Central Venous Catheter Colonization Research Articles

Correlation between catheter colonization of central venous catheters and clinical biochemical indicators: A retrospective analysis of the MIMIC‑IV database

Clinical studies have not fully assessed the potential impact of patients' biochemical indicators on the rate of positive for central venous catheter-tip microorganism culture (PCMC). Data were obtained from an online Medical Information Mart for Intensive Care IV database. Patients who were ≥18 years old and had central venous catheter-tip culture results without continuous renal replacement therapy were included in the study. A comparison of patient characteristics and their biochemical indicators was made between negative and positive culture results. A total of 5,323 patients were included in the analysis, including 612 positive (PCMC group) and 4,711 negative culture results (negative for central venous catheter tip catheter-tip microorganism culture [NCMC] group). The only influence factor on PCMC in this study was the serum creatinine (Scr) (odds ratio: 1.312, 95% confidence interval: 1.084-1.590, P=.005), according to a binary logistic regression analysis. The cut-off value of Scr was 3.25mg/dL. The prevalence of PCMC (27.1% vs 9.1%, P<.001) and Staphylococcus aureus (43.0% vs 18.6%, P<.001) for central venous catheter-tip culture results was much higher in patients with Scr≥3.25mg/dL than those Scr<3.25mg/dL. We used the large dataset collected from Medical Information Mart for Intensive Care IV to show that patients with Scr≥3.25mg/dL had an increased risk for PCMC.

Curcumin-Functionalized Graphene Oxide Strongly Prevents Candida parapsilosis Adhesion and Biofilm Formation.

Candida parapsilosis is the major non-C. albicans species involved in the colonization of central venous catheters, causing bloodstream infections. Biofilm formation on medical devices is considered one of the main causes of healthcare-associated infections and represents a global public health problem. In this context, the development of new nanomaterials that exhibit anti-adhesive and anti-biofilm properties for the coating of medical devices is crucial. In this work, we aimed to characterize the antimicrobial activity of two different coated-surfaces, graphene oxide (GO) and curcumin-graphene oxide (GO/CU) for the first time, against C. parapsilosis. We report the capacity of GO to bind and stabilize CU molecules, realizing a homogenous coated surface. We tested the anti-planktonic activity of GO and GO/CU by growth curve analysis and quantification of Reactive Oxigen Species( ROS) production. Then, we tested the antibiofilm activity by adhesion assay, crystal violet assay, and live and dead assay; moreover, the inhibition of the formation of a mature biofilm was investigated by a viability test and the use of specific dyes for the visualization of the cells and the extra-polymeric substances. Our data report that GO/CU has anti-planktonic, anti-adhesive, and anti-biofilm properties, showing a 72% cell viability reduction and a decrease of 85% in the secretion of extra-cellular substances (EPS) after 72 h of incubation. In conclusion, we show that the GO/CU conjugate is a promising material for the development of medical devices that are refractory to microbial colonization, thus leading to a decrease in the impact of biofilm-related 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.

Infections and colonisation of central venous catheters in patients admitted to intensive care units at two tertiary care hospitals

Introduction: Central venous catheters (CVC) are frequently used in modern health care systems. However, CVCs are likely to get colonised with microorganisms, resulting in catheter-related blood stream infections (CRBSI). This study investigated microorganisms causing CRBSI and CVC colonisation, their antibiotic resistance, and factors associated with CRBSI in patients in the intensive care units (ICU) at the Colombo North Teaching Hospital (CNTH) and Apeksha hospital, Sri Lanka. Methods: The study included 300 adult patients in ICUs with a CVC in-situ for &gt;48 hours. Blood taken through the CVC, peripheral blood and CVC tips were cultured. Microorganisms were identified and tested for antibiotic susceptibility. Demographic factors were recorded. Results: Seventeen patients (13.1%) developed CRBSI. The CRBSI rate was 13.3 per 1,000 catheter days in CNTH while it was 10 (5.9%) cases and 5.2 per 1,000 catheter days in Apeksha hospital. In CNTH, CVC colonisation was detected in 35 (26.9%). Coagulase negative staphylococci (CoNS) were the leading cause of both CRBSI (41%) and colonisation (58%). In Apeksha hospital, Klebsiella sp. (5/10) were the predominant pathogens that caused CRBSI. Eighty-nine CVCs (52.3%) were colonised by CoNS (58%). In CNTH, CRBSI was detected more in males (14/17) (p&lt;0.05). The majority of microorganisms that caused CRBSI and CVC colonisation in both hospitals showed resistance to commonly used antibiotics. Conclusion: The CRBSI rates and the incidences were higher in CNTH. CoNS was the most common cause of CRBSI in CNTH and Gram negative bacteria in Apeksha hospital. CVC colonisation with CoNS was common in both hospitals. Antibiotic resistance was high among bacteria causing CRBSI and colonisation.

