Risk Of Catheter-related Bloodstream Infection Research Articles

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.

Risk Factors of Candida parapsilosis Catheter-Related Bloodstream Infection.

Catheter-related bloodstream infection (CRBSI) is an important healthcare-associated infection caused by various nosocomial pathogens. Candida parapsilosis has emerged as a crucial causative agent for the CRBSI in the last two decades. Many factors have been associated with the development of CRBSI including, demography, pre-maturity, comorbidities (diabetes mellitus, hypertension, heart diseases, neuropathy, respiratory diseases, renal dysfunction, hematological and solid organ malignancies, and intestinal dysfunction), intensive care unit (ICU) admission, mechanical ventilation (MV), total parenteral nutrition (TPN), prior antibiotic and/or antifungal therapy, neutropenia, prior surgery, immunosuppressant, and type, site, number, and duration of catheters. This study aims to determine C. parapsilosis CRBSI risk factors. A retrospective study has been performed in an 853-bedded tertiary-care hospital in north-eastern Malaysia. All inpatients with C. parapsilosis positive blood cultures from January 2006 to December 2018 were included, and their medical records were reviewed using a standardized checklist. Out of 208 candidemia episodes, 177 had at least one catheter during admission, and 31 cases had not been catheterized and were excluded. Among the 177 cases, 30 CRBSI cases were compared to 147 non-CRBSI cases [81 bloodstream infections (BSIs), 66 catheter colonizers]. The significance of different risk factors was calculated using multivariate analysis. Multivariate analysis of potential risk factors shows that ICU admission was significantly associated with non-CRBSI as compared to CRBSI [OR, 0.242; 95% CI (0.080–0.734); p = 0.012], and TPN was significantly positively associated with CRBSI than non-CRBSI [OR, 3.079; 95%CI (1.125–8.429); p = 0.029], while other risk factors were not associated significantly. Patients admitted in ICU were less likely to develop C. parapsilosis CRBSI while patients receiving TPN were more likely to have C. parapsilosis CRBSI when compared to the non-CRBSI group.

Catheter‐related infection rates in patients receiving customized home parenteral nutrition compared with multichamber bags

AbstractBackgroundThe risk of bloodstream infections may be increased in hospitalized patients receiving ready‐made parenteral nutrition (PN) multichamber bags (MCBs) compared with customized PN; however, as highlighted in recent international guidelines, there are no comparable data relating to home PN (HPN).MethodsData from a prospectively maintained database were analyzed to compare incidence rates of catheter‐related bloodstream infections (CRBSIs) between patients receiving customized HPN compared with MCB HPN at a national UK referral center between May 2018 and August 2020.ResultsSixty patients with chronic intestinal failure were commenced on MCBs and 45 received customized HPN for a total of 5914 and 7641 catheter days, respectively. No difference in CRBSI incidence was found (0.51/1000 catheter days for MCBs, 0.39/1000 catheter days for customized HPN; incidence rate ratio, 1.29; 95% CI, 0.26–6.37). Eighteen patients were switched from customized HPN to MCB HPN. The study period covered 7401 catheter days receiving customized HPN and 4834 days on MCBs. No significant change was noted in the CRBSI rates following this switch (0.27/1000 catheter days receiving customized HPN vs 0.21/1000 catheter days on MCBs; incidence rate ratio, 1.31; 95% CI, 0.12–14.3).ConclusionThe use of MCBs for HPN patients is not associated with an increased risk of CRBSI. This study will inform international guidelines and provide reassurance for the continued, safe use of MCB HPN.

Locked Away-Prophylaxis and Management of Catheter Related Thrombosis in Hemodialysis.

