Risk Of Catheter-related Bloodstream Infection Research Articles

Taurolidine and Heparin as Catheter Lock Solution for Central Venous Catheters in Hemodialysis.

Chronic kidney disease can lead to end-stage renal disease, and the prevalence is increasing. Many patients starting hemodialysis require central venous catheters (CVCs). Catheter-related bloodstream infections (CRBSIs) are a common complication and lead to significant morbidity and mortality. Interventions to prevent CRBSI include antimicrobial lock therapy but concern for the development of antimicrobial resistance and adverse effects. Nonantimicrobial antiseptics as catheter lock solutions have also been used. Taurolidine and heparin catheter lock solution is first approved by the Food and Drug Administration for the prevention of CRBSI in patients on hemodialysis. Taurolidine has a unique mechanism of action and favorable safety profile. Taurolidine and heparin catheter lock solution have both antimicrobial and anticoagulant properties. Taurolidine is derivative of the amino acid taurine, and heparin is derived from porcine intestinal mucosa. Taurolidine not only damages microbial cell walls but also prevents the adherence of microorganisms to biological surfaces, preventing biofilm formation. Taurolidine and heparin catheter lock solution is intended to be used intraluminally within the catheter and should be aspirated. Because it is used locally, limited pharmacokinetic and pharmacodynamic data are available. The LOCK-IT-100 trial is a randomized, double-blind, phase 3 study, which included 795 end-stage renal disease patients on hemodialysis with CVC. Taurolidine and heparin was compared with the control heparin alone. The results of the study showed a 71% risk reduction in CRBSI for taurolidine and heparin arm (95% confident interval, 38%-86%, P = 0.0006). Other studies have also shown that taurolidine lock solution leads to decreased CRBSI episodes. Several systematic reviews and meta-analysis consisted of taurolidine in adult, and pediatric populations also showed reduction in the incidence of CRBSIs. Taurolidine and heparin lock solution represents a novel preventive strategy for those undergoing hemodialysis through a CVC by reducing the risk of CRBSI. This is significant progress because there are no other similar options available for patients for whom catheters are the only options for their life-saving treatment.

KiteLock 4%: the next generation of CVAD locking solutions.

Central venous access devices (CVADs), including peripherally inserted central catheters (PICCs) and cuffed tunnelled catheters, play a crucial role in modern medicine by providing reliable access for medication and treatments directly into the bloodstream. However, these vital medical devices also pose a significant risk of catheter-related bloodstream infections (CRBSIs) alongside associated complications such as thrombosis or catheter occlusion. To mitigate these risks, healthcare providers employ various strategies, including the use of locking solutions in combination with meticulous care and maintenance protocols. KiteLock 4% catheter lock is a solution designed to combat the triple threat of infection, occlusion and biofilm. This locking solution is described as the only locking solution to provide cover for all three complications.

Outcomes for central venous catheter repair in patients receiving long-term home parenteral support: A descriptive cohort study.

Central venous catheter (CVC) complications are frequently reported in patients receiving home parenteral support (HPS). Compromised CVC integrity or breakage is one such issue. Repairing such breakages can potentially avoid costly and risky catheter replacements. We completed a retrospective descriptive cohort study using a prospectively maintained data set, in a national UK intestinal failure reference center. Repair success, CVC longevity, and catheter-related bloodstream infection (CRBSI) rates after repair were the primary outcome measures. A total of 763 patients received HPS. There were 137 CVC repairs: 115 (84%) tunneled CVCs and 22 peripherally inserted central catheters (PICCs) attempted in 72 patients. Of the 137 attempts at CVC repair, 120 (88%) were deemed to be successful, allowing a median duration of subsequent CVC use of 336 days following repair (range 3-1696 days), which equates to 99,602 catheter days of HPS infusion. Three patients had a CRBSI within 90 days of repair, and patients required admission to the hospital for refeeding on 14 occasions following repair, such that hospitalization was avoided in 103/120 (86%) occasions following successful CVC repair. There was no increase in the recorded rate of CRBSIs in patients undergoing CVC repair compared with the CRBSI rates of all HPS-dependent patients under our care during the study period (0.03 vs 0.344/1000 catheter days, respectively). This is the largest single-center experience to demonstrate that CVCs, including PICCs, used for the administration of HPS can be safely repaired, prolonging CVC longevity without leading to an increased risk of CRBSI.

