Catheter Tip Cultures Research Articles

P-235. Non-utility of Catheter Tip Cultures in the Diagnosis of Catheter-related Bloodstream Infections

Abstract Background Catheter-related bloodstream infections (CRBSIs) affect approximately 3 to 27% of patients. As per IDSA (2009) criteria, concordant organisms from blood and catheter tip cultures, or specific criteria met by two blood samples are required for CRBSI diagnosis. Catheter tip cultures necessitate removal of the line and entail increased healthcare costs. Emerging evidence questions the reliability of this labor-intensive practice in diagnosing CRBSI. We aimed to determine the utility of catheter tip cultures in diagnosing CRBSI at our Institute. Catheter tip culture and Blood culture results CRBSI: Catheter-related Bloodstream Infection; TC: Catheter tip culture; BC: Blood culture; + or - , growth or no growth Methods We conducted a prospective observational study in patients with suspected CRBSI. Catheter tips and paired blood samples collected within 48 hours, were sent for culture. CRBSI was diagnosed as per IDSA 2009 guidelines. The utility of catheter tip cultures in diagnosing CRBSI was calculated. Results One-hundred and thirty events of suspected CRBSI were included in 116 patients. Sixty-two percent of patients were male with a mean age of 43.75 ± 16.5 years. The prevalence of CRBSI was 16.9%, of which only 27% of CRBSI were identified by catheter tip cultures. The sensitivity, specificity, positive predictive value, and negative predictive value of catheter tip cultures in diagnosing CRBSI were 27.3% (10.7- 50.2), 77.8% (68.8-85.2), 20.0% (10.4- 35.0) and 84.0% (79.9-87.4) respectively. Catheter tip colonization was observed in 20.8% of catheter tip cultures. All repeat blood cultures sent in the following two weeks in patients with catheter-tip colonization, were sterile. Amongst patients with CRBSI, Multidrug-Resistant Acinetobacter baumanii and Klebsiella pneumoniae were the most frequently isolated organisms, followed by Candida spp (predominantly Candida auris), accounting for 27% of CRBSI cases. Conclusion Our study showed poor sensitivity and low positive predictive value of catheter tip cultures in diagnosing CRBSI. Employing catheter-sparing methods, such as evaluation of differential time to positivity and quantitative paired blood cultures, will improve the diagnosis of CRBSI, and can lower hospital expenses. Disclosures All Authors: No reported disclosures

P-1603. Is it Time to Abandon Intravascular Catheter Tip Cultures for the Diagnosis and Management of Central Line-Associated Bloodstream Infections (CLABSIs)?

