Catheter Infection Research Articles

P-802. The Predictive Accuracy of Clinical Covariates in Differentiating Staphylococcus aureus Bacteremia with and without Deep-Seated Foci of Infection via Application of Different Variable Selection Methodologies

Abstract Background Staphylococcus aureus bacteremia (SAB) is a common bloodstream infection with a mortality rate of 20-30%. SAB is frequently associated with deep-seated foci of infection (DSFI) for which IDSA/ESCMID draft guidelines propose using clinical features early in evaluation to risk stratify for DSFI. However, literature for using combinations of clinical features to identify DSFI is limited, and the best process of variable selection is not defined. We explored variable selection methods to identify a combination of clinical features with the best predictive accuracy for identifying SAB with DSFI. Methods 242 adults admitted to a 500-bed teaching hospital in Portland, Oregon with incident SAB between January 1, 2016 and December 31, 2017 were included. Patients who died, transitioned to comfort or discharged before medically advised within 7 days, or without an infectious disease consultation were excluded. Clinical information was abstracted from electronic medical records. We performed four variable selection methods: best subset, forward and backward stepwise regression, and the LASSO. Variables were selected using 5-fold cross-validation. We estimated the area under the receiver operating curve (AUC) and fit a multivariable logistic regression model to evaluate the expected performance of the predictor combinations. Results The cohort is described in Table 1 and 2. SAB with one or more DSFI was diagnosed in 65% (n=158). Predictors selected by the four methods are described in Table 3. The combination of bacteremia duration, hospital acquired SAB (haSAB), central venous catheter (CVC), skin and soft tissue infection (SSTI), and any cardiac device had the highest predictive accuracy with an AUC of 82%. The odds of DSFI is estimated to increase by 32% (95% CI; 15% to 53%) for every 1 day increase in bacteremia after adjusting for haSAB, CVC, SSTI and any cardiac device (Table 4). Conclusion Duration of bacteremia, haSAB, and CVC were included regardless of the variable selection method. Our model shows that combinations of clinical features are more predictive of DSFI than any single feature. Larger studies in different cohorts are needed to verify the predictive accuracy of these variables used in combinations to risk stratify for SAB with DSFI. Disclosures All Authors: No reported disclosures

P-1038. Clinical Analysis of Nosocomial Candidemia: Species Profile, Resistance Patterns and Mortality Determinants

Abstract Background Candidemia has become one of the commonest nosocomial blood stream infection (BSI) secondary to infected central venous catheters or surgical site infections. Prompt diagnosis followed by early treatment is needed to reduce the high mortality associated with it. Hence this study was conducted to analyse the epidemiology, clinical characteristics, species distribution, resistance profile, outcome and factors related to outcome in nosocomial candidemia. Methods It was a retrospective observational analysis done for the period of 1 year in a tertiary health care centre of western Rajasthan from 1st July 2022 to 30th June 2023. All adult patients admitted in multispeciality intensive care unit (ICU) for more than 48 hours and developing candidemia were included and those patients with a single blood fungal culture positive from the sample obtained from indwelling central venous catheter were excluded as colonisers. Data was collected by regular AMS rounds and was analysed using SPSS version 20. Results Out of total 76 cases of candidemia,61 were included in the study. As shown in figure 1, the most common species isolated was Candida tropicalis followed by Candida parapsilosis.both were associated with high mortality. Clinicoepidemiological characters are described in table1. Overall, all cause 28th day mortality was 63.9 %. Highest resistance was found for the azoles. As depicted in table 2, on univariate and multivariate analysis infection with Candida tropicalis, use of inotropes, ventilator use, and high SOFA scores were the independent factors affecting mortality in candidemia. Conclusion Candidemia is a nosocomial infection with very high mortality which needs to be diagnosed early. Candida tropicalis being the most frequent species isolated in our ICU setup with a significantly high mortality. Disclosures All Authors: No reported disclosures

A nomogram for predicting central venous catheter-related infections in maintenance hemodialysis: A 4-year single-center study.

