Incidence Of Bloodstream Infections Research Articles

Pattern of bacterial infections in neutropenic febrile patients (experience of the Specialized BMT center - Medical city complex - Baghdad, Iraq)

Abstract: BACKGROUND: Infectious complications occur in most of the patients undergoing hemopietic stem cell transplantation (HSCT), these carry high risk of mortality mainly due to Gram-negative bacteria unless effective antibiotic treatment is provided. OBJECTIVES: The aims of the study were to review bacterial isolates from different samples in febrile neutropenic patients underwent HSCT in terms of incidence, types, and antimicrobial resistance, and to assess the efficacy of infection control measures used in transplantation ward. PATIENTS AND METHODS: This is retrospective study. The medical records of a total of 82 patients who underwent HSCT in the Specialized BMT Center, Baghdad Medical City, in 2021 and 2022 were reviewed; for any patient with neutropenic fever (NF), the clinical assessment was made, and samples were taken for culture any sensitivity before starting empirical antibiotics. The study was reviewed by the ethical committee of the hematology transplant center in the Medical City Complex, and since the study is retrospective, no consent is needed from the patient. RESULTS: There were 57 patients who developed NF, two at the time of collection, while 55 patients during transplant. In 16 patients, there was a clinical focus for NF, most commonly respiratory. From 175 samples sent for culture and sensitivity, bacterial growth was detected in 103 samples, and the incidence of bloodstream infection was 53%. Polymicrbial bacterial growth was detected in 6 patients with NF. Gram-positive bacteria were slightly more common than Gram negative. Staphylococcus epidermidis and Burkholderia cepacia were the most common Gram positive and Gram negative, respectively. An increasing number of patients admitted to transplant centers were associated with more infections. Ten out of 13 bacteria were multidrug resistant (MDR). Only two patients died from infection posttransplant. CONCLUSIONS: The predominance of Gram-positive cocci and Burkholderia cepacia complex supported the need to review the adherence to infection control policy. The empirical antibiotic protocol should be guided by local antibiogram, and since the high rate of blood stream infection (BSI) with MDR pathogens, a de-escalating strategy utilizing carbapenems – as advised by the ECIL-4 guidelines – would be more appropriate while awaiting culture result. The ability to quickly identify infections and their susceptibility profile is still crucial for choosing antibiotic therapy.

Effectiveness of oral vancomycin as prophylaxis against Clostridioides difficile infection in hematopoietic stem cell transplant patients

Abstract Objective: Patients receiving hematopoietic stem cell transplants (HSCT) are at increased risk for Clostridioides difficile infection (CDI). The purpose of this study was to assess the effectiveness of oral vancomycin prophylaxis (OVP) for CDI in HSCT patients. Design: Single-center, retrospective cohort. Setting: Tertiary care academic medical center in New Jersey. Patients: Patients ≥18 years old during admission for the HSCT were included. Patients who were admitted <72 hours or who had an active CDI prior to HSCT day 0 were excluded. Methods: Medical records of patients admitted between January 2015 and August 2022 to undergo an allogeneic or autologous HSCT were reviewed. The primary end point was the incidence of in-hospital CDI. Secondary end points included the incidence of vancomycin-resistant enterococci (VRE) bloodstream infections, VRE isolated from any clinical culture, gram-negative bloodstream infections, hospital survival, and hospital length of stay. Exploratory end points, including 1-year survival, relapse, and incidence of graft-versus-host disease, were also collected. Results: A total of 156 HSCT patients were included. There was 1 case of CDI (1 of 81, 1.23%) in the OVP group compared to 8 CDI cases (8 of 75, 10.67%) in the no OVP group (P = .0147). There were no significant (P > .05) between-group differences in incidence of gram-negative bloodstream infections, hospital survival, and length of stay. There were zero clinical cultures positive for VRE. Conclusions: In-hospital incidence of CDI in HSCT patients was significantly decreased with OVP. Randomized controlled trials are needed in this high-risk population to assess the efficacy and risks of OVP for CDI.

Increased Peripheral Venous Catheter Bloodstream Infections during COVID-19 Pandemic, Switzerland.

