Use Of Intravascular Catheters Research Articles

Randomized controlled trial on healthy volunteers of pharmacokinetic and antimicrobial activity of a novel hydrogel-containing chlorhexidine dressing to prevent catheter-related bloodstream infection.

Catheter-related blood stream infection (CRBSI) is one of the most relevant complications associated to the use of intravascular catheters. In this context, chlorhexidine gluconate (CHG) releasing dressings have been developed to reduce the catheter colonization rate and the risk of infection. The aim of this study is to analyze the release rate of CHG and the antimicrobial activity of a novel CHG-releasing dressing, Oper film® protect CHG, and to compare these parameters to those of the dressing Tegaderm™ CHG in healthy volunteers. The study was performed in a cohort of 25 healthy volunteers. Two commercially available chlorhexidine-containing dressings were evaluated and compared in this study, Oper film® protect CHG and Tegaderm™ CHG. The release of CHG and the antimicrobial capacity was determined for one week. HPLC analysis revealed that both dressings have an equivalent CHG release to the skin 2 days (Oper film® protect CHG, 321 μg/cm2; Tegaderm™ CHG, 279 μg/cm2) and 7 days (Oper film® protect CHG, 456 μg/cm2; Tegaderm™ CHG, 381 μg/cm2) after the placement of the products in the non-disinfected back of the subjects. On the other hand, Oper film® protect CHG and Tegaderm™ CHG similarly reduced colony forming units (CFU) in cultures obtained from the skin under the CHG-containing hydrogel compared to control cultures at both 2 days (control, 3.34 log10 cfu/cm2; Oper film® protect CHG, 0.64 log10 cfu/cm2; Tegaderm™ CHG, 0.7 log10 cfu/cm2) and 7 days (control, 3.95 log10 cfu/cm2; Oper film® protect CHG, 0.11 log10 cfu/cm2; Tegaderm™ CHG, 1 log10 cfu/cm2). Data confirm that the recent commercially available dressing Oper film® protect CHG maintains the release of CHG and the antimicrobial activity during at least 7 days, and possesses equivalent drug release and antimicrobial action to Tegaderm™ CHG.

Utility of Echocardiogram in Neutropenic Patients with Gram Positive Bacteremia: A Retrospective Study

Introduction: Hemato-oncology patients are vulnerable to bloodstream infections (BSI) due to their immunocompromised and neutropenic state, and the common use of intravascular catheters. The risk of infective endocarditis (IE) among non-neutropenic patients with gram positive bacteremia is substantial, however the risk is considered to be lower among neutropenic patients, though data is limited. We aimed to evaluate the incidence of IE among neutropenic hemato-oncology patients' cohort, and to explore the yield of echocardiogram in this specific population. Methods: A single center, retrospective study. Between 01/2007 and 12/2019, hospitalized patients in the Hematology department consisting of the hemato-oncology and bone marrow transplantation units were included, if they had positive blood cultures for specific organisms known to cause IE while neutropenic. Patient characteristics, results and timing of blood cultures and echocardiogram obtained during hospitalization were collected. Results: Two hundred seventy-four patients had positive blood cultures with pathogens known to be associated with IE. Overall, 340 isolates have been identified. After excluding 57 coagulase negative staphylococcus (CONS) isolates which were suspected as a contamination (identified in a single collection), 241 patients were included with 283 isolates. CONS were the most commonly isolates found, followed by streptococcus viridans, comprising 31.4% (89) and 24.3% (69) of isolates, respectively. Trans thoracic echocardiography (TTE) was performed in 108 (45%) patients overall, of which 14 (5.8%) had additional trans esophageal echocardiogram (TEE). Only one case of IE was diagnosed in our series, of a forty-seven-year-old female patient with a diagnosis of multiple myeloma in relapse after autologous stem cell transplantation. The patient presented with a stroke caused by septic emboli, fever and streptococcus viridans bacteremia. Lab works showed neutropenia of 0K/micl and thrombocytopenia of 8K/micl. TTE and TEE failed to demonstrate valvular pathology consistent with IE in this case. Valvular vegetations have not been identified on TTE nor on TTE in any other case as well. Conclusion In our experience, the yield of echocardiogram in hemato-oncological neutropenic patients with gram positive bacteremia is extremely low, owing to reduced probability of IE in this population, and thus could be avoided in most cases.

Upper extremity deep vein thrombosis: An intensivist's perspective.