To develop and validate a nomogram model for predicting central venous catheter-related infections (CRI) in patients with maintenance hemodialysis (MHD). MHD patients with central venous catheters (CVCs) visiting the outpatient hemodialysis (HD) center of Xuzhou Medical University Affiliated Hospital from January 2020 to December 2023 were retrospectively selected through a HD monitoring system. Patient data were collected, and the patients were divided into training and validation sets in a 7:3 ratio. The training set was used to establish the model, which was verified using the validation set. Multiple logistic regression analysis was performed to identify risk factors for central venous CRI and develop a nomogram prediction model. A total of 300 MHD patients were enrolled. Multivariate analysis showed that catheter duration, catheter site, catheter reinsertion, history of catheter infection, diabetes, and albumin <35 g/L were risk factors for central venous CRI. The area under the receiver operating characteristic (ROC) curve (AUC) for the training set was 0.902 (95% confidence interval (CI) = 0.862-0.941), with a sensitivity of 85.7%, specificity of 80%, and a Youden index of 65.7%, and that for the validation set was 0.826 (95% CI = 0.726-0.905), with a sensitivity of 80.5%, specificity of 77.9%, and a Youden index of 58.4%. The model demonstrated good discrimination and calibration (Hosmer-Lemeshow goodness-of-fit test statistics: training set: χ2 = 4.709, p = 0.788; validation set: χ2 = 7.171, p = 0.518). This study identified six risk factors associated with central venous CRI in MHD patients. This predictive model demonstrates good prognostic performance and can be used by clinicians to screen for high-risk patients with central venous CRI, thereby enabling the early implementation of risk management strategies.

Acylase-Based Coatings on Sandblasted Polydimethylsiloxane-Based Materials for Antimicrobial Applications.

Indwelling medical devices, such as urinary catheters, often experience bacterial colonization, forming biofilms that resist antibiotics and the host's immune defenses through quorum sensing (QS), a chemical communication system. This study explores the development of antimicrobial coatings by immobilizing acylase, a quorum-quenching enzyme, on sandblasted polydimethylsiloxane (PDMS) surfaces. PDMS, commonly used in medical devices, was sandblasted to increase its surface roughness, enhancing acylase attachment. FTIR analysis confirmed that acylase retained its three-dimensional structure upon immobilization, preserving its enzymatic activity. The antibacterial efficacy of the coatings was tested against Pseudomonas aeruginosa (P. aeruginosa) (a common biofilm-forming pathogen), Staphylococcus aureus (S. aureus), and Escherichia coli (E. coli). The results showed that sandblasted PDMS surfaces had improved bacterial adhesion due to increased focal adhesion points, but acylase-functionalized surfaces had significantly reduced bacterial attachment and biofilm formation. Notably, the coatings inhibited P. aeruginosa growth by 40% under static conditions, demonstrating the potential of acylase-functionalized PDMS for medical applications. This approach offers a promising strategy for creating antimicrobial surfaces that prevent biofilm-related infections in urinary catheters and other medical devices. The findings highlight the dual role of surface roughness in enhancing enzyme attachment while reducing bacterial adhesion through effective QS inhibition.

Analysis of risk factors for postoperative thrombosis in patients with hematological diseases undergoing PICC surgery.

This study analyzes the prognostic factors of thrombosis in patients with hematological diseases after peripherally inserted central catheter (PICC) surgery. We conducted a retrospective analysis of 223 patients with hematological diseases who underwent PICC catheterization between January 2017 and June 2021. These patients were categorized into the thrombotic group and non-thrombotic group based on the occurrence of thrombosis following PICC catheterization. Subsequently, we identified influencing factors for thrombosis in patients with hematological diseases after PICC catheterization using univariate and multivariate logistic regression. Furthermore, we drew the ROC curve and calculated the AUC value to obtain the ideal critical value for predicting thrombosis risk in these patients. After PICC catheterization in 223 patients with hematological tumors, 107 cases developed thrombosis. The univariate analysis revealed significant differences in age, catheter placement, catheter-related complications (infection), the proportion of underlying diseases, and coagulation-related indicators between the 2 groups. Furthermore, the multivariate analysis demonstrated that catheter infection, diabetes, history of thrombosis, fibrinogen degradation products (FDP), antithrombin III (AT-III) and D-dimer were all independent factors of thrombosis in patients with hematological diseases after PICC. The AUC areas of the working characteristic curves of FDP, AT-III, and D-dimer in predicting post PICC thrombosis in patients with hematological diseases were 0.744, 0.651, and 0.595, respectively. Hematological diseases patients with catheter infection, diabetes, history of thrombosis, FDP > 3.24 mg/L, AT-III < 93%, or D-dimer > 2.41 µg/mL are prone to thrombosis after PICC surgery.

Trends in the epidemiology of intravascular device-associated bacteremia among French hematology patients: insights from the SPIADI prospective multicenter study, 2020-2024.

