Intravascular Catheter Research Articles

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

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

P-314. A Retrospective Review of Long-Acting Lipoglycopeptide Utilization at a VA Tertiary Teaching Medical Center

Abstract Background Dalbavancin and oritavancin are long-acting lipoglycopeptides (LA-LGPs) approved by the Food and Drug Administration (FDA) for acute skin and soft tissue infections (ASSTIs). With their long-acting pharmacokinetics and broad activity against gram-positive bacteria, LA-LGPs are ideal options for patients with serious infections, such as bone, joint, and bloodstream, who (1) require prolonged antimicrobial therapy, (2) are not candidates for long-term intravascular catheter access, (3) prefer to avoid hospital admission, and/or (4) need early discharge. Methods A retrospective chart review was conducted on patients ages older than 18 with a medication order of dalbavancin or oritavancin from September 2020- August 2023 at the Atlanta VA Medical Center. Patients were excluded if the patient did not have an active infection or a LA-LGP was ordered but not administered. Pertinent demographic, clinical, and microbiological data were collected from the patient’s medical record. Results Resolution of infection in 3 months with LA-LGPs was found to be 76% (35/46) effective in lower extremity osteomyelitis and 74% (72/98) effective for all indications. The mean total length of stay (inpatient) after LA-LGP infusion was 3.9 days. The most common adverse events were nausea and vomiting, which occurred at a rate of 6.1% (6/98). Conclusion The utilization of LA-LGPs showed to be effective in infection resolution in a 3-month period in majority of patients. Specifically, lower extremity osteomyelitis, a non-FDA approved use, showed promising results in resolution of infection. The use of LA-LGPs can be beneficial in shortening hospital length of stay and prevention of hospitalizations with minimal adverse events. This can possibly lead to decreased health care cost and hospital acquired infections. In all, the use of LA-LGPs has significant potential use in other serious infections other than ASSTIs with a variety of benefits from the patient and healthcare perspective. Disclosures All Authors: No reported disclosures

Noninvasive estimation of PaCO2 from volumetric capnography in animals with injured lungs: an Artificial Intelligence approach.

To investigate the feasibility of non-invasively estimating the arterial partial pressure of carbon dioxide (PaCO2) using a computational Adaptive Neuro-Fuzzy Inference System (ANFIS) model fed by noninvasive volumetric capnography (VCap) parameters. In 14 lung-lavaged pigs, we continuously measured PaCO2 with an optical intravascular catheter and VCap on a breath-by-breath basis. Animals were mechanically ventilated with fixed settings and subjected to 0 to 22 cmH2O of positive end-expiratory pressure steps. The resultant 8599 pairs of data points - one PaCO2 value matched with twelve Vcap and ventilatory parameters derived in one breath - fed the ANFIS model. The data was separated into 7370 data points for training the model (85%) and 1229 for testing (15%). The ANFIS analysis was repeated 10 independent times, randomly mixing the total data points. Bland-Altman plot (accuracy and precision), root mean square error (quality of prediction) and four-quadrant and polar plots concordance indexes (trending ability) between reference and estimated PaCO2 were analyzed. The Bland-Altman plot performed in 10 independent tested ANFIS models showed a mean bias between reference and estimated PaCO2 of 0.03 ± 0.03 mmHg, with limits of agreement of 2.25 ± 0.42 mmHg, and a root mean square error of 1.15 ± 0.06 mmHg. A good trending ability was confirmed by four quadrant and polar plots concordance indexes of 95.5% and 94.3%, respectively. In an animal lung injury model, the Adaptive Neuro-Fuzzy Inference System model fed by noninvasive volumetric capnography parameters can estimate PaCO2 with high accuracy, acceptable precision, and good trending ability.

Factors affecting the unused short peripheral catheters: A neverending debate? A cross-sectional study in hospitalized patients.