Upper extremity deep vein thrombosis (UEDVT) is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients. Increasing cancer incidence, prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT. It is also associated with high rates of complications like pulmonary embolism, post-thrombotic syndrome and recurrent thrombosis. Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT; hence, a high suspicion index is required for diagnosis. Doppler ultrasound is commonly employed for diagnosis, but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients. Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies. Anticoagulant therapy alone is sufficient in most patients, and thrombolysis and surgical decompression is seldom indicated. The outcome depends on the cause and underlying comorbidities.

Epidemiological surveillance of intravascular catheter-related infections in the multidisciplinary healthcare setting: problems and solution ways

The issue of prevention and treatment of healthcare-associated infections (HCI), and in particular intravascular catheter-related infections associated with (ICRI), still remains unresolved. The purpose of the work was to determine the shortcomings in the epidemiological surveillance (ES) for ICRI and the ways to correct them, with the further development of an effective system of ES for ICRI in multidisciplinary healthcare settings. In 2019‒2020, a comprehensive epidemiological study was conducted. It was conducted on the basis of the surgical and intensive care units in multidisciplinary healthcare settings. The study included a retrospective epidemiological analysis of 160 medical records of inpatients on the use of intravascular catheters, a cross-sectional epidemiological study of the use of intravascular catheters, prospective epidemiological observation of 94 patients with intravascular catheters (n=149), a cross-sectional epidemiological study of the level of knowledge, attitude and practice of using intravascular catheters and adherence to infection control rules of 123 healthcare workers (HCW). No cases of catheter-related phlebitis or other ICRI were documented in the medical records of inpatients. An analysis of the completeness of the documentation of the catheterization procedure revealed that in 100% of cases, the probable duration of catheterization, the results of daily observation of the catheterization site, information about the change of dressings and washing of the vascular catheter were not routinely recorded. HCW have an insufficient level of knowledge about epidemiological features, infection control and prevention of ICRI. The majority of HCW (80.0±3.65%) feel the need to receive additional information regarding possible complications of vascular catheterization, infection control, and prevention of ICRI. Taking into account the mentioned shortcomings, a system of ES for ICRI in the multidisciplinary healthcare setting was developed. It includes three structural modules: informational, diagnostic and management. The developed ES system according to the ICRI is suitable for use in multidisciplinary healthcare settings and can be adapted according to the material and technical capacity of the healthcare settings. Keywords: infection control, catheter-related phlebitis, catheter-related bloodstream infections, epidemic situation.

Risk factors for infection and mortality caused by carbapenem-resistant Klebsiella pneumoniae: A large multicentre case–control and cohort study

ObjectivesTo elucidate the predictors of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and help clinicians better identify CRKP infection at an early stage. MethodsWe conducted a multicentre case–control study of 422 patients with CRKP infection and 948 with carbapenem-susceptible K. pneumoniae (CSKP) infection from March to July 2017. Binary logistic regression was used to identify risk factors for CRKP infection. The subgroups of CRKP respiratory infection, intra-abdominal infection, and bloodstream infection were also evaluated. Patients were followed up for 28 days. Independent risk factors for 28-day crude mortality of CRKP infection were analysed using Cox proportional hazards regression models. ResultsLonger stay of hospitalization, stay in the intensive care unit (ICU), previous exposure to antibacterial agents (especially carbapenems, quinolones, aminoglycosides, and tigecycline), invasive procedures, intravascular catheter use, tracheotomy, and admission to ICU in the preceding 90 days were risk factors for CRKP infection. Carbapenem exposure was the only common predictor of different types of CRKP infection. The 28-day crude mortality of CRKP infection was 24.2% and was independently associated with sex, admitted unit, and type of infection. ConclusionsStrict policies for antibiotic use, cautious decisions regarding the implementation of invasive procedures, and careful management of patients with catheters, especially intravascular catheters, are necessary to handle CRKP infection.

Duration of antibiotic therapy in central venous catheter-related bloodstream infection due to Gram-negative bacilli.

The aim of this study was to review recent data evaluating the duration of antibiotic therapy in central venous catheter-related bloodstream infection (CRBSI) due to Gram-negative bacilli (GNB). CRBSI is the most common complication associated with the use of intravascular catheters. CRBSI directly contributes to increase additional days of hospitalization, morbidity and therefore economic costs.The incidence of GNB CRBSI has been increasing considerably in the last years; this has raised a concern due to the high reported rate of multi drug resistant bacteria in these infections what poses a considerable challenge for effective treatment. However, there are no specific guidelines for management of GNB-CRBSI and optimal treatment duration has not been clearly defined.Recent studies evaluating the impact of the duration of antibiotic therapy of GNB-CRBSI have shown that short-course antibiotic therapy might be as effective as long-course therapy once the central venous catheter (CVC) has been removed. CRBSI due to GNB has shown a rapid increase in the last years. Current guidelines recommend antibiotic treatment for at least 7-14 days, although no randomized clinical trials have evaluated the optimal duration of antibiotic therapy for GNB-CRBSI. Recent data suggest that administration of appropriate antibiotic therapy for 7 days or less may be as well tolerated and effective as longer courses in episodes of GNB-CRBSI, once the CVC has been removed.

