Central Venous Catheter-associated Bloodstream Infections Research Articles

Analysis of Risk Factors for Peripherally Inserted Central Venous Catheter-Associated Bloodstream Infection

Purpose: Despite guidelines on the prevention of central venous line-associated bloodstream infection, it is left to the clinical judgment of the attending physician to determine the risk of infection and how long a central line should remain in place. This study aimed to identify risk factors for peripherally inserted central venous catheter (PICC)-associated infection.Methods: This retrospective study included 1,136 patients with a PICC who were hospitalized at the National Health Insurance Service Ilsan Hospital (January 2015 to January 2022). Electronic medical records were reviewed for patients with positive blood cultures. Patients with suspicion of infection at the PICC insertion site or with unclear infection at other sites were defined as having a PICC-associated infection.Results: Thirty-five patients (3.08%) had a PICC-associated infection. There were significant differences in hypertension (<i>p</i> = 0.026), lung disease (<i>p</i> = 0.001), PICC duration > 14 days, and antibiotic use before PICC insertion (<i>p</i> = 0.016) between no PICC-associated infection, and infection in the bloodstream. Total parenteral nutrition with PICC was not significantly different between groups. Logistic regression analysis identified hypertension, lung disease, PICC duration > 14 days (OR 2.088, 95% CI 1.032-4.224, <i>p</i> = 0.041), and antibiotic use before PICC insertion (OR 0.159, 95% CI 0.049-0.515, <i>p</i> = 0.002) as independent risk factors for PICC-associated infection.Conclusion: The study suggested that PICCs maintained longer than 14 days is a risk factor for PICC-associated infection. Antibiotic use prior to PICC insertion was observed as a negative factor for PICC-associated infection.

Etiology of nosocomial infections in intensive care patients in German hospitals: An analysis of trends between 2008 and 2022

PurposeData from the intensive care component of the German hospital infection surveillance system (KISS) was used to investigate the epidemiology of pathogens responsible for the most frequent device-associated infections and their development over time. MethodThe 10 most common pathogens were identified for ventilator-associated lower respiratory tract infections (VALRTI), catheter associated urinary tract infections (CAUTI), and central venous catheter associated bloodstream infections (CVC-BSI). The development over time was analyzed based on three five-year time periods: 2008–2012, 2013–2017, 2018–2022. ResultsData from 1425 ICUs were included together with 121,762 device-associated infections with 138,299 isolated pathogens. A remarkable and significant increase in the frequency of Klebsiella spp. was found for VALRTI, that was almost twice as high during 2018–2022 compared to 2008–2012. For CAUTI, there was a significant increase of all Enterobacterales with the most prominent increase in Klebsiella spp. With regard to CVC-BSI, the situation for coagulase-negative staphylococci and E. coli was relatively stable; while there was a significant increase in Enterococcus spp. and Klebsiella spp. and a decrease in S. aureus. ConclusionKnowledge about the current frequency of pathogens responsible for nosocomial infections in intensive care units is important for guiding empirical antimicrobial therapy. Data from national nosocomial infection surveillance systems can provide relevant information about the development of pathogens.

Influencing factors of central venous catheter-associated bloodstream infection in patients with emergency hemorrhagic shock

Objective: To investigate and analyze the influencing factors of central venous catheter-associated bloodstream infection in patients with emergency hemorrhagic shock. Methods: According to the inclusion criteria, 249 patients with hemorrhagic shock and central venous catheterization admitted to the emergency department of Shanghai First People's Hospital from June 2016 to June 2022 were retrospectively analyzed, and divided into the infection group (54 cases) and the non-infection group (195 cases) according to whether catheter-related bloodstream infection occurred.Multivariate Logistic regression was used to analyze the relationship between central venous catheter-related bloodstream infection and various influencing factors. The etiological and drug susceptibility test data of peripheral venous blood culture, puncture site samples and catheter tip samples from patients with central venous catheter-associated bloodstream infection were statistically analyzed. Results: There were significant differences in age, catheterization location, ultrasound-guided puncture, APACHE ⅱ score, catheter indwelling time and application of broad-spectrum antibiotics between the infected group and the non-infected group (P<0.05). Staphylococcus epidermidis accounted for 44.4%, Escherichia coli 24.1%, and fungi 11.1% in 54 infected patients. The lowest resistance rate of Gram-positive cocci was to vancomycin (3.4%), followed by tetracycline 34.5%, and the highest resistance rate was to amoxicillin 100.0%. Conclusion: The risk factors of central venous catheter-related bloodstream infection in patients with emergency hemorrhagic shock include advanced age, femoral vein catheterization, non-ultrasound-guided puncture, high APACHE ⅱ score, catheter retention time, and application of broad-spectrum antibiotics. Staphylococcus epidermidis the common pathogen of central venous catheterization related infection in emergency hemorrhagic shock patients.