Studies suggest that central venous catheter bloodstream infections (BSIs) increased during the COVID-19 pandemic. We investigated catheter-related BSIs in Switzerland and found peripheral venous catheter (PVC) BSI incidence increased during 2021-2022 compared with 2020. These findings should raise awareness of PVC-associated BSIs and prompt inclusion of PVC BSIs in surveillance systems.

Bloodstream infections after solid organ transplantation: clinical epidemiology and antimicrobial resistance (2016-21).

Solid organ transplant (SOT) recipients are at risk of bloodstream infections (BSIs) with MDR organisms (MDROs). To describe the epidemiology of BSI in the year after several types of SOT, as well as the prevalence of MDRO infections in this population. We conducted a single-centre, retrospective study of kidney, liver, heart, and multi-organ transplantation patients. We examined BSIs ≤1 year from SOT and classified MDRO phenotypes for Staphylococcus aureus, enterococci, Enterobacterales, Pseudomonas aeruginosa and Candida spp. We compared BSI characteristics between SOT types and determined risk factors for 90 day mortality. We included 2293 patients [1251 (54.6%) kidney, 663 (28.9%) liver, 219 (9.6%) heart and 160 (7.0%) multi-organ transplant]. Overall, 8.5% of patients developed a BSI. BSIs were most common after multi-organ (23.1%) and liver (11.3%) transplantation (P < 0.001). Among 196 patients with BSI, 323 unique isolates were recovered, 147 (45.5%) of which were MDROs. MDROs were most common after liver transplant (53.4%). The most frequent MDROs were VRE (69.8% of enterococci) and ESBL-producing and carbapenem-resistant Enterobacterales (29.2% and 27.2% of Enterobacterales, respectively). Mortality after BSI was 9.7%; VRE was independently associated with mortality (adjusted OR 6.0, 95% CI 1.7-21.3). BSI incidence after SOT was 8.5%, with a high proportion of MDROs (45.5%), especially after liver transplantation. These data, in conjunction with local antimicrobial resistance patterns and prescribing practices, may help guide empirical antimicrobial selection and stewardship practices after SOT.

Bloodstream infections in cardiac intensive care units from a tertiary care center

Blood stream infections (BSIs) occur more frequently in patients hospitalized in Intensive care units (ICUs). Intravascular devices are the most frequent predisposing factor causing BSI. To compare the proportion, risk factors, microbiological profile of Blood stream Infections and Central line associated bloodstream infection in Cardiology Intensive care units (CICU) and Cardiothoracic Intensive care units (CTICU).This is a prospective study conducted by the Dept. of Microbiology along with Cardiology Intensive care unit(CICU), and Cardiothoracic Intensive care unit (CTICU) of a tertiary care centre, from June 1st 2017-Oct 312018.Laboratory confirmed BSIs (LCBSI’s), occurring more than 48hrs after ICU admission were included in the study. Identification of pathogens were done by standard methods.A total of 1640 blood cultures were analyzed (CICU=890,CTICU=750).73 Primary BSIs were observed with male preponderance.68/73 diagnosed to have non CLABSI (CTICU=35/68 51.4%, CICU=33/68, 48.5%) and 5/73 cases diagnosed to have CLABSI (CTICU=5/73, 6.84% CICU=0%) 47.94% of our isolates were Gram negative pathogens with as the predominant followed by 35.6% of Gram positive with as the major pathogen &amp; 16.4% were Candida spp. 20.5% were multi drug resistant and 10% were ESBL producers. Prevalence and incidence rates were high in CTICU (5.3% &amp; 1.5%) compared to CICU (3.7% &amp; 0%) of BSI &amp; CLABSI respectively.BSI is preventable costly complication that occur with greater frequency in the ICU settings. Strict adherence to Infection control measures such as hand hygiene, aseptic precautions during blood culture collection and bundle care measures can decrease the BSI and CLABSI incidence rates.