Insights on catheter-related bloodstream infections: a prospective observational study on the catheter colonization and multidrug resistance

Central venous catheter-related bloodstream infection (CRBSI) is a huge public health concern with considerable impact on mortality and health costs. A three-year observational study enrolling three tertiary hospitals located in Lisbon, Portugal, was designed to identify the major aetiological agents of CRBSI, their ability to colonize central venous catheters and their antimicrobial resistance profiles. Aetiological agents of CRBSI were identified by Vitek 2. Whole-genome sequencing was used to confirm CRBSI by the most prevalent aetiological agents and characterize their resistome. Central venous catheter colonization (namely by biofilm assembly) was monitored by scanning electron microscopy. Staphylococci were the most prevalent causative agent (36/58, 62.0%), with S.aureus and coagulase-negative S.epidermidis accounting for 24.1% and 36.2% of CRBSIs, respectively. Fifty-nine of 72 staphylococci isolates were meticillin resistant. Comparative genomic analysis of central venous catheters/haemoculture pairs of isolates revealed genomic matches for 35 of 36 pairs and a good correlation between antibiotic susceptibility phenotype and the presence of antimicrobial resistance genetic determinants. Biofilms were present on 48.6% of the central venous catheters; nevertheless, no statistically significant association was established between biofilm assembly and CRBSI, and the presence/absence of ica operon and agr groups did not correlate with biofilm phenotypes, highlighting the need for further studies to elucidate biofilms' role on this healthcare-associated infection. Whole-genome sequencing was shown to be a valuable tool to confirm CRBSI. Although more than 42.3% of the central venous catheters were colonized by staphylococci, no statistically significant association was found between CRBSI and biofilms.

Central Venous Catheter-Related Infectious Complications in Pediatric Surgical Patients: A Single-Center Experience.

The purpose of this study was to estimate the rate of central venous catheter (CVC) colonization and catheter-related bloodstream infections (CRBSIs) in pediatric surgical patients at our institute and to determine the various risk factors for their occurrence. The electronic medical records of 260 children undergoing surgery with simultaneous CVC insertion were retrospectively reviewed. Data on demographics, primary organ system involved, site of CVC, CVC dwell time, CVC colonization, CRBSI, and organisms isolated on culture were collated, categorized, and analyzed. The rate of CVC colonization and CRBSI was 32.8 per 1,000 catheter days (19.6%) and 17.4 per 1,000 catheter days (10.4%), respectively. Patients with CVC colonization and CRBSI had a significantly higher proportion of patients younger than 1 year of age ( p = 0.014). The CVC dwell time was significantly higher in both CVC colonization (7 [5-8] days) and CRBSI (6 [5-9] days) patients ( p = 0.005). The frequency of femoral catheterization was significantly higher in patients with CRBSI and CVC colonization ( p < 0.001). Coagulase negative staphylococcus was the commonest isolate in CVC infections. Age (adjusted odds ratio [OR] = 0.87; p = 0.009), CVC dwell time (adjusted OR = 1.28; p = 0.003), and femoral CVC (adjusted OR = 9.61; p < 0.001) were independent risk factors for CRBSI. Conclusion: This study reveals important observations regarding the infectious complications of CVC in pediatric surgical patients. The rates of CVC colonization and CRBSI in this study were found to be higher as compared with previously reported rates in Western literature. However, these findings are significant in view of paucity of existing literature in pediatric surgical patients. In our study, higher risk of CRBSI was associated with younger age, increasing CVC dwell time, and femoral venous catheterization. We recommend strict compliance with CVC insertion and maintenance practices and adherence to CVC care bundles to minimize these serious complications.

Frequency and antimicrobial susceptibility pattern of isolates in central venous catheter colonization.

