Catheter Removal Rate Research Articles

Comparing results of midline catheter and peripherally inserted central catheter in cancer patients under chemotherapy.

Peripherally inserted central catheters (PICC), and peripherally inserted midlines (MC) represent a possible less invasive alternative option to totally implantable vascular access devices (TIVAD) in cancer patients. This study aims to investigate the outcomes of PICC, and MC devices in patients undergoing chemotherapy. A prospective non-concurrent observational study was conducted at the IRCCS Ospedale Policlinico San Martino, Genova (Italy) on 559 cancer patients candidate to chemotherapy bearing PICC, and MC during the period 2019-2022. The primary endpoint was the comparative analysis for failure of the different types of peripheral insertion accesses requiring removal. Secondary outcome measures were age at diagnosis, gender, period of diagnosis, cancer site and type of chemotherapy. The negative binomial regression analysis was applied to estimate catheter removal rate ratios (RR), along with 95% confidence limits (95% CL), in each category of the risk factors. The median follow-up time was 2.6 months (IQR = 1.4-4.6; min-max = 0.03-12.7), and at the end of the study period, a total of 45 catheter failures were detected. A risk reduction of approximately 75% (RR = 0.24; 95% CL = 0.11-0.51) was emphasized for patients with PICC when compared with those with MLC. Type of chemotherapy and cancer site appeared to be important predictive factors for catheter removal risk. For cancer patients undergoing chemotherapy by a non TIVAD, PICC must be preferred to MC because of higher safety and efficacy.

The performance and complications of long peripheral venous catheters: A retrospective single-centre study.

Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound-guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. Retrospective, observational single-site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all-cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4-103.8). The median dwell time was 8 days (IQR 5-14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all-cause catheter failure (p < .001) and catheter failure due to phlebitis (p < .001). In multivariable analyses, vancomycin infusion was not significantly associated with all-cause catheter failure (HR 1.15 (0.55-2.42), p = .71) or catheter failure due to phlebitis (HR 1.49 (0.49-4.53), p = .49). The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses.

#2355 Eradication of Staphylococcus aureus carriage in patients undergoing peritoneal dialysis

Abstract Background and Aims Peritonitis is a common and serious complication of peritoneal dialysis (PD). A single episode of severe peritonitis or multiple peritonitis episodes frequently leads to diminished peritoneal ultrafiltration capacity, hospitalization, and a switch to hemodialysis. Prevention of infection is the mainstay for the reduction of peritonitis rate. According to the current guidelines, we use nasal antibiotic prophylaxis if patients are identified as nasal Staphylococcus aureus carriers on screening prior to PD beginning. Eradication of S. aureus Regular with nasal mupirocin reduces the rate of exit-site infections but has uncertain effects on the risk of peritonitis. The aim of this study was to evaluate the rate of S. aureus peritonitis in our cohort of patients receiving PD. Method A retrospective single-center study was conducted in a large Italian PD center. We reviewed all cases of bacterial peritonitis from 1999 to 2023. Demographic and clinical characteristics of the patients and microbiological features of the bacteria identified in cultures were extracted from electronic health record. From 2011, all patients were screened before surgery for Methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) with nares swabs. All patients with positive nasal colonization for MSSA and MRSA were treated with nasal mupirocin (nasal ointment twice daily for 5 consecutive days every 4 weeks) until eradication was confirmed by a nasal swab. According to our protocol, from 2011, screening for S. aureus carriage along peritoneal fluid culture was performed in all patients on PD with an episode of peritonitis to verify nasal colonization with S. aureus. The study was approved by the regional ethical committee of Emilia Romagna (507/2021/OSS/AOUMO SIRER ID 2845). Results Overall, 345 cases of peritonitis were reviewed in 214 patients who received peritoneal dialysis. In our center, the rate of peritonitis was 0.23 episodes/patient-year. After the introduction of nasal screening for S. aureus carriage, the episodes of S. aureus peritonitis decreased in frequency (0.0093 episodes/patient-year vs. 0.034 episodes/patient-year) and as absolute number (17.8% vs 3.6%; p = 0.001). No differences were observed in the rate of catheter removal in the two populations (p = 0.99). The age of 109 patients screened for S. aureus carriage was 64.1 ± 17 years. Males accounted for 58.9% and automated PD (APD) was chosen by 66% of the subjects. After an average period of 1.6 years from the start of PD, 7 patients experienced S. aureus peritonitis in the absence of exit-site or tunnel catheter infection. Nasal screening at the time of peritonitis showed that half of them were carriers of S. aureus and half were negative (one patient was not screened). Colonization from S. aureus was found in another 9 patients whose peritonitis was caused by a different type of bacteria (44% S. epidermidis, 33.3% Enterobacteriaceae, 11.1% Acinetobacter, and 11.1% culture-negative peritonitis). Conclusion Our data document that screening for S. aureus, along with other preventive measures, contributes to significantly reducing the rate of S. aureus peritonitis in patients screened and treated for S. aureus carriage at the time of PD start. Routine screening and the use of a mask during connection are required because recolonization occurs frequently in this population.