Vascular access modalities in a pediatric intensive care unit in tertiary hospital indications and outcomes: a single-center cross-sectional study

BackgroundVascular access is a mainstay of pediatric critical care. The selection of the route of access and equipment used will depend on patient- and provider-specific factors, which constantly need revision to achieve more effective assessment and management.ObjectiveTo evaluate the use, indication, and outcome of different vascular access modalities in critically ill children in the Emergency Pediatric Intensive Care Unit (ER-PICU) of a tertiary university hospital.Patients and methodsThis cross-sectional descriptive study was based on data collected by reviewing all modes of vascular access used for 168 consecutive patients admitted to ER-PICU during a 6-month period from May to October 2020.ResultsAmong the study group (n = 168), there were 92 males (54.8%) and 76 females (45.2%). The median age of cases was 18 months. 333 vascular access devices were observed: 219 peripheral (65.8%) and 114 central catheters (34.2%). Catheters lasted a total of 1920 catheter days. Central venous catheters lasted significantly more than peripheral lines (P < 0.001); median of 8.5 and 3 days, respectively. The incidence of peripheral line complications (35.2%) was found significantly higher compared to central venous catheters (22.8%) (P. = 0.021). Longer dwell time of central access was associated with a higher incidence of catheter-related bloodstream infection. The incidence of catheter-related bloodstream infection was 9.05 per 1000 catheter days. Mortality rate was 24.4%.ConclusionsDespite having lower incidence of complications than peripheral lines, central venous catheters’ complications are considered more serious. Dwell time of central venous catheters (CVC) should be revised daily to avoid the occurrence of infection.

Epidemiology and incidence of catheter-related bloodstream infections in patients receiving parenteral nutrition in an Asian tertiary hospital

Epidemiology and incidence of catheter-related bloodstream infections in patients receiving parenteral nutrition in an Asian tertiary hospital

Post-Transplantation Cyclophosphamide and Tacrolimus for Graft-versus-Host Disease Prevention after Allogeneic Hematopoietic Cell Transplantation from HLA-Matched Donors Has More Advantages Than Limitations

This study compared the efficacy of graft-versus-host disease (GVHD) prophylaxis with post-transplantation cyclophosphamide (PTCy) and tacrolimus (Tac) versus other regimens in 272 adults undergoing peripheral blood (PB) allogeneic hematopoietic cell transplantation (allo-HCT) from HLA-matched donors. Of these 272 patients, 95 (34.9%) received PTCy/Tac. The times to neutrophil and platelet engraftment were longer in the PTCy/Tac group (20 days versus 16 days for neutrophils and 19 days versus 12 days for platelets). The day +30 cumulative incidence (CuI) of bacterial bloodstream infection was higher in the PTCy/Tac group (43.2% versus 13.0%; P < .001). The CuIs of grade II-IV and grade III-IV acute GVHD (aGVHD) at day +180 were 14.7% and 4.2%, and the CuI of moderate/severe cGVHD at 2 years was 2.4% in the PTCy/Tac group and 41.8% (hazard ratio [HR], .29; P < .001), 15.8%, (HR, .24; P = .007), and 47.0% (HR, .05; P < .001), respectively, in the no-PTCy group. The duration of immunosuppression was shorter in patients receiving PTCy/Tac (6.2 months versus 9.0 months; P < .001). PTCy/Tac patients had higher OS (2 years: 74.3% versus 60.9%; HR, .54; P = .012), lower NRM (2 years: 8.6% versus 15.8%; HR, .54; P = .11), comparable CuI of relapse (2 years: 26.0% versus 24.4%; HR, 1.03; P = .89), and higher GRFS (2 years: 59.1% versus 16.7%; HR, .32; P < .001). Using PTCy/Tac in HLA-matched PB allo-HCT improved transplantation outcomes at out institution compared with previous prophylactic regimens, including a higher probability of survival despite more delayed engraftment and a higher rate of bacterial infection.

The Impact of Immune Function on Hematopoietic Reconstitution and Infection in Patients with Lymphoma after Autologous Hematopoietic Stem Cell Transplantation