Colonization of central venous catheters increases the risk of blood stream infections and is associated with increased morbidity, mortality and excess hospital costs. Objectives: To estimate frequency of central venous catheter colonization. Study Design: Cross Sectional study. Setting: Microbiology Laboratory of Punjab Institute of Cardiology, Lahore. Period: May 2018 to December 2018. Material and Methods: Total 116 specimens of central venous catheters were received in the laboratory and processed to isolate various organisms. Organisms were identified on the basis of colonial morphology, Gram staining and biochemical tests. Antimicrobial sensitivity testing was performed and results were recorded. Results: Out of total 116 specimens of central venous catheters, bacterial growth was obtained from 74.1% of central venous catheter tips. From 86 cultures yielding growth, 94 micro-organisms were isolated. The most frequent organisms isolated from central venous catheter tip culture in decreasing order of frequency were Coagulase negative staphylococci (29.8%), S. aureus (24.5%), Candida species (23.4%), Klebsiella species (12.8%), and Acinetobacter spp. (4.3%). Drug susceptibility pattern of isolates was recorded. Conclusion: Central venous catheters can get colonized and lead to catheter related infections. Implementation of prevention programs can result in decrease in colonization rate of catheters and thus Catheter related infections.

Detection of sasX Gene and Distribution of SCCmec Types in Invasive and Non-invasive Coagulase-negative Staphylococci

Background:Coagulase-negative staphylococci, which belong to the normal microbiota of the skin and mucous membranes, are opportunistic pathogens. sasX, a newly described protein, is thought to play an important role in nasal colonization and methicillin-resistant Staphylococcus aureus virulence, and it may be acquired from coagulase-negative staphylococci by horizontal gene transfer. It has been considered that understanding the function of sasX gene may help clarify the relevance of the different adhesion mechanisms in the pathogenesis of infections associated with biofilm.Aims:To investigate the sasX gene presence, staphylococcal cassette chromosome mec types, and antimicrobial resistance patterns of invasive and noninvasive coagulase-negative staphylococci isolates.Study Design:Cross-sectional study.Methods:The study included a total of 180 coagulase-negative staphylococci strains. Non-invasive isolates (n=91) were obtained from the hands of healthy volunteers who do not work at the hospital (n=30), the nasal vestibule of healthy volunteer hospital workers (n=26), and central venous catheter (n=35). Invasive isolates (n=89) were isolated from peripheral blood cultures of inpatients who do not have catheters. All isolates were identified by conventional microbiological methods, automated systems, and, if needed, with matrix-assisted laser desorption/ionization-time of flight. Staphylococcal cassette chromosome mec typing, sasX and mec gene detection, antibiotic susceptibility, and sasX gene sequence analysis were performed.Results:Peripheral blood, central venous catheter colonization, and nasal vestibule isolates were positive for the sasX gene, whereas hand isolates were negative. sasX gene was present in 17 isolates, and no statistical significance was found between invasive and noninvasive isolates (p=0.173). Sequence analysis of the sasX genes showed high homology to related proteins of Staphylococcus phage SPbeta-like and Staphylococcus epidermidis RP62A. staphylococcal cassette chromosome mec type V was the most prevalent regardless of species. staphylococcal cassette chromosome mec type II was more frequent in invasive isolates and found to be statistically important for invasive and noninvasive S. epidermidis isolates (p=0.029). Staphylococcus haemolyticus isolates had the overall highest resistance rates. Resistance to ciprofloxacin, trimethoprim-sulfamethoxazole, and erythromycin was found to be higher in isolates from catheter and blood culture. Staphylococcus hominis isolates had the highest rate for inducible clindamycin resistance. None of the isolates were resistant to vancomycin, teicoplanin, and linezolid.Conclusion:The sasX gene is detected in 9.44% of the isolates. There is no statistical difference between the sasX-positive and -negative isolates in terms of antibacterial resistance and the presence of sasX and SCCmec types. Further studies about the role of sasX at virulence in coagulase-negative staphylococci, especially from clinical samples such as tracheal aspirate and abscess isolates, and distribution of staphylococcal cassette chromosome mec types are needed.

