Central Venous Catheter-associated Infections Research Articles

The economic impact of healthcare-associated infections in hospitalization in intensive care units

Objective: To evaluate the economic impact caused by the occurrence of healthcare-associated infections (HAIS) in patients in the Intensive Care Unit (ICU). Methods: Integrative literature review, which adopted the PICO strategies – Population: ICU patients, Interest: HAIS, and Outcome: economic impact, Extraction, Conversion, Combination, Construction, and Use (ECUs) and Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) for searching and sampling in the databases that are part of the CAPES Periodicals Portal. Results: Twenty-one studies were included, categorized according to author, year, title, location, journal, type of study, and average cost of HAI during ICU admission. In the meantime, the cost of hospitalization of patients with HAI in the ICU is up to four times higher, associated with longer stays, use of antimicrobials and laboratory investigations, especially exacerbated in the detection of multidrug-resistant microorganisms. Final considerations: The most common HAI described were respiratory infections, especially Ventilator-Associated Pneumonia and Hospital-Acquired Pneumonia, bloodstream infections, distributed in sepsis, surgical site infection, central venous catheter-associated infection, and urinary tract infection associated with a bladder catheter.

Phyto-assisted synthesis of zinc oxide nanoparticles for developing antibiofilm surface coatings on central venous catheters.

Medical devices such as Central Venous Catheters (CVCs), are routinely used in intensive and critical care settings. In the present scenario, incidences of Catheter-Related Blood Stream Infections (CRBSIs) pose a serious challenge. Despite considerable advancements in the antimicrobial therapy and material design of CVCs, clinicians continue to struggle with infection-related complications. These complications are often due colonization of bacteria on the surface of the medical devices, termed as biofilms, leading to infections. Biofilm formation is recognized as a critical virulence trait rendering infections chronic and difficult to treat even with 1,000x, the minimum inhibitory concentration (MIC) of antibiotics. Therefore, non-antibiotic-based solutions that prevent bacterial adhesion on medical devices are warranted. In our study, we report a novel and simple method to synthesize zinc oxide (ZnO) nanoparticles using ethanolic plant extracts of Eupatorium odoratum. We investigated its physio-chemical characteristics using Field Emission- Scanning Electron Microscopy and Energy dispersive X-Ray analysis, X-Ray Diffraction (XRD), Photoluminescence Spectroscopy, UV-Visible and Diffuse Reflectance spectroscopy, and Dynamic Light Scattering characterization methods. Hexagonal phase with wurtzite structure was confirmed using XRD with particle size of ∼50nm. ZnO nanoparticles showed a band gap 3.25eV. Photoluminescence spectra showed prominent peak corresponding to defects formed in the synthesized ZnO nanoparticles. Clinically relevant bacterial strains, viz., Proteus aeruginosa PAO1, Escherichia coli MTCC 119 and Staphylococcus aureus MTCC 7443 were treated with different concentrations of ZnO NPs. A concentration dependent increase in killing efficacy was observed with 99.99% killing at 500μg/mL. Further, we coated the commercial CVCs using green synthesized ZnO NPs and evaluated it is in vitro antibiofilm efficacy using previously optimized in situ continuous flow model. The hydrophilic functionalized interface of CVC prevents biofilm formation by P. aeruginosa, E. coli and S. aureus. Based on our findings, we propose ZnO nanoparticles as a promising non-antibiotic-based preventive solutions to reduce the risk of central venous catheter-associated infections.

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.