Objective To investigate the impact of immune function on hematopoietic reconstitution and infection in lymphoma patients after autologous hematopoietic stem cell transplantation (auto-HSCT). Methods: A total of 20 patients with lymphoma who underwent auto-HSCT in Chongqing University Cancer Hospital from January 2021 to December 2021 were retrospectively analyzed. According to whether the number of CD4+T cells was greater than or equal to 200 cells /ul, the patients were divided into normal immune function group and immunocompromised group. The hematopoietic reconstitution of the two groups was observed, including the time of neutrophil engraftment and platelet engraftment, as well as the occurrence of infection, including the pathogen could not be identified in some patients with neutropenia, it was necessary to judge according to physical examination, laboratory and imaging examination or empirical antimicrobial treatment was effective. Results 1. Immunocompetent and immunocompromised patients included 10 patients, respectively. The durations of neutrophil engraftment were 9.5 (7-12) days and 12 (8-15) days (P = 0.007), and the durations of grade 3 neutropenia were 1.5 (0-4) days and 3 (1-7) days (P = 0.030), respectively. The duration of grade 4 neutropenia was 9 (5-16) days and 11 (6-20) days, respectively (P = 0.010). There was no significant difference in platelet engraftment time and incidence of grade IV anemia between the two groups (P &amp;gt;0.05). 2. The incidence of febrile neutropenia in immunocompetent group and immunocompromised group was 60% and 80%, respectively, and the median duration of febrile neutropenia was 3.5 (1-10) days and 5 (1-20) days, respectively (P = 0.005). 3. The incidence of infection in immunocompetent group and immunocompromised group was 20% and 30%, and the incidence of bloodstream infection was 20% and 30%. 4. The length of hospital stay in immunocompetent group and immunocompromised group was 31.5 (23-43) days and 37 (25-75) days, respectively (P&amp;lt;0.001). Conclusion The immune function of lymphoma patients before transplantation has a certain impact on hematopoietic reconstitution and infection. Normal immune function is superior to immunocompromised in terms of neutrophil engraftment, shortening the duration of febrile neutropenia, and the incidence of infection after transplantation.

2418. Incidence and Characteristics of Midline-Associated Bloodstream Infections in an Urban Healthcare System

Abstract Background Midline catheters may carry a lower infection risk than central venous catheters, but available data is limited. Central line-associated bloodstream infection (CLABSI) incidence has increased during the COVID-19 pandemic, but is unclear what influence the pandemic has had on midline-associated bloodstream infections (MABSI). The objective of this study was to determine the incidence of MABSI during the COVID-19 pandemic and which pathogens were involved. Methods A health system infection prevention database was used to identify adult patients admitted to 6 acute care hospitals in 2021 who had a midline during admission and a positive blood culture. Cases were reviewed by a hospital epidemiologist and 3 supervised trainees for demographic data, microbiology data, and MABSI attribution using National Healthcare Safety Network (NHSN) CLABSI definitions. Midline-Associated Bloodstream Infection Identification Results 579 patients with possible MABSI were identified. 88 patients were determined to have a MABSI. 28 patients were excluded due to having a CLABSI-eligible central line at the time of the BSI. The remainder were excluded because the BSI did not fall within a MABSI eligibility period or because the BSI was secondary to another infection. MABSI and CLABSI rates for each hospital are shown in Table 1. MABSI occurred mostly in medicine patients (73, 82.95%). A slight majority of patients were male (48, 54.54%), and median age was 66 years (range 24-96). The most common organisms were Candida spp. (27), coagulase-negative Staphylococcus spp. (17), Enterococcus spp. (17), and Staphylococcus aureus (15). The 2021 yearly health system MABSI and CLABSI rates were similar (1.29 vs. 1.2), with variation between hospitals. Quarterly MABSI and CLABSI rates are shown in Figure 2. The health system MABSI rate appeared to increase during Winter 2021, while the CLABSI rate seemingly decreased. MABSI and CLABSI Rates MABSI and CLABSI rates by quarter of 2021. The blue line represents the MABSI rate, while the orange line represents the CLABSI rate. Organisms isolated from blood cultures in MABSI patients. Gram positive bacteria were the most common isolates (57/123, 46.34%). More than 88 organisms were detected as many MABSI involved ≥2 possible pathogens (27/88, 30.68%). Conclusion In this study MABSI demographics were similar to those reported for CLABSI in other studies. While gram positive bacteria were common, as described in CLABSI, we also observed a high proportion of infections due to Candida spp. The health system MABSI rate was higher than the CLABSI rate, contrary to some studies. This was primarily driven by hospitals which were heavily impacted by the Omicron subvariant surge. Disclosures Bernard Camins, MD, MSc, Puro Lighting, LLC: Advisor/Consultant

696. Effectiveness of Oral Vancomycin as Prophylaxis against Clostridioides difficile Infection in Hematopoietic Stem Cell Transplant Patients