Transurethral Resection of the Prostate in Younger Men: Effectiveness and Long-term Outcomes.

This study aims to investigate the efficacy and outcomes of transurethral resection of the prostate (TURP) in the context of younger male patients. Males aged ≤55 who underwent TURP at Rambam Health Care Campus from January 2011 to August 2023 were retrospectively reviewed. Clinicodemographic characteristics, indications for surgery, uroflowmetry, pressure-flow study, and early and late postoperative outcomes were collected. Patients with urethral or bladder abnormalities were excluded. Chi-square and Fisher's exact tests were employed for bivariate analysis. Inclusion criteria were met by 58 men who underwent TURP at a median age of 52 years (interquartile range [IQR] 49.5-54). Median prostate size was 35 mL (24.5-56), with median prostate-specific antigen of 1.4 ng/mL (0.65-3.1). A total of 60% of patients used α-blockers, and 19% used 5α-reductase inhibitors pre-surgery. Overall, 54 (93.1%) had severe lower urinary tract symptoms (LUTS), with 34 (59%) being predominantly emptying and 20 (35%) storage. Most surgeries were performed for refractory LUTS in 38 (66%), followed by urinary retention in 16 (28%). At 6 weeks, 57 (98%) patients were catheter-free. The maximum flow rate and residual volume showed significant improvement from a median of 6.85 mL/s to 17.9 mL/s (P<0.001), and from 120 mL to 10 mL (P=0.0142), respectively. Pathology revealed benign prostatic hyperplasia in 53 (91.4%), and inflammation in 5 (8.5%). A total of 13 auxiliary procedures were required in 12 patients (20.7%) during follow-up: 7 transurethral bladder neck incisions, 3 re-TURP, 1 meatus widening, and 1 patient required artificial urinary sphincter implantation followed by simple cystectomy for end-stage bladder. In young men, TURP showed short-term gains in flowmetry and catheter removal rates, but a sustained need for subsequent procedures in the long run. In this unique population, patients should be carefully selected, and alternative, less aggressive, interventions should be considered.

Does Consciousness Level Determine the Timing of Successful Removal of Urinary Catheters at Neurosurgery Intensive Care Unit-Implication to Nosocomial Infection Prevention

Objective This study aimed to investigate whether the level of consciousness can be used as an indicator to determine the successful removal of urinary catheters in post-stroke patients admitted to the neurosurgical intensive care unit (NICU). Methods The study included 97 patients who had urinary catheters in NICU and were divided into three groups based on their level of consciousness. Our analyses was performed by various statistical methods, including the chi-square test, one-way ANOVA, univariate and multivariate regression. Results The overall success rate of catheter removal was found to be 62.9%. On average, the catheters were retained for 6.3 ± 3.6 days. The presence of diabetes mellitus was identified as the only factor that significantly influenced the successful removal of catheters (Adjusted Odds Ratio = 0.236, p = 0.035). No significant differences were observed among patients with different degrees of consciousness impairment. Implementing a nursing-driven circle strategy and bladder sonography scan protocol significantly could decrease the catheter-associated urinary infection (CAUTI) rate from 10.25/1,000 catheter days to 6.69/1,000 catheter days. Conclusions Based on our findings, we recommend removing urinary catheters five days after initial placement for patients with a Glasgow Coma Scale (GCS) score greater than eight and for non-intubated patients, as well as for intubated patients and aphasic patients in the NICU with a GCS score greater than 4. This protocol can potentially prevent CAUTI cases resulting from delayed UC removal