Hematology patients require central venous catheters for cancer treatment and nutrition, which increases their risk of intravascular device-associated bacteremia. In the absence of recent data, we investigated intravascular device-associated bacteremia in this specific context. A three-month surveillance was conducted annually in 27 hematology wards, using a protocol derived from the HAI-Net ICU ECDC protocol (2020-2024). We analyzed the characteristics of infected patients, the sources and microorganisms of healthcare-associated bacteremias, and intravascular device-associated bacteremias (including catheter type: central venous catheter (CVC), implantable venous access device (IVAD), peripherally inserted central catheter (PICC), midline catheter (MID), and peripheral venous catheter (PVC)), the time between catheter insertion and infection onset, and bacteremia incidence rates per 1,000 patient-days. Over the five-year period, 1,835 patients experienced healthcare-associated bacteremia. No significant changes were observed in patient characteristics over the five-year period. The two primary sources of bacteremias were intravascular devices (n = 682; 37.2%) and the digestive tract (n = 467; 25.4%). The incidence rates of intravascular device-associated bacteremias acquired in the participating wards remained stable. Among the 682 intravascular device-associated bacteremias, 648 (95.0%) involved central venous catheters, primarily PICCs (42.8%), IVADs (25.6%), and CVCs (24.8%). The types of central venous catheters involved shifted over the five years, with a decrease in the proportion of CVCs (from 31.1% in 2020 to 16.8% in 2024) and, conversely, an increase in PICCs (from 35.2% in 2020 to 52.8% in 2024; p = 0.007). Among the microorganisms identified, coagulase-negative Staphylococci (n = 330; 40.6%) and Enterobacterales (21.9%) were the most common. Overall, 59 bacteremias (8.6%) were associated with multidrug-resistant organisms, with no significant trend over the study period. Of the 682 cases, 88.2% were nosocomial, while 11.8% were acquired following care provided in the community or at home. The two groups of bacteremias did not differ regarding microorganisms, and the increasing proportion of PICC-associated bacteremias was noted in both populations. In contrast, the proportion of bacteremias acquired in the community or at home significantly increased over the five-year period, starting in 2022 (6.9% of bacteremias in 2020, 6.5% in 2021, 11.8% in 2022, 16.4% in 2023, and 18.0% in 2024; p = 0.006), at the expense of nosocomial bacteremias. PICC-associated bacteremias were more common in patients with bacteremias acquired in the community or at home (57.7% vs. 40.3% for nosocomial bacteremias; p = 0.021). In addition, while most intravascular device-associated bacteremias involving central venous catheters were late-onset, with the time between catheter insertion and the onset of bacteremia exceeding 7 days in 84.8% of cases, nosocomial bacteremias were less frequently late-onset (82.8%) compared to those acquired outside healthcare institutions (97.3%; p = 0.002). The mechanisms behind the increase in the proportion of PICC-associated bacteremias occurring long after catheter placement and acquired in hematology wards or in the community/at home should be investigated. Given that Staphylococci, common components of the skin flora, are involved in approximately half of PICC-associated bacteremias, our findings raise concerns about adherence to aseptic techniques during line manipulations and catheter dressing changes, both in hematology wards and in community settings. Therefore, to improve the prevention of PICC-associated bacteremias in patients, our data should encourage local infection prevention teams to implement targeted educational programs to reinforce strict aseptic practices during catheter manipulations and dressing changes. As these procedures are increasingly performed outside hospitals, training should be extended beyond healthcare workers in hematology wards to include those providing home care.

Assessment Of Knowledge Attitude And Practices Of Operation Theatre Staff Regarding Prevention Of Catheter Associated Urinary Tract Infection