In vitro assessment of isopropanol leakage from antiseptic barrier caps into commonly used needleless connectors.

Needleless connectors (NCs) can be disinfected using antiseptic barrier caps (ABCs) to reduce the risk of catheter-related bloodstream infections. However, recent evidence suggests that isopropanol can leak from the ABC into the NC, posing concern about their safe use. We sought to determine in vitro which ABC and NC parameters influence the leakage of isopropanol through the infusion circuit. We assessed 13 NCs and 4 ABCs available in the European market. In vitro circuits consisting of an isopropanol cap, a NC, and an 11-cm catheter line were created. The circuits were left in place for 1 to 7 days at room temperature to assess the kinetics of isopropanol leakage. Isopropanol content in ABC and in circuit flushing solutions (5 mL NaCl 0.9%) after exposure to the cap were measured using gas chromatography with a flame ionization detector. The leakage of isopropanol from the cap to the NC was dependent on the NC, but not the cap. The NC mechanism did not predict the leakage of isopropanol. The Q-Syte NC exhibited the most isopropanol leakage (7.01±1.03 mg and 28.32±2.62 mg at 24 hours and 7 days, respectively), whereas the Caresite NC had the lowest isopropanol leakage at 7 days (1.69±0.01 mg). The use of isopropanol ABCs can cause isopropanol leakage into the catheter circuit according to NC parameters. Caution should be exercised when using these devices, especially in the pediatric and neonatal population.

2078. Comparison of Complication Types in Patients Receiving Vesicant Intravenous Antimicrobials or Vasopressors via Midlines and PICCs: A Retrospective Review

Abstract Background Peripherally inserted central catheters (PICC) are frequently used for long-term intravenous access in hospitalized patients; however, their use is associated with an increased risk of catheter-related bloodstream infection (CRBSI). Midline catheters (MC) have emerged as a potentially safer alternative and are associated with reduced rates of CRBSI but increased risk of thrombosis. Until recently, the use of several vasopressors and antibiotics via MC has been limited due to unknown adverse events. We aimed to compare the hazard ratios for CRBSI, thrombosis, catheter occlusion, and overall adverse events (AE) in adult intensive care unit (ICU) patients receiving vesicant antibiotics or vasopressors through PICC or MC. Methods We reviewed patients in 13 ICUs at one quaternary care center from April 2021 to September 2022 who received selected vesicant antibiotics (vancomycin, meropenem, and fluoroquinolones) or vasopressors through either PICC or MC. Patients who received both PICC and MC or other central access during the admission were excluded. Hazard ratios (HR) were compared using Kaplan-Meier survival curves and the log-long rank test. Cox regression was applied to adjust for potential confounding factors, including age, gender, ICU type (medical vs. surgical), duration of therapy, and length of stay. Results 445 patients (359 MCs, 86 PICCs) were included with 4,897 device days (3,910 MCs, 987 PICCs). Patient characteristics were similar across the two arms (Table 1). Figure 1 shows Kaplan-Meier survival estimate curves comparing PICC and MC. After adjusting for confounders (Table 2), the HR for CRBSI (0.86 [95% CI, 0.08 – 9.41)] and thrombosis (0.41 [95% CI, 0.09- 1.91]) were similar between the two devices. Compared to MC, PICCs were associated with higher occlusion rates (HR, 11.93 [95% CI, 2.97 – 47.89]). There were no significant differences in overall AE between the two groups (HR 1.72 [95% CI, 0.81 – 3.64]).Table 1:Characteristics of patients who received PICC or MC.MC: Midline Catheter; PICC: Peripherally Inserted Central Catheter; MICU: Medical Intensive Care Unit; SICU: Surgical Intensive Care Unit; DOT: Days of TherapyFigure 1:Kaplan-Meier Survival Estimate Curves Comparing PICC and MC. PICC: Peripherally Inserted Central Catheter; MC: Midline Catheter; The log-rank test was used for statistical significance.Table 2:Cox proportional-hazards multivariable model. DVT: Deep Vein Thrombosis; SVT: Superficial Vein Thrombosis; PICC: Peripherally Inserted Central Catheter; MC: Midline Catheter; SICU: Surgical Intensive Care Unit; MICU: Medical Intensive Care Unit; DOT: Days of Therapy; CI: 95% Confidence Interval Conclusion This study suggests similar infection and thrombosis hazards in ICU patients receiving vesicant antibiotics and vasopressors via PICC or MC. Notably, the study was not sufficiently powered to detect differences in outcomes. Larger studies are needed to assess the safety of administering these medications in MCs. Disclosures Sabra L. Shay, BSN, MPH, Premier Inc.: Employee