Abstract Background The diagnostic and therapeutic utility of intravascular catheter tip cultures (CTCx) has been contested. The 2009 Infectious Diseases Society of America (IDSA) guidelines recommend a CTCx with blood cultures (BCx) to diagnose CLABSIs. Recent studies have demonstrated that BCx alone are sufficient to guide therapy. This study aims to evaluate the diagnostic and therapeutic utility of CTCx in CLABSIs.Figure 1.Summary of Catheter Tip Cultures and Corresponding Blood Cultures from 2017-2023CTCx, Catheter tip cultures; (+) or (-), growth or no growth in cultures; BCx, blood cultures; CFU, colony forming units; AMx, antimicrobials; PD, peritoneal dialysis; VPS, ventriculoperitoneal shunts; FC, Foley catheters; Cx, cultures; Concordant Cx, at least 1 similar organism was isolated on both CTCx and BCx. Discordant Cx, CTCx, and BCx isolated different organism/s. Methods We performed a retrospective chart review of patients with cultures labeled “Catheter tip” from 2017 to 2023. We looked at the concordance (similar organism/s isolated) or discordance (isolated different organism/s) of CTCx and BCx. We also conducted chart reviews to evaluate whether CTCx resulted in a change in antimicrobials (AMx).Table 1.Classification of Intravascular Catheter Types and Culture Results n=442, Total number of CTCx; n=177, Total number of CTCx with at least 1 organism isolated. Results There were 442 CTCx out of 448 cultures collected (see Figure 1). Only 177 (40.05%) had ≥1 organism/s isolated. Out of 177 cases, 119 (67.23%) CTCx grew ≥15 colony forming units (CFU). About 58% (154/265) of negative CTCx had positive BCx. Table 1 listed the catheter types and the number of positive CTCx. The average time from BCx identification to catheter removal was 30 hours. Concordance was seen in 75.89% (107/141) and discordance in 24.11% (34/141). For all CTCx, concordance was present only in 24.21% (107/442). There were ≥15 CFU in 75.70% (81/107) of concordant cases, and 50% (17/34) in discordant cases. In CTCx with no BCx obtained or negative BCx, 58.33% (21/36) had ≥15 CFU. Figure 2 listed the organisms isolated on CTCx and Figure 3 showed the organisms isolated in concordant and discordant cases. CLABSIs were the source of bacteremia in 71.63% (101/141). In CTCx with positive BCx, CTCx results changed AMx in 6 cases (4.26%, 2 concordant, 4 discordant), no change in 132 cases (93.62%, 102 concordant, 30 discordant), and unclear in 3 cases. In CTCx with no BCx obtained or negative BCx, 30.56% (11/36) resulted in a change in AMx (10 with negative BCx and 1 without BCx) and was unclear in 1 case.Figure 2.Organisms Isolated from Catheter Tip CulturesCONS, coagulase-negative staphylococcus; MSSA, methicillin-susceptible staphylococcus aureus; MRSA, methicillin-resistant staphylococcus aureus. Other gram-negatives: Elizabethkingia meningoseptica (1), Ochrobactrum anthropic (1), Serratia marcescens (1), Stenotrophomonas maltophilia (1), Proteus mirabilis (1), and Citrobacter freundii (1); Other gram-positives: Rothia mucilaginosa (1), Staphylococcus aureus, unspecified (3). Conclusion Our study showed that CTCx didn’t result in a significant change in AMx. The majority of the CTCx were not able to identify any organisms. CTCx has limited utility for both diagnostic and therapeutic purposes when it comes to CLABSIs. We recommend the current IDSA criteria for diagnosing CLABSIs be reevaluated in favor of abandoning the practice of CTCx.Figure 3.Organisms Isolated in Catheter Tip Cultures with Corresponding Blood cultures Figure 3a. Organisms isolated in CTCx in concordant cases separated by CFU. Other Gram Negatives: Acinetobacter baumannii (1), Ochrobactrum anthropic (1), Serratia marcescens (1). Figure 3b. Organisms isolated in CTCx in discordant cases separated by CFU. Other Gram Negatives: Stenotrophomonas maltophilia (1), Providencia stuartii (2), Acinetobacter baumannii (1), Elizabethkingia meningoseptica (1); Other Gram Positives: Corynebacterium species (1), Staphylococcus aureus, unspecified (1). Disclosures All Authors: No reported disclosures

Subsequent bacteremia associated with intravascular catheter colonization with Staphylococcus aureus, Gram-negative rods, and Candida species in children.

Subsequent bacteremia developed in 14% of patients with positive catheter tip cultures but concurrent negative blood cultures. The occurrence of subsequent bacteremia did not differ significantly by pathogens (Staphylococcus aureus, Gram-negative rods [GNR], and Candida spp.). Mortality was higher in patients with GNR and Candida spp. than with S. aureus.

Bacterial Resistances and Sensibilities in a Tertiary Care Hospital in Romania-A Retrospective Analysis.

The increase in bacterial resistance is currently a global burden for the health care system. In order to evaluate the resistance rates of several bacteria from the most encountered cultures in clinical practice, we performed a retrospective analysis of all of the positive cultures from the year 2021 in a tertiary care hospital in Romania. Our analysis captured 3299 positive cultures. The median age of the patients was 62 years (IQR: 41-71 years old) with a slight predominance among females (53.1%). Overall, the most common cultures were urocultures, wound secretion cultures and blood cultures, and the most common identified bacteria were Escherichia coli, Staphylococcus aureus and Klebsiella spp. Positive cultures with the highest resistance rates were found in the bronchial aspirate cultures, catheter tip cultures, urocultures and blood cultures. Escherichia coli (n = 996) had the highest resistance to ampicillin (19.8%) and trimetoprim-sulfametoxazole (16.4%), while Staphylococcus aureus (n = 698) presented the highest resistance rates to clindamycin (27.4%) and oxaciline (19.7%). Klebsiella (n = 481) presented the highest resistance rates to piperaciline-tazobactam (25.2%) and ampicillin (20.4%), whereas Acinetobacter baumanii (n = 123) presented a resistance rate of more than 50% to carbapenems, gentamicin, ciprofloxacin and ceftazidime. The aim of our study was to identify bacterial resistance rates in order to provide updated clinical data to guide physicians in choosing the best empirical antibiotic treatment, especially in the west part of Romania.