Evaluation of the incidence of central venous catheter-associated infections in patients admitted in the intensive care unit of a tertiary hospital in Nigeria

Background: Presence of a central venous catheter (CVC) though useful may lead to CVC-associated bloodstream infections (CVCBSIs), resulting in increased morbidity and mortality. Objectives: The objectives of the study were to determine the incidence of CVCBSIs, the predominant causative microorganisms, the antibiotic sensitivity pattern of the microorganisms, and the associated risk factors. Materials and Methods: This prospective observational study evaluated the incidence of CVCBSIs in patients who had the catheter inserted on admission into the intensive care unit (ICU) of a tertiary hospital in South-East, Nigeria. Sixty-eight patients were recruited for the study. Blood samples were collected aseptically from a peripheral vein on admission, 72 h after the insertion of CVC, and at removal of CVC for blood culture. The distal 5 cm of the CVC was also collected at removal for microscopy, culture, and sensitivity testing. Results: Six out of all the patients recruited developed CVCBSIs, giving an incidence rate of 9.2%, whereas 48% (n = 31) developed catheter bacterial colonization. Over one-fifth (22.7%) of the patients with catheter duration beyond 5 days had CVCBSIs. Patients whose CVC duration was beyond 5 days had a higher risk of CVCBSIs (P = 0.015) than others. The commonest microorganism isolated was Staphylococcus aureus, whereas the most susceptible antibiotic was aminoglycoside (gentamycin). Conclusion: The incidences of CVCBSIs and CVC colonization were 9.2% and 48%, respectively. The duration of catheterization was found to be a major risk factor for CVCBSIs. The most predominant organism isolated was S. aureus. The most sensitive antibiotic agent was the aminoglycoside (gentamycin). It is therefore recommended that catheter care bundle which includes hand hygiene, use of chlorhexidine for skin preparation during insertion, use of barrier precautions during insertion, and the removal of unnecessary central lines should be strictly adhered to. Gentamycin should be used as empirical antibiotics in the ICUs.

BURKHOLDERIA BACTEREMIA PRESENTING AS SEPTIC SHOCK AND MASSIVE HEMOPTYSIS IN A PATIENT WITH SICKLE CELL DISEASE

BURKHOLDERIA BACTEREMIA PRESENTING AS SEPTIC SHOCK AND MASSIVE HEMOPTYSIS IN A PATIENT WITH SICKLE CELL DISEASE

A Multicenter Comparison of Rates of Central Venous Catheter-Associated Bloodstream Infections By Central Venous Catheter Type Among Pediatric Patients Receiving Treatment for Newly Diagnosed Acute Myeloid Leukemia