Antibiotic Lock Therapy with Linezolid for the Treatment of Persistent Catheter-Related Infection in Children with Cancer

Abstract Objective Central venous catheter (CVC) colonization is a common problem in the pediatric oncology department. Initial colonization of CVC by coagulase-negative staphylococci (CoNS), Staphylococcus aureus, and enterococci is followed by the growth of intraluminal biofilm formation, and results in antibiotic therapy failure. The removal of the old CVC and insertion of new CVC is a difficult and expensive procedure in small children with cancer. The present article aimed to study our treatment results of antibiotic lock therapy (ALT) with linezolid in pediatric cancer patients. Methods This study was planned as retrospective presentation of case series with eight pediatric cancer patients treated with 11 courses of systemic and linezolid lock therapy. Demographic information, clinical findings, laboratory data, blood culture results, complications, and outcome were collected for each patient retrospectively and descriptive statistical methods were used. Results Prior to treatment, peripheral and CVC blood culture results showed Staphylococcus epidermidis in seven patients and Staphylococcus hominis in four patients. All pathogens were susceptible to vancomycin and teicoplanin; first-line treatment was vancomycin in six and teicoplanin in five patients. After first-line treatment, peripheral blood cultures of all patients were negative, whereas blood cultures from CVC remained positive. During second-line therapy with linezolid, microbiological eradication was achieved on the fourth day of treatment in each patient. Median catheter survival time for all patients was 14 (range: 8–30) months. No side effects were observed during the treatment and no resistant organisms were documented. Conclusion Although multicentric prospective controlled trials will be required to provide more generalizable results, we suggest that systemic antibiotics combined with linezolid lock therapy used in pediatric cancer patients may be an effective option in treating catheter-related bloodstream infection (CRBSI) and prolonging CVC survival when CoNS are identified.

The Insertion Site Should Be Considered for the Empirical Therapy of Short-Term Central Venous and Arterial Catheter-Related Infections.

Little is known on causative pathogens of intravascular catheters infection according to the catheter insertion site. The present study aimed to describe the epidemiology of causative microorganisms of catheter-related infection and colonization according to the insertion site. Multicenter observational study using data from four large randomized controlled trials investigating different prevention strategies in which extensive prospective high-quality data collection at catheter insertion and catheter removal was performed. Twenty-five ICUs in France. Patients were recruited from 2006 to 2014 as soon as they required a catheterization with a short-term central venous catheter or peripheral arterial catheter with an expected duration of use of more than 48 hours. We described the distribution of microorganisms in central venous catheter and arterial catheter-related bloodstream infections and colonization according to the insertion type (femoral vs nonfemoral) included in the four studies. None. A total of 7,235 patients and 15,259 catheters were included. Among central venous catheter, the distribution of microorganisms associated with catheter-related bloodstream infection and colonization was significantly different between femoral and nonfemoral sites. Among central venous catheter catheter-related bloodstream infection, nonfermenting Gram-negative bacilli were more frequently detected at the femoral site (31% vs 4% for nonfemoral site; p < 0.01). After adjustment for confounding factors, the femoral site was still associated with an increased risk for catheter-related bloodstream infection due to nonfermenting Gram-negative bacilli (odds ratio, 6.33; 95% CI, 1.59-25.28; p < 0.01). Among colonized arterial catheters, the distribution of microorganisms was significantly different between femoral and radial site (p < 0.01). Colonized arterial catheters due to nonfermenting Gram-negative bacilli were more frequently observed at the femoral site (20% vs nonfemoral site 12%; p = 0.01). The proportion of intravascular catheter infections due to nonfermenting Gram-negative bacilli was high for the femoral insertion site. Empirical antipseudomonal therapy should be considered if a femoral catheter-related bloodstream infection is suspected.

Positive-pressure needleless connectors did not increase rates of catheter hub colonization respecting the use of neutral-pressure needleless connectors in a prospective randomized trial

IntroductionThe aim of this study was to compare the colonization rates of central venous catheter (CVC) and arterial catheter (ArtC) hubs fitted with two types of needleless connectors (NCs). MethodsWe designed a prospective randomized study to compare rates of catheter hub colonization of CVC and ArtC hubs fitted with two types of needleless connectors: neutral-pressure NCs (NP-NCs) and positive-pressure NCs (PP-NCs) in critically ill patients. All NCs were replaced every 7 days of use. ResultsWe obtained 326 cultures from 146 catheters (81 CVC and 65 ArtC) in 70 patients. The total cumulative days of risk were 1250 catheter-days. Global swab cultures were positive in NP-NCs in 29/198 (14.6%) versus 17/128 (13.3%) in PP-NCs during catheter use. We did not observe any cases of CRBSI. ConclusionsIn our experience, the use of PP-NCs did not result in significantly more frequent hub colonization with respect to NP-NCs.