Facilitating personal hygiene choices for renal patients with central venous lines: a multi-phase study

This study explored personal hygiene options of renal patients that maintain the integrity of central venous catheter exit site dressings between dialysis sessions. Background: Infection is a major life-limiting risk for patients undergoing haemodialysis via a central venous catheter. Meticulous attention to keeping the exit site dressings clean and dry is an essential defence in preventing local and systemic infections. It is difficult to maintain the integrity of water-resistant dressings in tropical environments. Study Design: A three-phase exploratory study was conducted in a northern Australian Renal Service. Methods: Phase 1 employed a cross-sectional, anonymous, online survey of renal nurses about the acceptability and feasibility of two hygiene options for patients: bathing wipes and a waterproof dressing cover. The survey also canvassed their concerns about the options. Descriptive statistics were used to summarise Likert-scale responses and content analysis was used for responses to open-ended survey questions. Phase 2 used conversational-style interviews with patients about their hygiene preferences, how they endeavoured to keep their dressings dry, and their impressions regarding the proposed options. Phase 3 was a series of case studies of patients trialling the provided options over a six-week period. Participants were progressively recruited to this phase and were provided with the product/s of their choice at each dialysis session; renal nurses also assessed the integrity of the dressings at each dialysis session. Research nurses discussed with the participants their experiences with the options. Results: Phase 1: Nurses (N=37, response rate 58.7%) considered both options acceptable and feasible for patients, noting some practical concerns related to their use. Phase 2: Patients (N=27, 100% participation rate) described hygiene preferences and difficulties they encountered with keeping dressings dry. Only one participant had a bath, as per written advice. All were enthusiastic about trying the proposed options. Phase 3: Patients (N=22) appreciated being able to shower without wetting their exit site dressings. Individuals were inventive in modifying the application and use of the waterproof cover according to their body shape and the central venous catheter exit site location. Although participants liked both options, the waterproof covering was most popular and most frequently used. Intactness of the dressings was 83% during the trial; there were no central venous catheter-associated infections during the study. Conclusion: Self-management and choice were motivating factors for participants. Patients embraced being able to keep their dressings dry and intact during personal hygiene in a tropical environment. Implications for research, policy, and practice: Patients demonstrated their willingness to undertake a more active role in their dressing care, while exercising choice with respect to personal hygiene. Studies that further increase patients’ participation in other aspects of their self-care warrant further investigation. The organisation is pursuing options for the ongoing provision of the products used in this study and how their use can be monitored in clinical practice. What is already known about the topic? Intact dressings provide an important line of defence against infection in the vulnerable population of patients receiving dialysis via central lines. Hygiene needs are also an important consideration for quality of life, empowerment, and autonomy. Patients’ current attempts to meet their own hygiene needs often result in a disruption to the intactness of the dressing site and predispose them to systemic infections. What this paper adds This study facilitated exploration of two feasible hygiene options in an open and culturally safe manner, from both patients’ and nurses’ perspectives. The opportunity to perform personal hygiene according to individual preferences resulted in a willingness of participants to undertake a more active role in the care of their dressing. The identification of two acceptable and feasible personal hygiene options has the potential of removing one of the many lifestyle modifications faced by people who undergo haemodialysis via a central venous catheter.

Prevención de CLABSI por el uso de tapón desinfectante 3M Curos®: metanálisis y evaluación económica

Background. Healthcare-associated infections are a relevant health-public issue because of their economic and social impact; thus, they represent a challenge for the health institutions and the personnel in charge of fighting the infections. Particularly, central venous catheter-associated infections require a long-period administration of antibiotics, which increases the catheter blockade. That may derive in replacing the catheter, more extended hospital stays, and a higher sepsis risk. Objective. To analyze the efficacy of the disinfectant cap (3M Curos®), compared to the traditional disinfection method of the needle-free connectors, catheters or disinfectant ports. Material and Methods. A systematic review, meta-analysis, and cost-effectiveness study were performed to determine the effectiveness of the disinfectant cap in order to define the efficiency compared to the traditional disinfection method. Univariate, multivariate, and probabilistic sensitivity analyses were performed to reduce uncertainty. Results. The disinfectant cap had an infection ratio of 1.54 infections per 1,000 catheters / day vs. traditional desinfection methods, which had a ratio of 4.84 infections per 1,000 catheters / day. Those results led to find a cost difference of $21,819.39 USD for 3M Curos® and $67,165.26 USD for traditional methods. Conclusions. The disinfectant cap proves to be a more efficient alternative for pediatric health in Mexico.