A retrospective study of patients with Stenotrophomonas maltophilia peritonitis undergoing peritoneal dialysis

BackgroundStenotrophomonas maltophilia (S. maltophilia) is being increasingly recognized as an important cause of nosocomial infections, particularly in immunocompromised patients, such as patients undergoing dialysis. S. maltophilia peritonitis is strongly associated with the loss of peritoneal catheter among patients undergoing peritoneal dialysis (PD) owing to its resistance to different groups of antibiotics. Thus, the aim of this study was to investigate the characteristics of and risk factors for S. maltophilia peritonitis in patients undergoing PD.MethodsThis single-center, retrospective, case–control study was conducted between April 2013 and October 2022. Patients who were undergoing PD at Kawashima Hospital and were diagnosed with S. maltophilia peritonitis were included in this study. Controls were randomly selected from among patients who were undergoing PD and were diagnosed with peritonitis caused by microorganisms other than S. maltophilia. The demographic data, clinical characteristics, and initial treatment data of the patients were analyzed to determine the risk factors for PD-related S. maltophilia peritonitis.ResultsFive patients with S. maltophilia peritonitis and 15 controls (three controls to one case) were included in this study. The incidence of S. maltophilia peritonitis was significantly more frequent among patients with diabetes mellitus (80.0% vs. 20.0%; p = 0.031) and among patients with higher white blood cell counts in the dialysate after appropriate antibiotic therapy (2561/µL [349–4654/µL] vs. 20/µL [20–23/µL]; p = 0.0006) than among the control patients. Although all the patients were treated with appropriate antibiotics after the identification of S. maltophilia, they had a significantly higher rate of catheter removal than the controls (80.0% vs. 0.0%; p = 0.001).ConclusionsDiabetes mellitus may be an important risk factor for S. maltophilia peritonitis in patients undergoing PD.

The Impact of Anticoagulation on Indwelling Pleural Catheter Removal due to Pleurodesis in Patients with Malignant Pleural Effusion

Background: A well-recognized therapy to improve the symptoms of patients with malignant pleural effusion (MPE), indwelling pleural catheters (IPCs) can also achieve spontaneous pleurodesis. Chemical pleurodesis is associated with a significant pro-coagulation and fibrinolytic environment. Hence, anticoagulation could theoretically interfere with this process. Objective: The aim of this study was to evaluate if anticoagulation can interfere with successful spontaneous pleurodesis in patients treated with IPC. Methods: This was a cohort study of all patients with MPE treated with IPC. The primary objective was to determine if anticoagulant use after IPC placement decreased the rate of spontaneous pleurodesis. The secondary objective was to identify other factors associated with spontaneous pleurodesis. We used a Fine-Gray subdistribution hazard model and a direct acyclic graph to identify variables associated with time to spontaneous pleurodesis. Results: Of the included 410 patients, 210 patients (51.2%) achieved pleurodesis and had their IPC removed. We found no association between anticoagulation and likelihood of pleurodesis. Multivariate analyses revealed that prior chemotherapy, ECOG score of 2–4 were associated with unsuccessful pleurodesis, while chemotherapy or radiotherapy after IPC placement remained associated with increased likelihood of spontaneous pleurodesis. Conclusions: We failed to demonstrate an association between anticoagulation and pleurodesis. We found that better performance status and chemotherapy or radiotherapy after IPC placement can increase the rate of pleurodesis and catheter removal.

Clinical outcomes of image-guided percutaneous drainage of pericardial effusion in cancer patients: A single-center retrospective analysis.