Bacterial colonization of non-permanent central venous catheters in hemodialysis dogs

Non-permanent central venous catheters (CVCs), are the most commonly used vascular access in veterinary patients undergoing hemodialysis. In human dialysis patients, CVC infection represents a common cause of morbidity and mortality. The aim of this retrospective observational study was to evaluate the prevalence of bacterial colonization of CVCs in dogs submitted to hemodialysis treatment at time of CVC removal.The CVCs of all dogs submitted to hemodialysis (n = 23) at the Veterinary Teaching Hospital ''Mario Modenato'' of the University of Pisa between January 2015 and December 2016 were considered. For all dogs, data regarding signalment, reason for hemodialysis treatment, duration of catheterization (≤15 or >15 days), CVC complications, and 30-day survival were considered. Statistical analysis was performed using Graph Pad Prism™. Five over 23 dogs (22%) showed positive bacterial culture of CVC (+), and 18/23 dogs (78%) negative culture of CVC (-). The most prevalent microorganism was Staphylococcus Spp (3/5; 60%). No significant difference was found in the prevalence of CVC infection according to age, gender, reason for hemodialysis, CVC complications, duration of catheterization, and outcome. No statistically significant difference (p = 0.64) in survival curves was reported at log rank analysis between dogs with CVC - and CVC +.The prevalence of bacterial CVC contamination in our dialysis dogs showed relatively low. Exclusive use of CVC for hemodialysis, good hygiene practice during CVC management, and use of chlorhexidine as an antiseptic should be strongly encouraged.

Positive-pressure needleless connectors did not increase rates of catheter hub colonization respecting the use of neutral-pressure needleless connectors in a prospective randomized trial

IntroductionThe aim of this study was to compare the colonization rates of central venous catheter (CVC) and arterial catheter (ArtC) hubs fitted with two types of needleless connectors (NCs). MethodsWe designed a prospective randomized study to compare rates of catheter hub colonization of CVC and ArtC hubs fitted with two types of needleless connectors: neutral-pressure NCs (NP-NCs) and positive-pressure NCs (PP-NCs) in critically ill patients. All NCs were replaced every 7 days of use. ResultsWe obtained 326 cultures from 146 catheters (81 CVC and 65 ArtC) in 70 patients. The total cumulative days of risk were 1250 catheter-days. Global swab cultures were positive in NP-NCs in 29/198 (14.6%) versus 17/128 (13.3%) in PP-NCs during catheter use. We did not observe any cases of CRBSI. ConclusionsIn our experience, the use of PP-NCs did not result in significantly more frequent hub colonization with respect to NP-NCs.

Risk factors for central venous catheter related bloodstream infection: a multicenter study of intensive care unit and haemodialysis unit

The clinical condition of the patient, type of central venous catheter (CVC), site and duration of CVC placement are the factors affecting the risk of infection. The aim of this study was to examine and find out the risk factors of CVC related blood stream infections (CVC-BSI). This cross sectional study was carried out in the Department of Microbiology and Immunology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of July 2011 to June 2012. One hundred patients who were admitted in ICU of BSMMU and ICU and haemodialysis unit of Dhaka Medical College Hospital (DMCH) having central venous catheter, were enrolled in the study. The rate of CVC-BSI was 11% and the incidence was observed to be 11.14/1000 catheter days. Both CVC-BSI and CVC colonization were higher in trilumen than in bilumen central venous catheter. CVC-BSI rate was 12.79% in trilumen whereas there was no CVC-BSI in patient with bilumen catheter. The mean duration from CVC insertion to development of CVC-BSI was 14 days, CVC colonization was 8.41 days and noninfected CVC was 6 days. CVC-BSI and CVC colonization were most common in right femoral vein where CVC-BSI was 18.52% and CVC colonization was 59.26%, whereas no CVC-BSI was found in right internal jugular vein. Risk factors for CVC-BSI included type of CVC, site of CVC placement, duration of catheterization were not found statistically significant in this study. CVC-BSI and CVC colonization were higher in trilumen catheter and rate raised with increased duration of placement and highest number of CVC-BSI and colonization was found in right femoral vein.&#x0D; Bangladesh Med J. 2018 Jan; 47 (1): 18-21

NDV-3A vaccination prevents C. albicans colonization of jugular vein catheters in mice