Bacteriological study of central line and Foleys catheter in surgical patients

Objectives: The objectives were to determine the incidence of bacterial colonisation and catheter-related infection on the central line and Foley’s tip in surgical patients and to evaluate the risk factors for the same. Materials and methods: One hundred and five patients above the age of 18 years were admitted to the surgical ICU and patients who underwent elective or emergency surgical procedures, who have a central line and Foleys catheter inserted were included. Patient details were recorded under the following parameters: age, sex, diagnosis, surgery performed, number of days of central line and Foley’s catheterization, presence of shock, fever, neutropenia, total parenteral nutrition (TPN) and blood transfused via central line, the culture of central line and catheter tip. Result: Bacterial colonisation on central venous catheter occurred in 31(29.5%) patients, on Foleys catheter in 28(26.7%) patients and on both catheters occurred in four(3.8%) patients. Three(2.9%) patients were found to have a central venous catheter-associated infection and 16(15.2%) patients were found to have Foleys catheter-related infection. Neutropenia, TPN and blood transfused through the central line were found to be risk factors for colonisation of organisms on the central line with an odds ratio of 4.62, 11.5, and 2.53 respectively. The presence of shock was found to reduce the risk of colonisation on the central line with an odds ratio of 0.28. The risk factors associated with colonisation on Foleys catheter were patients being in shock and duration of catheterization of more than three days with an odds ratio of 2.53 and 8.19 respectively. The most common organism cultured from a central venous catheter was Candida species, and that cultured from Foleys catheter was E. coli. Conclusion: Central line and Foleys catheter-related infections are quite prevalent among surgical patients and recognising their risk factors is necessary for preventing them.

New Insights Into the Indications for Intestinal Transplantation: Consensus in the Year 2019.

In 2001, a Statement was published that described indications for intestinal transplantation in patients with intestinal failure expected to require parenteral nutrition indefinitely. Since 2001, advances in the management of intestinal failure including transplantation and patient survival, both on extended parenteral nutrition and after transplantation, have improved, leading to a reduction in the number of intestinal transplants worldwide from a peak of 270 per year in 2008 to 149 per year in 2017. These changes suggest that the original 2001 Statement requires reassessment. All patients with permanent intestinal failure should be managed by dedicated multidisciplinary intestinal rehabilitation teams. Under care of these teams, patients should be considered for intestinal transplantation in the event of progressive intestinal failure-associated liver disease, progressive loss of central vein access, and repeated life-threatening central venous catheter-associated infections requiring critical care. Additional indications for transplantation include large desmoid tumors and other intra-abdominal tumors with reasonable expectation of posttransplant cure, extensive mesenteric vein thrombosis and intestinal infarction, total intestinal aganglionosis, and nonrecoverable congenital secretory diarrhea. Quality of life typically improves after successful intestinal transplantation and may support the decision to proceed with transplantation when other indications are present. However, the requirement for life-long immunosuppression and its associated side effects preclude intestinal transplantation if motivated only by an expectation of improved quality of life. Increasing experience with intestinal transplantation and critical appraisal of transplant outcomes including graft survival and patient quality of life together with potential advances in immunosuppression can be expected to influence transplant practices in the future.

SUN-057 Reducing Central Venous Catheter Burden in Haemodialysis Patients: The Impact of Changing Practice within an Australian Renal Unit