Impact of the COVID-19 pandemic on the incidence and the epidemiology of catheter-related bloodstream infection two years later

IntroductionThe COVID-19 pandemic increased catheter-related bloodstream infections (C-RBSI), but its subsequent impact has not been adequately described. Our hospital has already depicted the effects of the COVID-19 pandemic in the first wave. However, we still do not know whether C-RBSI rates and aetiology are similar to those described before the COVID-19 pandemic. We aimed to evaluate the impact of the COVID-19 pandemic on the evolution of C-RBSI in a large tertiary teaching hospital two years later. Material and methodsWe prospectively collected all confirmed C-RBSI episodes in a clinical microbiology laboratory database by matching blood cultures and catheter tip cultures with the isolation of the same microorganism (s). We compared our C-RBSI incidence rates and aetiology from 2018 to 2023. C-RBSI was defined as bacteremia or fungemia in a patient with clinical manifestations of infection and no other apparent source except the catheter. ResultsDuring the study period, we collected 556 C-RBSI episodes. C-RBSI incidence rate per 1000 admissions each year was as follows: 2018: 2.2; 2019: 1.7; 2020: 3.29; 2021: 2.92; 2022: 2.69. and 2023: 2.01. Mainly, C-RBSI episodes occurring in critical care units each year were, respectively: 2018: 57 (54.8 %), 2019: 38 (45.2 %), 2020: 89 (63.6 %), 2021: 69 (60.5 %), 2022: 58 (50.9 %) and 2023 (61.4 %). The distribution of microorganisms showed an increase in Gram-negative episodes after the pandemic. ConclusionOur study shows an increase in the incidence rate of C-RBSI during the COVID-19 pandemic, with a discrete decrease after that. C-RBSI episodes were mainly caused by coagulase-negative Staphylococci but with a rise in Gram-negative bacilli.

Clinical Features of Candida Catheter-related Bloodstream Infections and Persistent Infections Associated with Early Catheter Reinsertion: A 6-year Retrospective Study.

Catheter-related persistent Candida infections (CRPCI) may develop after Candida catheter-related bloodstream infections (CRBSI) due to colonization of the newly inserted catheter. However, the optimal timing for new catheter insertion remains controversial. The aim of this study was to determine the clinical features of CRBSI due to Candida species and CRPCI. This was a retrospective study conducted in a teaching hospital in Japan. We retrospectively collected clinical information on hospitalized patients diagnosed with Candida CRBSIs by catheter tip culture from 2015 to 2020. CRPCI was defined as the growth of the same Candida species from the tip culture of a newly inserted catheter after the onset of a Candida CRBSI. The Chi-squared and Fisher's exact tests were used to compare differences between the case and control groups. Sixty-three cases of Candida CRBSI were collected. Fifty-four (85.7%) received total parenteral nutrition. CRPCI developed in 12 (48%) patients of the 25 in whom cultures of newly inserted catheters were performed. Despite antifungal therapy in these patients, persistent fungemia incidence was significantly higher (50.0% vs. 9.1%, odds ratio = 10.0, P = 0.033). The mean number of days from removal of infected catheter to reinsertion was significantly shorter for patients with CRPCI (0.27 days vs. 3.08 days, P = 0.038). Total parenteral nutrition may be a major risk factor in the development of Candida CRBSI. CRPCI often leads to persistent fungemia. Early insertion of a new catheter after removal of an infected catheter may be a risk factor for CRPCI.

Treatment of positive catheter tip culture without bloodstream infections in critically ill patients. A case-cohort study from the OUTCOMEREA network

PurposeThis study aimed to evaluate the impact on subsequent infections and mortality of an adequate antimicrobial therapy within 48 h after catheter removal in intensive care unit (ICU) patients with positive catheter tip culture.MethodsWe performed a retrospective analysis of prospectively collected data from 29 centers of the OUTCOMEREA network. We developed a propensity score (PS) for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a 1:1 case-cohort study matched on the PS score of being adequately treated. A PS-matched subdistribution hazard model was used for detecting subsequent infections and a PS-matched Cox model was used to evaluate the impact of antibiotic therapy on mortality.ResultsWe included 427 patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched 150 patients with an adequate antimicrobial therapy with 150 controls. In the matched population, 30 (10%) subsequent infections were observed and 62 patients died within 30 days. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day-30 was similar between treated and non-treated groups (subdistribution hazard ratio [sHR] 1.08, 95% confidence interval [CI] 0.62–1.89, p = 0.78). Using Cox proportional hazard models, the 30-day mortality risk was similar between treated and non-treated groups (HR 0.89, 95% CI 0.45–1.74, p = 0.73).ConclusionsAntimicrobial therapy was not associated with decreased risk of subsequent infection or death in short-term catheter tip colonization in critically ill patients. Antibiotics may be unnecessary for positive catheter tip cultures.