Reliable vascular access is necessary for effective hemodialysis. Guidelines recommend chronic hemodialysis via an arteriovenous fistula (AVF), however, in a significant number of patients, permanent central venous catheters (CVCs) are used. The use of a tunneled catheter is acceptable if the estimated dialysis time is less than a year or it is not possible to create an AVF. The main complications associated with CVC include thrombosis and catheter-related bloodstream infections (CRBSIs), which may result in loss of vascular access. The common practice is to use locking solutions to maintain catheter patency and minimize the risk of CRBSI. This paperwork summarizes information on currently available locking solutions for dialysis catheters along with their effectiveness in preventing thrombotic and infectious complications and describes methods of dealing with catheter dysfunction. The PubMed database was systematically searched for articles about locking solutions used in permanent CVCs in hemodialysis patients. Additional studies were identified by searching bibliographies and international guidelines. Articles on end-stage kidney disease patients dialyzed through a permanent CVC were included. Information from each primary study was extracted using pre-determined criteria including thrombotic and infectious complications of CVC use, focusing on permanent CVC if sufficient data were available. Of the currently available substances, it seems that citrate at a concentration of 4% has the best cost-effectiveness and safety profile, which is reflected in the international guidelines. Recent studies suggest the advantage of 2+1 protocols, i.e., taurolidine-based solutions with addition of urokinase once a week, although it needs to be confirmed by further research. Regardless of the type of locking solution, if prophylaxis with a thrombolytic agent is chosen, it should be started from the very beginning to reduce the risk of thrombotic complications. In case of CVC dysfunction, irrespective of the thrombolysis attempt, catheter replacement should be planned as soon as possible.

Efficacy of Antimicrobial Lock Solutionsagainst Catheter-Related Infections in Hemodialysis Patients

INTRODUCTION: Hemodialysis patientsare at increased risk of catheter-related bloodstream infections (CRBSI) and catheter thrombosis asdialysis requires regular access to blood circulation through catheters. Antimicrobial Locking Solutions (ALS) containing anticoagulants and antimicrobial agents (antibiotic/non-antibiotic) are used to seal catheters in order to prevent thrombosis and CRBSI.&#x0D; &#x0D; PURPOSE: The investigation of internationalclinical studies regarding the efficacy and safety of the various ALS treatments for CRBSI in hemodialysis patients (HD patients) comparing to conventional approaches such as heparin treatment or catheter removal. &#x0D; &#x0D; METHODOLOGY: The review included prospective or retrospective clinical studies, randomized clinical trials or cohort studies published since 2015. Publications were retrieved from the &amp;ldquo;Pubmed&amp;rdquo;, &amp;ldquo;Google Scholar&amp;rdquo; and &amp;ldquo;Elsevier&amp;rdquo; databases using &amp;lsquo;catheter&amp;rsquo;, &amp;lsquo;catheter removal&amp;rsquo;, &amp;lsquo;hemodialysis&amp;rsquo; &amp;lsquo;bacteremia&amp;rsquo;, &amp;lsquo;antimicrobial lock therapy&amp;rsquo;as key words.&#x0D; &#x0D; RESULTS: 17 articles were found to meet the criteria for this systematic review. These studies investigated locking solutions containing various antibiotic (Cefazolin, Gentamicin, Vancomycin, Cotrimoxazole, Daptomycin, Trimethoprim) or/and non-antibiotic agents (Citrate, taurolidine, ethanol, urokinase, Cathasept) +/- anticoagulants, single or in various combinations. The main objective of these studies was to identify the efficacy of ALS with respect to CRBSI risk rates, catheter exchange rates and related adverse effects.&#x0D; &#x0D; CONCLUSIONS: Antimicrobial Locking Therapy appears significantly beneficial forHD patients as it reduces CRBSI risk and prolongs catheter survival at considerable rates, so it should be seriously considered for systematic useagainst catheter-related infections. Further researchis required to establish safe and effective prevention and therapeutic protocols as alternatives to catheter removal practices.

Central Venous Catheter-Related Infectious Complications in Pediatric Surgical Patients: A Single-Center Experience.