Despite varying worldwide practice, renal guidelines suggest minimisation of central venous catheter (CVC) use for dialysis access in haemodialysis (HD) patients as CVCs may lead to increases in morbidity and mortality. Few prospective studies have described the impact of renal unit initiatives aimed at reducing catheter burden and their potential effect on patient survival. We present data from a 10 year observational cohort study in an adult tertiary renal unit in Sydney, Australia. Initiatives introduced included; regular review of data regarding CVC infection rates and CVC exposure within the unit, appointment of a vascular access nurse specialist and regular multi-disciplinary team meetings between renal physicians, vascular surgeons and dialysis co-ordinators. Eligible patients over 18 years of age who required HD and did not have a functioning dialysis access, thereby requiring a CVC, were included. Patients were classified by treating physician into one of 4 groups based upon reason for CVC insertion. Patients believed to have acute kidney injury (AKI) and expected to recover to dialysis independence were classified as AKI; patients starting maintenance dialysis without a permanent access in place were classified as end stage kidney disease (ESKD); patients with failure of an existing HD access were classified as HD failure and patients transferring from peritoneal dialysis (PD) without an HD access were classified as PD failure. Prospective data were collected over 10 years on all patients and CVCs and linked to administrative health and registry data. Descriptive and survival analyses were performed and have been censored for transplantation. The study cohort included 557 patients and 1067 CVCs. The median patient age was 71.7 years [59.3-78.6]. The reasons for initial CVC insertion were; AKI (246 patients, 44% of total), ESKD (182, 33%), HD failure (84, 15%) and PD failure (45, 8%). Despite this, the majority of CVCs were required for HD failure (368, 35%), followed by AKI (338, 32%), ESKD (272, 25%) and PD failure (89, 8%). Over the data collection period the reasons for initial CVC placement changed. From 2005 to 2015 the proportion of patients requiring an initial CVC due to ESKD fell from 23% to 18%, whereas the proportion resulting from AKI rose from 27% to 59%. Total CVC days increased across the study period from 4859 days in 2005 to 5445 days in 2015, however days attributed to ESKD, HD failure and PD failure fell (1554 to 1200, 2330 to 2026, 595 to 542 respectively) (Figure 1). Use of tunnelled CVCs rose from 61% to 80%. Rates of CVC infection, classified as either a confirmed bacteraemia or the removal of a CVC due to suspicion of infection, fell from 5.76/1000 catheter days to 0.37/1000 catheter days. This prospective study describes how simple initiatives introduced in an Australian renal unit may reduce CVC burden and mitigate CVC associated infection rates.

Oncology nurses' knowledge of guidelines for preventing catheter-related bloodstream infections

This descriptive cross-sectional survey evaluated Jordanian oncology nurses' knowledge of the guidelines for preventing central venous catheter-associated infection. Poor knowledge was evident from the very low mean total scores and the low percentage of correct answers for each item in the questionnaire.

A multicenter study of targeted surveillance at Intensive Care Unit acquired MRSA infection in Tianjin district

Objective To study the incidence and risk factors of infection caused by methicillin-resistant staphylococcus aureus(MRSA)with a targeted surveillance at intensive care unit(ICU)acquired MRSA infection in Tianjin area. Methods A prospective multi-center observational analysis of consecutive patients admitted to 15 adult ICUs from March 1, 2012 through March 31, 2014 was carried out. The ICUs were divided into four groups according to the type of the ICU. All of the patients were cared for with routine MRSA surveillance. A number of risk markers and prognostic factors were recorded. The risk factors contributing to ICU acquired MRSA were evaluated using a logistic regression model. Comparison of survival between groups was analyzed with Kaplan-Meier method. Results A total of 1 787 patients were enrolled, and 144 cases of them were MRSA infections. The patients with MRSA infection were significantly older than those with non-MRSA infection (P=0.043), length of ICU stay, length of antimicrobial therapy, the history of repeated administration of antibiotics in recent days, history of operation in the past five years, history of MRSA infection or colonization, frequent application of and the overall length of time for mechanical ventilation and central venous catheter and catheter-associated infection were significantly higher than those with non-MRSA infection. The survival rate of patients with non-MRSA infection were higher than those with MRSA infection (χ2=9.23, P=0.004). The rate of MRSA infection and MRSA colonization in 2013 were significantly lower than that in 2012, because the rate of hand hygiene rule execution and bacterial clearance rate were significantly higher in 2013. Multivariate Logistic regression analysis demonstrated that advanced age (OR=1.05, 95%CI: 1.009-1.086), length of ICU stay (OR=1.05, 95%CI: 1.01-1.08), history of MRSA infection or colonization(OR=1.33, 95%CI: 1.82-3.27), glucocorticoid therapy(OR=2.85, 95%CI: 1.18-6.91), antacid medicine(OR=4.92, 95%CI: 1.18-20.58), history of recent or repeated application of antibiotics(OR=3.26, 95%CI: 1.06-4.59)catheter-associated infections (OR=2.22, 95%CI: 1.08-4.59) were associated with ICU acquired MRSA infections. Conclusions Performing the rule of hand hygiene strictly as well as strengthening prevention and control of MRSA infections can effectively reduce the incidence of ICU acquired MRSA infections. The advanced age, length of ICU stay, history of MRSA infection or colonization, glucocorticoid therapy, antacids medicine, history of recent or repeated application of antibiotics, catheter-associated infections were independent risk factors of ICU acquired MRSA infections. Key words: Intensive care unit; Methicillin resistant staphylococcus aureus(MRSA); Risk factor; Targeted surveillance