Catheter removal, survival, and recurrence rates after percutaneous pericardial effusion drainage in cancer patients are not fully understood. We evaluated the clinical outcomes of image-guided percutaneous pericardial effusion drainage in cancer patients. From January 2014 to September 2017, 113 percutaneous drainages for symptomatic pericardial effusion were performed in 100 cancer patients (median 60 years; range, 7-84 years) using ultrasound or angio-computed tomography. An 8-Fr drainage catheter was placed using the Seldinger technique via the subxiphoid (n=73), apical (n=23), or left parasternal (n=17) routes. Success rates, complications, and postprocedural clinical outcomes of drainages were retrospectively assessed. The technical and clinical success rates were 100% and 99%, respectively, without major complications. The median duration of catheterization and evacuated pericardial effusion volume were 6 days (range, 1-72 days) and 970ml (range, 140-7635ml), respectively. Catheters were removed after the first drainage in 86 cases (86%). Symptomatic pericardial effusion recurred in nine patients after catheter removal, in whom redrainages were performed 13 times with a median duration to redrainage time of 48 days (range, 13-529 days). During the follow-up period (median 106 days [range, 1-1396 days]), 61 patients died. The median survival was 140 days (95% confidence interval [CI], 95-276 days), and the median catheter-free survival was 111 days (95% CI, 60-152 days). Image-guided percutaneous pericardial effusion drainage for cancer patients is safe and helps alleviate symptoms. Additionally, catheter removal is possible in most patients, allowing a catheter-free period for patients.

Expanded Criteria Same Day Catheter Removal After Holmium Laser Enucleation of the Prostate.

Abstract Introduction and Objectives: Holmium laser enucleation of the prostate (HoLEP) is a highly effective treatment of benign prostatic hyperplasia (BPH). Technical advances and improved hemostatic properties of holmium lasers have allowed for increased efficiency and outcomes. Same day catheter removal after HoLEP was described at our institution in 2020 after a 30-patient pilot trial. We now present an expanded update after widespread adoption at our facility. Methods: We reviewed patients who underwent same day catheter removal after HoLEP between January 1, 2020 and March 21, 2021. Unlike previous trials, there were no limitations to prostate size. Other changes included catheter removal in phase two of recovery when nursing was available rather than the urology clinic. Descriptive statistics are presented of preoperative, operative, and postoperative data. Univariate and multivariate analysis was performed to assess associations with failure of same day void trial. Results: The success rate of same day catheter removal for the 114 identified patients was 87.7%. Mean age was 69.1 ± 8.6 years and prostate volume was 109.2 ± 61.5 cc, 35% were dependent on catheterization for urinary retention preoperatively and 9% were on antiplatelet/anticoagulant therapy. A total of 26.5% of patients with American Society of Anesthesiology score (ASA) 3 or 4 failed catheter removal compared with 3.9% of patients with ASA 1 or 2 (likelihood ratio 9.32, p = 0.002), ASA status lost significance on multivariate analysis (p = 0.076). Effective catheter removal was not significantly associated with age, body mass index, prostate size, catheter dependency, anticoagulation/antiplatelet therapy, American Urologic Association symptom score, prior BPH surgery, or prostate cancer in final pathology report. Conclusion: Regardless of prostate size, same day catheter removal is a safe and reliable method of post-HoLEP patient management. Patients with an ASA 3 or 4 should be counseled regarding potential risks of temporary re-catheterization. Given ongoing nationwide shortages in hospital beds and staffing, same day discharge and catheter removal may allow for wider availability of surgical treatment for BPH.

Accidental epidural catheter removal rates and strength required for disconnection: a retrospective cohort and laboratory study

BackgroundEpidural catheters are associated with certain risks such as accidental epidural catheter removal, including dislodgement and disconnection. Globally, neuraxial connector designs were revised in 2016 to provide new standardization aimed at decreasing the frequency of misconnections during the administration of medications. However, no studies have investigated accidental epidural catheter removal after the revised standardization. This study aimed to examine differences in dislodgement and disconnection rates associated with different catheter connector types, and to investigate the linear tensile strength required to induce disconnection.MethodsThis retrospective cohort study included adult patients who underwent elective surgery and received patient-controlled epidural analgesia. Patients were divided into groups according to the type of catheter connection used: old standard, new standard, and new standard with taping groups. Furthermore, we prepared 60 sets of epidural catheters and connectors comprising 20 sets for each of the old, new, and taping groups, and used a digital tension meter to measure the maximum tensile strength required to induce disconnection.ResultsThis clinical study involved 360, 182, and 378 patients in the old, new, and taping groups, respectively. Dislodgement rates did not differ statistically among the three groups, while there was a significant difference in disconnection rates. Propensity score matching analysis for disconnection rates showed no difference between the old and new groups (2.8% vs. 4.5%, p = 0.574), while the new group had higher rates than the taping group (6.5% vs. 0%, p = 0.002). This laboratory study identified that a tensile strength of 12.41 N, 12.06 N, and 19.65 N was required for disconnection in the old, new, and taping groups, respectively, and revealed no significant difference between the new and old groups (p = 0.823), but indicated a significant difference between the new and taping groups (p < 0.001).ConclusionsThis clinical study suggested that dislodgement rates did not change among the three groups. Both clinical and laboratory studies revealed that disconnection rates did not change between the old and new connectors. Moreover, as a strategy to prevent accidents, taping the connecting points of the catheter connectors led to an increase in the tensile strength required for disconnection.