Concern about unused vascular access devices has increased, but data on idle short peripherally intravascular catheters in medical-surgical units is still scarce. We aimed to assess the prevalence of unused short peripheral catheters in hospitalized patients and identify risk factors and reasons that lead nurses to maintain them in situ. A cross-sectional observational study was performed in September 2022. Clinical observation (24h) and medical records review were assessed to collect patient demographics and catheter-related information. Nurses were asked the main reason for continuing the use of the unused catheter. The primary outcome was the prevalence of unused short peripheral catheters, which were no longer used for intravenous fluids or medications in the previous 24 h. Multivariate logistic regression has been performed to evaluate risk factors for unused catheters. The STROBE checklist was used to report our study. Seven hundred and sixty-four patients were included; out of the 621 patients with at least one short peripheral catheter, one-third had at least one unused catheter. The risk of having an unused peripherally intravascular catheter was almost double when the catheter was positioned in the emergency department. Catheters of smaller calibers and in situ for fewer days were less likely to be unused. The main reasons for keeping a peripherally intravascular catheter unused in situ were clinical conditions. Unused short peripheral catheters are still quite frequent. While specific clinical needs justified some unused short peripheral catheters, a proportion remained unexplained and potentially avoidable. Nurses and policymakers can use the findings to inform decision-making and protocols to manage peripherally inserted catheters to reduce unused short peripheral catheters and, consequently, complications and costs and improve patient safety and quality of care.

Predictors for noncompliant intravascular catheter insertion site dressings at a large academic center.

Using intravascular catheter dressing audit data, we evaluated factors associated with noncompliant dressing. Male sex and gauze dressing had a higher risk of noncompliant dressing; presence of one or more lumens infusing, central venous catheter, peripherally inserted central catheters line, implantable port and contact precautions were associated with a lower risk of noncompliant dressing.

Part 1: Pushing the boundaries of neurointerventional surgery: A historical review of the work of Dr Gerard Debrun.

French-American neurointerventionalist and pioneer, Dr Gerard Debrun, laid the groundwork for treatments which have become irreplaceable in neurointerventional surgery today. This article aims to outline the career of Dr Debrun while highlighting his accomplishments and contributions to the field of neurointerventional surgery. We selected relevant articles from PubMed authored or co-authored by Dr Debrun between 1941 and 2023. All included articles discuss the accomplishments and contributions of Dr Debrun. Dr Debrun began his career in France by investigating neurointerventional techniques, most notably the intravascular Detachable Balloon Catheter (DBC). His work was recognized by renowned neurosurgeon Dr Charles Drake, who recruited him to London, Ontario. Dr Debrun created the foundation for homemade manufacturing of DBCs, building on one of the largest series for use of DBCs in cerebrovascular disease. Dr Debrun spent time as faculty at Massachusetts General Hospital (MGH) and Johns Hopkins Hospital, before arriving at the University of Illinois Chicago (UIC) where he remained until his retirement. Dr Debrun's subsequent contributions included the calibrated-leak balloon catheter, pioneering of glue embolization, setting the foundation for preoperative AVM embolizations, and as an early adopter of the Guglielmi detachable coil (GDC), including mastering the balloon remodeling technique for wide neck aneurysms. Dr Debrun established the first integrated neurointerventional surgery program at UIC, establishing a well sought-after fellowship program. Dr Debrun lectured extensively and was a prolific writer on neurointerventional surgery throughout this career. His contributions established the foundation for several techniques which have since become standard practice in present-day neurointerventional surgery.

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

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

Analyzing Surgeon–Robot Cooperative Performance in Robot-Assisted Intravascular Catheterization

Analyzing Surgeon–Robot Cooperative Performance in Robot-Assisted Intravascular Catheterization

Comparison of clinical characteristics, risk factors, and outcomes of patients infected with Bacteroides fragilis group at a tertiary care hospital in central China between 2017 and March 2024

ObjectivesThis study aimed to explore the epidemiology, clinical presentation, and risk factors for treatment failure in patients infected with various Bacteroides fragilis group (BFG) species. MethodsWe analyzed clinical and laboratory data from 178 patients infected with BFG who were admitted to our hospital between 2017 and 2024. We analyzed categorical data using Chi-square and Fisher exact tests, continuous variables using Student's t-tests or Mann–Whitney U-tests, and risk factors using multivariate logistic regression and Pearson's chi-squared tests. ResultsBacteroides fragilis (69.7 %) and Bacteroides thetaiotaomicron (16.9 %) were the most prevalent species among 178 BFG isolates. Most patients had polymicrobial infections, with the following pathogens isolated from concurrent samples: Escherichia coli, Klebsiella spp., and Enterococcus spp. Intra-abdominal sites were most frequently infected with BFG. Patients aged >50 years and those who had intravascular catheters were infected with more other Bacteroides species than B. fragilis. Admission to an ICU, respiratory, renal and cardiovascular diseases, and chest drainage were associated more often with B. thetaiotaomicron than with B. fragilis. Gastrointestinal diseases, tracheal intubation, and ICU admission were associated more frequently with treatment failure in patients infected with B. fragilis whereas solid cancers, renal disease, multiple organ dysfunction syndrome, and tracheal intubation were more likely to be associated with treatment failure in patients infected with other Bacteroides spp. ConclusionsThe most prevalent BFG species in the patients were B. fragilis and B. thetaiotaomicron. The demographic characteristics of the patients, underlying diseases, and risk factors for poor clinical outcomes clearly differed among species.