The purpose of this study was to estimate the rate of central venous catheter (CVC) colonization and catheter-related bloodstream infections (CRBSIs) in pediatric surgical patients at our institute and to determine the various risk factors for their occurrence. The electronic medical records of 260 children undergoing surgery with simultaneous CVC insertion were retrospectively reviewed. Data on demographics, primary organ system involved, site of CVC, CVC dwell time, CVC colonization, CRBSI, and organisms isolated on culture were collated, categorized, and analyzed. The rate of CVC colonization and CRBSI was 32.8 per 1,000 catheter days (19.6%) and 17.4 per 1,000 catheter days (10.4%), respectively. Patients with CVC colonization and CRBSI had a significantly higher proportion of patients younger than 1 year of age ( p = 0.014). The CVC dwell time was significantly higher in both CVC colonization (7 [5-8] days) and CRBSI (6 [5-9] days) patients ( p = 0.005). The frequency of femoral catheterization was significantly higher in patients with CRBSI and CVC colonization ( p < 0.001). Coagulase negative staphylococcus was the commonest isolate in CVC infections. Age (adjusted odds ratio [OR] = 0.87; p = 0.009), CVC dwell time (adjusted OR = 1.28; p = 0.003), and femoral CVC (adjusted OR = 9.61; p < 0.001) were independent risk factors for CRBSI. Conclusion: This study reveals important observations regarding the infectious complications of CVC in pediatric surgical patients. The rates of CVC colonization and CRBSI in this study were found to be higher as compared with previously reported rates in Western literature. However, these findings are significant in view of paucity of existing literature in pediatric surgical patients. In our study, higher risk of CRBSI was associated with younger age, increasing CVC dwell time, and femoral venous catheterization. We recommend strict compliance with CVC insertion and maintenance practices and adherence to CVC care bundles to minimize these serious complications.

Systematic Review and Meta-Analysis of Antibiotic and Antimicrobial Lock Solutions for Prevention of Hemodialysis Catheter-Related Infections.

Catheter-related bloodstream infection (CRBSI) with hemodialysis catheters are associated with increased mortality, morbidity and pose significant financial burden on healthcare. Antibiotic and antimicrobial locking solutions are effective in reducing risk of CRBSI. From inception to April 2020, we looked for relevant clinical controlled trials throughout the following databases: EBSCO, PubMed, Cochrane CENTRAL, MEDLINE, EMBASE, clinicaltrial.gov, and Google Scholar performing a metanalysis comparing antibiotic and antimicrobial lock solutions to heparin. Twenty-six studies with 4,967 patients reported the incidence of catheter-related bacteremia (CRB). The overall pooled risk ratio (RR) showed that the intervention group was associated with a significantly lower incidence of CRB by 30% compared with heparin (RR = 0.30, 95% confidence interval [CI] [0.25, 0.36], p < 0.001). Subgroup analysis showed that administration of antibiotic regimens led to a decreased risk of CRB episodes by 28% compared with the heparin group (RR = 0.28, 95% CI [0.21, 0.37], p < 0.0001). Antimicrobial solutions was associated with reduced risk of CRB by 32% compared with patients of the control group (RR = 0.32, 95% CI [0.25, 0.41], p < 0.0001). A test of subgroup differences was revealed no significant favoring of any of the two interventions. Both antibiotic and antimicrobial solutions are effective in reducing CRBSI.

Repair of central venous access devices in intestinal failure patients is safe and cost-effective: A retrospective single centre cohort study

Patients with chronic intestinal failure (IF) require home parenteral nutrition (HPN). Central venous access is needed for prolonged use of PN, usually via a long term central venous access device (CVAD). Post insertion there may be mechanical complications with a CVAD such as catheter rupture or tear. Repair of damaged CVADs is possible to avoid risks associated with catheter replacement in patients with IF. However, catheter related blood stream infections (CRBSI) are a concern when CVAD's are accessed or manipulated. To investigate the success of repair of CVADs in patients with IF on HPN, related to repair longevity and incidence of CRBSI following repair. Nutrition team records of CVAD repairs carried out in patients with IF were reviewed retrospectively for the period April 2015 to March 2019. Nutrition Clinical Nurse Specialists carried out 38 repairs in 27 patients. Male n=5, female n=22; mean age 55 years. Catheter longevity before first repair (n=27): median 851 days, IQR 137-1484 days. 30/38 (78.9%) of repairs were successful lasting ≥30days. Hospital admission was avoided in 76% of cases. 4 patients in the failed repair group underwent catheter re-insertion where 4 had a further, subsequently successful, repair, an overall success rate of 89.4% (34/38). 30-day CRBSI rate was 0.09/1000 catheter days in repaired catheters. In comparing costs, there is a potential cost saving of 2766GBP for repair compared to replacement of damaged CVADs. Repair of tunnelled CVADs in patients with IF is successful and safe with no increased risk of CRBSI. Significant cost savings may be made.