MO702: Etiology and the Impact of Refractory Peritonitis on Clinical Outcomes of Patients on Peritoneal Dialysis—12 Years’ Single-Center Experience from Turkey

Abstract BACKGROUND AND AIMS The outcomes of refractory peritonitis in peritoneal dialysis (PD) patients have been reported to be inferior to those of solitary peritonitis. The current study aimed to examine the factors associated with treatment failure in PD patients experiencing refractory peritonitis. METHOD This single-center retrospective study included all episodes of refractory peritonitis in adult PD patients in Marmara University Hospital, Turkey, between 2009 and 2020. Patient characteristics, microbiological data, outcomes and factors associated with refractory peritonitis were analysed. The primary outcome was peritonitis-related catheter loss. Secondary outcomes were hospitalization and peritonitis-related death. RESULTS Overall, 236 episodes of refractory peritonitis occurring in 135 patients were included. Gram-positive, gram-negative and fungal infections accounted for 44.1%, 20.4% and 2.4% of all peritonitis episodes, respectively. Forty-seven patients (34.8%) needed catheter removal, 2 patients (1.5%) died due to peritonitis complications and 59 episodes (25%) needed hospitalization. Mean fifth day PD fluid cell count was significantly greater among patients who required PD catheter removal (3621.3 $ \pm $ 3144.1 versus 1589.4 $ \pm $ 2316.6 P &amp;lt; 0.001). Furthermore, patients with &amp;gt;1000/mm3 cell count on the fifth day had higher rate of catheter removal (72.3% versus 37.6%, P &amp;lt; 0.001) as compared to patients with cell count under 300/mm3. Treatment failure was more common in peritonitis episodes caused by gram (−) organisms (31.9% versus 14.8%, P:0.012). Pseudomonas and fungi-associated peritonitis were also significantly correlated with catheter loss (P:0.001 and P: &amp;lt;0.001) (Table 1). When peritonitis episodes with more and &amp;lt;1000 cells/mm3 on the fifth day were compared, there were more episodes with gram (−) bacteria (29.7% versus 12.9%, P:0.003) and hospitalization (41.9% versus 11.4%, P: &amp;lt;0.001) in the group with more than 1000 cells/mm3. In the multivariate analysis, factors associated with catheter loss were a cell count of &amp;gt;1000 on the fifth day and hospitalization, while presence of gram (+) bacteria related peritonitis was inversely correlated with catheter loss (Table 2). CONCLUSION Our study shows that the PD cell count on the fifth day of peritonitis can be used as a prognostic tool to determine the prognosis of refractory peritonitis episodes. Although we were unable to show the adverse prognostic effect of gram (−) bacteria related peritonitis, gram (+) bacteria related peritonitis was associated with better outcome. Prospective studies are needed to assess the risk factors for adverse outcomes of patients with refractory peritonitis, as the evidence in this area is sparse.

Associations, microbiology and outcomes of pre-training peritoneal dialysis-related peritonitis.