Student nurses’ knowledge of guidelines for preventing central venous catheter-associated infections

Background: Despite the advantages of Central venous catheters (CVC), patients are at high risk of infection (local and systematic) that could be lethal. Lack of knowledge of the available guidelines for the prevention of CVC-associated infection may increase the rate of CVC-associated infections.Objective: The purpose of the study is to evaluate student nurses’ knowledge of the guidelines for preventing CVC-associated infection.Methods: A descriptive cross-sectional survey was used. This study involved 267 student nurses from four government universities. They were in their second-, third- or fourth-year of study.Results: Most of the students were female (72.3%) with a mean age of 21.2 (SD 2.5). The mean total score of students’ knowledge was very low at 1.6 (SD 1.5) out of 10, the maximum score, and ranged from 0 to 7. Students who reported having received adequate theoretical and clinical education about CVC had higher mean total knowledge scores than those who had not.Conclusions: The results showed that Jordanian student nurses have insufficient knowledge about the prevention of CVC-associated infection. In order to improve their knowledge, an evidence-based teaching approach is required in the theoretical classes. This should be combined with the best clinical training through the use of simulation techniques.

542 - Prevention of Central Venous Catheter-Associated Blood Infections in a Hematopoietic Stem Cell Transplantation Unit in Brazil

542 - Prevention of Central Venous Catheter-Associated Blood Infections in a Hematopoietic Stem Cell Transplantation Unit in Brazil

Staphylococcus saprophyticus Bacteremia in a Pediatric Patient with Central Venous Catheter-Associated Infection

Staphylococcus saprophyticus Bacteremia in a Pediatric Patient with Central Venous Catheter-Associated Infection

A Prospective and Observational Study of Central Venous Catheter-Associated Infection for Three Consecutive Years in a 600-Bed Japanese Hospital

Central venous catheters (CVCs) have been used for critically ill patients for administration of nutrition and medication. Central line-associated blood stream infection (CLABSI) is the important issue associated with the use of CVCs that affects patients’ prognosis. The objective of this study is to determine the influence of various factors (e.g., CVC insertion site, CVC type) on the rate of infection associated with CVCs.

Infectious complications associated with the use of central venous catheters in patients undergoing hematopoietic stem cell transplantation

In this prospective, observational study, we sought to investigate the incidence, risk factors, and outcomes of central venous catheter-associated infection in 56 patients admitted for hematopoietic stem cell transplantation. In multivariate analysis, we found a 7-fold higher risk of central line-associated bloodstream infection with central venous catheter insertion in the internal jugular vein as compared with the subclavian access. Patients with central line-associated bloodstream infection had a higher incidence of acute renal failure.