Reduction of Tunnelled Haemodialysis Catheters Related Infections by Intervention and Training: A 12 and 18-month Audit

Introduction: Catheter-Related Blood Stream Infections (CRBSI) are an important complication of both non tunnelled and tunnelled haemodialysis catheters, but are often poorly reported for tunnelled haemodialysis-catheters. Aim: To assess the rate, aetiology, and outcomes of CRBSI in patients using a tunnelled catheter at 12-month and 18-month audits at the newly-opened haemodialysis unit having care bundle as a part of routine catheter care. Materials and Methods: A retrospective cross-sectional study involving two audits of CRBSI risk (12-month and 18-month audit) was conducted by the dialysis unit doctors and nursing staff at Medanta Super-Specialty Private Hospital, Indore, Madhya Pradesh, India. Centres for Disease Control (CDC) and prevention core intervention/care bundle for Blood Stream Infections (BSI) reduction were incorporated as a part of routine catheter care. The 12-month (May 2018 to April 2019) and 18-month (May 2018 to November 2019) internal clinical audit were evaluated to assess the impact of care bundle on incidence of CRBSIs. Kidney-Disease- Outcome Quality-Initiative (KDOQI)-2006-criteria was used to define CRBSI. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 19.0 software (IBM Corporation, New York, United States). Descriptive and dispersion statistical analysis was done for studied variables. Results: Total patients in 12-months audit with tunnelled haemodialysis catheter were 14 (7 male and 7 female) with median age 64 years and in 18-months audit patient with tunnelled haemodialysis catheter were 18 (11 male and 7 female) with median age 67.5 years. CRBSI incidence was 2.58 per 1000 catheter days at the end of 12-month, with 132 (71.25-202.25) days of median catheter use. Over the 18-month, the incidence of CRBSI dropped to 1.99 per 1000 catheter days. Median period of catheter use increased to 149.5 (83.5-294.5) days. The primary organisms isolated were predominantly gram negative bacterias. Conclusion: Tunnelled catheters may be a reasonable alternative vascular access for haemodialysis in patients with arteriovenous fistula failure as implementation and maintenance of multidisciplinary care bundle reduces CRBSI rate in such patients.

Importance of nurses in reducing catheter-related bloodstream infections connected with parenteral nutrition

Rationale: The multidisciplinary nutritional support team (MNST) consists in a clinician, dietitian, pharmacist and nurse, and it improves the quality of patient care mostly though education that improves nutritional assessment, appropriate nutrient delivery and reduces mechanical, infective and metabolic complications. The nurse plays an important role, mainly in reducing the risk of catheter-related bloodstream infections connected with parenteral Nutrition (CRBSI-PN).

Effects of a Quality Improvement Program to Reduce Central Venous Catheter-Related Infections in Hemodialysis Patients

BackgroundCentral catheter infections are of concern in patients on hemodialysis because of the high risk of catheter-related bloodstream infections, sepsis, and death. Adequate nursing is critical for the prevention of such infections. This study aimed to use the PDCA (plan-do-check-act) method to reduce the incidence of central venous catheter infection using management in the maintenance of central venous catheter in patients on hemodialysis, compared with routine care. MethodsThis pilot study recruited patients on hemodialysis via central venous catheterization at the Blood Purification Center of Ruijin Hospital between November 2017 and November 2018. The patients were randomized to the routine and PDCA groups. All participants received routine nursing. The PDCA group received central venous catheter management by PDCA. The incidence of central venous catheterization-related infections, nursing satisfaction, and quality of life were compared between the two groups. ResultsA total of 122 participants were enrolled in each group. The incidence of central catheter-related bloodstream infection, as the primary outcome, was 0.8 and 8.8 cases per 1000 catheter days in the PDCA and routine groups, respectively (P < 0.001). In addition, as the secondary outcomes, the scores of nursing satisfaction (health guidance, nursing technology, and therapeutic effects) score and quality of life (physiological, psychological, social, and environmental status) were better in the PDCA group than in the routine group (all P < 0.01). ConclusionsThis pilot study suggests that the PDCA cycle model can effectively reduce the incidence of central venous catheter-related infections and improve satisfaction and quality of life in patients on hemodialysis.

Catheter-related bloodstream infections in palliative care patients receiving parenteral nutrition by medical home care.