▪Therapy for pediatric acute myeloid leukemia (AML) requires long term central vascular access, which puts patients at risk for central line-associated bloodstream infections and their associated morbidity and mortality. Options for central venous catheter (CVC) access include tunneled external catheters, implanted ports, or peripherally inserted central catheters (PICC). Multiple studies provide conflicting reports on which CVC type is least likely to be associated with bloodstream infections in pediatric hematology-oncology patients. This multicenter cohort of pediatric AML patients is the first to investigate the course-specific incidence of positive CVC blood cultures by line type.The study included patients receiving frontline chemotherapy for AML between 1/1/2012 and 6/30/2017 at 12 US institutions. Trained personnel completed manual chart abstraction from 12/1/2015 to 07/15/2017 to obtain information on demographics, diagnosis, treatment, antibacterial prophylaxis, CVC type at the start of each course, neutropenia duration, and blood culture results obtained from CVC. Abstractors followed a standardized protocol and were required to achieve >95% concordance with trainer before starting formal chart review.Course-specific follow-up began the first day absolute neutrophil count (ANC) fell below 200 cells/uL and continued to the earliest of first positive CVC culture (overall and separately for gram-positive and gram-negative species), ANC recovery, start of conditioning for stem cell transplant, relapse, death or start of next course. Per National Healthcare Safety Network guidance, common commensals were not considered true events with the exception of viridans group streptococci (VGS). Nonbacterial pathogens were also excluded. Covariate distributions were compared by CVC type using chi-square tests. Variability in CVC type by site was examined graphically. Incidence rates for CVC positive blood cultures were reported by line type as per 1000 neutropenic days. Multivariate Poisson regression with log of neutropenia duration as offset was used to compute adjusted rate ratios (aIRR) comparing rates of positive CVC blood cultures by line type, controlling for covariates itemized in Table 1. General estimating equation methods were used to account for non-independence of observations from patients from the same institution.The study population included 357 patients who received 1,164 chemotherapy courses. Median course duration was 38 days (IQR: 34-44) with a median neutropenia duration of 19 days (IQR: 14-25). CVC were present in all patients at the start of each course, with the exception of 11 (3.3%) patients lacking a CVC at the start of Induction I. While tunneled CVC were most prevalent representing 59.1% of courses, PICC and implanted ports were utilized in 28.9% and 11.6% of courses, respectively. There was considerable variation in the distribution of CVC type by treating institution (Figure 1). Age, race, and ethnicity distributions varied by line type (Table 1). Antibacterial prophylaxis was utilized in 47% of courses.In total, there were 300 (25.8%) courses in 199 (55.7%) patients complicated by a positive CVC blood culture during the neutropenic period. The overall incidence rate of positive CVC blood cultures was 6.5 per 1000 neutropenic days. Rates increased over the course of frontline treatment from 3.1 per 1000 neutropenic days in Induction I to 9.6 per 1000 neutropenic days in Intensification II. The rate of gram-positive events (4.2 per 1000 neutropenic days) was higher than gram-negative events (2.0 per 1000 neutropenic days). The most common isolated organisms were VGS at 57.3% and less than 1% of events were polymicrobial infections. Overall rates of positive CVC blood cultures were higher for PICC relative to tunneled CVC (aIRR=1.19, 95% CI: 1.02, 1.38), while rates for implanted ports and tunneled CVC were similar (aIRR=1.06, 95% CI: 0.75, 1.51).While bacteremia is an expected complication during post-chemotherapy neutropenia and not always due to the presence of a CVC, the risk for a positive CVC blood culture is significantly increased for children with PICC compared with those with tunneled CVC or implanted port. Also, the risk was higher after Induction I and increased with age. Given the notable practice variation in line choice, these data highlight an opportunity for standardization with a goal to reduce infectious complications. [Display omitted] DisclosuresFisher:Pfizer: Research Funding; Merck: Research Funding. Gramatges:Bristol Meyer Squibb: Research Funding.

Evaluation of effectiveness of central venous catheter related bloodstream infections in the antesty and reanimation intensive care units of the bundle

Aim: The aim of this study is to evaluate the efficacy of prevention bundle study on central venous catheter-associated bloodstream infection (CLABSI) in the Anesthesia and Reanimation Intensive Care Unit (ICU) patients who have central venous catheter. Invasive vehicle related infections, especially CLABSIs, are one of the most difficult infections in ICUs. It has been reported that the use of proven interventions as a bundle to prevent infections associated with invasive tools is effective in reducing infection rates. Materials and Methods:The study was conducted interventionally between July and December 2017. Data, physician and nurse information form, CLABSI package tracking form, CLABSI package information test form, CVC insertion process observation form, bedside CLABSI package tracking form, and CLABSI package tracking form. Ethics committee permission was obtained for the study. Approval was obtained from nurses and doctors. The study was carried out in three stages. Number, Percentage, Chi-square, Fisher Exact Chi-square Test and Wilcoxon Test were used in the research.Results: The overall compatibility of ICUs for the CLABSI bundle was 61%, 65% and 70%, respectively. As a result of the Bundle study, CLABSI rates per 1000 catheter days were decreased, from 11.3 to 9.5 in ICU1, from 9.4 to 6.8 in ICU2, and from 17.1 to 10.6 in ICU3.Conclusion: As a result, it was seen that CLABSI precaution bundle study prepared with evidence based guidelines decreased infection rates. The bundle is recommended for use in intensive care units.