Abstract Background Patients receiving hematopoietic stem cell transplants (HSCT) are at increased risk for Clostridioides difficile infection (CDI) due to decreased immune function, frequent exposure to broad-spectrum antibiotics and chemotherapy, prolonged hospitalizations, and alteration in gut microbiome. The purpose of this study was to assess the effectiveness of oral vancomycin prophylaxis (OVP) for CDI in all patients admitted for HSCT. Methods This was a single-center, retrospective, cohort study conducted at a tertiary care academic medical center in New Jersey. Medical records of patients admitted between June 2019 to August 2022 to undergo an allogeneic or autologous HSCT were reviewed. Universal OVP from admission to discharge for HSCT patients began December 2019. Patients ≥ 18 years at the time of admission for the HSCT were included. Patients who were admitted less than 72 hours or who were being treated for an active CDI prior to HSCT were excluded. The primary endpoint was the incidence of in-hospital CDI. Secondary endpoints included incidence of vancomycin-resistant enterococci (VRE) bloodstream infections, VRE isolated from any clinical culture, gram-negative bloodstream infections, hospital survival, and hospital length of stay. Exploratory endpoints including one-year survival, relapse, and incidence of graft-versus-host disease were also collected. Confounding by relevant covariates were assessed and controlled for in a multivariable regression model. Results A total of 132 HSCT patients were included. There was one case (1/68, 1.47%) of CDI in the prophylaxis group compared to six CDI cases (6/64, 9.38%) in the no prophylaxis group (P=0.057). There were no significant (P&amp;gt;0.05) between-group differences of incidence of gram-negative bloodstream infections, hospital survival, and length of stay. There were zero clinical cultures positive for VRE in either group. Conclusion In-hospital incidence of CDI in HSCT patients was decreased with the use of OVP but did not meet statistical significance. Randomized controlled trials are needed in this high-risk patient population to assess the efficacy and long-term risks of OVP for CDI. Disclosures Pinki Bhatt, MD, Sanofi: Grant/Research Support Navaneeth Narayanan, PharmD, MPH, BCIDP, Astellas: Honoraria|Beckman Coulter: Honoraria|Merck: Grant/Research Support|Shionogi: Grant/Research Support

2440. Central Line-Associated Bloodstream Infection Incidence Reduction Accompanies Initial-Specimen Diversion Device Adoption

Abstract Background Established lines are poor sites for sampling blood (frequently host to enterococci and Candida species) but peripheral venipuncture is an imperfect alternative as antiseptics struggle to eliminate deeply embedded microorganisms. State-of-the-art initial-specimen diversion device (ISDD) use can facilitate near-zero blood culture contamination rates, but impact on central line-associated bloodstream infection (CLABSI) incidence is unclear. Methods Intervention took place within a Joint Commission-accredited, 200-bed, acute-care community hospital serving nine Southeastern United States counties toward the objective of reduced CLABSI reporting. From September 2021 through March 2023, ISDD use augmented all peripheral venipuncture sample collection for adult patient blood culture. CLABSI reporting and the associated National Healthcare Safety Network (NHSN) standardized infection ratio (SIR) data for the 18-month intervention period was compared to the preceding 18-month period. Results For the 18 months prior to ISDD use, 6.5 CLABSIs were predicted and 17 CLABSIs were reported. For the 18 months during which ISDD use augmented standard procedure, 5.5 CLABSIs were predicted and 3 CLABSIs were reported. ISDD use accompanied an 80% reduction in SIR, from 2.6 to 0.5. Conclusion The study period coincided with the COVID-19 pandemic, a nationwide struggle with considerable quality control shortcomings observed in this space that, by juxtaposition, reinforce the strengths of the intervention. SIRs are the primary means of tracking healthcare-associated infection trends, and financial penalties follow performances failing to meet predictions. As CLABSI reporting throughout the intervention period was dramatically below NHSN prediction, the author concludes that ISDDs have standard-of-care potential and encourages further study in the interest of antimicrobial stewardship and quality control. Disclosures All Authors: No reported disclosures

Comparison of clinical and microbiological characteristics of community-acquired hypervirulent Klebsiella pneumoniae liver abscess in diabetic and non-diabetic patients.