Catheter-related bloodstream infections (CRBSIs) constitute a major complication associated with the use of central venous lines (CVL). The aim of this study was to investigate the incidence proportion and risk factors of CRSBI in palliative care patients with CVL receiving home parenteral nutrition (HPN). Medical records from patients admitted to a medical home care unit in stockholm, Sweden, during 2017 were reviewed (n=1022) and 454 palliative care patients with a CVL were identified. Data on CRBSI cases, HPN exposure time, type of parenteral nutrition (PN), age, diagnosis and type of CVL were collected. Twenty-nine of 143 patients receiving HPN through a CVL were diagnosed with a CRBSI (20%). Nine of 311 patients with CVL without exposure for HPN developed CRBSI (3%). The risk of a CRBSI was significantly higher in patients receiving HPN compared with those not receiving HPN, OR 8.5 (95% CI 4.0 to 18.7). For those receiving HPN six to seven times a week the risk was even higher, OR 13 (95% CI 5.1 to 30.3). The highest incidence proportion of CRBSI (31%) was found in a home care team where patients had been trained to disconnect themselves from the PN drip. Sex, cancer versus non-cancer, type of CVL or protein content in the PN, did not differ between patients that developed CRBSI versus those that did not develop the outcome. HPN entails a high risk of CRBSI. A high frequency of PN and incautious handling of the disconnection of the drip, seem to be the most important risk factors.

Catheter Infection Among Hemodialysis Patients: A Report From Fars Province, Iran

Background: Catheter-related bloodstream infection (CRBI) is one of the main causes of mortality and morbidity among hemodialysis patients. Thus, documenting its prevalence and risk factors in each center will help control them and improve patients’ prognosis. Methods: This one-year cross-sectional study was performed in the educational hospitals of Shiraz University of Medical Sciences. Patients were selected using the census method. The included cases aged more than 18 years and had hemodialysis using a double lumen catheter. Finally, data were analyzed by SPSS analytical software. Results: In general, 345 patients with a mean age of 57.90±16.59 were included (192 men and 153 women) in this study. In addition, 138 (40%) patients had the elementary education and 127 (36.8%) study participants were housekeepers. Further, the subclavian vein was the most used site for the catheter (228 cases, 66.10%). Further, 187 (54.20%) cases had CRBI of whom, 181 patients had a previous history of CRBI. Furthermore, fever and chills at the time of hemodialysis were the most prevalent manifestations. Eventually, patients’ age, job, level of education, location of the catheter, previous history of CRBI, hand washing (patient and health-care personnel), use of gloves (health-care personnel), oral administration of antibiotics, use of topical antibiotic ointment, and the pattern of dressing change had a significant impact on the risk of CRBI (P<0.001). Conclusions: The prevalence of CRBI is still high. Accordingly, it is needed that interventions be conducted to reduce modifiable risk factors for this issue and prevent hemodialysis patients’ morbidity and mortality.

P1340CATHETER-RELATED BLOODSTREAM INFECTIONS IN HEMODIALYSIS: ANALYSIS OF PATIENT- AND CATHETER- ASSOCIATED RISK FACTORS

Abstract Background and Aims Tunneled central venous catheter (T CVC) use is rising among patients undergoing chronic hemodialysis (HD) and non-tunneled (NT) CVCs are often used for HD initiation in late referral chronic kidney disease (CKD) or acute kidney injury (AKI). Catheter-related bloodstream infections (CRBSI) are a major complication of CVC use. This study examines potential patient- and CVC- related factors associated with CRBSI incidence and its microbiological features. Method In this retrospective single-center study, 413 patients undergoing an extracorporeal treatment (HD or Plasma Exchange) between February 1st 2014 and January 31st 2017 with 561 CVCs were recruited. Clinical data at study entry and CVC type are summarized in table 1. All bloodstream infections (BSI) occurring during the observation period were recorded and classified into CRBSI or non-CRBSI (nCRBSI), and their infecting agents collected. An incidence rate ratio (IRR (95% CI)) was calculated to assess the association between CRBSI incidence rate (IR), expressed as events/1000 catheter-days, and each clinical variable or CVC type. Significant associations at the univariate analyses were investigated with multivariate cox models. Results During a cumulative follow-up time of 66686 catheter-days, 54 (IR: 0.81) CRBSI and 30 (IR: 0.45) nCRBSI events occurred. CRBSI had higher frequency of GRAM+ bacteria compared with nCRBSI (70% vs 33%, p&amp;lt;0.001). Among CRBSI, GRAM- bacteria were more frequent in patients with age &amp;lt;80y (16 (36%) vs 0, p=0.02), and T CVC (40% vs 18%, p=0.07). At the univariate analysis, male sex, age &amp;lt;80y and AKI were associated with higher CRBSI IR (table 2). Compared with T Jugular CVC, higher CRBSI IR was associated with NT Jugular (IRR 6.45 (2.99-13.56), p&amp;lt;0.0001) and NT Femoral (IRR 12.90 (5.87-27.61), p&amp;lt;0.0001) CVC; T Femoral CVC was associated with higher non-significant IR (IRR 2.45 (0.93-5.85), p=0.07). At the multivariate analyses, factors associated with higher CRBSI IR were AKI (hazard ratio - HR 3.03 (1.38–6.67), p=0.006), NT CVC (HR 3.11 (1.30–7.41), p=0.01), and Femoral CVC (HR 2.63 (1.36–5.07), p=0.004). Conclusion Patients affected by AKI and use of NT or Femoral CVCs are independently associated with CRBSI risk.