A clinical study of patients with central venous catheter associated bloodstream infections in a tertiary care hospital

Background: Central venous access puts the patients at risk of iatrogenic complications and is associated with bloodstream infections. Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus and Methicillin Resistant Staphylococcus aureus (MRSA) are responsible for at least two-thirds of the infections followed by Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Enterococcus spp and Acinetobacter spp. Due to the scarcity of Central Venous Catheter associated Blood Stream Infections (CVC-BSI) data, this study was taken up in our tertiary care hospital. Aims: This study is aimed to study the profile of organisms causing CVC-BSI, assess their antimicrobial susceptibility, the clinical course and outcome.Methods: All subjects whose central venous catheter samples (n=84) were sent for culture and sensitivity during the study period were included in this prospective observational study. The study was done in the Department of Microbiology from July 2019 to December 2019. The catheter tips were streaked onto blood agar plate using Roll plate technique. After biochemical identification of the organisms, antimicrobial susceptibility testing was performed by modified Kirby-Bauer disc diffusion method as per the Clinical Laboratory Standard Institute (CLSI) guidelines. Results: Growth of pathogens was seen in 64.3% (n=54). The common organisms were Coagulase Negative Staphylococcus aureus (CONS) in 27.78% (n=15), Enterococcus spp, Klebsiella pneumoniae in 14.8% each (n=8) and Acinetobacter spp in 11.1% (n=6). Resistance was seen with amoxicillin + clavulanic acid, cefepime, ciprofloxacin and cefoperazone. The organisms were sensitive to levofloxacin, tetracycline and vancomycin.Conclusion: Aseptic precautions taken by the healthcare personnel will bring down the infections and curb the spread of multi-drug resistant hospital acquired infections.

A quality improvement study on the reduction of central venous catheter-associated bloodstream infections by use of self-disinfecting venous access caps (STERILE)

Contamination of the catheter hub is an important source of central line-associated bloodstream infections (CLABSI); catheter hub caps incorporating a 70% isopropyl alcohol aim are designed to reduce contamination and hence CLABSI rates. Supporting data in high-risk hematological and oncological patients on the clinical effectiveness of this approach are sparse. We conducted a before-after single center study accompanying the introduction of such caps at our department. Retrospective data from the year prior to the introduction were compared to 1 year of prospective data. The control and antiseptic barrier cap (ABC) groups consisted of 309 and 289 patients presenting a CLABSI rate of 15.28 and 10.38 per 1,000 catheter days (P= .042), respectively. However, after multivariate analysis, ABCs were not identified as a statistically significant independent protective factor for the occurrence of CLABSI (hazard ratio 0.69, P= .120). There was no significant difference between the groups with respect to time to CLABSI (P= .681), nor the proportion of catheters removed due to suspicion of infection (P= .076). The introduction of ABCs in this high-risk population did not significantly alter CLABSI rates.

Normal saline (0.9% sodium chloride) versus heparin intermittent flushing for the prevention of occlusion in long-term central venous catheters in infants and children.

Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion; there is debate, however, regarding the need for heparin and evidence to suggest normal saline (0.9% sodium chloride) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. This is an update of the review published in 2015. To assess the clinical effects (benefits and harms) of intermittent flushing of normal saline versus heparin to prevent occlusion in long-term central venous catheters in infants and children. The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases; World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials register to 9 April 2019. We also undertook reference checking, citation searching and contact with study authors to identify additional studies. We included randomised controlled trials (RCTs) that compared the efficacy of intermittent flushing with normal saline versus heparin to prevent occlusion of long-term CVCs in infants and children aged up to 18 years of age. We excluded temporary CVCs and peripherally inserted central catheters (PICC). Two review authors independently assessed trial inclusion criteria, trial quality and extracted data. We assessed study quality with the Cochrane 'Risk of bias' tool. For dichotomous outcomes, we calculated the rate ratio (RR) and corresponding 95% confidence interval (CI). We pooled data using a random-effects model; and we used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. We identified one new study for this update, bringing the total number of included studies to four (255 participants). The four trials directly compared the use of normal saline and heparin; the studies all used different protocols for the intervention and control arms, however, and all used different concentrations of heparin.Different frequencies of flushes were also reported between studies. In addition, not all studies reported on all outcomes. The certainty of the evidence ranged from moderate to very low because there was no blinding; heterogeneity and inconsistency between studies was high; and the CIs were wide. CVC occlusion was assessed in all four trials. We were able to pool the results of two trials for the outcomes of CVC occlusion and CVC-associated blood stream infection. The estimated RR for CVC occlusion per 1000 catheter days between the normal saline and heparin groups was 0.75 (95% CI 0.10 to 5.51; 2 studies, 229 participants; very low certainty evidence). The estimated RR for CVC-associated blood stream infection was 1.48 (95% CI 0.24 to 9.37; 2 studies, 231 participants; low-certainty evidence). The duration of catheter placement was reported to be similar for the two study arms in one study (203 participants; moderate-certainty evidence), and not reported in the remaining studies. The review found that there was not enough evidence to determine the effects of intermittent flushing with normal saline versus heparin to prevent occlusion in long-term central venous catheters in infants and children. It remains unclear whether heparin is necessary to prevent occlusion, CVC-associated blood stream infection or effects duration of catheter placement. Lack of agreement between institutions around the world regarding the appropriate care and maintenance of these devices remains.