Objective: to evaluate the knowledge, attitudes, and practices of operating theatre staff concerning CAUTI prevention at Health Sciences, Superior University, Lahore, Pakistan. Study Design: A Cross sectional Study Place and Duration of the Study: A cross-sectional study was performed with operating theater personnel, comprising physicians, nurses, and technicians, at Health Sciences, Superior University, Lahore. Methodology: A standardized questionnaire was employed to assess participants' understanding of CAUTI causes, dangers, and preventative measures; attitudes towards CAUTI prevention; and compliance with suggested actions. Data were gathered and examined to pinpoint knowledge deficiencies and intervention opportunities. Results: The study measured the knowledge, attitude, and practices (KAP) of operating room staff with relation to preventing catheter-associated urinary tract infections (CAUTIs). The results showed that, on average, 1.8 out of a possible 5.0 points were deemed sufficient, and that 52.7% shown moderately adequate knowledge. A mean attitude score of 2.05 (SD = 0.75) was produced by the mixed attitudes, with 40.9% exhibiting somewhat positive attitudes and 29.1% indicating favorable attitudes. The staff's level of practice adherence varied; on average, 1.88 (SD=0.6), with 56.4% indicating moderate practice and 43.6% indicating adequate practice. Staff members acknowledged the significance of aseptic technique to a degree of 94.5%, and 79.1% were in favor of prompt catheter removal to avoid CAUTI, according to key responses. Higher levels of practice adherence were linked to more professional experience (χ² = 19.172, p &lt; 0.01), and there were notable positive associations between attitude and practice (rho = 0.264, p &lt; 0.01). Despite a moderate degree of knowledge and practice, patient safety can only be improved by targeted education that fills attitude gaps and enhances CAUTI prevention strategies. Conclusion: CAUTI is a common healthcare-associated disease. Healthcare personnel had sufficient CAUTI prevention knowledge, attitudes, and practices in this study. Every hospital's infection prevention program must create, implement, and monitor urinary catheter infection prevention policies. Health care organizations must establish medical education programs, interdisciplinary training, and catheter care checklist audits to improve staff knowledge and practices. Keyword: knowledge attitude and practices, operation theatre staff, urinary tract infection, catheter

Therapeutic Drug Monitoring of Vancomycin in Hemodialysis Patients in a Hospital in North-East Romania.

Background/Objectives: Vancomycin is a reserve antibiotic that is frequently prescribed for central venous catheter (CVC)-associated infections in hemodialysis patients. Hemodialysis patients are very fragile patients and the presence of CVCs increases the risk of sepsis. We conducted a prospective study, evaluating the needs of changes in vancomycin dosing for treatment based on the use of the new 2020 vancomycin dosing guidelines, to increase drug safety (preventing subtherapeutic or supratherapeutic doses and offering therapeutic concentrations of the drug) in a particular group of patients with sepsis caused by catheter infections and being on intermittent hemodialysis. Methods: This prospective study included patients with sepsis caused by catheter infections and being on intermittent hemodialysis, treated with vancomycin, admitted in the nephrology department and intensive care unit (ICU). Vancomycin levels were adjusted according to the 2020 vancomycin guidelines. Results: In our study, nine (45%) patients had a vancomycin AUC between 400 and 600 mcg × h/mL, five (25%) patients had a subtherapeutic AUC, and six (30%) patients had a supratherapeutic AUC. It is important to mention that in 10 (50%) of the patients included in the study, the loading and maintenance doses mentioned in the protocol were respected, but 50% of them had a supratherapeutic AUC. We observed that a supratherapeutic AUC occurred when the loading dose was 1500 mg or 2000 mg, and in one case at 1000 mg with a low BMI. Conclusions: a therapeutic level of vancomycin can often be difficult to achieve because of different reasons, mainly in hemodialysis patients.

COMPARISON OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS TENCKHOFF CATHETER INSERTION (OPEN SURGERY VS LAPAROSCOPIC) – A CASE CONTROL STUDY

Objective: This study aims to investigate post-operative complication rate of Tenckhoff catheter placement methods between open surgery and laparoscopic. Material &amp; Methods: This is a case control comparative study reviewed from the medical records of patients who required insertion, removal, or repairment of Tenckhoff catheter for the provision of CAPD at Hasan Sadikin Bandung general hospital between January 2015 to December 2020. Clinical outcome and complication were compared between the open surgery and laparoscopic group. Results: We obtained 30 patients who required insertion of a Tenckhoff catheter for the provision of CAPD, 15 patients by open surgery and 15 patients by laparoscopic technique. Insertion of Tenckhoff catheter using open surgery have a higher risk of catheter migration (p=0.049; O R=3.25) and infection (p=0.014; OR=12.25) compared to laparoscopic. Discussion: Laparoscopic technique facilitates omentectomy, allows better fixation under direct visualisation, and for lysis of adhesions to increase peritoneal surface. Conclusion: Tenckhoff catheter insertion by using laparoscopic surgery tend to have better outcome compared to open surgery, with lower risk of catheter migration and infection. Keywords: Tenckhoff catheter, laparoscopic, CAPD.

Prophylactic anticoagulation in children receiving home parenteral nutrition: An international prospective multicenter study.