Pre-training peritonitis (PTP), defined as peritonitis that occurred after catheter insertion and before peritoneal dialysis (PD) training, is increasingly recognized as a risk factor for adverse patient outcomes, yet poorly understood with limited studies conducted to date. This study was conducted to identify the associations, microbiologic profiles and outcomes of PTP compared to post-training peritonitis. This single-centre, case-control study involved patients with kidney failure who had PD as their first kidney replacement therapy and had experienced an episode of PD peritonitis between 1 January 2005 and 31 December 2015. Individuals experiencing their first episode of peritonitis were included in the study and categorized according to whether it occurred pre- or post-training. The primary outcome was peritonitis cure rates and composite outcome of hemodialysis (HD) transfer for ≥30 days or death. The secondary outcomes included catheter removal and refractory peritonitis rates. Among 683 patients who received PD for the first time, 121 (17.7%) had PTP while 265 (38.8%) had post-training peritonitis. PTP patients were more likely to have had exit-site infection (ESI) prior to peritonitis (24.8% compared to 17% in the post-training peritonitis group, p = 0.2). Culture-negative peritonitis was significantly more common in the PTP patients (53.7%) than in the post-training group (27.3%, p < 0.001). The cure was achieved in 68.9% of cases and was not significantly different between the PTP and post-training peritonitis groups (66.1% vs. 70.2%; OR 0.83, 95% CI 0.51-1.35). Lower odds of cure were associated with peritonitis caused by moderate and high severity organisms (OR 0.49, 95% CI 0.29-0.85; OR 0.18, 95% CI 0.08-0.43, respectively). Composite outcome of HD transfer or death was more commonly observed among patients with PTP (87.5% vs. 75.8%; OR 2.2, 95% CI 1.20-4.48) in whom significantly shorter median time to HD transfer was observed (PTP 10.7 months vs. post-training peritonitis 21.9 months, p < 0.0001). PTP is a common condition that is highly associated with preceding ESI, is frequently culture-negative and is associated with worse composite outcome of HD transfer or death. PTP rates should be routinely monitored and reported by PD units for continuous quality improvement.

Percutaneous transhepatic treatment for biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation: a 9-year single-center experience.

To investigate clinical outcomes of percutaneous transhepatic treatment for biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation (LDLT). This retrospective study examined baseline characteristics, procedural details, clinical outcomes, drainage catheter removal rate within 8 months, and recurrence after catheter removal using patients' medical records and images. Risk factors for failure of drainage catheter removal within 8 months and recurrence of biliary stricture after drainage catheter removal were assessed via univariable and multivariable analyses. A total of 112 patients (53.4 ± 8.79 years, 91 men) were evaluated. Multiple drainage catheters were placed in 75 patients (70.0%). Drainage catheters were successfully removed in 107 patients (95.5%). Failure of drainage catheter removal within 8 months was associated with hepatic artery complications (p= 0.034) and strictures requiring alternative passage techniques (p= 0.034). The cumulative primary patency rates after drainage catheter removal at 1, 2, 3, and 5 years were 85.4%, 79.8%, 75.8%, and 68.4%, respectively. Recurrence of biliary stricture was associated with the presence of an untreated isolated sectoral duct (aHR, 3.632; 95% CI, 1.086-12.150, p= 0.037) and with concurrent bile leaks (aHR, 2.475; 95% CI, 1.090-5.621, p= 0.031). Percutaneous transhepatic treatment was effective for the treatment of biliary strictures after duct-to-duct biliary anastomosis in LDLT. Multiple drainage catheter maintenance was needed because multiple strictures often occurred in these patients. • Percutaneous transhepatic treatments are useful and effective for the treatment of biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation (LDLT), although an endoscopic approach is available for this type of reconstruction. • Multiple drainage catheters were frequently placed in these patients because of multiple complex strictures. • We found that recurrence after drainage catheter removal was associated with isolation of the sectoral duct and with concurrent bile leaks.

Characteristics Analysis, Clinical Outcome and Risk Factors for Fungal Peritonitis in Peritoneal Dialysis Patients: A 10-Year Case-Control Study.