Central venous catheter-associated bloodstream infections in children diagnosed with intestinal failure in Southern Israel.

To study the clinical, epidemiological, and microbiological associations between intestinal failure (IF) and central line-associated infections (CLABSI) in patients with central vein catheters (CVCs) during 2005-2016. We compared retrospectively CLABSI rates according to background disease, type of line access, pathogen distribution, and antibiotic susceptibilities. One hundred and fourteen children (64.1% < 4 years) were enrolled. Main diagnoses were persistent diarrhea (20, 17.5%), short bowel syndrome (13, 11.4%), continuous-TPN w/o diarrhea (11, 9.7%), very early-onset inflammatory bowel disease (VEO-IBD, 8, 7%), Hirschsprung's disease (3, 2.6%), non-oncologic hematologic conditions (13, 11.4%), and other diseases (46, 40.4%). 152.749 catheter days were recorded; 71.1% had Hickman's catheters. Two hundred and nine CLABSI episodes were recorded in 58 patients (82% with IF, 13.7 and 8.2/1000 catheter days in IF, and non-gastrointestinal conditions, P = 0.09). More CLABSI were recorded in continuous TPN vs. VEO-IBD or persistent diarrhea (38.8 vs.15.8 and 12.8/1000 catheter days, P < 0.004). Among patients with Hickman in jugular vein, highest CLBSI incidence was in continuous TPN, VEO-IBD, and persistent diarrhea (29.9, 15.84, and 12.49 episodes/1000 catheter days, respectively). CVCs were removed in 38.8% CLABSI. Two hundred and thirty-five pathogens were isolated (Enterobacteriaceae spp. in 39% of IF patients, mostly in persistent diarrhea and short bowel syndrome patients, 47.6% and 34.8%, respectively). Coagulase-negative Staphylococcus was the commonest pathogen in continuous TPN, VEO-IBD, and Hirschsprung's (71.4%, 55.6% and 46.1%, respectively). CLABSI rates in IF patients were among the highest reported. We reported a "hierarchy" in CLABSI incidence among patients with IF and showed that CLABSI incidence and etiology were different as function of background diseases and CVC insertion site.

Incidence of Central Venous Catheter-Related Bloodstream Infections: Evaluation of Bundle Prevention in Two Intensive Care Units in Central Brazil.

Background Central venous catheter-associated bloodstream infections (CVC-BSIs) have been associated with increased length of hospital stay, mortality, and healthcare costs, especially in intensive care units (ICUs). The aim of this study was to evaluate the incidence density of CVC-BSIs before and after implementation of the bundle in a hospital of infectious and dermatological diseases in Central Brazil. Methods A retrospective cohort study was conducted in two ICUs (adult and pediatric) between 2012 and 2015. Two periods were compared to assess the effect of the intervention in incidence density of CVC-BSIs: before and after intervention, related to the stages before and after the implementation of the bundle, respectively. Results No significant reduction was observed in the incidence density of CVC-BSIs in adult ICU (incidence rate ratio [IRR]: 0.754; 95.0% CI: 0.349 to 1.621; p-value = 0.469), despite the high bundle application rate in the postintervention period. Similarly, significant reduction in the incidence density in pediatric ICU has not been verified after implementation of the bundle (IRR: 1.148; 95.0% CI: 0.314 to 4.193; p-value = 0.834). Conclusion Not significant reduction in the incidence density of CVC-BSIs was observed after bundle implementation in ICUs, suggesting the need to review the use of process, as well as continuing education for staffs in compliance and correct application of the bundle. Further studies are needed to evaluate the effect of bundle in the reduction of incidence density of CVC-BSIs in Brazil.

Central venous catheter associated blood stream infections (CVC-BSIs) in the non-intensive care settings: Epidemiology, microbiology and outcomes.