Contemplating Catheter Induced Blood Stream Infections and Associated Risk Factors in Diverse Clinical Settings: A Comprehensive Review

Catheter-Related Bloodstream Infections (CRBSIs) are severe healthcare-associated complication that occurs when bacteria enter the bloodstream through a catheter. The risk of CRBSIs is influenced by various factors. Prolonged catheter placement increases the risk, as each day increases the potential for bacterial colonization and bloodstream infection. Proper aseptic technique and a sterile environment during catheter insertion are essential to minimize infection risk. Stringent infection control measures during insertion, including sterile gloves, thorough hand hygiene, and appropriate skin disinfection, are crucial. Inadequate catheter site care and suboptimal catheter management can contribute to CRBSIs. Regular cleaning, disinfection, and dressing changes are necessary to reduce the risk of infection. The type of catheter used also affects infection risk. Central Venous Catheters (CVCs) and arterial catheters, especially those inserted into the jugular or subclavian vein, carry a higher risk of CRBSIs compared to peripheral venous catheters. Individuals with compromised immune systems, such as chemotherapy patients, organ transplant recipients, and those with HIV/AIDS, are more susceptible to CRBSIs. Patients with existing infections, like pneumonia or urinary tract infections, are at a heightened risk of acquiring CRBSIs due to potential cross-contamination. Healthcare professionals who fail to practice thorough hand hygiene before and after catheter-related procedures can introduce pathogens into the bloodstream. Leaving catheters in place when no longer necessary or using them unnecessarily elevates the risk of infection. To prevent CRBSIs, strict infection control protocols, including effective hand hygiene, sterile catheter insertion techniques, routine site care, and prompt catheter removal when no longer needed, are imperative. Healthcare facilities often implement specific protocols to mitigate CRBSI risk and enhance patient safety.

Risk factors for catheter-related bloodstream infections associated with home parental nutrition in children with intestinal failure: A prospective cohort study

Catheter-related bloodstream infection (CRBSI) is the most common, potentially life-threatening complication of long-term parenteral nutrition (PN). We prospectively assessed the incidence and risk factors for CRBSI in children receiving long-term home PN (HPN) for intestinal failure (IF) in a single IF rehabilitation center. Data regarding episodes and potential risk factors for CRBSI in children on HPN were prospectively recorded. Forty-one of 75 children were diagnosed with CRBSI. The overall CRBSI rate was 1.61 per 1000 catheter days. The indications for HPN were gastrointestinal motility disorders in 35%, short bowel syndrome (SBS) in 28% graft versus host disease (GvHD) post bone marrow transplant in 17%, congenital enteropathy in 15%, and severe neurodevelopmental impairment in 5%. Gastrointestinal motility disorders had significantly higher CRBSI rate compared to other groups (p<0.0005; 2.74 in motility group vs 1.54 in GvHD group vs 0.52 in congenital enteropathies vs 0.36 in SBS group vs 0.67 in severe neurodevelopmental delay). Multivariate analysis revealed that enterocutaneous distal stoma (ileostomy or colostomy) (HR 3.35 [95% CI, 1.63-6.86]; p<0.001), age <2 years (HR 0.28 [95% CI, 0.15-0.53]; p<0.0001), male sex (HR 2.28 [95% CI, 1.51-3.43]; p<0.0001), non-use of taurolidine citrate lock (HR 2.70 [95% CI, 1.72-4.11]; p<0.0001) and gastrointestinal motility disorder (HR 3.02 [95% CI, 1.81-4.91]; p<0.001) were independent risk factors for developing CRBSI. Extra care in managing PN connections and disconnections should be taken in children with an underlying gastrointestinal motility disorder, distal enterocutaneous stoma, male sex and those aged <2 years since they are at a significantly higher risk of CRBSI. Early introduction of taurolidine lock should be considered.

Complications of Central Venous Access Devices Used in Palliative Care Settings for Terminally Ill Cancer Patients: A Systematic Review and Meta-Analysis.