Documentation of the vascular catheterization in the multidisciplinary healthcare setting as a component of epidemiological surveillance for intravascular catheter-related infections

Vascular catheterization is associated with a risk of infection. Today in Ukraine there aren't legal documents that regulate the record of the vascular catheterization and the epidemiological surveillance of intravascular catheter-related infections (ICRI). The purpose of the study is to evaluate the completeness of documentation of peripheral and central vascular catheterization, and interventions, related with the catheters insertion and care in the multidisciplinary healthcare setting. According to the results of a retrospective epidemiological analysis which was conducted in 2020 regarding 131 medical records (MR) of inpatients with neurosurgical diseases who were in the anesthesiology and intensive care unit in 2019, the lack of proper documentation of the vascular catheterization procedure was revealed. Documentary confirmation of the vascular catheterization was found in 82 MR, which was (62.6±4.23)% of the analyzed MR. In the most cases the documented information included the following: catheter type, insertion site, size of catheter, indications for central venous catheterization, technique of central venous catheters inserting and the fact of using aseptic dressing. Indications for the insertion of peripheral venous catheters in MR were almost never recorded. Information about the expected duration of catheterization, data of daily monitoring of the insertion site, interventions related with the catheter care (catheter cleaning prior to accessing and/or after accessing, and changing dressing), indications for catheter removal weren't recorded in MR. Documenting the daily monitoring of the catheter insertion site allows to assess dynamic changes and choose the optimal strategies to prevent the development of catheter-associated complications. Insufficient documentation of the vascular catheterization makes it difficult to monitor the use of intravascular catheters. This makes impossible to identify risk factors that can affect the incidence of ICRI in the healthcare setting. The documentation of the vascular catheterization is an integral component in the system of epidemiological surveillance of ICRI, and helps to manage the risks of catheter-associated infectious complications. Keywords: venous catheter, retrospective epidemiological study, in-patient medical record, checklist, infection control.

Clinical Prognosis of Right-Sided Infective Endocarditis not Associated with Cardiac Devices or Intravenous Drug use: a Cohort Study and Meta-Analysis

Right-sided infective endocarditis (RSIE), classically associated with intravenous drug use or intracardiac devices, is considered a good-prognosis infective endocarditis (IE) form. However, predisposing factors and prognosis for “NODID” RSIE (NOt associated with cardiac Devices or Intravenous Drug use) remain unclear. The aim of this study was to evaluate predisposing factors and prognosis of NODID RSIE compared to other RSIE forms. A retrospective cohort study (January 2008–January 2019) was conducted in a reference center on 300 patients diagnosed with IE. Endocarditis-related events were defined as related to IE in mortality or open-heart surgery during follow-up. A review and meta-analysis of associated literature (January 2008-January 2019) were also performed. Fifty-seven patients presented RSIE (19%), 22 of which were NODID RSIE (39%). Use of intravascular catheters (23% vs 3%; p = 0.027) and congenital heart diseases (18% vs 0%; p = 0.019) were associated with NODID RSIE. This group had a higher in-hospital mortality (23% vs 3%; p = 0.027) and endocarditis-related event rates (41% vs 6%; p = 0.001) than non-NODID RSIE. Furthermore, NODID RSIE was independently associated with in-hospital endocarditis-related events (OR = 19.29; 95%CI:2.23–167.16; p = 0.007). Our meta-analysis evaluated four studies and identified 96 cases (30%) of NODID RSIE from 320 total RSIE cases. NODID RSIE patients demonstrated higher in-hospital mortality (RR = 2.81; 95%CI:1.61–4.90; p < 0.001; I2 = 0.0%) and necessity of open-heart surgery (RR = 13.89; 95%CI:4.14–46.60; p < 0.001; I2 = 0.0%) than non-NODID RSIE cases. Our study suggests that NODID RSIE has the highest endocarditis-related event rate and in-hospital mortality among RSIE cases and therefore should not be considered a good-prognosis IE.