Catheter-related thrombosis (CRT) is a serious complication associated with home parenteral nutrition (HPN) in children with chronic intestinal failure (CIF). Guidelines on pediatric HPN state that there is insufficient evidence to advocate the prophylactic use of CRT. Aim is to evaluate the efficacy and safety of prophylactic anticoagulation in preventing CRT in children on HPN. We performed a prospective, international, multicenter study across three expertise centers. Children aged 0-18 years on HPN were included and divided into two groups: 1) primary/secondary prophylaxis- and 2) non-prophylaxis group. Participants were followed for 24 months and screened for CRT using ultrasonography annually. Primary outcomes included total incidence of CRT per 1000 catheter days, and association between prophylactic anticoagulation and CRT. Propensity score stratification and logistic regression were used to evaluate the association between prophylactic anticoagulation and CRT, adjusting for significant covariates differing between groups. Balance was visually assessed before and after stratification, and statistical significance (p<0.05) was determined. Secondary outcomes included incidence of catheter-related bloodstream infections (CRBSI) and bleeding events per 1000 catheter days. A total of 115 children, mean age of 6,9 years (SD 4,6), were included. Fifty-seven patients were receiving prophylactic anticoagulation (50%). The overall incidence of CRT was 0.17 per 1000 catheter days in 13 patients (11%), with no significant difference between the prophylaxis (n=6) and non-prophylaxis group (n=7) (odds ratio 0.64, 95% CI: 0.12-3.4, p=0.60). Incidence rate of CRBSIs was 0.34/1000 catheter days (n=25). Patients with CRT during follow up were significantly more likely to have a CRBSI (54%) compared to those without (14%) (p=0.010). Two minor bleeding events were reported in the prophylaxis group, resulting in an incidence of 0,03/1000 catheter days. Our study shows that prophylactic anticoagulation does not significantly reduce the incidence of CRT in children on HPN. Our results do underline the clinical importance of optimal catheter care and infection prevention as CRBSIs were more likely to occur in patients with CRT, and emphasize the need for larger multicenter trials to establish evidence-based recommendations for the use of prophylactic anticoagulation in children on HPN.

Nontuberculous Mycobacterial Infection: An Achilles Heel for Clinician

Nontuberculous mycobacterial (NTM) o Atypical mycobacterial (ATM) infection is becoming an upcoming challenge for the clinicians. Atypical Mycobacterial infections range from pulmonary to extra pulmonary including skin and soft-tissue infections, traumatic and surgical wound infections, catheter and implant-associated infections. They are commonly misdiagnosed as tuberculosis caused by M. tuberculosis (MTB). Appropriate diagnostic methods and tools are essential in order to facilitate the differential diagnosis of Atypical Mycobacterium from MTB infections. We aimed to collect data available on Atypical Mycobacterium for diagnosis and appropriate treatment and to create awareness among the physician to combat with challenges. Bangladesh J Medicine 2025; 36: 15-18

EFFECTIVENESS OF DOUBLE LUMEN CATHETER WOUND CARE USING 0.9% NaCL, 7.5% CHLORHEXIDINE, 15% CETRIMIDE ON DOUBLE LUMEN CATHETER INFECTION IN REGULAR HEMODIALYSIS PATIENTS

Background: The high incidence of double lumen catheter infections in Hemodialysis patients requires a solution including wound care using the antiseptic chlorhexidine 7.5% and cetrimide 15%. Objectives: The aim of this study is to identify the effect of double lumen catheter wound care using NaCL 0.9%, Chlorhexidine 7.5%, and Setrimide 15% on double lumen catheter infection in regular hemodialysis patients at Bhayangkara Lumajang Hospital. Methods: The research design used was quantitative research with a PreExperimental One-Group Pretest-Posttest Design approach. The population in this study was hemodialysis patients with double lumen access who meet the inclusion and exclusion criteria, with a sample of 31 respondents. The sampling technique uses accidental sampling. Results: The research results were obtained before wound treatment using NaCL 0.9%, Chlorhexidine 7.5%, and Setrimide 15%. From 31 respondents 12 (38.7%) respondents experienced infection and after wound treatment using NaCL 0.9%, Chlorhexidine 7.5%, and Setrimide 15%. From 31 respondents 7 (22.6%) respondents experienced infection. After statistical tests were carried out using the Willcoxon test, the result was P = (0.025 &lt; α 0.05), which means that there is a significant effect between treating double lumen catheter wounds using Nacl 0.9%, chlorhexidine 7.5 %, and cetrimide 15% against double lumen catheter infections in regular hemodialysis patients.