Hyperosmotic Infusion and Oxidized Surfaces Are Essential for Biofilm Formation of Staphylococcus capitis From the Neonatal Intensive Care Unit.

Staphylococcus capitis is an opportunistic pathogen often implicated in bloodstream infections in the neonatal intensive care unit (NICU). This is assisted by its ability to form biofilms on indwelling central venous catheters (CVC), which are highly resistant to antibiotics and the immune system. We sought to understand the fundamentals of biofilm formation by S. capitis in the NICU, using seventeen clinical isolates including the endemic NRCS-A clone and assessing nine commercial and two modified polystyrene surfaces. S. capitis clinical isolates from the NICU initiated biofilm formation only in response to hyperosmotic conditions, followed by a developmental progression driven by icaADBC expression to establish mature biofilms, with polysaccharide being their major extracellular polymer substance (EPS) matrix component. Physicochemical features of the biomaterial surface, and in particular the level of the element oxygen present on the surface, significantly influenced biofilm development of S. capitis. A lack of highly oxidized carbon species on the surface prevented the immobilization of S. capitis EPS and the formation of mature biofilms. This information provides guidance in regard to the preparation of hyperosmolar total parenteral nutrition and the engineering of CVC surfaces that can minimize the risk of catheter-related bloodstream infections caused by S. capitis in the NICU.

The Insertion Site Should Be Considered for the Empirical Therapy of Short-Term Central Venous and Arterial Catheter-Related Infections.

Little is known on causative pathogens of intravascular catheters infection according to the catheter insertion site. The present study aimed to describe the epidemiology of causative microorganisms of catheter-related infection and colonization according to the insertion site. Multicenter observational study using data from four large randomized controlled trials investigating different prevention strategies in which extensive prospective high-quality data collection at catheter insertion and catheter removal was performed. Twenty-five ICUs in France. Patients were recruited from 2006 to 2014 as soon as they required a catheterization with a short-term central venous catheter or peripheral arterial catheter with an expected duration of use of more than 48 hours. We described the distribution of microorganisms in central venous catheter and arterial catheter-related bloodstream infections and colonization according to the insertion type (femoral vs nonfemoral) included in the four studies. None. A total of 7,235 patients and 15,259 catheters were included. Among central venous catheter, the distribution of microorganisms associated with catheter-related bloodstream infection and colonization was significantly different between femoral and nonfemoral sites. Among central venous catheter catheter-related bloodstream infection, nonfermenting Gram-negative bacilli were more frequently detected at the femoral site (31% vs 4% for nonfemoral site; p < 0.01). After adjustment for confounding factors, the femoral site was still associated with an increased risk for catheter-related bloodstream infection due to nonfermenting Gram-negative bacilli (odds ratio, 6.33; 95% CI, 1.59-25.28; p < 0.01). Among colonized arterial catheters, the distribution of microorganisms was significantly different between femoral and radial site (p < 0.01). Colonized arterial catheters due to nonfermenting Gram-negative bacilli were more frequently observed at the femoral site (20% vs nonfemoral site 12%; p = 0.01). The proportion of intravascular catheter infections due to nonfermenting Gram-negative bacilli was high for the femoral insertion site. Empirical antipseudomonal therapy should be considered if a femoral catheter-related bloodstream infection is suspected.