Parallel intravascular lithotripsy catheters technique for calcified atherosclerotic abdominal aortic stenosis

Abstract BACKGROUND: Calcified atherosclerotic abdominal aortic stenosis is a rare and challenging condition, with heavily annular calcification limiting the effectiveness of traditional endovascular treatments. METHODS: A 66-year-old female with severe abdominal aortic stenosis underwent treatment using a parallel intravascular lithotripsy (IVL) catheter technique. Bilateral femoral access and arterial embolization were followed by parallel IVL angioplasty, stent implantation, and postdilation. A swine model was used to assess vascular injury after parallel IVL. RESULTS: The parallel IVL technique significantly relieved the stenosis without complications, as confirmed by angiography. In the swine model, histological analysis showed no significant vascular injury, except for expected intimal disruption and elastic lamina stretching. CONCLUSION: Parallel IVL catheter angioplasty is a feasible and safe approach for heavily calcified abdominal aortic stenosis, warranting further studies to validate its long-term outcomes.

Risk Analysis of Intravascular Shockwave Catheter and Discussion of Critical Control Points throughout Life Cycle

This study summarizes the clinical application, technical characteristics, and production process of intravascular shockwave catheters. It collects statistics on adverse events of related products from the MAUDE database, analyzes the causes of adverse events and failure modes of intravascular shockwave catheters, and identifies risk points. Based on the whole life cycle management method of medical devices, combined with product risks and the requirements of Good Manufacturing Practice for Medical Devices and related appendices, the critical control points of such products in the design and development, manufacturing, sales, and use stages are discussed.

Investigation of Chlorhexidine and Chitosan Gel-Based Coatings for the Prevention of Intravascular Catheter-Associated Infections Following Quality by Design Approach.

Intravascular catheter-associated infections pose a significant threat to the health of patients because of biofilm formation. Hence, it is imperative to exploit cost-effective approaches to improve patient compliance. With this aim, our present study reported the potential of an antimicrobial polymeric gel coating of chitosan (CS) and chlorhexidine (CHX) on the marketed urinary catheters to minimize the risk of biofilm formation. The study involved the implementation of the Quality by Design (QbD) approach by identifying the critical parameters that can affect the coating of the catheter's surface in any possible way. Later, design of experiments (DoE) analysis affirmed the lack of linearity in the model for the studied responses in a holistic manner. Moreover, in vitro studies were conducted for the evaluation of various parameters followed by the antibiofilm study. The coating exhibited promising release of CHX in the artificial urinary media together with retention of the coating on the catheter's surface. Therefore, this study aims to emphasize the importance of a systematic and quality-focused approach by contributing to the development of a safe, effective, and reliable catheter coating to enhance intravascular catheter safety.

Transportable, portable, wearable and (partially) implantable haemodialysis systems: comparison of technologies and readiness levels

