Frequency Of Catheter-related Infections Research Articles

Frequency and Microbiological Profile of Catheter-Related Infections in Hemodialysis Patients Receiving Gentamicin as Antimicrobial Lock Therapy for Prophylaxis

Antibiotic lock solution (ALS) in the lumen of catheter is a mean to decrease the possibility of catheter related blood stream infection (CRBSI). We conducted this study using Gentamicin as ALS to observe the frequency of catheter related infections (CRI) including CRBSI and exit site infection in this hemodialysis patients being dialyzed through tunneled and temporary hemodialysis catheters.
 Methods This descriptive, cross sectional study was conducted at Dr. Ziauddin Hospital, North Campus between January 2017- December 2017. Symptomatic patients for CRBSI were included in this study. Blood culture from the catheter ports and periphery and exit site swab if pus visible were sent for culture sensitivity. 
 Results Total 138 patients of either gender with age more than 18 years to less than 80 years were evaluated. 44.9% were male and mean age of patients was 58.79±14.05 years. 70.3% patients were diabetic for 15.61±4.61 years and 11.6% were using immunosuppressive drugs. The overall mean catheter duration was 22.27±14.39 days and mean hemodialysis duration was 25.32±44.31 weeks. Tunneled catheter was placed in 40.6% and 46.4% had femoral temporary catheters. Blood culture was done for 51 cases and 21.5% were positive. Tip culture was positive in 33.3% patients. In our study, 23.18% patients were found to have catheter related infections, out of which 61.5% were found with gentamicin resistance including colonization.
 Conclusion We report a high frequency of catheter related infections despite using ALS as prophylaxis, with predominant organisms being gram positives and a high incidence of gentamycin resistance.

Catheter related infection in hemodialysis patients with double lumen catheter.

Catheter related infections are common issue, a major cause of morbidity and mortality in patients with uremia. Clinical findings, including fever, redness, or tenderness at catheter site are unreliable for the diagnosis of catheter-related infection due to poor sensitivity and specificity. Study Design: Descriptive Cross sectional Study. Setting: Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi. Period: September 2014 to March 2015. Materials and Methods: All patients with age 25-50 years of either gender undergoing hemodialysis via double-lumen catheter were enrolled. Regular monitoring of temperature and WBC counts was carried out. If a patient develops fever (100 F or more) or leukocytosis (TLC 12,000 /mcl), a through re-examination, urinalysis and chest X-ray was done to exclude other causes of infection in this patient. Blood cultures from catheter tip and a peripheral blood culture was sent. Growth of the organism from both the cultures was noted and catheter related infection was termed positive if same organism s found to be present in both the cultures. Results: Mean age of the patients was 42.69 ±6.86 years. There were 75 (58.10%) females and 54 (41.90%) males. In majority of the patients, site of catheter was right internal jugular vein 54 (41.90%), followed by femoral vein 30 (23.30%), left internal jugular vein 24 (18.60%) and subclavian vein in 21 (16.30%) patients. Frequency of catheter related infection was found to be 19 (14.70%). Conclusion: The frequency of catheter related infection was found in 19 (14.70%) patients undergoing hemodialysis via double-lumen catheter.

Home parenteral support in patients with incurable cancer. Patient characteristics of importance for catheter related complications and overall survival

It is uncertain if home parenteral support (HPS) is of advantage in patients with incurable cancer and intestinal failure, functional obstruction or severe malabsorption. From a single centre cohort we present characteristics of patients with incurable cancer treated with HPS. Over a ten year period (2005-2015) data were retrospectively collected on patients with incurable cancer discharged on HPS from a Danish tertiary referral centre. Data on socio-demographics, catheters and parenteral nutrition, catheter related complications, re-admissions and mortality were analysed. The inflammation based score; modified Glasgow prognostic score (mGPS) was investigated as a prognostic score by Cox proportional hazard regression analyses adjusted for sex, age, diagnosis, and pathophysiological conditions. Eighty patients with incurable cancer, aged 25.1-83.6 (median 63.8) were identified. Patients with gynaecologic cancer accounted for 25% of the cohort, thus women predominated. Short bowel syndrome was more prevalent in the patients with gynaecologic or lower gastrointestinal cancer compared to the upper gastrointestinal cancer. Catheter related complications occurred in a minority of patients (31%); most frequent was catheter related bloodstream infection (CRBSI). CRBSI rate was overall 0.97 pr 1000 catheter days, depending on diagnosis. Eleven percent had several infections, and 75% did not have any. Patients self-administering the catheter were younger, less frail and had fewer CRBSI events. Re-admissions were prevalent, and only one fifth of the patients had no re-admissions after initiation of HPS. Patients with mGPS 0 or 1 survived significantly longer, median 372 (CI 39-2006) days versus patients scoring 2 in mGPS, median 43 (CI 6-578) (p<0.01). In patients with mGPS 0 or 1 survival at six months was 75% and in patients with mGPS 2, 20%. In multivariate cox regression analyses mGPS 2 was a significant predictor of mortality (HR 4.66, 95% CI 2.65-8.20, p<0.01). It is feasible to offer HPS to patients with incurable cancer. Frequency of catheter related infections is acceptable but most patients will be re-readmitted after initiation of HPS. Predictors of survival in patients with incurable cancer on HPS may include mGPS. However, our study does not give a clear answer; when to prescribe HPS and who might possible benefit from the treatment in patients with incurable cancer.

