause of morbidity and mortality. The early and efficient diagnosis of a neonatal BSI and the differentiation between bacterial and fungal BSI remains a challenging task. We compared the clinical features and blood test results in preterm infants with proven candidal or bacterial BSI in order to identify potential risk factors for developing a candidal BSI. Preterm infants with proven candidal BSI were significantly more prematurely born (mean age of gestation 27·7 vs. 29·8 weeks), had previously received significantly more antibiotics of multiple classes (mean 4·4 vs. 1·2) for significantly longer periods (mean 19·3 vs. 3·2 days), were ventilated more intensively, had a significantly longer stay at the neonatal intensive care unit before the onset of the BSI (mean 26·5 vs. 9·4 days), and had C-reactive protein values even higher than in preterm infants with a bacterial BSI (mean 90 vs. 71 mg l−1). The presence of thrombocytopenia (< 150 × 109 cells l−1) in all the preterm infants with candidal BSI was a significant difference. No differences were seen with regard to birth-weight, use of central intravascular catheters, total parenteral nutrition, white blood cell count and differentiation. In conclusion, candidal BSI can be strongly expected after the third week of admittance in the most premature neonates on a respirator and treated with multiple classes of antibiotics for a prolonged period of time. The presence of these risk factors in a ‘septic’ premature infant on antibiotic treatment justifies the empiric use of antifungals.

Candidal and bacterial bloodstream infections in premature neonates: a case-control study.

Nosocomial bloodstream infections (BSI) in premature neonates are an important cause of morbidity and mortality. The early and efficient diagnosis of a neonatal BSI and the differentiation between bacterial and fungal BSI remains a challenging task. We compared the clinical features and blood test results in preterm infants with proven candidal or bacterial BSI in order to identify potential risk factors for developing a candidal BSI. Preterm infants with proven candidal BSI were significantly more prematurely born (mean age of gestation 27.7 vs. 29.8 weeks), had previously received significantly more antibiotics of multiple classes (mean 4.4 vs. 1.2) for significantly longer periods (mean 19.3 vs. 3.2 days), were ventilated more intensively, had a significantly longer stay at the neonatal intensive care unit before the onset of the BSI (mean 26.5 vs. 9.4 days), and had C-reactive protein values even higher than in preterm infants with a bacterial BSI (mean 90 vs. 71 mg l(-1)). The presence of thrombocytopenia ( < 150 x 10(9) cells l(-1)) in all the preterm infants with candidal BSI was a significant difference. No differences were seen with regard to birth-weight, use of central intravascular catheters, total parenteral nutrition, white blood cell count and differentiation. In conclusion, candidal BSI can be strongly expected after the third week of admittance in the most premature neonates on a respirator and treated with multiple classes of antibiotics for a prolonged period of time. The presence of these risk factors in a 'septic' premature infant on antibiotic treatment justifies the empiric use of antifungals.

The illness scoring system, Baby Check, does not reduce use of health services

We performed a prospective analysis to determine the prevalence of nosocomial infection and associated risk factors in our neonatal intensive care unit (NICU).Data were collected prospectively on underlying diagnoses, therapeutic interventions/treatments, infections, and outcomes at 9 am every day from November 2004 through October 2005. Prevalence of nosocomial infection and infection site definitions were according to the National Nosocomial Infections Surveillance system of the Centers for Disease Control and Prevention.Among 528 infants enrolled, 60 (11.4%) had 97 nosocomial infections. The survival rate was 92%. The prevalence of nosocomial infections was 17.5%: bloodstream infection, 4.7%, clinical sepsis, 6.3%, pneumonia, 5.1%, urinary tract infections (UTIs), 0.7%, surgical site infection, 0.7%. Intervention-associated infection rate: central intravascular catheter–associated bloodstream infection, 13.7%, TPN-associated bloodstream infection, 15.8%, ventilator-associated pneumonia, 18.6%, surgical site infection 13.7%, urinary catheter–associated UTI, 17.3%. Cut-off values of onset of central intravascular catheter–associated bloodstream infection and ventilator-associated pneumonia were 6 days and 10 days after intervention, respectively. Patients with a birth weight <1000 g (relative risk, 11.8, 95% confidence interval, 7.66-18.18; P < .001) were at the greatest risk for nosocomial infection.This study revealed the high prevalence of nosocomial infections in NICU patients, and the urgent need for a national surveillance and more effective prevention interventions.

Risk factors influencing clinical outcome in Staphylococcus aureus bacteraemia in a Turkish University Hospital

A total of 101 episodes of Staphylococcus aureus bacteraemia were evaluated for the factors influencing prognosis. The overall episode mortality rate and the mortality rate due to bacteraemia were 43.6 and 21.8%, respectively. Episodes with methicillin-resistant S. aureus (MRSA) bacteraemia had a significantly higher overall mortality rate (58.7 vs. 30.9%, P<0.01) and mortality rate due to bacteraemia (32.6 vs. 12.7%, P=0.02) when compared with episodes caused by methicillin-sensitive S. aureus (MSSA). The multivariate analysis revealed that the underlying disease, presence of infective endocarditis, septic shock and central intravascular catheter and methicillin resistance of S. aureus were the five independent risk factors associated with a higher mortality rate.

Septic shock as a predictor of mortality in bacteremia caused by coagulase-negative staphylococci.

Fifty episodes of bacteremia caused by coagulase-negative staphylococci at Hacettepe University Hospital over a five-year period were reviewed to evaluate the factors influencing the prognosis. Overall mortality and mortality due to bacteremia were 36% and 24%, respectively. Septic shock was determined to be the only factor adversely influencing mortality in both univariate and multivariate analyses. Age, sex, duration of hospitalization, origin of infection, underlying disease, presence of central intravascular or urinary catheters, and prior antibiotic therapy were not statistically significant parameters in predicting septic shock.

Yield of positive blood cultures in pediatric oncology patients by a new method of blood culture collection.

The optimal number of blood cultures and the volume of blood for pediatric blood cultures have not been defined. In 1990 such criteria were established at our institution. We retrospectively reviewed records of all pediatric oncology patients who were admitted for febrile episodes in 1989 and in 1991 and 1992 to determine whether there was an increase in the detection of bacteremia and fungemia. Blood was drawn via venipuncture and central intravascular catheters and inoculated into the designated blood culture bottles. Each patient had a minimum of two separate blood draws, i.e. two separate cultures; the volume was determined by the patient's weight. In all cases < 1% of the patient's blood volume was drawn per culture. Patients' records were reviewed regarding type of malignancy, chemotherapy and neutropenia. The rate of bacteremic patients increased from 12% (13 of 113) in 1989 to 22% (27 of 123) in 1991. This increase continued through 1992 with 23% (27 of 118) of patients having positive blood cultures. Gram-positive bacteria predominated throughout the study period. Although factors such as more aggressive chemotherapy or a different spectrum of malignant diseases may contribute to the statistically significant increase in identification of bacteremic patients, a standardized method of blood culture collection is merited. The consistent volumes of blood per culture and the minimum of two cultures per febrile episode follow the principles of blood culture collection established for adults. The same principles should apply to pediatric patients.