(1) Background: Central venous access devices (CVADs) have been commonly employed during various courses of anticancer treatment. Currently, there are a few types of clinically available CVADs, which are associated with short-term and long-term complications. However, little is known about the complication rates when CVADs are used only in palliative care settings. We therefore performed a systematic review and meta-analysis of all the published literature to evaluate the complication rates of CVADs in this clinical setting. (2) Methods: A systematic review and meta-analysis were conducted to identify publications from PubMed/MEDLINE, Embase (Ovid), Scopus, Cochrane Library, CINAHL, Google Scholar, and trial registries. Publications reporting the complication rates of PICCs, central lines, and PORTs in palliative settings for terminally ill cancer patients were included, while those on the use of systemic anticancer therapy and peripheral venous catheters were excluded. The outcome measures included overall complication rate, rate of catheter-related bloodstream infection (CRBSI), and rate of thromboembolism (TE). This systematic review was registered with PROSPERO (CRD42023404489). (3) Results: Five publications with 327 patients were analyzed, including four studies on PICCs and one study on central lines. No studies on PORTs were eligible for analysis. The overall complication rate for PICCs (pooled estimate 7.02%, 95% CI 0.27-19.10) was higher than that for central lines (1.44%, 95% CI 0.30-4.14, p = 0.002). The risk of CRBSI with PICCs (2.03%, 95% CI 0.00-9.62) was also higher than that with central lines (0.96%, 95% CI 0.12-3.41, p = 0.046). PICCs also had a trend of a higher risk of TE (2.10%, 95% CI 0.00-12.22) compared to central lines (0.48%, 95% CI 0.01-2.64, p = 0.061). (4) Conclusions: PICCs for palliative cancer care were found to have greater complications than central lines. This might aid in the formulation of future recommendation guidelines on the choice of CVAD in this setting.

Study on the Risk Factors of Central Venous-Related Bloodstream Infection in Outpatients

Objective: To analyze the risk factors of catheter-related bloodstream infection in outpatients and propose feasible prevention and control measures. Methods: The medical records of outpatients with peripherally inserted central catheter (PICC) from January 2020 to December 2021 were selected for retrospective analysis, and the factors that may be related to the occurrence of catheter-related bloodstream infection were analyzed by logistic multivariate analysis. Results: The incidence rate of catheter-related bloodstream infection among the enrolled patients was 4.78%. It was found that age, duration of catheterization, catheter site, number of punctures, and diabetes were all risk factors for catheter-associated bloodstream infection, and the differences were statistically significant. Conclusion: Age, duration of catheterization, catheterization site, and diabetes are all risk factors for catheter-related bloodstream infection, and medical personnel should fully understand and learn more about these risk factors and actively develop countermeasures to reduce the risk of catheter-related bloodstream infection.

Which trial do we need? Infectious and non-infectious complications of peripherally inserted central venous catheters and midline catheters

Peripherally-inserted central venous catheters (PICCs) are frequently used in outpatient and inpatient settings. Recently, midline catheters have emerged as an alternative to PICCs, with an important increase in use over the last few years ( 1 Bing S. Smotherman C. Rodriguez R.G. Skarupa D.J. Ra J.H. Crandall M.L. PICC versus midlines: comparison of peripherally inserted central catheters and midline catheters with respect to incidence of thromboembolic and infectious complications. Am J Surg. 2022; 223: 983-987 Abstract Full Text Full Text PDF Scopus (2) Google Scholar ). Midline catheters have a shorter length and lower surface area reducing the theoretical risk of infectious and non-infectious complications ( 2 Lu H. Hou Y. Chen J. Guo Y. Lang L. Zheng X. et al. Risk of catheter-related bloodstream infection associated with midline catheters compared with peripherally inserted central catheters: A meta-analysis. Nurs Open. 2021; 8: 1292-1300 Crossref Scopus (4) Google Scholar ). These catheters are 7.5 to 25cm in length, usually inserted above the antecubital fossa, with the catheter tip residing in the basilic or cephalic vein just short of the subclavian vein. The recommended duration of midline catheter use is one to four weeks, while PICCs can remain indwelling for months ( 3 Chopra V. Flanders S.A. Saint S. Woller S.C. O'Grady N.P. Safdar N. et al. The michigan appropriateness guide for intravenous catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Ann Intern Med. 2015; 163: S1-S40 Crossref PubMed Scopus (324) Google Scholar , 4 Moss J.G. Wu O. Bodenham A.R. Agarwal R. Menne T.F. Jones B.L. et al. Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial. Lancet. 2021; 398: 403-415 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ).