Invasive device-associated hospital infection rates, etiological agents, and their antibiotic susceptibilities in the medical intensive care unit of a university hospital in Turkey

To determine the rate, etiological agents, antibiotic susceptibilities, and empirical treatment options of etiological agents of invasive device-associated hospital infections (IDAHIs) in the medical intensive care unit of a university hospital. Materials and methods: Between February 2007 and December 2009, 780 IDAHI cases were evaluated in 1650 patients. Results: Ventilator associated pneumonia, catheter-associated urinary tract infection, and central venous catheter-associated blood stream infection were observed in 415, 242, and 143 IDAHI cases, respectively. The most frequently isolated etiological agents were Acinetobacter spp. in ventilator-associated pneumonia, coagulase-negative staphylococci (CoNS) in central venous catheter-associated blood stream infection, and Candida spp. and E. coli in catheter-associated urinary tract infection. Conclusion: In our study, oxacillin resistance in coagulase-positive S. aureus and CoNS was high. Glycopeptides and linezolid should be considered as treatment options. Resistance of enteric bacteria is defined high against cephalosporin, aminoglycoside, and quinolone. Carbapenems can be considered in the empirical treatment of enteric bacterial infections. Colistin can be given in the treatment of resistant Acinetobacter infections as a therapeutic option. Since antifungal resistance is low, fluconazole should be the first drug of choice in the treatment of candidal infections.

Meta-analysis of subclavian insertion and nontunneled central venous catheter-associated infection risk reduction in critically ill adults*

Catheter-associated infections are common, costly, and potentially lethal. The impact of catheter insertion site on infection risk remains controversial. We aimed to establish whether nontunneled central venous catheters inserted in the subclavian vein are associated with lower risk of catheter-associated infection compared to femoral or internal jugular vein insertion. We searched MEDLINE (2000-2011), EMBASE (2000-2011), and Cochrane Library plus meta-analyses, gray literature, reference lists, and articles recommended by experts. We selected peer-reviewed, randomized, or prospective cohort studies with systematic catheter culture using semiquantitative or quantitative catheter culture techniques and data available for catheter-associated infection by insertion site. Two reviewers independently performed study selection, assessed study quality, and extraction. Discrepancies were resolved by discussion and consensus. Outcomes were mean catheter duration and catheter-associated infection expressed as incidence density per 1000 catheter days. Ten studies (3250 subclavian, 3053 internal jugular, and 1554 femoral vein) met the inclusion criteria, one of which was randomized (136 subclavian vein and 134 femoral vein). Subclavian vein catheters were left in place significantly longer than alternative catheters (mean difference: 2 days, 95% confidence interval [0.9-3.1], I=92%, p<.001). The subclavian vein site was associated with fewer catheter-associated infections (1.3 compared to 2.7 per 1000 catheter days for alternative sites, incidence density ratio 0.50; 95% confidence interval [0.33- 0.74], I=0%, p<.001). The same was true when comparisons were stratified by alternative sites (subclavian vein vs. internal jugular vein, incidence density ratio 0.46; 95% confidence interval [0.30-0.70], I=0%; subclavian vein vs. femoral vein, incidence density ratio 0.27; 95% confidence interval [0.15-0.48], I=31%). Shortcomings in study design, including channeling, confounding bias, and study heterogeneity, may limit the interpretation of our preliminary study results. Our analysis suggests that the subclavian site may be associated with a lower risk of catheter-associated infection. However, a large, randomized, controlled trial comparing each catheter site complication is warranted before the subclavian site can be unequivocally recommended as a first choice for central venous catheter insertion.

Acesso venoso central guiado por ultrassom: qual a evidência?

In recent years, international health quality assurance organizations have been recommending ultrasound guidance for central venous punctures. This article reviews the evidence behind these recommendations. The MEDLINE, PubMed and SCIELO databases were searched for the following MeSH terms: central venous access, ultrasonography, and adults. The search was conducted on September 24, 2010, and selected meta-analyses, randomized clinical trials and reviews, retrieving 291 papers. The 21 most important papers were analyzed in this review. The internal jugular vein is the most studied ultrasound-guided puncture site, with meta-analysis showing lower relative risks of failure and complications. In addition, the largest available randomized clinical trial demonstrated a reduced central venous catheter-associated blood stream infection rate. There are few studies involving subclavian vein puncture; however, ultrasound was shown to be beneficial in two meta-analyses (however, with small numbers of patients). Regarding the femoral venous site, only one randomized clinical trial (20 patients) was identified, showing positive findings. In a British cost-effectiveness study, ultrasound use lead to resource savings for different sites of venous puncture. There is strong evidence for ultrasound benefit for internal jugular vein puncture. Although the method appears attractive for the other sites, the data are not sufficient to support any recommendation.