Most studies have examined central venous catheter associated blood stream infections (CVC-BSIs) in Intensive Care Units (ICUs) but information on CVC-BSIs in non-ICU settings is sparse. This study aimed to determine the burden, microbiologic patterns, and associations of CVC-BSIs in non-ICU settings in a tertiary regional centre, University Hospital Geelong (UHG), Victoria, Australia. A retrospective study was conducted in the UHG from October 2016 to April 2018. Based on the National Healthcare Safety Network definition, 23 CVC-BSIs occurred in non-ICU settings. Data analysed using SPSS-v25 with a P value<0.05 was deemed as significant. The incidence rate was 1.2 per 10,000 bed-days. The mean age of patients was 57.22±18 years. 43.5% of patients had Charlson index score of ≥5 and 78% received appropriate empiric antibiotics. The 90-day mortality rate was zero. In total, 26 microorganisms were isolated. Gram-negative bacilli were more common than Gram-positive cocci. The mean catheter duration was 45.22±8.99 days. Hickman lines contributed to 52.2% of BSIs. Within the first two weeks of line insertion, 53.84% of CVC-BSIs occurred with 76.92% of CVC-Gram-negative bacteraemia and 71.4% of BSIs were related to Hickman lines. Also, 69.2% of CVC-BSIs occurred within ≤4 weeks of line insertion including 84.6% of CVC-Gram-negative bacteraemia. CVC-BSIs constitute a significant burden on high risk patients in non-ICU settings, with Gram negative bacilli predominating. A prospective surveillance program for all patients with CVC in the non-ICU setting may improve CVC management processes and influence educational measures.

Clinical Features of Bloodstream Infections Associated with Peripheral Versus Central Venous Catheters.

IntroductionThis study aimed to compare the clinical characteristics and prognoses of central venous catheter-associated bloodstream infections (CVC-BSIs) with peripheral venous catheter-associated BSIs (PVC-BSIs).MethodsThis retrospective observational study was conducted between April 2011 and March 2013 at a teaching hospital in Tokyo, Japan. Adult patients who developed CVC-BSIs and PVC-BSIs more than 2 days after admission were included. Patients with both CVC-BSIs and PVC-BSIs were excluded. Clinical characteristics of patients with CVC-BSIs and PVC-BSIs were obtained from medical records, and 30-day all-cause mortality was measured as the clinical outcome.ResultsWe enrolled 124 PVC-BSI cases and 110 CVC-BSI cases. Median age, age-adjusted Charlson score, Sequential Organ Failure Assessment score, sex, and ward type at BSI onset did not differ significantly between the two groups. The median duration of catheter indwelling was significantly shorter in the PVC-BSI group than in the CVC-BSI group. Staphylococcus aureus and Gram-negative bacilli infections were more frequent and coagulase-negative staphylococci (CNS) and Candida spp. infections were less frequent in the PVC-BSI group than in the CVC-BSI group. The prevalence of oxacillin resistance among causative S. aureus and CNS, 30-day all-cause mortality, and appropriateness of empirical and definitive antimicrobial therapies did not differ significantly between the two groups.ConclusionThe pathogen species distribution varies between PVC-BSIs and CVC-BSIs. However, all-cause mortality does not differ between the two groups. PVCs are not safer than CVCs with respect to BSIs; therefore, it is necessary to use similar precautions relevant to CVC use in order to avoid unnecessary use of PVCs.

1069. Predictive Factors for Metastatic Infection in Patients With Bacteremia Caused by Staphylococcus aureus

BackgroundMetastatic infections, such as infective endocarditis and pyogenic spondylitis, are very serious complications of Staphylococcus aureus bacteremia (SAB), because failure to identify metastatic infections may cause poor prognosis. The aim of the present study is to determine the predictive factors for metastatic infections of SAB.MethodsThis retrospective cohort study was conducted among patients with bacteremia due to S. aureus (including both methicillin-sensitive S. aureus and methicillin-resistant S. aureus: MSSA and MRSA) in The Jikei University Kashiwa Hospital. The study population comprised 125 adult patients with SAB between January 2014 and December 2017. Patients, that died or transferred within 3 months after the initial positive blood culture, were excluded, because metastatic infection was defined as deep-seated infection detected within 3 months after the initial positive blood culture. We analyzed several factors, including demographics, comorbidities, community acquisition, primary site of infection, persistent fever and laboratory data such as c-reactive protein (CRP) levels after treatment.ResultsSeventy-four patients met inclusion criteria of this study. The most common primary site of bacteremia was catheter-related [24 (32.4%) of 74]. Metastatic infection occurred in 22 (29.7%) of 74 patients, and spondylitis was most common, following psoas abscess. Of these, 11 infections (50% of 22) were community acquired. We did not find any significant differences in demographics and comorbidities, except central venous catheter-associated bloodstream infection, which was associated with low rate of metastatic infection. By multivariate analysis, the predictive factors associated with the development of metastatic infection were community onset of infection (OR 11.6; 95% CI 2.98–45.1; P < 0.001), persistent fever over 72 hours (OR 6.7; 95% CI 2.12–21.8; P = 0.001), and higher CRP levels (>3 mg/dL) lasting 2 weeks after the administration of appropriate antibiotics (OR 7.47; 95% CI 2.39–23.3; P < 0.001).ConclusionThis study demonstrated that additional diagnostic tests to identify metastatic infection should be performed, especially in the patients with community-acquired SAB, persistent fever or persistently high CRP levels after the administration of appropriate antibiotics.Disclosures All authors: No reported disclosures.