Clinical Outcome of Patients with Escherichia coli Isolated from Catheter Lumens and/or Peripheral Blood Cultures: A Retrospective Analysis.

Escherichia coli commonly causes catheter-related bloodstream infection (C-RBSI) in specific populations. The differential time to positivity (DTTP) technique is the recommended conservative procedure for diagnosing C-RBSIs. We conducted a retrospective study of episodes in which E. coli was isolated from catheter lumens obtained using the DTTP technique. Microbiological and clinical data were obtained based on the DTTP technique as either catheter colonization, C-RBSI, or non-C-RBSI. A total of 89 catheter blood cultures were included, classified as follows: catheter colonization, 33.7%; C-RBSI, 9.0%; and non-C-RBSI, 57.3%. Only 15.7% of the catheters were withdrawn, with no positive catheter-tip cultures. We found no statistically significant differences in catheter type, antibiotic treatment, or clinical outcome among the groups, except for the frequency of catheter lock therapy or in the frequency of successful treatment. Mortality was associated with C-RBSI in only one patient. E. coli bacteremia diagnosed by the DTTP technique was classified as non-catheter-related in most patients. As the majority of the catheters were retained, E. coli bacteremia could not be microbiologically confirmed as catheter-related by the catheter-tip culture. Future studies are needed to assess the profitability of the DTTP technique for diagnosing E. coli C-RBSIs.

Perioperative arterial catheterization: A prospective evaluation of ultrasound, infection, and patient-focused outcomes.

There is little information regarding complications of arterial catheterization in modern clinical care. We aimed to determine the incidence of abnormal duplex vascular ultrasound and catheter related infections following perioperative arterial catheterization. Patients requiring arterial catheterization for elective surgery were included and insertion details collected prospectively. Duplex ultrasound evaluation was performed 24 h after catheter removal. Symptomatic patients were identified by self-reported questionnaire. On Day 7, patients answered questions by telephone, related to the insertion site, pain, and function. Results of catheter tip and blood culture analyses were sought. Univariate associations of patient and surgical characteristics with abnormal ultrasound were assessed with p < 0.05 considered significant. Of 339 catheterizations, 105 (40%) had ultrasound evaluation. Catheters were indwelling for median (IQR, range) duration of 6.0 h (4.4-8.2, 1.8-28) with no catheter-related infections. There were 16 (15.2%, 95% CI 9.0%-23.6%) abnormal results, including 14 radial artery thromboses, one radial artery dissection, and one radial vein thrombosis. Those with abnormal ultrasound results were more likely to have had Arrow catheters inserted (68.8% vs 27%, p = 0.023) and more than one skin puncture (37.5% vs 26.8%, p = 0.031). Two of the 16 (12.5%) patients with abnormal ultrasound results reported new symptoms related to the hand compared with nine of the 88 (10.2%) with normal results (p = 0.1). No patients required urgent referral for management. Thrombosis was the most common abnormality and was usually asymptomatic. There were no infections, few post-operative symptoms, and minimal functional impairment following arterial catheterization.

Endoscopic Ventricular Lavage in Pediatric Pyogenic Cerebral Ventriculitis Associated with Shunt: Outcomes and Technical Notes

Pyogenic cerebral ventriculitis (PCV) is a rare infectious entity characterized by a potent inflammatory reaction of the ventricular ependyma, which in most cases leads to death. We aim to present the technical note and protocol, based on our center's 10-year experience of the use of endoscopic ventricular lavage in pediatric patients with PCV and ventriculoperitoneal shunt (VPS). For this study, all pediatric patients (<16 years) with VP shunts and PCV who were treated with endoscopic ventricular lavage between January 2012 and January 2022 were included. 34 pediatric patients with ventriculitis were analyzed. The median age was 6 years, with 61.7% being male. Most consultations occurred on Day 2 of symptoms. Fever (38.2%) and altered consciousness (26.5%) were the most common initial symptoms. Early ventriculitis was observed in 67.7% of patients. Pathogen identification in the initial cerebrospinal fluid (CSF) sample was 70.6%, while samples from ventricular peritoneal shunt (VPS) yielded 23.53% and catheter culture 79.4%. Gram-positive bacteria, mainly S.epidermidis (44.1%), was the most commonly isolated agent. Endoscopic ventricular lavage was performed in 73.5% on the second or third day. Reinfection occurred in 23.5%, and 26.5% of patients died. Concordance analysis showed 85.3% agreement between LP and catheter tip samples. Functionality improved, with 55.88% achieving a Lansky score of 90. Early ventriculitis was associated with better Lansky scores. Endoscopic ventricular lavage can be a useful tool in the management of PCV in cases with VP shunts. Our study suggests a higher chance of isolating an infection-causing germ in the catheter tip culture specimen compared to the cerebrospinal fluid (CSF) culture. However, future studies with a larger number of patients, or multicentric studies are required for further analysis.