Invasive infection caused by hypervirulent Klebsiella pneumoniae (HvKP) has been reported worldwide. Most of the patients are community population, related to diabetes mellitus (DM), chronic liver disease and other basic diseases, which prone to systemic migratory infection. In this study, we collected 377 patients with community acquired Klebsiella pneumoniae liver abscess in our hospital from January 2013 to December 2018, 65.8% of whom were male, and 49.6% had DM. Patients with DM are prone to eye and central nervous system (CNS) infection, which need continuous local abscess drainage during treatment. Among them, patients with poor blood glucose control have a higher rate of blood stream infections (BSI). 219 strains of HvKP were obtained, with K1/K2 Serotype accounted for 81.7%. The incidence of BSI in K2 patients was higher than that in K1 patients. The PCR results indicate that the carrying rate of virulence genes (rmpA、areo、kfu、allS、iroN、magA、uge、wcaG) in K1/K2 type strains is significantly higher than that in non K1/K2 type strains. ST23 and ST65 are the most common multilocus sequence typing (MLST), which belong to K1 and K2 Serotype respectively. All of HvKP strains showed high sensitivity to commonly used clinical antibiotics other than ampicillin, with 54.3% of the strains exhibiting high viscosity characteristics. Meanwhile, 35 classic Klebsiella pneumoniae (cKP) strains were collected, and their serum typing is mainly non K1/K2. The carrying rate of virulence genes and viscosity degree in HvKP are significantly higher than those in cKP. Primary liver abscess caused by HvKP is prone to multiple tissue and organ infections, but it shows higher sensitivity to most commonly used antibiotics in clinical practice except for ampicillin. After effective treatment, the overall prognosis of patients is better. This study analyzes the pathogenic characteristics of HvKP and elaborates on the clinical characteristics of patients, which can provide reference for clinical and scientific research work.

Incidence, Etiology, Risk Factors, and Outcomes of Bloodstream Infection after a Second Hematopoietic Stem Cell Transplantation.

Objective Infections after a second hematopoietic stem cell transplantation (HSCT) occur commonly and are associated with high mortality. However, studies on bloodstream infection (BSI) after a second HSCT are lacking. We therefore evaluated the details of BSI after a second HSCT. Methods We retrospectively evaluated the incidence, etiology, risk factors, and outcomes of BSI after a second HSCT. Patients Fifty-two adult patients with hematological malignancies who underwent allogeneic HSCT, including cord blood transplantation (CBT; n=33), as the second transplantation were enrolled. The second transplantation was limited to allogeneic HSCT. Patients who underwent HSCT for graft failure were excluded. Results The median HSCT interval was 438 (range: 39-3893) days. Overall, 31 (59.6%) patients received autologous HSCT as the first HSCT. The cumulative incidence of BSI was 40.4% at 100 days after the second HSCT, with Gram-positive bacteria accounting for the majority (30.8%) of pathogens. Overall, 92.0% of BSIs occurred during the pre-engraftment period, and Enterococcus faecium accounted for 29.6% of pathogens. On a multivariate analysis, CBT was most closely associated with pre-engraftment BSI after the second HSCT (hazard ratio: 3.43, 95% confidence interval: 1.05-11.23, P=0.042). The 1-year survival rate after the second HSCT was lower in patients with BSI than in patients without BSI (P=0.10). Conclusion BSI is common after a second HSCT, especially with CBT. During the pre-engraftment period, BSI caused by pathogens such as E. faecium should be anticipated and appropriately treated to improve transplant outcomes.

Impact of intestinal colonization by Gram-negative bacteria on the incidence of bloodstream infections and lethality in critically ill neonates

BackgroundEarly detection of antimicrobial-resistant microorganisms is crucial to prevent subsequent invasive infections and contain their spread in the Neonatal Intensive Care Unit (NICU). This study aims to investigate the association between intestinal colonization (IC) by Gram-negative bacteria and the risk of bloodstream infection (BSI) in critically ill neonates. MethodsData from the electronic medical records of 678 newborns admitted to a NICU Brazilian between 2018 and 2022 were retrospectively analyzed. Participants were monitored by the National Health Security Network. ResultsAmong neonates, 6.9 % had IC (56.9 % attributed to Acinetobacter baumannii); of these, 19.1 % developed BSI (66.7 % by Staphylococcus spp.). Within the A. baumannii colonization, 34.5 % occurred during an outbreak in September 2021. Colonized individuals had a longer mean length of stay (49.3 ± 26.4 days) and higher mortality rate (12.8 %) compared to non-colonized individuals (22.2 ± 16.9 days; 6.7 %, respectively). Previous use of antimicrobials and invasive devices significantly increased the risk of colonization. Colonization by drug-resistant microorganisms, along with the occurrence of BSI, was associated with increased mortality and reduced survival time. ConclusionsIC contributed to the incidence of BSI, leading to more extended hospital stays and higher mortality rates. Its early detection proved to be essential to identify an outbreak and control the spread of resistant microorganisms within the NICU.