ABSTRACT Background Dialysis modalities and their various treatment schedules result from complex compromises (‘trade-offs’) between medical, financial, technological, ergonomic, and ecological factors. This study targets summarizing the mutual influence of these trade-offs on (trans)portable, wearable, or even (partially) implantable haemodialysis (HD) systems, identify what systems are in development, and how they might improve quality of life (QoL) for patients with kidney failure. Methods HD as defined by international standard IEC 60601–2-16 was applied on a PUBMED database query regarding (trans)portable, wearable, and (partly) implantable HD systems. Out of 159 search results, 24 were included and scanned for specific HD devices and/or HD systems in development. Additional information about weight, size, and development status was collected by the internet and/or contacting manufacturers. International airplane hand baggage criteria formed the boundary between transportable and portable. Technology readiness levels (TRLs) were assigned by combining TRL scales from the European Union and NATO medical staff. Results The query revealed 13 devices/projects: seven transportable (six TRL9, one TRL5); two portable (one TRL6–7, one TRL4); two wearable (one TRL6, one frozen); and two partly implantable (one TRL4–5, one TRL2–3). Discussion Three main categories of technical approaches were distinguished: single-pass, dialysate regenerating, and implantable HD filter with extracorporeal dialysate regeneration (in climbing order of mobility). Conclusions Kidneys facilitate mobility by excreting strongly concentrated waste solutes with minimal water loss. Mimicking this kidney function can increase HD system mobility. Dialysate-regenerating HD systems are enablers for portability/wearability and, combined with durable implantable HD filters (once available), they may enable HD without needles or intravascular catheters. However, lack of funding severely hampers progress.

HOCl Production Modelling for an Electrochemical Catheter

Intravascular catheters are used in critically ill patients to deliver fluids and lifesaving medications, and for hemodynamic monitoring. These catheters are at risk for infection, especially when in place for prolonged periods of time. The management of catheter-related infections are challenged by both the presence of biofilms and the frequent association with multidrug-resistant organisms. Efforts to mitigate central line-associated bloodstream infections (CLABSIs) have focused on preventive measures. Several strategies to prevent intraluminally sourced CLABSI have been developed and used, including antimicrobial agent locks and antimicrobial-impregnated catheter lumens. Although antimicrobial locks have reduced CLABSI rates, this strategy is prone to complications, including resistance selection, allergic reactions, catheter damage, and host toxicity due to the high concentrations of agents needed. Largely because of these factors, antimicrobial locks are infrequently used for CLABSI prevention in clinical practice. Antimicrobial impregnated catheter lumens have also shown variable effects against CLABSI and are likewise not regularly used. Therefore. innovative therapeutic solutions are necessary, especially those that allow catheter retention. In this context, the integration of electrochemical technologies for hypochlorous acid (HOCl) production within intravascular catheters emerges as a promising strategy to combat CLABSIs. HOCl is a strong oxidizing agent that damages microbial cells by interacting with lipids, nucleic acids, sulfur-containing amino acids, and membrane components. It is found in all mammals as an endogenous substance produced by the immune system to protect the body from pathogens. In this study, electrochemical generation of HOCl in an electrochemical catheter (e-catheter) was simulated using a model called Electrochemical Hypochlorous Acid Production (EHAP), implemented in COMSOL Multiphysics®. The e-catheter has two components, a hub and a tube, both filled with 0.9% saline solution. Titanium wires are used as working and counter electrodes.The model was used to define critical variables that may impact HOCl generation and distribution. In addition to predicting HOCl concentrations, the EHAP model was used to monitor effects of 1) a waiting period after constant polarization, 2) operational voltage, 3) working electrode length and 4) working electrode surface area. Findings using the EHAP model revealed the following: 1) Diffusion limitations predominate when the electrodes are localized to the hub, yielding a lower HOCl concentration in the tube compared to the hub. Increasing the voltage between the working and the reference electrodes increases HOCl generation, however concentrations are not enough to deliver HOCl to the tube. 2) HOCl concentrations are higher in the tube compared to hub when the working electrode extends the entire length of the tube. 3) HOCl concentration distributions can be tuned by changing the surface area of the working electrode within different compartments of the e-catheter.

Evaluation of the Efficiency of the Newly Developed Needle in Emergency Room: A Single-Center Observational Study.