Background: Fungal peritonitis (FP) is a rare but severe complication that can appear in patients receiving peritoneal dialysis (PD). This study aimed to investigate the incidence rate and clinical characteristics of FP, evaluate clinical outcomes between FP and bacterial peritonitis (BP) patients on PD, and especially estimate the risk factors for FP outbreak.Methods: All episodes of FP diagnosed in our hospital from January 1, 2011, to December 31, 2020, were reviewed in this single-center study. FP cases were analyzed and compared with patients diagnosed with BP in a 1:6 ratio matching for case-control study. Patient information, including clinical information, biochemical analysis, and outcomes, was recorded. Univariate and multivariate logistic regression model were used to analyze the risk factors for FP.Results: A total of 15 FP episodes were observed in 15 PD patients, with an FP rate of 0.0071 episodes per patient-year. Seventeen strains of fungi were isolated and identified. Candida was the most common pathogen (15 strains, 88.2%), followed by Aspergillus fumigatus (2 strains, 11.8%). Between the groups, FP group showed a higher rate of HD transfer and catheter removal, and a lower rate of PD resumption in the short-term outcome (all P < 0.01), while no significant difference in the mortality was noted during the whole study period. The multivariate logistic regression analysis showed that longer PD duration (odds ratio [OR] 1.042, 95% confidence interval [CI] 1.012–1.073, P < 0.01), higher serum potassium (OR 3.373, 95% CI 1.068–10.649, P < 0.05), elevated estimated glomerular filtration rate (eGFR) (OR 1.845, 95% CI 1.151–2.955, P < 0.05), reduced serum albumin level (OR 0.820, 95% CI 0.695–0.968, P < 0.05) and peritoneal effluent polymorphonuclear (PMN) count (OR 0.940, 95%CI 0.900–0.981, P < 0.01) were significantly increased the risk for FP.Conclusion: These results suggested that FP leads to higher rate of catheter removal and HD transfer, and a lower rate of PD resumption than BP, and that additional attention should be paid to hypoalbuminemia, increased serum potassium, long PD duration, and low peritoneal effluent PMN in PD patients.

Poorer clinical outcomes of early-onset peritonitis in elderly peritoneal dialysis patients: A longitudinal and multicenter study.

Early-onset peritonitis (EOP) is a risk factor for mortality in peritoneal dialysis (PD) patients. This study investigates the clinical features and outcomes of EOP in elderly patients. This multicenter retrospective study evaluated 433 elderly PD patients with end-stage renal disease. The cohort was divided into nonperitonitis group (n=239), EOP group (≤12 months, n=109) and late-onset peritonitis (LOP) group (>12 months, n=85). Clinical data, treatment results, and outcomes were compared between the groups. Compared with LOP group, there were no significant intergroup differences in the rate of primary recovery, complete cure, relapse, catheter removal, or death from PDAP (p >0.05) in the most recent PDAP episode. However, Kaplan-Meier analysis showed that patients in the EOP group were likely to have multiple episodes of PD-associated peritonitis (PDAP), technique failure, all-cause death, and composite endpoint in the long-term prognostic outcomes (p <0.001). EOP is significantly associated with poorer clinical outcomes in older PD patients.

Risk Factors for Complications Associated with Peripherally Inserted Central Catheters During Induction Chemotherapy for Acute Myeloid Leukemia.

Objective Peripherally inserted central catheters (PICCs) are widely used in patients with hematologic malignancies. However, the risks of PICC-related complications during chemotherapy for acute myeloid leukemia (AML) are not fully understood. Methods We conducted a retrospective review of 128 adult patients with AML who received induction therapy by way of PICC insertion between 2012 and 2019. Results The median duration of PICC insertion was 30 days. The incidence rate of catheter-related bloodstream infection (CRBSI) was 2.4% at 30 days, and women were more likely to suffer from CRBSI than men. Local reactions at the insertion site were observed in 56 patients; however, these events did not predict CRBSI. The incidence rates of catheter-related thrombosis (CRT) were 1.6% at 30 days. Obesity put patients at an increased risk for CRT. Unexpected PICC removal occurred in 59 patients, and women were at a higher risk of catheter removal than men. Conclusion Low PICC-related complication rates, possibly associated with high rates of catheter removal, were observed during intensive chemotherapy for AML. Women and obese patients require careful monitoring of their PICC. Procedures to achieve appropriate PICC removal without increasing the complication rate need to be considered.

Epidemiology, management, and prevention of exit site infections in peritoneal dialysis patients.