External Ventricular Drain Misadministration Events: Systematic Literature Review and Report of a Case.

External ventricular drain (EVD) is a common neurosurgical procedure with potential complications, including catheter misplacement, infection, mechanical obstruction, and inadvertent catheter pull-out. A less discussed but critical complication is the misadministration of medications into EVD. This project aimed to review the literature on EVD misadministration and discuss preventative measures, emphasizing the new International Organization for Standardization (ISO) standard for neuraxial connectors. A systematic review of PubMed, Embase, and SCOPUS databases was conducted to identify studies reporting misadministration in EVD systems. We also present a case of misadministration of a blood product into an EVD. Factors contributing to these events were researched, relevant guidelines from professional organizations were reviewed, and preventive strategies, including the novel NRFit® connector designed to prevent such errors, were discussed. The literature review identified 7 reports of 8 cases of misadministration involving substances such as gadolinium-based contrast agents, anesthetic agents, and antiepileptic drugs. In addition, we report a case of an 87-year-old man with multiple traumatic brain injuries, where a blood transfusion line was mistakenly connected to the EVD. This incident is the first reported case of blood misadministration through EVD. Despite immediate drainage and flushing of the EVD system with saline, the patient's condition did not improve, and he eventually died. Contributing factors included unfamiliarity with the EVD system, similarity to IV connectors, and poor visibility during procedures. Importantly, the novel ISO 80369 standard for all neuraxial connectors, including NRFit® connectors that have a 20% smaller nozzle outside diameter than traditional Luer connectors, has been recommended to prevent misconnection errors and mitigate associated risks. Misadministration to EVD connectors is a preventable event that highlights the need for enhanced safety solutions. Adoption of ISO standard neuraxial connectors, thorough training, and the use of distinctly marked equipment are critical steps in minimizing risks.

Abstract 4114994: Nursing Management Practice Variations related to Externalized Ventricular and Lumbar Drains

Introduction/Background: Nursing management of neurologic patients may include placement of externalized ventricular drains (EVDs) or lumbar drains (LDs) to monitor/drain cerebrospinal fluid (CSF), but knowledge and practice related to EVD management varies widely, despite a high potential for life-threatening complications. Limited data exists relative to the relationship between intracranial pressure (ICP) and CSF drainage. These gaps may undermine patient safety. Research Question: What are the nursing practices and perspectives regarding management of EVDs and LDs? Methods/Approach: A 16-question multiple-choice/text entry survey was distributed electronically to nurses and advanced practice nurses who were members of the American Association of Neuroscience Nurses. Data analysis included chi-square test for multiple choice responses, and qualitative data was analyzed using a six-step thematic analysis and an inductive approach. Results/Data: Of 219 participants, 42.8% reported roles as Neuroscience ICU nurses, and 39.2% managed an EVD at least 75% of the time. Neuro ICU nurses were most likely to have a patient with an EVD ( p =.002). Approximately 63% of respondents reported consulting with colleagues about EVDs nearly every time they cared for a patient with an EVD. Nurses reported a very high care burden, including re-leveling the transducer 4 or more times per shift (n=76), and re-zeroing every 8 hours (n=72) to assure accurate calibration. Of these 82.2% reported that they re-zeroed the EVD more often to obtain an accurate reading. Approximately 25% reported accidental over-drainage, some with negative outcomes. Many (79.3%) reported caring for patients with LDs, 47.4% to diagnose normal pressure hydrocephalus. The nursing care workload was described as 30-120 minutes each shift. Conclusion: A wide heterogeneity of nursing practices was revealed in EVD and LD management. No standardized nursing care practices have been adopted by nurses for the management of CSF. The complications of these practice variations have been shown to result in untoward patient outcomes. Increased patient morbidity and mortality are linked to catheter infection and over/under drainage of CSF and may be directly related nursing practice. This reveals critical need for improved, standardized care nursing practices in the management of EVDs and LDs, and an empiric understanding of the relationship between intracranial pressure and the volume and rate of CSF drainage.

Epidural Catheter Bacterial Colonization and Infection in a Secondary Portuguese Hospital Setting.