The Frequency of Catheter-Related Infections in Children: One-Year Experience

The Frequency of Catheter-Related Infections in Children: One-Year Experience

Çocuk Hastalarda Kateter İlişkili Enfeksiyon Sıklığı; Bir Yıllık Deneyim

Çocuk Hastalarda Kateter İlişkili Enfeksiyon Sıklığı; Bir Yıllık Deneyim

The Use Of Polyurethane Transparent Film In Indwelling Central Venous Catheter

Dressing is an intervention aimed to prevent infection in central venous catheter. This study aimed to analyze the frequency of catheter-related infection and skin toxicity in the use of transparent film in Hickman's catheter in patients who underwent allogeneic hematopoietic stem cell transplantation. A case series with 10 cases was carried out. Due to the presence of exudate on the average for 12 days, sterile gauze dressing was used for 12.9 days (average). Transparent film was used, on average, for 15.1 days. Catheters were precociously removed due to infection in four cases. The highest degree of skin toxicity occurred in a case that used gauze dressing and in three cases with film. The transparent film permitted visualization of the exit site of the catheter and changes with longer intervals.

Comparison of enteral nutrition with combined enteral and parenteral nutrition in post-pancreaticoduodenectomy patients: a pilot study

BackgroundMany clinical studies have demonstrated that early postoperative enteral nutrition (EN) improved the postroperative course. Post-pancreaticoduodenectomy (PD), patients tend to suffer from postoperative nausea, abdominal distention, and diarrhoea, causing difficulty in the introduction of EN. In this pilot study, we investigated the appropriate nutritional mode post-pancreatic surgery.MethodsBetween October 2006 and March 2007 2 postoperative nutritional methods were implemented in 17 patients in a prospective single-centere study. Eight patients received only enteral nutrition (EN group) and 9 patients received enteral nutrition combined with parenteral nutrition (EN + PN group).ResultsThere were no differences in the patient characteristics and postoperative morbidity between the 2 groups. The rate of discontinuance of enteral feeding was significantly high in the EN group, and the duration of enteral feeding was significantly longer in the EN + PN group. The central venous line was retained for a significantly longer period in the EN + PN group, but there was no difference in the frequency of catheter-related infection between the 2 groups.ConclusionEN combined with PN is more adequate for patients after pancreatic surgery.

Risk factors and outcome for breakthrough candidaemia in patients with cancer

While candidaemia that develops during systemic antifungal prophylaxis or therapy [breakthrough (BT) candidaemia] has been reported increasingly, the risk factors and outcome of BT candidaemia are not yet known definitely. We evaluated a consecutive series of cancer patients with candidaemia at Asan Medical Center during 6 years to identify risk factors and outcome in BT candidaemia comparing with non-BT candidaemia. Fifty-four episodes of candidaemia in cancer patients diagnosed during this period were reviewed retrospectively. There were 10 episodes (18.5%) of BT candidaemia in which the species distribution and frequency of catheter-related infection in the BT and non-BT groups were similar. BT candidaemia had a tendency to occur more frequently in patients with haematological than non-haematological diseases. Profound neutropenia and disseminated candidiasis were more common in the BT group; however, these differences were not statistically significant (P = 0.17 and 0.07 respectively). The duration of prior antibiotic therapy and duration of profound neutropenia (<100 mm(-3)) were identified as risk factors for BT candidaemia (P < 0.01 and 0.02 respectively) in univariate analysis and the latter was the only risk factor in multivariate analysis. The death rates due to candidaemia were 85.7% in the BT group and 42.9% in the non-BT group (P = 0.08); however, BT candidaemia alone did not increase mortality rate.

Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes

Objective: To determine correlates of clinical outcomes in patients with short bowel syndrome (SBS). Methods: Retrospective medical record review of neonates treated between 1986 and 1998 who met our criteria for SBS: dependence on parenteral nutrition (PN) for at least 90 days after surgical therapy for congenital or acquired intestinal diseases. Results: Thirty subjects with complete data were identified; 13 (43%) had necrotizing enterocolitis, and 17 (57%) had intestinal malformations. Mean (SD) residual small bowel length was 83 (67) cm. Enteral feeding with breast milk (r = –0.821) or an amino acid–based formula (r = –0.793) was associated with a shorter duration of PN, as were longer residual small bowel length (r = –0.475) and percentage of calories received enterally at 6 weeks after surgery (r = –0.527). Shorter time without diverting ileostomy or colostomy (r = 0.400), enteral feeding with a protein hydrolysate formula (r = –0.476), and percentage of calories received enterally at 6 weeks after surgery (r = –0.504) were associated with a lower peak direct bilirubin concentration. Presence of an intact ileocecal valve and frequency of catheter-related infections were not significantly correlated with duration of PN. In multivariate analysis, only residual small bowel length was a significant independent predictor of duration of PN, and only less time with a diverting ostomy was an independent predictor of peak direct bilirubin concentration. Conclusions: Although residual small bowel length remains an important predictor of duration of PN use in infants with SBS, other factors, such as use of breast milk or amino acid–based formula, may also play a role in intestinal adaptation. In addition, prompt restoration of intestinal continuity is associated with lowered risk of cholestatic liver disease. Early enteral feeding after surgery is associated both with reduced duration of PN and less cholestasis. (J Pediatr 2001;139:27-33)