NDV-3A, a novel fungal vaccine undergoing clinical trials, contains a recombinant version of the Candida albicans rAls3 N-terminus protein (rAls3p-N) in aluminum hydroxide. In a Phase 1b/2a clinical trial, NDV-3A protected women from recurrent vulvovaginal candidiasis. Here, we reveal that active immunization in mice with NDV-3A induces high titers of anti-rAls3p-N antibodies that interfere with C. albicans ability to adhere to and invade endothelial cells, and form biofilm in vitro. Anti-rAls3p-N antibodies also significantly inhibit yeast dispersal from the hyphal layers of biofilms. Compared to placebo, NDV-3A vaccination inhibited C. albicans dissemination to kidneys and prevented colonization of central venous catheters in mice. Overall, these preclinical studies suggest that NDV-3A may serve as an immunotherapeutic strategy for prevention of infections on indwelling medical devices.

Educational interventions alone and combined with port protector reduce the rate of central venous catheter infection and colonization in respiratory semi-intensive care unit

BackgroundCentral Line-Associated BloodStream Infections (CLABSIs) are emerging challenge in Respiratory semi-Intensive Care Units (RICUs). We evaluated efficacy of educational interventions on rate of CLABSIs and effects of port protector as adjuvant tool.MethodsStudy lasted 18 months (9 months of observation and 9 of intervention). We enrolled patients with central venous catheter (CVC): 1) placed during hospitalization in RICU; 2) already placed without signs of systemic inflammatory response syndrome (SIRS) within 48 h after the admission; 3) already placed without evidence of microbiologic contamination of blood cultures.During interventional period we randomized patients into two groups: 1) educational intervention (Group 1) and 2) educational intervention plus port protector (Group 2).We focused on CVC-related sepsis as primary outcome. Secondary outcomes were the rate of CVC colonization and CVC contamination.ResultsEighty seven CVCs were included during observational period. CLABSIs rate was 8.4/1000 [10 sepsis (9 CLABSIs)]. We observed 17 CVC colonizations and 6 contaminations. Forty six CVCs were included during interventional period. CLABSIs rate was 1.4/1000. 21/46 CVCs were included into Group 2, in which no CLABSIs or contaminations were reported, while 2 CVC colonizations were found.ConclusionsOur study clearly shows that both kinds of interventions significantly reduce the rate of CLABSIs. In particular, the use of port protector combined to educational interventions gave zero CLABSIs rate.Trial registrationNCT03486093 [ClinicalTrials.gov Identifier], retrospectively registered.

Differences in The Number of Germs in The Insertion Area of Central Venous Catheter (CVC) Done by Polyurethane Transparent and Plaster Gauze Dressing

A central venous catheter is a catheter that is placed directly on a large vein in the body and its tip lies in one of the central veins that is often used on critical care patients. Colonization of bacteria (germ) around the insertion area of the CVC is an area that is very likely to cause infection even though it has been closed by dressing. The factor that should always be considered is that the state of moisture retention occurs beneath the dressing. Moisture will cause an increase in colonization of the insertion area and increase the risk of catheter-related infection. As is known the humidity level of Indonesia with other countries is higher and the results of positive swabs in the insertion area are associated with Percutaneous Central Venous Catheter (PCVC) colonization and Catheter-related Sepsis (CRS). Transparent polyurethane and plaster gauze are two types of dressings that are different and often used. The transparent polyurethane is widely used in invasive procedures, there are still many medical staff who use plaster gauze dressings. The purpose of this study is to determine the difference in the number of germs in the CVC insertion area that are dressed using transparent polyurethane and plaster gauze. The design of this study is a quasi-experimental pretest-posttest control group with positive sampling. The number of samples is 12 for the intervention group and 11 for the control group. The intervention group performed transparent polyurethane dressings and a control group with plaster gauze. Calculation in the number of germs is with the cup count method. Wilcoxon and Mann-Whitney tests are for te data analysis. Based on the results of the study, it can be concluded that there is no difference in the number of CVC insertion germs between the use of dressings transparent polyurethane and plaster gauze so that both types of dressings can be used for CVC dressings in critical patient care settings.

Microbe Isolation from Blood, Central Venous Catheters, and Fluid Collections after Liver Resections.