Exit site infection (ESI) is a leading complication of peritoneal dialysis (PD), at an incidence of 0.6 episodes per year in the United States, and a major risk factor for catheter removal and peritonitis. An estimated 20% of all peritonitis cases are preceded by an ESI, with up to 50% of Staphylococcus aureus peritonitis associated with ESI. Gram-negative ESIs are less associated with succeeding peritonitis than their gram-positive counterparts, though when present, are associated with a lower peritonitis cure rate. The rate of catheter removal for refractory ESI is relatively highest in ESI due to mycobacteria (up to 40%), S. aureus (35%), Pseudomonas aeruginosa (28%), followed by Corynebacterium, Serratia, and fungi. In review of relevant literature, we found no prophylactic benefit of dressings over nondressings, specific antiseptics over normal saline, or topical honey over topical antibiotic prophylaxis, and thus recommend individualized exit site hygiene. We found topical gentamicin effective for prevention of most ESIs, including gram-negative ESIs, and thus recommend consideration of prophylactic topical gentamicin in areas of high gram-negative peritonitis incidence. With long-term use, observational studies detect up to 25% of gram-positive and 14% of gram-negative ESIs may be mupirocin and gentamicin resistant, respectively. We review empiric and targeted ESI management, including indications for ultrasound, anti-VMRSA, anti-Pseudomonal, and anti-mycobacterial antibiotic use, and catheter removal. We recommend further investigation into the earlier use of second-line treatment agents and the utility of treating post-infectious exit site colonization as avenues to decrease refractory and repeat ESI.

MP01-18 PROSTATIC ARTERY EMBOLIZATION: RESULTS FROM A LARGE MULTI-INSTITUTIONAL ITALIAN SERIES

MP01-18 PROSTATIC ARTERY EMBOLIZATION: RESULTS FROM A LARGE MULTI-INSTITUTIONAL ITALIAN SERIES

Development and implementation of a novel decision support tool on physical restraint use in critically ill adult patients.

To investigate whether a novel decision support tool would effectively minimize physical restraint use in critically ill adult patients. A nonequivalent quasi-experimental design combined with a descriptive qualitative approach was used. A Restraint Decision Tree was developed based on a qualitative study that explored the barriers to employ the Restraint Decision Wheel. During the quasi-experimental study, patients admitted to the unit between October 2017 and March 2018 were enrolled as the control group receiving the Restraint Decision Wheel (n = 528), whereas patients between April 2018 and September 2018 were enrolled as the intervention group receiving the Restraint Decision Tree (n = 564). The physical restraint rate, accidental catheter removal rate and nurses' satisfaction were compared. The Restraint Decision Tree significantly decreased physical restraint use. No significant difference in the rate of accidental catheter removal was found. Nurses reported increased satisfaction with the restraint decision-making. The Restraint Decision Tree could minimize physical restraint use. Physicians' involvement in the restraint decision-making and nurses' competence in delirium assessment may be essential for successful implementation of the Restraint Decision Tree.

Incidence and utility of follow-up blood cultures in cancer patients with gram-negative bacteremia

Benefit of follow-up blood cultures (FUBC) in cancer patients with gram-negative bacteremia (GNB) is unknown. Multicenter, retrospective review was performed in adult cancer patients with GNB between January and December 2018. Primary outcome was FUBC incidence. Chi-square, t-tests/Wilcoxon rank‐sum, and bivariate regression (logistic/Poisson) analyses compared secondary outcomes (catheter removal, ID consultation, antibiotic duration, length stay, mortality) between patients with versus without FUBC. Of 52 patients with GNB, majority (35/52; 67%) received ≥1 FUBC (mean per patient 3.6, SD 4.3, range 0–29). Majority FUBC had no growth (157/173; 90.8%). Rates of catheter removal and ID consultation were similar between groups (P > 0.05). Patients with FUBC had greater LOS (mean 21 vs 15 days; coefficient = 0.31, CI 0.17–0.45), longer duration of antibiotics (mean 13 vs 11 days, coefficient 0.19, P = 0.013), but no mortality difference (P = 1). FUBC are frequently performed yet infrequently positive in cancer patients with GNB, but were associated with increased LOS and antibiotic duration.