Correlation between increased flushing intervals and malfunction and infectious complications in fully implantable catheters during the COVID-19 pandemic.

To evaluate the incidence of malfunction and colonization rates of fully implantable long-term catheters left unflushed during the COVID-19 pandemic; and to evaluate the average cost of transporting each patient to the hospital for flushing. During the COVID-19 pandemic, patients reduced the number of hospital visits and stopped flushing their catheters periodically with saline solution. After the pandemic stabilized in 2022, patients who completed chemotherapy treatment had their long-term catheters removed. We evaluated the catheters' function and colonization rates. To evaluate the incidence of malfunctions and the colonization rate of these catheters, we tested the flow and reflux during removal surgery, before removal, and by culturing their tips. These catheters were divided into two groups: a standard group, in which the last flushing occurred before 90 days, and another group, in which the last flushing occurred after 90 days. We analyzed the correlation between the time at which these catheters were closed, the incidence of malfunction, and the colonization rate of these catheters. To avoid confusion due to the reduced sample size, a second analysis was performed between the group of catheters that did not work and those that worked, evaluating the time they were closed and the catheter tip culture. We also analyzed the financial costs for each patient from home to the hospital. Among the 66 patients included in the study, 28 spent >90 days without catheter flushing, and 38 spent <90 days. The incidence of infection occurred in two patients with >90 days of flushing and in three patients with <90 days of flushing. Catheter malfunction occurred in 4 patients in the group with >90 days without flushing and in 5 patients with <90 days of flushing. In the secondary analysis, the group with a functioning catheter (n=52) had a mean time of 152 days, whereas for the group with a non-functioning catheter (n=9), the mean time was 229 days (p=0.51). No differences were statistically significant. No correlation was found between the colonization rate of catheter in the group with a functioning or non-functioning catheter, as the group with a functioning catheter had three cases of positive catheter tip culture and the group with a non-functioning catheter had one case of positive catheter tip culture. The average cost for each patient to travel from home to the hospital was 39.01 reais (approximately 7.50 USD). Among the patients followed up at our hospital during the COVID-19 pandemic, no statistically significant difference was observed in the function and colonization rate of long-term catheters between those who underwent flushing at intervals of <90 days and those with intervals of >90 days.

Luteibacter jiangsuensis blood stream infection: a first case report

BackgroundLuteibacter jiangsuensis is a gram-negative aerobic bacillus that was first isolated from soil samples at a pesticide factory in China and reported in 2011. Here, we describe the first case of L. jiangsuensis infection in human.Case presentationA 59-year-old Japanese woman undergoing treatment for Crohn’s disease was admitted to our hospital with fever. Clinical examination indicated catheter-related bloodstream infection. The catheter was removed and meropenem was initiated. Morphologically identical glucose non-fermentative gram-negative bacilli were detected from two sets of aerobic blood culture and catheter-tip cultures. MALDI-TOF mass spectrometry failed to identify the bacterium, which was later identified as L. jiangsuensis by 16 S rRNA gene sequencing. Antimicrobial susceptibility test revealed that the isolate was resistant to carbapenem, therefore meropenem was switched to intravenous levofloxacin (500 mg/day). After 14 days of treatment with levofloxacin, the patient was discharged.ConclusionsThis is the first case of L. jiangsuensis infection in human. The strain was identified by 16 S rRNA gene sequence analysis.

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.

Hemophagocytic lymphohistiocytosis and histiocytic necrotizing lymphadenitis secondary to hemodialysis catheter-related bloodstream infection caused by Corynebacterium Striatum