Catheter-related bloodstream infections in children receiving parenteral nutrition: Experience of a single center with 178 patients

ObjectiveCatheter-related bloodstream infections are common in children who require parenteral nutrition and can have serious consequences, including mortality. This study aims to evaluate the frequency and nature of catheter-related bloodstream infections in children receiving parenteral nutrition. Materials and MethodsPatients between one month and 18 years of age who received parenteral nutrition within two years were evaluated for indications and complications by focusing on catheter-related bloodstream infections. ResultsTwenty-nine different catheter-related bloodstream infections were detected in 24 of 147 episodes in which parenteral nutrition was delivered via a catheter. The frequency of catheter-related bloodstream infections was 7.7 infections per 1000 catheter days. Coagulase-negative staphylococci, Gram-negative enteric bacilli, enterococci, and Candida species were the most common causative microorganisms. Five patients died. Infection frequency increased with increasing PN duration and receiving PN via a non-tunneled internal jugular catheter. Gender, age, and the number of catheter lumens were not associated with infection frequency. ConclusionCatheter-related bloodstream infection is a common complication in children receiving parenteral nutrition. Appropriate management is essential. Because parenteral nutrition duration is a risk for catheter-related bloodstream infections, the transition to enteral feeding should be considered as soon as possible.

Reducing catheter related bloodstream infection risk of infant with a prophylactic antibiotic therapy before removing peripherally inserted central catheter: A retrospective study.

This study examined the efficacy of prescribing antibiotics, specifically a single dose of vancomycin, in reducing the incidence of culture-positive and culture-negative sepsis prior to the removal of peripherally inserted central catheters (PICCs). We retrospectively reviewed charts of infants who had PICCs in a tertiary level hospital during the period from 2010 to 2019. The incidence of post-catheter removal clinical sepsis between the groups with or without antibiotics was compared. The antibiotic group was defined by receiving a single dose of vancomycin or any other antibiotic prior to line removal. We enrolled 585 PICC removal episodes in 546 infants for analysis. Antibiotics were given prior to removal in 257 cases (43.9%) and not given prior to removal in 328 cases (56.1%). There were 13 episodes of post-catheter removal clinical sepsis detected within 72h (2.2%), 2 of which were culture-positive (0.3%). A 9.3-fold decrease in the odds for clinical sepsis was observed in the antibiotic group (p=0.01). The incidence of post-catheter removal sepsis was decreased by a single prophylactic dose of vancomycin (p=0.02), whereas the use of other antibiotics showed no effect (p=0.35). Logistic regression analysis demonstrated that comorbidities with gastrointestinal diseases (p=0.01), PICC insertion sites in the scalp and neck (p=0.04), and no vancomycin administration prior to line removal (p=0.02) were independent risk factors for subsequent clinical sepsis. A single prophylactic dose of vancomycin prior to PICC line removal might reduce clinical sepsis events in infants.

Catheter-Related Bloodstream Infection With Femoral Central Access Versus Internal Jugular Access in Patients Admitting to Medical Intensive Care Unit.