Cytomegalovirus Reactivation Concurrent with Bloodstream Infection Early after Allogeneic Hematopoietic Stem Cell Transplantation: Association with Poor Prognosis

In patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), infections are a leading cause of death, particularly cytomegalovirus reactivation (CMVr) and bloodstream infection (BSI). This retrospective study aimed at evaluating the incidence of CMVr and BSI, identify the risk factors, assess their impact on survival, and examine the association between CMVr and BSI in allo-HSCT recipients during the first 100 days post-transplantation. The study population consisted of 500 allo-HSCT recipients who were CMV-DNA-negative before allo-HSCT. Of these, 400 developed CMVr, and 75 experienced BSI during the 100 days after allo-HSCT. Multivariate regression analysis indicated that graft failure and acute-GVHD were significant risk factors for poor prognosis, while CMVr and BSI were not. Among the 500 patients, 56 (14%) developed both CMVr and BSI. CMVr did not increase the incidence of BSI, but the combination of CMVr and BSI significantly reduced the 6-month overall survival (P=0.003) and long-term survival (P=0.002). Our study provides real-world data on the impact of post-transplant CMVr and BSI on survival, particularly in regions such as our China province, where CMV IgG prevalence is high.

Ultrasound-guided placement of Midline catheters performed by Neurosurgery resident as a substitute for conventional central venous catheter placement in Neurosurgical Intensive Care Unit patients

Background: Midline catheters (MCs) and peripherally inserted central venous catheters (PICCs) are placed by a specialist or trained nurse to avoid the complications of conventional central venous catheters (CCVCs). The safety of MC placements by residents has not been evaluated. We investigated the safety of ultrasound-guided MC placement by neurosurgery residents as a substitute for CCVC placement in patients in the neurosurgical intensive care unit (ICU) requiring intravenous (IV) therapy ≤14 days.Methods: Between July 2022 and June 2023, 57 MCs for 44 patients, 36 CCVCs for 35 patients, and 32 PICCs for 32 patients were placed during their ICU stay. One resident performed all MC placements under ultrasound guidance. The baseline and procedure-related parameters of the three catheter groups (MC, CCVC, and PICC) were analyzed, with focus on the comparison of complications between MC and CCVC.Results: The first-attempt success rate was significantly higher (p=0.003) in the MC group (96.5%) than in the CCVC group (80%). Insertional injuries occurred more frequently in the CCVC group than in the MC group (13.3% vs 0%, p=0.012). The rate of completion of therapy was significantly higher (p=0.002) in the MC group (86.0%) than in the CCVC group (53.3%). The incidence of bloodstream infections did not differ significantly between the MC and CCVC groups (p=0.605). Conclusion: MCs placed under ultrasound guidance by neurosurgery residents for neurosurgical ICU patients is safe and may be a substitute for CCVC indicated for IV therapy ≤14 days.

Reducing the rate of central line-associated bloodstream infections; a quality improvement project