BackgroundWe herein described the coexistence of hemophagocytic lymphohistiocytosis (HLH) and histiocytic necrotizing lymphadenitis, alternatively known as the Kikuchi disease (KD), secondary to hemodialysis catheter-related bloodstream infection (BSI) caused by Corynebacterium striatum.Case presentationA patient on maintenance hemodialysis had developed persistent fever and Corynebacterium striatum was subsequently identified from the culture of both catheter tip and peripheral blood. During mitigation of the BSI, however, his fever was unabated and ensuing workup further found thrombocytopenia, hyperferritinemia, hypertriglyceridemia, low NK cell activity and a surge in serum CD25 levels. Moreover, biopsy of the bone marrow and lymph node detected histopathological evidence of hemophagocytosis and KD, respectively. Upon these abnormalities, the title-bound diagnosis was considered and the patient was eventually recovered from the treatment of dexamethasone instead of antibiotics. Consistently, aberrations in his serum CD25 levels and NK cell activity had subsided two months after discharge.ConclusionsArguably, this encounter offered a unique chance to unravel the principal pathogenic cascade in immunobiology that made the three entities one disease continuum. As such, our work may add new understandings of HLH and/or KD secondary to severe infections in general and excessive release of cytokines in particular among patients with kidney diseases. The resultant early diagnosis is crucial to initiate appropriate treatment and improve the survival of patients with these challenging and potentially life-threatening disorders.

Safety of mid-thigh exit site venous catheters in multidrug resistant colonized patients.

Venous catheters inserted in superficial femoral vein and with mid-thigh exit site have emerged as a feasible and safe technique for central or peripheral tip's venous access, especially in agitated, delirious patients. The spread of multidrug-resistant bacterial (MDR) strains is an emerging clinical problem and more and more patients are being colonized by these types of bacteria. The aim of this study is to evaluate the incidence of central line associated bloodstream infections (CLABSI) or catheter related bloodstream infections (CRBSI) in mid-thigh catheters in patients with positive rectal swabs to evaluate the safety of this procedure and the real infection risk. In this retrospective observational study, we analyzed data on patients with mid-tight catheters inserted from May 2021 to November 2022. All surveillance rectal swabs were recorded. In addition, to collect data on CLABSI and CRBSI, the results of all blood and catheter tip cultures performed during the hospital stay were acquired. Six hundred two patients were enrolled, 304 patients (50.5%) had a rectal swab; 128 (42.1%) swabs were positive for MDR. Nine CLABSI (only two in patients with a positive rectal swab) and three CRBSI were detected. No statistical difference in the absolute number of CLABSI and CRBSI and in the number of infections per 1000 catheter days emerged between the overall population and patients with positive rectal swabs (respectively p = 0.45 and p = 0.53). Similarly, no statistical difference in the number of CLABSI and CRBSI was found among patients with a negative swab and patients with a positive one (respectively p = 0.43 and p = 0.51). According to our data, cannulation of the superficial femoral vein represents a safe location in patients with positive rectal swabs.

#4229 SECONDARY BACTERIAL AND FUNGAL INFECTIONS IN COVID-19 PATIENTS WITH ACUTE KIDNEY INJURY AND RELATION WITH CYTOKINE STORM SYNDROME

Abstract Background and Aims Both COVID-19 and acute kidney injury (AKI) are associated with impaired host immunity. Virus-induced immunosuppression, overuse of antibiotics and corticosteroids are COVID-19 related factors, while dysregulation of the inflammatory response, increased volemia, hemodialysis catheters are AKI-related factors which favor secondary infections. We aimed to search the relation between markers of cytokine storm syndrome (interleukin-6 – IL-6; ferritin; C-reactive protein – CRP) and incidence of secondary infections and to identify the microorganisms involved in secondary infections in patients admitted with acute kidney injury and COVID-19 patients. Method Patients with both COVID-19 and AKI admitted in the 2nd and 3rd waves of the COVID-19 pandemic (May-December 2021) in an COVID-only hospital were included in this retrospective analysis. Diagnosis of AKI was established according to KDIGO creatinine-based criteria. Obstructive AKI cases were excluded. AKI was classified as A-AKI when it was diagnosed at the moment of admission and HA-AKI when it developed during hospitalization. Bacterial and/or fungal infections and the sites of positive cultures were registered in all patients. Colonizations with nonpathogenic microorganisms were excluded. Median values of IL-6, ferritin and CRP (maxim levels recorded during hospitalization) were compared between infected and non-infected patients. Results A total of 247 patients with AKI+COVID-19 were included in the study: 146 had A-AKI and 101 had HA-AKI. Secondary bacterial and fungal infections were registered in 111 patients (44.93%) cumulating 161 positive urine, blood, hemodialysis catheter tip, sputum, wounds, feces and tracheal intubation tubes cultures. Secondary infections were noted significantly more frequent in HA-AKI cases than in A-AKI cases: 61.38% (62 patients) vs 33.56% (49 patients) – Fischer exact test, p&amp;lt;0.001. The responsible microorganisms and the sites of positive culture are presented in Table 1. Median values of IL-6, ferritin and CRP (maximum levels recorded during hospitalization) were significantly higher in infected patients than in non-infected patients (Table 2) in the entire study group. IL-6 was significantly higher in infected HA-AKI patients when compared with infected A-AKI (231.40 pg/mL vs 124 pg/mL; p = 0.015), but no significant difference was found between the two subgroups of infected AKI patients regarding median ferritin levels (2481.5 ng/mL vs 1785 ng/mL; p = 0.324) or regarding median CRP values (206.27 mg/L vs 179.59 mg/L; p = 0.546). Conclusion Incidence of secondary bacterial and/or fungal infections in patients admitted with AKI and COVID-19 was very high in our study and it was associated with more severe altered markers of cytokine storm syndrome. Secondary infections in COVID-19 patients are important drivers of hospital-acquired AKI or they can aggravate its evolution.