Universal decolonization with octenidine: First experiences in a tertiary burn intensive care unit

BackgroundBurn patients are predisposed for nosocomial infections during their stay on a burn intensive care unit. Moreover, several outbreaks affecting burn units for example caused by Methicillin-resistant Staphylococcus aureus (MRSA) have been reported. One attempt to address these challenges is the use of universal decolonization. MethodsIn 2015 we implemented universal decolonization for all burn patients using the antiseptic agent octenidine for intact skin and the nasopharyngeal mucosa. We conducted a retrospective analysis to evaluate the effect of the decolonization on primary, central line (central venous catheter)-associated bloodstream infections (CLABSI), the frequency of nosocomial clusters (4 or more cases with epidemiologic link and identical molecular pattern) with multidrug-resistant bacteria (MDRB) and the incidence of MRSA. ResultsIn the decolonization period a reduction of the incidence of CLABSI, nosocomial MRSA acquisition and the frequency of nosocomial MDRB clusters was observed. The incidence rate of CLABSI decreased from 2/1000 central venous catheter days in the pre-decolonization phase to 0.8/1000 central venous catheter days in the decolonization period, although this was not statistically significant. The implementation was accompanied by several feedback talks and training for the staff. The user experience was positive and no adverse effects occurred. ConclusionOur results show that universal decolonization in burn patients using octenidine is a promising concept to address hospital acquisition of MRSA; occurrence of CLABSI as well as the spread of MDRB causing clusters. It is of high relevance to further assess the value of this measure in terms of reducing CLABSI in burn patients in larger study groups. Therefore further studies including more burn patients guaranteeing adequate sample size are needed.

Fractured pediatric central venous catheters — Repair or replace?

IntroductionCentral venous catheter (CVC) fracture is a common complication. The aim of this study is to examine risk factors resulting in CVC fracture and compare outcomes of children undergoing CVC repair versus replacement. MethodsA retrospective chart review was conducted from 2000 to 2016 for children with tunneled CVCs. Children with CVC fractures were compared to those without to identify risk factors resulting in fracture. Children with fractured CVCs were divided into repair or replacement treatment groups and outcomes compared. A logistic regression model determined independent predictors of CVC-associated bloodstream infections (CLABSI) after fracture. ResultsIn the 236 children with CVCs, the fracture rate was 29.2%. Fractured CVCs were more common with double lumen CVC (p = 0.040) and children whose indication was total parenteral nutrition (p = 0.003). Given children often underwent multiple repairs or replacements. 98 CVC repairs and 41 replacements were analyzed. CVC replacements had longer durability than repair (181.98 vs. 98.9 days, p = 0.038). There were no differences in CLABSI incidence for repair vs. replacement (OR 0.5 CI 0.05–4.97) after controlling for other factors. ConclusionsCVC fracture is a frequent complication in children with tunneled CVCs. CVC repair has no increased incidence of CLABSI but eliminates the intraoperative and anesthetic risks of CVC replacement. Type of studyRetrospective cohort study. Level of evidenceLevel III.

Early planned removal versus expectant management of peripherally inserted central catheters to prevent infection in newborn infants.