Characteristics of invasive Acinetobacter infection: A multicenter investigation with molecular identification of causative organisms

We examined microbiological and clinical characteristics of invasive Acinetobacter infection occurring in four hospitals located in the Minami-Ibaraki Area. Glucose-non-fermentative Gram-negative bacilli isolated from the blood and the cerebrospinal fluid in independent cases between 2001 and 2014 were consecutively collected and those possibly to be Acinetobacter species were re-identified using molecular methods. Of 158 strains identified as Acinetobacter species, 155 were classified into 16 officially designated species, including 42 Acinetobacter pittii and 40 Acinetobacter baumannii. Imipenem non-susceptibility was detected only in 4 strains, none of which demonstrated multidrug resistance. Retrospective analyses of 154 cases for which medical records were fully available showed that the most common cause of infection was primary bloodstream infection (134 cases), of which 128 were related to intravascular catheter use. The mortality on day 28 after the onset was independently associated with cerebrovascular disease, moderate to severe renal disease, the Pitt bacteremia score, and infection other than primary bloodstream infection but not with appropriate empiric antimicrobial therapy. Isolation of A. baumannii was significantly associated with septic shock but not with the 28-day mortality. These findings, obtained in a region where drug-resistant Acinetobacter strains were much less prevailing, indicated that non-baumannii Acinetobacter species were common pathogens, that the most predominant cause of invasive Acinetobacter infection was intravascular catheter-related infection, that virulence of A. baumannii might be higher than those of other species but its association with mortality was unclear, and that administration of broad-spectrum antibiotics targeting Acinetobacter species might be deferrable in a certain situation.

Conocimiento y cumplimiento del cuidado de catéteres centrales en un Hospital Mexicano

Introducción: El uso de catéteres intravasculares constituye una herramienta fundamental para el cuidado de los pacientes, mismos que han sido asociados a las bacteriemias nosocomiales entre un 15 y 30%. El objetivo de estudio fue determinar el nivel de conocimiento y cumplimiento del personal de enfermería respecto al protocolo de cuidados de accesos vasculares centrales. Materiales y métodos: estudio descriptivo, transversal, observacional, que incluyó a 67 profesionales de enfermería que tuvieron a su cuidado pacientes con catéter venoso central. Para la recolección de datos se utilizaron dos instrumentos diseñados a partir del protocolo de cuidados emitido por la Comisión Permanente de Enfermería. Resultados: Se encontró personal con antigüedad laboral promedio de 7.9 años. En conocimiento el 58.2% se ubicó en categoría Conoce, en contraste con el cumplimiento resultando el 91% del personal en categoría Cumple. No hubo correlación entre conocimiento y cumplimiento (rho = -0.181, p = 0.797). Discusión: El cumplimiento contrastó con el conocimiento, sin embargo, los enunciados para ambas variables se relacionaron con la falta de lavado de manos, dejar el tiempo adecuado de los antisépticos y la desinfección de lúmenes a la hora de la manipulación. Conclusiones: La falta de conocimiento y cumplimiento de elementos del protocolo se relacionan directamente con situaciones procedimentales que realiza el profesional de enfermería, por lo que la falta de material e insumos no son factores para no seguir la estandarización del cuidado.