Prospective Comparative Study of External Ventricular Drain Catheter Colonization: Antibiotic-Impregnated versus Conventional Drains

Our aim was to compare the prevalence of biofilm formation on antibiotic-impregnated (AIC) versus standard (SC) external ventricular drain (EVD) catheters. From March 2018 to November 2020, all consecutive EVD catheters inserted in adult patients were included. After removal, EVD catheters were analyzed under scanning electronic microscopy, on both extraluminal and intraluminal faces. Standard culture of catheter tips was also performed. Overall, 114 catheters were included in 101 patients. There were 48 AICs and 66 SCs. Standard culture showed that ventriculostomy-related colonization was more frequent in SC than in AIC (26 vs. 10%; P= 0.06). Gram-negative rods accounted for 25% of ventriculostomy-related colonization in AICs, and none was documented in SCs. Scanning electronic microscopy observation showed mature biofilm on more than 80% of catheters, without significant difference between catheter type. Also, there was no difference between extraluminal and intraluminal colonization rate. There were 2 ventriculostomy-related infections in each group (5% and 3% among AICs and SCs respectively; P= 1). Mature biofilm presence on the intraluminal and the extraluminal faces is similar on AICs and SCs. Accordingly, AICs do not seem to efficiently prevent biofilm formation on EVD catheters. The impact of AICs on the microbiological epidemiology of colonizing biofilm should be further evaluated.

The First Report of Chryseobacterium gleum Caused Ventriculoperitoneal-shunt Infection in a Child.

To The Editors: Ventriculoperitoneal (VP) shunt is one of the most widely used and effective methods in the treatment of hydrocephalus in childhood. VP shunt infections have been observed in approximately 3.2%–25%, and Chryseobacterium spp. is a rare cause of VP shunt infections.1,2 Herein, we report the first VP shunt infection caused by Chryseobacterium gleum. A 12-month-old female (corrected age 8 months) born via spontaneous vaginal delivery, weighed 700 g at 25 weeks of gestation, was admitted to our emergency department with a fever with a maximum peak temperature of 39°C, projectile vomiting, and decreased oral intake. Her history included long-term ventilation in the neonatal intensive care unit with a diagnosis of moderate bronchopulmonary dysplasia. At 4 months of age, she developed intraventricular hemorrhage and progressive hydrocephalus, and a VP shunt was inserted. She had several episodes of VP shunt infections caused by S. epidermidis and S. aureus. At admission, the patient was febrile, tachycardic (heart rate, 160/min) and tachypneic (respiratory rate of 48/min). Physical examination showed weakness, lethargy and sleepiness. Her total Glasgow Coma Scale score was 12 (E3V4M5). Laboratory tests were as follows: white blood cell (WBC) count: 12.5 × 103/μL (neutrophil 37% and lymphocyte 54%), C-reactive protein: 20 mg/L, procalcitonin: 0.09 μg/L. The cerebrospinal fluid (CSF) WBC count was 120/mm3, protein 107 mg/dL and glucose 42 mg/dL. With the preliminary diagnoses of sepsis and shunt infection, intravenous (IV) cefotaxime (300 mg/kg/day) and IV vancomycin (60 mg/kg/day) was initiated empirically. Peripheral/catheter blood cultures and CSF samples were inoculated into aerobic and anaerobic culture bottles (BacT/ALERT, BioMérieux, Durham, USA). The patient underwent VP shunt externalization. The blood and urine cultures were negative during the patient’s follow-up. Chryseobacterium gleum was isolated in the CSF, shunt and ventricular catheter tip cultures on the 3rd day of treatment. The organism had high-level minimum inhibitory concentration (MIC) levels for meropenem (MIC = 32 μg/mL), imipenem (MIC = 32 μg/mL) and piperacillin-tazobactam (MIC = 250 μg/mL). MIC level of ciprofloxacin was 0.125 μg/mL and trimethoprim-sulfamethoxazole was 0.5 μg/mL. Cefotaxime and vancomycin were switched to IV trimethoprim/sulphamethoxazole (5 mg/kg every 6 hours) and ciprofloxacin (10 mg/kg every 8 hours). On the 5th day of the combined therapy, the patient’s CSF sample was evaluated and showed a WBC count of 30/mm3, glucose 42 mg/dL and protein 360 mg/ dL, and the CSF culture was sterile. Antibiotics were continued for 21 days. The patient was clinically stable, and no adverse effects or seizures were observed during or after the treatment. The extra ventricular drainage was removed, the VP shunt was inserted following 2 consecutive negative CSF cultures, and the patient was discharged. Chryseobacterium species are common in nature but are not found in human flora. Most cases are nosocomial and are frequently associated with immunosuppression or implantable devices. Chryseobacterum gleum is typically a low-virulence organism that can cause serious infections. It has been reported that Chryseobacterum gleum can cause infections such as central-line-associated bloodstream infection, community-acquired pneumonia and urinary tract infection in adults.3–5 Unlike previous reports, Chryseobacterium was isolated in the cerebrospinal fluid in our study. Chryseobacterum gleum commonly colonizes mechanical devices, causing device-associated infections, and can form biofilm. According to this study, VP shunt may be a risk factor for Chryseobacterium gleum infections. This report emphasizes the significance of Chryseobacterium species as a causative agent of a wide range of infections, and VP shunts can pose a risk for this agent. Data on the management of Chryseobacterium is limited. Antimicrobial susceptibility testing guidelines for Chryseobacterium infections should be developed for more effective and accurate treatment.