Background and study goal Epidural analgesia is effective for postoperative pain control but carries risks of infection, including bacterial colonization. This study aimed to determine the incidence of epidural catheter colonization and infection in a Portuguese hospital, identify common microorganisms and antibiotic resistance profiles, and assess potential risk factors. Materials and methods We conducted a prospective observational study from November 2022 to March 2023 in a Portuguese secondary care center. Adult patients undergoing surgery with epidural analgesia were included. Data related to patient demographics, surgical details, and the epidural technique were collected. Incidence rates were calculated, and risk factors for colonization were analyzed. Results and discussion Overall, 215 patients were included (mean age: 52.12 years; 76.7% women). The average catheter duration was 2.66 days. The incidence of bacterial colonization was 16.3% (95% CI=11.3-21.2%), with 74.3% showing antibiotic resistance. Staphylococcus epidermidis was the most frequent isolate (37.1%). No cases of epidural space infection were observed. Exploratory analyses indicated a potential higher risk of colonization when multiple punctures were needed (adjusted odds ratio (aOR): 4.52, p=0.33). Conclusion Epidural catheter colonization occurred in 16.3% of cases, with Staphylococcus epidermidis being the predominant agent. Despite colonization, clinical infections were rare. The high rate of antibiotic resistance underscores the need for improved stewardship and aseptic practices.

Functional redundancy in Candida auris cell surface adhesins crucial for cell-cell interaction and aggregation

Candida auris is an emerging nosocomial fungal pathogen associated with life-threatening invasive disease due to its persistent colonization, high level of transmissibility and multi-drug resistance. Aggregative and non-aggregative growth phenotypes for C. auris strains with different biofilm forming abilities, drug susceptibilities and virulence characteristics have been described. Using comprehensive transcriptional analysis we identified key cell surface adhesins that were highly upregulated in the aggregative phenotype during in vitro and in vivo grown biofilms using a mouse model of catheter infection. Phenotypic and functional evaluations of generated null mutants demonstrated crucial roles for the adhesins Als4112 and Scf1 in mediating cell-cell adherence, coaggregation and biofilm formation. While individual mutants were largely non-aggregative, in combination cells were able to co-adhere and aggregate, as directly demonstrated by measuring cell adhesion forces using single-cell atomic force spectroscopy. This co-adherence indicates their role as complementary adhesins, which despite their limited similarity, may function redundantly to promote cell-cell interaction and biofilm formation. Functional diversity of cell wall proteins may be a form of regulation that provides the aggregative phenotype of C. auris with flexibility and rapid adaptation to the environment, potentially impacting persistence and virulence.

Two Endogenous Endophthalmitis Cases Accompanying Nephrological Condition in Diabetic Patients

Aims: This report aims to highlight the importance of prompt diagnosis and intervention in cases of endogenous endophthalmitis, with particular focus on its nephrological etiology and associated systemic infections. Presentation of Case: Two cases of endogenous endophthalmitis were observed in patients with nephrological complications. Case 1 involved a 50-year-old man with end-stage renal disease on hemodialysis, who presented with severe visual impairment in the right eye due to Staphylococcus aureus sepsis from a hemodialysis catheter infection. Despite aggressive treatment with intravitreal and systemic antibiotics, the patient’s visual prognosis was poor. Case 2 involved a 65-year-old woman with acute pyelonephritis and undiagnosed diabetes, presenting with unilateral visual loss and ocular inflammation. Systemic and intravitreal antibiotics, alongside corticosteroids, led to a favorable outcome with a final visual acuity of 7/10. Discussion: Diabetic patients with nephrological conditions are particularly susceptible to endogenous endophthalmitis due to compromised immunity and increased risk of systemic infections. Both cases underscore the link between systemic infections, particularly in patients with renal or diabetic conditions, and endogenous endophthalmitis. Prompt recognition of ocular symptoms in patients with systemic infections is critical, as appropriate intervention can preserve visual function. The role of broad-spectrum antibiotics, intravitreal injections, and systemic infection control is emphasized. Conclusion: These cases illustrate the importance of multidisciplinary intervention in managing endogenous endophthalmitis secondary to nephrological infections. While outcomes vary depending on disease severity and patient health, rapid diagnosis and treatment are vital to improving prognosis and preserving vision.