Our goal was to evaluate the microbe species responsible for bacteremia or infections related to central venous catheter (CVC) or fluid collections after liver resection. Data from 112 patients (68 males, 44 females) who underwent liver resection over a period of 63 months were reviewed. Patient and tumor characteristics, intra-operative and post-operative data, and the results from cultures of peripheral blood, CVC tips and drained intra-abdominal or intra-throracic fluid collections were collected. There were positive blood cultures in 20 patients (17.9%). Coagulase-negative staphylococci (CoNS) and bacteria of enteric flora were the micro-organisms found most frequently and half of the cases had multiple isolated microbe species. The construction of a bilioenteric anastomosis was an independent risk factor for microbe isolation in peripheral blood (odds ratio [OR]: 11, p = 0.01). Furthermore, there were positive cultures of the CVC tip in 14 patients (12.5%), with CoNS being the micro-organism found most frequently and most cases had only one isolated microbe species. No specific risk factor for catheter-related infections was detected. In addition, there were positive cultures of drained fluid collections in 19 patients (17%), with bacteria of enteric flora being the micro-organisms found most frequently and the majority of cases had multiple isolated microbe species. The construction of a bilioenteric anastomosis (OR: 23.5, p = 0.002) and the laparoscopic approach (OR: 4.7, p = 0.0496) were independent risk factors for microbe isolation in drained fluid collections. Finally, the presence of positive blood cultures was associated with the presence of positive culture of CVC tips (p = 0.018) and drained fluid collections (p = 0.001). Post-operative bacteremia, colonization of CVCs, and contamination of fluid collections occur frequently after liver resections and various microbe species may be involved. Patients who undergo hepatectomy and a synchronous construction of a bilioenteric anastomosis are at increased risk of bacteremia development and contamination of fluid collections.

Antimicrobial Efficacy and Safety of a Novel Gas Plasma-Activated Catheter Lock Solution.

Antimicrobial lock solutions are important for prevention of microbial colonization and infection of long-term central venous catheters. We investigated the efficacy and safety of a novel antibiotic-free lock solution formed from gas plasma-activated disinfectant (PAD). Using a luminal biofilm model, viable cells of methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Candida albicans in mature biofilms were reduced by 6 to 8 orders of magnitude with a PAD lock for 60 min. Subsequent 24-h incubation of PAD-treated samples resulted in no detectable regrowth of viable bacteria or fungi. As a comparison, the use of a minocycline-EDTA-ethanol lock solution for 60 min led to regrowth of bacteria and fungi, up to 107 to 109 CFU/ml, in 24 h. The PAD lock solution had minimal impact on human umbilical vein endothelial cell viability, whereas the minocycline-EDTA-ethanol solution elicited cell death in nearly half of human endothelial cells. Additionally, PAD treatment caused little topological change to catheter materials. In conclusion, PAD represents a novel antibiotic-free, noncytotoxic lock solution that elicits rapid and broad-spectrum eradication of biofilm-laden microbes and shows promise for the prevention and treatment of intravascular catheter infections.

Effect of an acrylic terpolymer barrier film beneath transparent catheter dressings on skin integrity, risk of dressing disruption, catheter colonisation and infection

ObjectivesWe assessed the effect of a skin-protective terpolymer barrier film around the catheter insertion site on frequency of dressing disruptions and skin integrity issues (hyperaemia, skin irritation, residues of adhesives and moisture under the dressing). Secondary outcomes included colonisation of the central venous catheter (CVC) and rates of central line-associated bloodstream infection. Research methodologyA monocentric, open-label, randomised controlled trial was performed comparing a control group receiving standard transparent catheter dressings without the skin-protecting barrier film and an intervention group receiving a transparent chlorhexidine-impregnated dressing with use of the skin-protective acrylic terpolymer barrier film (3M™ Cavilon™ No - Sting Barrier Film, 3 M Health Care, St. Paul, MN, USA). ResultsSixty patients were enrolled and randomised in the study accounting for 60 central venous catheters and a total of 533 catheter days. Dressing disruptions occurred more frequently and at sooner time point in the control group. Skin integrity issues were significantly less observed in the intervention group. No differences in CVC colonisation or central line-associated bloodstream infection were observed. ConclusionsThe application of a barrier film creating a skin-protective polymer layer beneath transparent catheter dressings is associated with less dressing disruptions and skin integrity issues without altering the risk of infectious complications if used in combination with a chlorhexidine-impregnated catheter dressing.