BackgroundThe current research focused on studying the pattern of catheter-related bloodstream infections (CRBSI) with femoral central access versus internal jugular access in patients admitted to the medical intensive care unit (ICU).MethodsA cross-sectional study was conducted at the Department of Emergency Medicine, Shifa International Hospital, between March 4, 2022, and August 4, 2022. All individuals who presented to the ICU who needed a central venous catheter (CVC) for more than 48 hours were included. Catheter insertion was not permitted if the patient had a history of dermatitis or burns at the site of insertion or if the hemodialysis procedure necessitated the insertion of the catheter into a blood vessel. Three groups of patients were created: group A patients had been diagnosed with CRBSI; group B patients had catheter colonization (CC); and group C did not have CRBSI or CC. Standard microbiological methods were used to identify all of the bacteria collected from the cultures. All data was documented in a predefined pro forma.ResultsOverall, 20 (12.12%) patients had positive CRBSI, 68 (41.5%) had CC, and the remaining 46.3% of cultures were negative. Elderly populations were more prone to acquiring CRBSI showing a significant correlation between older age and CRBSI (p < 0.0001). CC was significantly associated with a longer duration of ICU stay, i.e., 30.3 ± 3.7 (p = 0.003). The absence of both CRBSI and CC was significantly associated with a lower duration of catheterization (11 ± 8.5 days in group C versus 22.1 ± 6.9 and 18.7 ± 7 days in groups A and B, respectively; p < 0.0001). Our study revealed a higher risk of CRBSI when the femoral access was compared to the internal jugular access (58.3% vs. 41.7%; p = 0.0008). The study did not find any significant association of CC with femoral or internal jugular access. Furthermore, a significantly higher rate of negative cultures was reported in patients with internal jugular access as compared to femoral vein access (85.8% vs. 14.2%; p = 0.007).ConclusionThe need for routinely monitoring and observing the microbiological spectrum in patients receiving care in intensive care units is highlighted by the current investigation. The patients with internal jugular vein access had a decreased incidence of CRBSI and CC, while those with femoral access experienced CRBSI more frequently. Escherichia coli and Pseudomonas aeruginosa were the most frequently isolated germs, and both were resistant to various drugs that are used today. It is essential to regularly monitor the epidemiology of CRBSI in order to adopt preventative measures for infection prevention and control, such as staff education, strict hygiene standards, and a higher nurse-to-patient ratio.

Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients?

BackgroundIn children in the ICU, catheter-related bloodstream infections (CRBSI) have also been linked to mortality, morbidity, and healthcare costs. Although CRBSI poses many potential risks, including the need to avoid femoral access, there is debate regarding whether jugular access is preferable to femoral access in adults. Study reports support both perspectives. There is no consensus in meta-analyses. Children have yet to be examined in depth. Based on compliance with the central line bundle check lists, we aim to determine CRBSI risk in pediatric intensive care units for patients with non-tunneled femoral and internal jugular venous access.MethodsA retrospective cohort study was conducted on patients with central venous catheters in the pediatric ICU of King Abdulaziz University Hospital between January 1st, 2017 and January 30th, 2018. For the post-match balance, we use a standardized mean difference of less than 0.1 after inverse probability treatment weighting for all baseline covariates, and then we draw causal conclusions. As a final step, the Rosenbaum sensitivity test was applied to see if any bias influenced the results.ResultsWe recorded 145 central lines and 1463 central line days with 49 femoral accesses (33.79%) and 96 internal jugular accesses (66.21%). CRBSI per 1000 central line days are 4.10, along with standardized infections of 3.16. CRBSI risk differed between non-tunneled femoral vein access and internal jugular vein access by 0.074 (− 0.021, 0.167), P-value 0.06, and relative risk was 4.67 (0.87–25.05). Using our model, the actual probability was 4.14% (0.01–0.074) and the counterfactual probability was 2.79% (− 0.006, 0.062). An unobserved confounding factor was not identified in the sensitivity analysis.ConclusionsSo long as the central line bundle is maintained, a femoral line does not increase the risk of CRBSI. Causation can be determined through propensity score weighting, as this is a trustworthy method of estimating causality. There is no better way to gain further insight in this regard than through the use of randomized, double-blinded, multicenter studies.

Meta-analysis of the efficacy of taurolidine in reducing catheter-related bloodstream infections for patients receiving parenteral nutrition.

BackgroundParenteral nutrition administered via central venous catheter is an established treatment option for people with intestinal failure. A serious complication of central venous catheters is the high risk of catheter‐related bloodstream infections (CRBSIs). Catheter‐locking solutions are one strategy for CRBSI prevention, with the solution taurolidine showing beneficial effects. The aim of this meta‐analysis was to identify and synthesize evidence to assess taurolidine efficacy against comparators for the prevention of CRBSI for people with intestinal failure receiving parenteral nutrition.MethodsSix health literature databases were searched for efficacy data of rate of CRBSI for taurolidine vs control among our study population; no study design limits were applied. Individual study data were presented for the number of CRBSIs and catheter days, and rate ratio. Overall data were synthesized as a pooled risk ratio, with subgroup analyses by study design, control type, and taurolidine solution.ResultsThirty‐four studies were included in the final analysis. At the individual level, all studies showed superior efficacy of taurolidine vs control for prevention of CRBSIs. When the data were synthesized, the pooled risk ratio was 0.49 (95% CI, 0.46–0.53; P ≤ 0.0001), indicating a 51% decreased risk of CRBSI through the use of taurolidine. Subgroup analysis showed no difference depending on study design (P = 0.23) or control type (P = 0.37) and a significant difference for taurolidine type (P = 0.0005).ConclusionTaurolidine showed superior efficacy over controls regardless of study design or comparator group. The results show that taurolidine provides effective CRBSI reduction for people with intestinal failure receiving parenteral nutrition.