Dual prostacyclin infusions: A case report of a patient symptom-driven transition from high-dose intravenous epoprostenol to subcutaneous treprostinil for the treatment of pulmonary arterial hypertension.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. A case of successful transition from high-dose epoprostenol to high-dose subcutaneous treprostinil for treatment of pulmonary arterial hypertension (PAH) is reported. PAH is a chronically progressive disease characterized by pulmonary artery luminal narrowing that causes increased pulmonary artery pressures leading to right ventricular failure. Parenteral prostacyclin analogues, such as epoprostenol and treprostinil, are direct vasodilators and are cornerstones of therapy for patients with severe disease that have been proven to reduce mortality and increase exercise tolerance. These agents must be administered continuously via intravenous or subcutaneous devices and are high-risk medications due to their potent vasodilatory actions. Chronic use of these medications requires constant attention from both providers and patients because of potential complications including central venous catheter infection, thromboembolism, therapy interruptions, and other undesirable consequences. This case report describes management of a 35-year-old male patient on high-dose outpatient intravenous epoprostenol (101ng/kg/min; dosing weight, 47kg) for treatment of PAH who was admitted to the hospital with a malfunctioning central venous catheter. Surrounding manipulation of the central catheter, the patient experienced an ischemic stroke that led to cognitive disability resulting in a lack of ability to manage his previously used home infusion device. The patient was successfully transitioned from intravenous epoprostenol to subcutaneous treprostinil (discharge dose, 200ng/kg/min) over 5 days by infusing both medications simultaneously and adjusting doses based upon patient-reported symptoms. This successful transition from high-dose epoprostenol to high-dose subcutaneous treprostinil demonstrates the importance in considering patient-specific factors during high-risk medication transitions, the value of a patient-directed flexible prostacyclin transition plan, and the benefit of institutional training and education in ensuring the safe use of parenteral prostacyclin analogues.

Regulate the Risk Factors of Pseudomonas aeruginosa by some of Sigma Factor Genes

In this research, a study was conducted isolating and identification of Pseudomonas aeruginosa bacteria from clinical samples from various pathological conditions such as burns , otitis media , urinary tract infection , wounds, eye infection, blood infection, catheter infection, throat , vaginal infection and surgical. The present study includes 313 samples collected from patients who attend Alsader Medical City and Al- Hakim General Hospital during the period extended From September 2023 to December 2023 ( men and women ) with age groups between (1 -77) years. The identification of bacterial isolates were detected by classical and molecular technique (PCR), were the frequency among males 163 (52.07% ) was more than that in female 150 (47.92). The samples distribution is made according age group , it appears high for the following high (15.97) and (12.77) with group (16-30) years of male and female respectively . The results revealed that 57/313 specimens of the total number of samples are Pseudomonas aeruginosa by identified according to their morphological, physiological and biochemical properties. Also with molecular identification by using four primers wre the results showed 16S rRNA gene was detected in 57/57 (100%) P. aeruginosa isolates , the Las biofilm gene was detected in 43/57 (75.43%) , the algD gene was detected in 41/57 (71.92%) and 41/57 samples show positive results with the oprL gene. Six types of antibiotics were also tested to determine the resistance of the samples to them.

Subcutaneous tunnelling versus conventional insertion of peripherally inserted central catheters in hospitalized patients (TUNNEL-PICC): a multi-centre, open-label, randomized, controlled trial

We aimed to evaluate whether subcutaneous tunneling in peripherally inserted central catheters (PICC) placement could reduce the occurrence of central-line associated blood stream infection (CLABSI). We conducted an open-label, multicentre, randomized, controlled trial in five tertiary hospitals. Adult hospitalized patients requiring a PICC were randomized in a one-to-one ratio to conventional (cPICC) or tunneled PICC (tPICC) arms using a centralized web-based computer-generated stratified randomization. CLABSI rates between groups were compared in a modified intention-to-treat population. Safety including the incidence of exit-site infection or hemorrhage-associated catheter removal were also compared. This trial was registered with Clinical Research Information Service of Republic of Korea (KCT0005521). From November 2020 to March 2023, 1,324 participants were enrolled and randomly assigned to tPICC (n=662) and cPICC (n=662). This study was terminated early due to the cohort CLABSI rate being lower than estimated, therefore, the original sample size of 1,694 would render the study underpowered to detect a difference in CLABSI rates. In the tPICC, CLABSI occurred in 13 of 651 participants over 11,071 catheter-days (1.2/1,000 catheter-days), compared with 20 among 650 patients with cPICC over 11,141 catheter-days (1.8/1,000 catheter-days, rate ratio 0.65, 95% CI 0.30-1.38, p=0.30). The incidence of exit-site infection (29 tPICC, 36 cPICC, p=0.5) and hemorrhage-associated catheter removal (11 tPICC, 11 cPICC, p=0.99) was not different between both groups. Due to insufficient sample size, this study could not demonstrate a statistically significant CLABSI risk reduction in the tPICC group compared to the cPICC group. Both groups had similar rates of exit site infection and bleeding.