Interventions to reduce central venous catheter-associated infections in children: which ones are beneficial?

Interventions to reduce central venous catheter-associated infections in children: which ones are beneficial?

Catheter-Associated Bloodstream Infection Incidence and Risk Factors in Adults with Cancer: A Prospective Cohort Study.

Abstract 1382Poster Board I-404 Background:Central venous catheter-associated blood stream infections (CA-BSI) cause considerable morbidity in adult patients with hematologic cancers and solid tumors. A range of central venous access devices (CVAD) may be used across differing patient diagnoses and for varying indications. The aim of our study was to determine the incidence and risk factors for CA-BSI. Methods:A prospective observational cohort study of consecutive adult patients requiring a CVAD in a hematology-oncology unit (including autologous but not allogeneic transplantation) was performed. All CVADs were inserted under ultrasound guidance in a dedicated interventional radiology facility with peripherally inserted central venous catheters (PICCs) inserted in the basilic or cephalic vein and tunnelled lines, non-tunnelled lines and implantable ports inserted via the internal jugular vein. Standardized surveillance methods for CA-BSI were applied and data on CVAD complications were recorded. Results:1119 CVADs were assessed in 723 patients over 50,478 line days. Median patient age was 55yrs and 56% were male. Patient diagnoses included aggressive hematologic malignancies (48%, includes AML (17%), MDS (1%), NHL (22%) and MM (8%)), Hodgkin lymphoma (3%), other hematologic malignancies (3%), oesophageal/colon/rectal cancers (26%), and all other solid tumors (20%). CVAD types included PICCs (71%), non-tunnelled lines (14%), tunnelled lines (14%), and implantable ports (1%). 291 lines were removed due to a clinical suspicion of infection, 133 of these had CA-BSI and 34 of these had a positive tip culture in addition to meeting the definition of CA-BSI. The four most common bacterial isolates were S. epidermidis (n=23), S. aureus (n=15), Pseudomonas sp (n=12) and Stenotrophomonas sp (n=10). The rate of CA-BSI per 1,000 line days was 2.63. In multivariate analysis, factors associated with CA-BSI included: type of CVAD (greatest for non-tunnelled lines (HR 3.67, p<0.0001) and tunnelled lines (HR 1.83, p=0.0062) compared to PICC lines); patient diagnosis (greatest for aggressive haematological malignancies (HR 2.95, p=0.0031) and least for oesophageal, colon and rectal cancers (HR 0.26, p=0.014) compared to other solid tumours); side of insertion (greatest for right-sided lines (HR 1.61, p=0.024)); and number or prior line insertions (HR1.2, p=0.016). In a subgroup analysis of patients with aggressive hematologic malignancies, the association between CA-BSI and line type (greater infection for tunnelled (HR 1.46, p=0.09) and non-tunnelled lines (HR 3.73, p<0.001) compared to PICCs) and side of line insertion (more infection with right sided lines (HR1.66, p=0.035)) remained. 4.8% of lines were complicated by symptomatic thrombosis which was less common in patients with oesophageal, colon and rectal cancer (HR 0.43, p=0.027) and in lines inserted in the internal jugular vein (HR 0.2, p=0.0083) compared to PICC lines. Conclusions:Incidence of CA-BSI in an Australian adult cancer population is comparable to other reports in the literature. This study highlights the utility of a standardised CA-BSI surveillance strategy in adult patients with cancer, provides further data to support the use of PICC lines in such patient populations, including patients with hematological malignancies, and suggests that the side of line insertion may influence CA-BSI. Disclosures:No relevant conflicts of interest to declare.