A Meta-Analysis of Incidence of Catheter-Related Bloodstream Infection with Midline Catheters and Peripherally Inserted Central Catheters.

In order to provide reference for the prevention and treatment of CRBSI during clinical intravenous infusion therapy, this paper investigates the incidence of catheter-related bloodstream infection (CRBSI) in the treatment of midline catheters (MCs) and peripherally inserted central catheters (PICCs) by intravenous infusion. Web of Science, PubMed, Scopus, Embase, Cochrane Library, and ProQuest are searched to collect CRBSI-related studies on MC and PICC. The retrieval time is from the database construction to August 2020. Two researchers independently searched and screened literature quality evaluation and extracted data according to inclusion and exclusion criteria, and RevMan 5.3 software was used for analysis. Eleven studies are included, with a total of 33809 patients. The incidence of CRBSI in the MC group is 0.599% (43/7079), and that in the PICC group is 0.4993% (133/26630). Meta-analysis showed that the incidence of CRBSI in the MC group is higher than that in the PICC group (OR = 0.72, 95% CI = 0.43–1.08, P=0.11), and the difference is statistically significant when low-quality studies are excluded (OR = 0.60, 95% CI = 0.39–0.93, P=0.02). There is no significant difference in the incidence of CRBSI between MC group and PICC group (P > 0.05), American subgroup (OR = 0.52), and British subgroup (OR = 4.86), the results of the two groups are opposite, and the incidence of CRBSI between the MC group and PICC group is statistically significant. There is no significant difference in the incidence of CRBSI between the adult and other subgroups (all P > 0.05). There is no significant difference in the incidence of CRBSI between the MC group and the PICC group (P > 0.05). Overall, the inter-study stability is general, the quality is good and the medium is good, and there is no obvious publication bias. The risk of CRBSI in MC and PICC is systematically evaluated and meta-analyzed for the first time. The incidence of CRBSI in MC group is lower than that in PICC group during intravenous infusion therapy. Under the same conditions, MC patients can be given priority for intravenous infusion therapy. More high-quality and child-related studies are needed to further evaluate and explore the risk of CRBSI between MC and PICC.

Risk factors for peripherally inserted central catheterization-associated bloodstream infection in neonates.

To study the features of catheter-related bloodstream infection (CRBSI) or central line-associated bloodstream infection (CLABSI) after peripherally inserted central catheterization (PICC) in neonates admitted to the neonatal intensive care unit (NICU) and the risk factors for CRBSI or CLABSI. A retrospective analysis was performed on the medical data of the neonates who were treated and required PICC in the NICU of the Children's Hospital, Zhejiang University School of Medicine from June 1, 2018 to May 1, 2020. The catheterization-related data were collected, including placement time, insertion site, removal time, and antimicrobial lock of PICC. The multivariate logistic regression model was used to investigate the risk factors for CRBSI or CLABSI in the neonates. A total of 446 neonates were enrolled, with a mean gestational age of (30.8±4.0) weeks, a mean birth weight of (1 580±810) g, a median age of 9 days, and a median duration of PICC of 18 days. The incidence rates of CLABSI and CRBSI were 5.6 and 1.46 per 1 000 catheter days, respectively. Common pathogens for CLABSI caused by PICC included Staphylococcus epidermidis (n=19) and Klebsiella pneumoniae (n=11), and those for CRBSI caused by PICC included Klebsiella pneumoniae (n=6). The risk of CLABSI caused by PICC increased significantly with prolonged durations of PICC and antibiotic use, and the PICC-related infection probability at head and neck was significantly lower than that in the upper and low limbs (P<0.05), while the above conditions were more obvious in neonates with a birth weight of <1 500 g. The risk of CRBSI caused by PICC decreased with the increase in gestational age (P<0.05). CRBSI and CLABSI remain serious issues in NICU nosocomial infection. The identification of the risk factors for CRBSI and CLABSI provides a basis for improving the quality of clinical care and management.

Infectious outcomes of fibrin sheath disruption in tunneled dialysis catheters.