Peripheral intravascular catheter (PIVC) insertion is frequently performed in the emergency room (ER) and many failures of initial PIVC insertion occur. To reduce the failures, new needles were developed. This study aimed to investigate whether the use of the newly developed needle reduced the failure of initial PIVC insertion in the ER compared with the use of the existing needle. This single-centre, prospective observational study was conducted in Japan between April 1, 2022, and February 2, 2023. We included consecutive patients who visited our hospital by ambulance as a secondary emergency on a weekday during the day shift (from 8:00 AM to 5:00 PM). The practitioners for PIVC insertion and assessors were independent. The primary and secondary outcomes were the failure of initial PIVC insertion and number of procedures, respectively. We defined the difficulty of titrating, leakage, and hematoma within 30 s after insertion as failures. To evaluate the association between the outcomes and the use of newly developed needles, we performed multivariate logistic regression and multiple regression analyses by adjusting for covariates. In total, 522 patients without missing data were analysed, and 81 (15.5%) patients showed failure of initial PIVC insertion. The median number of procedures (interquartile range) was 1 (1-1). Multivariate logistic regression analysis revealed no significant association between the use of newly developed PIVCs and the failure of initial PIVC insertion (odds ratio, 0.79; 95% confidence interval, [0.48-1.31]; p = 0.36). Moreover, multiple regression analysis revealed no significant association between the use of newly developed PIVCs and the number of procedures (regression coefficient, -0.0042; 95% confidence interval, [-0.065-0.056]; p = 0.89). Our study did not show a difference between the two types of needles with respect to the failure of initial PIVC insertion and the number of procedures.

Development of a Machine Learning-Based Model for Predicting the Incidence of Peripheral Intravenous Catheter-Associated Phlebitis.

Early and accurate identification of high-risk patients with peripheral intravascular catheter (PIVC)-related phlebitis is vital to prevent medical device-related complications. This study aimed to develop and validate a machine learning-based model for predicting the incidence of PIVC-related phlebitis in critically ill patients. Four machine learning models were created using data from patients ≥ 18 years with a newly inserted PIVC during intensive care unit admission. Models were developed and validated using a 7:3 split. Random survival forest (RSF) was used to create predictive models for time-to-event outcomes. Logistic regression with least absolute reduction and selection operator (LASSO), random forest (RF), and gradient boosting decision tree were used to develop predictive models that treat outcome as a binary variable. Cox proportional hazards (COX) and logistic regression (LR) were used as comparators for time-to-event and binary outcomes, respectively. The final cohort had 3429 PIVCs, which were divided into the development cohort (2400 PIVCs) and validation cohort (1029 PIVCs). The c-statistic (95% confidence interval) of the models in the validation cohort for discrimination were as follows: RSF, 0.689 (0.627-0.750); LASSO, 0.664 (0.610-0.717); RF, 0.699 (0.645-0.753); gradient boosting tree, 0.699 (0.647-0.750); COX, 0.516 (0.454-0.578); and LR, 0.633 (0.575-0.691). No significant difference was observed among the c-statistic of the four models for binary outcome. However, RSF had a higher c-statistic than COX. The important predictive factors in RSF included inserted site, catheter material, age, and nicardipine, whereas those in RF included catheter dwell duration, nicardipine, and age. The RSF model for the survival time analysis of phlebitis occurrence showed relatively high prediction performance compared with the COX model. No significant differences in prediction performance were observed among the models with phlebitis occurrence as the binary outcome.

Rotational Intravascular Multidirectional Ultrasound Catheter for Sonothrombolysis of Retracted Clots: An in Vitro and in Vivo Study

Thromboembolism in blood vessels poses a serious risk of stroke, heart attack, and even sudden death if not properly managed. Sonothrombolysis combined with ultrasound contrast agents has emerged as a promising approach for the effective treatment of thromboembolism. Recent reports have highlighted the potential of intravascular sonothrombolysis as a safe and effective treatment modality for deep vein thrombosis (DVT). However, its efficiency has not been validated through in vivo testing of retracted clots. This study aimed to develop a miniaturized multidirectional transducer featuring two 4-layer lead zirconate titanate (PZT-5A) stacks with an aperture size of 1.4 mm × 1.4 mm, enabling both forward- and side-looking treatment. Integrated into a custom two-lumen 10-French (Fr) catheter, the capability of this device for intravascular sonothrombolysis was validated both in vitro and in vivo. With low-dose tissue plasminogen activators and nanodroplets, the rotational multidirectional transducer reduced the retracted clot mass (800 mg) by an average of 52% within 30 min during in vitro testing. The lysis rate was significantly higher by 37% than that in a forward-viewing transducer without rotation. This improvement was particularly noteworthy in the treatment of retracted clots. Notably, a long-retracted clot (> 10 cm) was successfully treated within 40 min in vivo by creating a flow channel with a diameter > 4 mm in a porcine DVT model. In conclusion, these findings strongly suggest the potential of this technique for clinical applications in sonothrombolysis, offering a feasible solution for effectively treating thromboembolism, particularly in challenging cases involving retracted clots.