Safe duration of silicon catheter replacement in urological patients.

This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks, six weeks, and eight weeks). A cross-sectional study with stratified simple random sampling. Urology Unit, Korle Bu Teaching Hospital. One hundred and thirty-seven male patients with long-term urinary catheters. Participants were grouped into 3 weeks, 6 weeks, and 8 weeks duration of catheter replacements. Symptoms due to the urinary catheters, urinalysis, urine and catheter tip cultures, sensitivity, and catheter encrustations were assessed. Eighty-six patients had a primary diagnosis of benign prostatic hyperplasia (BPH), 35 had urethral strictures,13 had prostate cancer, two had BPH and urethral strictures, and one participant had bladder cancer. There was no difference in the symptoms the participants in the different groups experienced due to the urinary catheters (p > 0.05). The frequency of occurrence of complications (pyuria, p = 0.784; blocked catheter, p=0.097; urethral bleeding, p=0.148; epididymo-orchitis, p=0.769 and bladder spasms, p=1.000) showed no differences in the three groups. There was no statistical difference in the urinalysis for the three groups (p>0.05) and the degree of encrustations (3 weeks: 0.03 ± 0.06, 6 weeks: 0.11±0.27 and eight weeks: 0.12 ±0.27) with p=0.065. In this study, the duration of urinary catheterisation using silicone Foley's catheters did not influence the complication and symptom rates; hence silicon catheters can be placed in situ for up to 8 weeks before replacement instead of the traditional three-weekly change. Enterprise Computing Limited.

Usefulness of differential time to positivity between catheter and peripheral blood cultures for diagnosing catheter-related bloodstream infection: Data analysis from routine clinical practice in the intensive care unit

PurposeTo assess the accuracy of differential time to positivity (DTP) method for the diagnosis of catheter-related bloodstream infections (CRBSI) in the routine practice of our intensive care unit (ICU). Materials and methodsOver a five-year study period, ICU patients with a central venous catheter in place for ≥48 h and undergoing DTP test with catheter tip culture were analyzed. We investigated: the accuracy of DTP test with the usual threshold of 120 min in confirming the clinical suspicion of CRBSI; the most accurate threshold value of DTP to detect CRBSI; the diagnostic accuracy of the ratio (rather than the difference) between times to positivity. ResultsAmong 278 episodes of paired blood cultures, 13% were CRBSIs. DTP value ≥120 min used for the diagnosis of CRBSI yielded 41% sensitivity and 74% specificity. Performance of DTP values in predicting CRBSI was low (AUC = 0.60 [95%CI: 0.48–0.72]). Cutoff value of the ratio between times to positivity was 0.80, with 46% sensitivity and 79% specificity. ConclusionsThe routine use of the DTP method at any cutoff point has inadequate accuracy in detecting CRBSI in the real every day clinical practice. Not even the ratio between times to positivity seems to be clinically useful.