Duration of use may be a modifiable risk factor for central venous catheter-associated bloodstream infection in newborn infants. Early planned removal of peripherally inserted central catheters (PICCs) is recommended as a strategy to reduce the incidence of infection and its associated morbidity and mortality. To determine the effectiveness of early planned removal of PICCs (up to two weeks after insertion) compared to an expectant approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants. We searched of the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), Ovid MEDLINE, Embase, Maternity & Infant Care Database, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (until April 2018), and conference proceedings and previous reviews. Randomised and quasi-randomised controlled trials that assessed the effect of early planned removal of umbilical venous catheters (up to two weeks after insertion) compared to an expectant management approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants. Two review authors assessed trial eligibility independently. We planned to analyse any treatment effects in the individual trials and report the risk ratio and risk difference for dichotomous data and mean difference for continuous data, with respective 95% confidence intervals. We planned to use a fixed-effect model in meta-analyses and explore potential causes of heterogeneity in sensitivity analyses. We planned to assess the quality of evidence for the main comparison at the outcome level using "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) methods. We did not identify any eligible randomised controlled trials. There are no trial data to guide practice regarding early planned removal versus expectant management of PICCs in newborn infants. A simple and pragmatic randomised controlled trial is needed to resolve the uncertainty about optimal management in this common and important clinical dilemma.

Clinical Characteristics and Risk Factors of Long-term Central Venous Catheter-associated Bloodstream Infections in Children.

Central line-associated bloodstream infections (CLABSIs) account for significant morbidity and mortality in patients with long-term central venous catheters (CVCs). This study was performed to identify the characteristics and risk factors of CLABSIs among children with long-term CVCs. A retrospective review of children who had a long-term CVC in Seoul National University Children's Hospital between 2011 and 2015 was performed. Data on patient demographics, the isolated pathogens and the status of CVC placement were collected. Clinical variables were compared between subjects with and without CLABSIs to determine the risk factors for CLABSIs. A total of 629 CVCs were inserted in 499 children during the 5-year period. The median age at insertion was 6.0 years (14 days-17.9 years), and hemato-oncologic disease was the most common underlying condition (n = 497, 79.0%). A total of 235 CLABSI episodes occurred in 155 children, with a rate of 0.93 per 1,000 catheter days. The most common pathogens were Klebsiella pneumoniae (n = 64, 27.2%), coagulase-negative staphylococci (n = 40, 17.0%) and Staphylococcus aureus (n = 28, 12.0%). In the univariate analysis, the gender, underlying disease, catheter characteristics and insertion technique did not increase the risk for CLABSI. In both the univariate and logistic regression analyses, patients with prior BSIs (odds ratio 1.66; 95% confidence interval: 1.090-2.531; P = 0.018) were more likely to have a CLABSI. CLABSI prevention is of particular concern for children with a prior BSI. Furthermore, the antimicrobial resistance of major pathogens should be monitored to enable the empiric selection of appropriate antibiotics in patients with long-term CVCs.

Infecciones asociadas a procedimientos invasivos. Hospital de alta complejidad. Paraguay en eñ 2015

Las infecciones asociadas a la atención en salud (IAAS) prolongan la estadía hospitalaria, incrementan la mortalidad y los costos. El objetivo del estudio fue determinar las características de los pacientes, tasa de incidencia y los microorganismos aislados en las IAAS asociadas a dispositivos. Estudio, descriptivo, retrospectivo, realizado desde enero a diciembre del año 2015, que incluyó pacientes internados en la Unidad de Cuidados Intensivos de Adultos (UCIA), con catéter venoso central (CVC), ventilación mecánica invasiva (VM) y catéter urinario permanente (CUP). Los datos fueron extraídos a partir de la hoja de factores de riesgo y la ficha de notificación de IAAS utilizado para la vigilancia. Se analizaron 75 fichas de IAAS. La tasa de incidencia de neumonía asociada a ventilación mecánica (NAM) fue de 15,9/1.000 días de VM, la tasa de infección del torrente sanguíneo asociada a catéter venoso central (ITS/CVC) fue de 9,2/1.000 días CVC y la tasa de infección del tracto urinario asociado a catéter urinario permanente (ITU/CUP) fue de 4,5/1000 días de CUP. Los microorganismos más frecuentes fueron: en NAVM, A. baumannii complex 10/31 (32%), P. aeruginosa 8/31 (26%), K pneumoniae 5/31 (16%). En ITS/CVC S. aureus 7/28 (25%), K. pneumoniae 5/28 (18%), E. faecalis 5/28 (18%) y en ITU/CUP predominio de Candida sp 4/13 (31%), Candida tropicalis, 3/13 (23%), A. baumannii 2/13 (15%). El 80% de los Enterococcus spp resultaron resistentes a Vancomicina, 42% de los Staphylococcus spp fueron meticilino resistentes, el 70% de los Acinetobacter spp, el 33% de P. aeruginosa y fueron multiresistentes. Resultaron ser productores de Carbapenemasa el 33% de K. pneumoniae. Se ha observado alta resistencia para lo cual es fundamental la implementación de medidas preventivas.