Fibrin sheath (FS) formation around tunneled central venous catheters (CVC) increases the risk of catheter-related bloodstream infections due to bacterial adherence to a biofilm. We sought to investigate whether FS disruption (FSD) at the time of CVC removal or exchange affects infectious outcomes in patients with CVC-related infections. Retrospective cohort study of 307 adult maintenance hemodialysis patients aged 18 years or older at a single center academic-based hemodialysis program (UHN, Toronto) who developed CVC-related infections requiring CVC removal or exchange between January 2000 and January 2019. Exposure was FSD at the time of CVC removal or exchange. Outcomes were infectious metastatic complications, recurrent infection with the same organism within 1 year, or death due to infection. We created a Markov Multi-State Model (MMSM) to assess patients' trajectories through time as they transitioned between states. A time-to-event analysis was performed, adjusted for clinically relevant factors. There was no significant relationship between FSD status at the time of CVC removal, the development of infectious complications in the multivariable model (adjusted HR = 0.71, 95% CI 0.09-5.80, p = 0.76), or mortality from infection (HR = 0.84, 95% CI 0.34-2.11, p = 0.73). FSD at the time of CVC removal was not associated with increased risk of infectious complications or death due to infection. Further prospective study is needed to determine whether FSD contributes to reducing CVC infectious related complications.

Assessment of risk factors associated with outpatient parenteral antimicrobial therapy (OPAT) complications: A retrospective cohort study

To characterize factors associated with increased risk of outpatient parenteral antimicrobial therapy (OPAT) complication. Retrospective cohort study. Four hospitals within NYU Langone Health (NYULH). All patients aged ≥18 years with OPAT episodes who were admitted to an acute-care facility at NYULH between January 1, 2017, and December 31, 2020, who had an infectious diseases consultation during admission. Overall, 8.45% of OPAT patients suffered a vascular complication and 6.04% suffered an antimicrobial complication. Among these patients, 19.95% had a 30-day readmission and 3.35% had OPAT-related readmission. Also, 1.58% of patients developed a catheter-related bloodstream infection (CRBSI). After adjusting for key confounders, we found that patients discharged to a subacute rehabilitation center (SARC) were more likely to develop a CRBSI (odds ratio [OR], 4.75; P = .005) and to be readmitted for OPAT complications (OR, 2.89; P = .002). Loss to follow-up with the infectious diseases service was associated with increased risks of CRBSI (OR, 3.78; P = .007) and 30-day readmission (OR, 2.59; P < .001). Discharge to an SARC is strongly associated with increased risks of readmission for OPAT-related complications and CRBSI. Loss to follow-up with the infectious diseases service is strongly associated with increased risk of readmission and CRBSI. CRBSI prevention during SARC admission is a critically needed public health intervention. Further work must be done for patients undergoing OPAT to improve their follow-up retention with the infectious diseases service.

Effect of sutureless securement on hemodialysis catheter-related bloodstream infection

The use of sutureless securement devices during catheterization might reduce the risk of catheter-related bloodstream infection (CRBSI) by suppressing catheter-exit infection and catheter dislodgement. However, the effectiveness of these devices in reducing CRBSI risk when securing hemodialysis catheters has not been explored. This single-center retrospective observational study examined 211 non-tunneled hemodialysis catheters (NTHCs) from 110 hemodialysis inpatients, of which 121 were secured using conventional skin sutures (Suture group) and 90 with GRIP-LOK (GRIP-LOK group). The stabilized inverse probability of treatment (SIPT)-weighting method was used to generate a new population (SIPT-weighted model) without group differences for each of the 12 predictors of CRBSI development (i.e., age, sex, dialysis history, concomitant acute kidney injury or diabetes, concurrent use of immunosuppressant drugs or aspirin, NTHC insertion site, methicillin-resistant Staphylococcus aureus, carriage, bacteremia event within 3 months before catheterization, hemoglobin level, and serum albumin titer). The effect of GRIP-LOK compared with sutures on CRBSI in the SIPT-weighted model was evaluated using univariate SIPT-weighted Cox proportional regression analysis, which showed a significant CRBSI suppression effect of GRIP-LOK compared with sutures (hazard ratio: 0.17 [95% CI 0.04–0.78], p = 0.023). GRIP-LOK affords a lower risk of CRBSI due to indwelling NTHCs than conventional securement using sutures.