BackgroundThe burden of central line-associated bloodstream infections is significant and has negative implications for healthcare, increasing morbidity and mortality risks, increasing inpatient hospital stays, and increasing the cost of hospitalization. Efforts to reduce the incidence of central line-associated bloodstream infections have utilized quality improvement projects that implement, measure, and monitor outcomes. However, variations in location, healthcare organization, patient risks, and practice gaps are key to the success of interventions and approaches. This study aims to evaluate interventions of a quality improvement project on the reduction of central line-associated bloodstream infection rates at a university teaching hospital.MethodsThis was a retrospective review of a quality improvement project that was implemented using the Plan-Do-Study-Act quality improvement cycle. Active surveillance of processes and outcomes was performed in the critical care areas; compliance to central line care bundles, and central line-associated bloodstream infections. Interrupted time series was used to analyze trends pre and post-intervention and regression modeling to estimate data segments preceding and succeeding the interventions.ResultsThere were 350 central line insertions, 3912 catheter days, and 20 central line-associated bloodstream infection events during the intervention period. Compliance with central line care bundles was at 94%. There was a trend in the reduction of central line-associated bloodstream infections by 18% that did not reach statistical significance (p = 0.252).ConclusionsImprovement projects to reduce central line-associated bloodstream infections face challenges and complexities associated with implementing interventions in real-world healthcare settings. There is a great need to continuously monitor, evaluate, readjust, and adapt interventions to achieve desired results, sustain improvements in patient outcomes, and investigate reasons for non-adherence as keys to achieving desired outcomes.

Novel scores relevant to antimicrobial resistance and hospital-acquired infections developed with data from a multi-hospital consortium in the Parisian region of France

Indicators for comparing and understanding differences in antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) for benchmarking are essential to identify priorities for hospitals. This study measured the incidence of hospital-acquired or resistant Gram-negative bacilli bloodstream infections (GNB-BSIs) in a large public healthcare consortium in the Parisian region of France. Within each hospital, there was a strong positive correlation between the incidence of GNB-BSIs due to resistant GNB and the incidence of hospital-acquired GNB-BSIs. Two scores measuring AMR and HAI rates by combining different GNB-BSI incidence rates were developed as indicators. These scores were highly variable within the hospital consortium. On multi-variate analysis, AMR and HAI scores were significantly associated with the proportion of surgical beds, staff absenteeism and the consumption of alcohol-based hand rub, with the latter two characteristics being amenable to interventions. Carbapenem use was also linked to AMR, but this may be because carbapenems are the preferred drug for treating resistant infections. These results shed light on the incidence of HAIs and AMR in the study hospitals, and suggest possibilities for targeted interventions at healthcare facility level.

Foundation for implementing a comprehensive vascular access excellence initiative organization-wide to improve vascular access device insertion and standardize care: best practice for an acute care hospital.

In 2016, a 263-bed public district hospital in California trialed a peripheral intravenous catheter (PIVC) inserted using ultrasound, with the potential to increase first attempt success in difficult intravenous access (DIVA) patients. This led to the implementation of a hospital-wide initiative to improve nursing vascular access skills and expedite vascular access device (VAD) placement. To trial a PIVC and ultrasound-guided (USG) insertion, a training program was developed and led to a doctoral Capstone project piloting an evidence-based nurse-driven protocol for the identification of DIVA patients. A Vascular Access Committee was established to achieve vascular access excellence throughout the hospital by increasing the number of nurses with advanced skills in VAD placement and by developing a central venous access device (CVAD) insertion and maintenance bundle to decrease the incidence of central line-associated bloodstream infections (CLABSI). With ongoing support of nursing leadership and achievement of ANCC Magnet Recognition® in 2021, the hospital developed a comprehensive initiative to provide patients with a consistent level of nursing expertise for VAD placement across all shifts. Requests for USGPIVCs increased throughout the hospital, DIVA patients themselves requested ultrasound guidance be used for PIVC insertions, and there were fewer requests for Emergency Department (ED) physicians to insert CVADs. From the related Doctor of Nursing Practice (DNP) Capstone project, there were higher first-attempt cannulation successes, longer PIVC dwell times, and a reduction in devices and supplies utilized. The CVAD bundles resulted in the number of central line-associated bloodstream infections decreasing from four in 2019 to one in 2020. Since the initiative's inception, a total of 92 nurses completed the USGPIVC insertion training, and patient access to advanced-skilled clinicians is now available around the clock. This manuscript discusses the initiative implemented to standardize patient care through a collaborative multidisciplinary approach and has potential generalizability to other acute care hospitals to reduce associated healthcare costs and to prevent poor patient outcomes by expediting the arrival of a vascular access nurse for DIVA patients. The vascular access excellence initiative implemented provided an effective strategy to enhance the skills and confidence of nurses in VAD placement and improved efficiency in processes to expedite the arrival of an advanced skilled nurse to place VADs on DIVA. Targeted educational initiatives improved patient outcomes by reducing catheter-related bloodstream infections.