Regulation of candidalysin underlies Candida albicans persistence in intravascular catheters by modulating NETosis.

Candida albicans is a leading cause of intravascular catheter-related infections. The capacity for biofilm formation has been proposed to contribute to the persistence of this fungal pathogen on catheter surfaces. While efforts have been devoted to identifying microbial factors that modulate C. albicans biofilm formation in vitro, our understanding of the host factors that may shape C. albicans persistence in intravascular catheters is lacking. Here, we used multiphoton microscopy to characterize biofilms in intravascular catheters removed from candidiasis patients. We demonstrated that, NETosis, a type of neutrophil cell death with antimicrobial activity, was implicated in the interaction of immune cells with C. albicans in the catheters. The catheter isolates exhibited reduced filamentation and candidalysin gene expression, specifically in the total parenteral nutrition culture environment. Furthermore, we showed that the ablation of candidalysin expression in C. albicans reduced NETosis and conferred resistance to neutrophil-mediated fungal biofilm elimination. Our findings illustrate the role of neutrophil NETosis in modulating C. albicans biofilm persistence in an intravascular catheter, highlighting that C. albicans can benefit from reduced virulence expression to promote its persistence in an intravascular catheter.

Impact of Catheter-Drawn Blood Cultures on Patient Management: A Multicenter, Retrospective Cohort Study.

Nosocomial bloodstream infections associated with intravascular catheters pose significant financial burden, morbidity, and mortality. There is much debate about whether or not blood cultures should be drawn through central venous catheters, and while guidelines advocate for catheter-drawn cultures when catheter infection is suspected, there is variable practice in this regard. We performed a retrospective cohort study assessing episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures in tertiary care hospitals in the United States and Spain. We identified 143 episodes in 122 patients meeting inclusion criteria. Thirty percent of such episodes revealed growth of potential pathogens such as Staphylococcus aureus. Overall, 21% of follow-up percutaneously-drawn blood cultures obtained within 48 hours revealed growth of the same microbe after an episode of positive catheter-drawn blood cultures with negative concomitant percutaneously-drawn cultures (33% when potential pathogens were isolated; 16% when common skin contaminants were isolated). Patients with cultures growing pathogenic organisms were more likely to receive targeted antimicrobial therapy and have their catheters removed sooner. Many episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures lead to growth from percutaneously-drawn follow-up blood cultures. Thus, such initial discordant results should not be disregarded. Our findings advocate for a nuanced approach to blood culture interpretation, emphasizing the value of catheter-drawn blood cultures in clinical decision making and management.

Adherence to guidelines and central-line-associated bloodstream infection occurrence during insertion and maintenance of intravascular catheters: evidence from 20 tertiary hospitals

To investigate adherence to intravascular catheter (IVC) insertion and maintenance guidelines in Chinese tertiary hospitals. A cross-sectional questionnaire survey of adult inpatients with IVC placements was conducted from July to September 2022 in 20 tertiary hospitals in China. One clinical staff member from each department in each hospital was assigned to participate in the survey. Questionnaires were uniformly collected and reviewed after 3 months. This study included 1815 cases (62.69%) of central venous catheter, 471 cases (16.27%) of peripherally inserted central catheter, 461 cases (15.92%) of PORT, and 147 cases (5.08%) of haemodialysis catheter insertions. Statistically significant differences in compliance were observed across the four IVC types, specifically in relation to the insertion checklist, standard operating procedure, and insertion environment (P<0.05). Practice adherence during IVC maintenance differed significantly across the four IVC types in aspects such as availability of IVC maintenance verification forms, daily scrubbing of the catheterised patients, and catheter connection methods (P<0.05). A total of 386 (13.34%) patients developed fever, 1086 (37.53%) were treated with therapeutic antibiotics, 16 (0.55%) developed central line-associated bloodstream infections, two (0.07%) developed local skin infections, and six (0.21%) developed deep vein thrombosis. Adherence to guidelines regarding insertion and maintenance differed across the four IVC types; there is a gap between the recommended measures and the actual operation of the guideline. Therefore, it is necessary to further enhance training and develop checklists to prevent CLABSIs.