A CASE OF TSUKAMURELLA PULMONIS MASQUERADING AS PLEURAL TB IN AN IMMUNOCOMPETENT PATIENT

SESSION TITLE: Interesting Presentations of Infectious Diseases SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/20/2019 1:00 PM - 2:00 PM INTRODUCTION: Respiratory infections due to Tsukamurella have been described in immunodeficient patients. To our knowledge, only one other case report of respiratory infection has been described in an immunocompetent patient. We hereby present a case of Tsukamurella infection causing tuberculosis like syndrome in an immunocompetent patient. CASE PRESENTATION: A 42-year-old male with a past medical history of hyperthyroidism who recently moved to the United States from India presented to the hospital with chest pain and shortness of breath (SOB). The patient had a viral upper respiratory infection three weeks before presentation and eventually developed worsening sharp chest pain and SOB. He saw a provider in the clinic who recommended a chest X-ray which revealed a right-sided pleural effusion. He underwent an outpatient thoracentesis, a liter of fluid was drained and revealed an eosinophilic predominant exudative fluid. A Quantiferon gold test was negative during that time. At our hospital, the patient was again found to have a right-sided pleural effusion, underwent repeat thoracentesis and eventually, a chest tube was placed. Pleural fluid analysis revealed a monocyte predominant exudative fluid. He later underwent a decortication procedure due to re-accumulation of fluid. Cultures from the fluid and the tissue were negative for acid-fast bacilli. Pathology of the pleura revealed benign tissue with fibrinous pleuritis. Initially, testing for Acid Fast Bacilli (AFB) on three sputum samples and nucleic acid amplification testing (NAAT) remained negative. Throughout this, the patient remained under airborne precautions and was being empirically treated for pleural tuberculosis. Eventually one of the sputum cultures grew acid-fast bacilli within the first week, and this was deemed to be a rapid grower and not Mycobacterium tuberculosis. The culture was sent to Mayo clinic for identification and came back positive for Tsukamurella pulmonis. His antitubercular therapy was discontinued, and he was treated with levofloxacin and rifabutin for 3-6 months. He remained stable and disease free on follow up at 2 months. DISCUSSION: Tsukamurella species are obligate, aerobic, gram-positive, weakly acid-fast Actinomycetales. Infections are mostly related to immunocompromised state and use of intravascular catheters and prosthetic devices. Diagnosis remains a challenge as demonstrated in our case and the infection can mimic tuberculosis like syndrome leading to inappropriate treatment with anti-tubercular therapy. No guidelines exist regarding appropriate treatment, but levofloxacin and rifabutin have been described for treatment of pulmonary infection. CONCLUSIONS: As outlined in our case, Tsukamurella can mimic tuberculosis and diagnosis remains a challenge. A high index of suspicion is required to diagnose this infection in patients with high risk for tuberculosis as it changes management significantly. Reference #1: Inchingolo R., Nardi I., Chiappini F., Macis G., Ardito F., Sali M. First case of Tsukamurella pulmonis infection in an immunocompetent patient. Respir Med CME Reference #2: Chen C.H., Lee C.T., Chang T.C. Tsukamurella tyrosinosolvens bacteremia with coinfection of Mycobacterium bovis pneumonia: case report and literature review. SpringerPlus. 2016;5:2033. Reference #3: Safaei, S., Fatahi-Bafghi, M., & Pouresmaeil, O. (2017). Role of Tsukamurella species in human infections: first literature review. New microbes and new infections, 22, 6-12. https://doi.org/10.1016/j.nmni.2017.10.002 DISCLOSURES: Speaker/Speaker's Bureau relationship with Gilead Please note: $1-$1000 Added 03/15/2019 by Paul Anthony, source=Web Response, value=Honoraria No relevant relationships by Gaurav Manek, source=Web Response No relevant relationships by Anand Muthu Krishnan, source=Web Response No relevant relationships by Nihar Shah, source=Web Response

Etiological structure and antibiotic resistance of the nosocomial strains of microorganisms in the department of anaesthesiology and resuscitation

Due to the formation and wide spread of strains of microorganisms that are multiresistant to modern antimicrobial drugs, the problem of healthcare associated infections (HAIs) is relevant for all healthcare organizations. Most often HAIs are related to intravascular catheter use, mechanical ventilation, bladder catheterization, surgery and enteral feeding. Knowledge of the etiological structure of the nosocomial strains of microorganisms, regular microbiological monitoring, monitoring of antibiotic resistance are necessary to control HAIs and timely implementation of sanitary and anti-epidemic measures. The purpose of the study is to analysis of the etiological structure and determination of antibiotic resistance of the nosocomial strains isolated from patients and environmental objects in the Department of anesthesiology and resuscitation № 1 of City Clinical Hospital № 7. Materials and methods . We used conventional microbiological methods for isolating a pure culture of the pathogen with determining the sensitivity to antibiotics by the diffusimetric method (Kirby-Bauer), including the presence methicillin resistance of staphylococcal strains and extended-spectrum β-lactamases. Results and conclusion . Multiresistant strains of Acinetobacter baumannii, Proteus mirabilis and Klebsiella pneumonia were isolated in the department of anesthesiology and resuscitation. It will allow to conduct adequate antibiotic therapy, and as a result, reduce the incidence of complications, the risk of death and substantial economic losses.

A prospective clinical trial to assess peripheral venous catheter–related phlebitis using needleless connectors in a surgery department

The use of intravascular catheters is often complicated by phlebitis, which is associated with increased morbidity and extended duration of hospitalization. We conducted a study to investigate the impact of needleless intravenous access devices on the rate of phlebitis in peripheral venous catheters (PVCs). We prospectively recruited patients in 2 phases. The first group was treated with a regular cap, and the second group was treated with a needleless connector. The incidence of catheter-related phlebitis (CRP) was recorded as the primary end point. A total of 620 PVCs using regular caps were inserted into 340 patients and CRP rates were recorded. In the second phase of the study, 169 PVCs using needleless connectors were inserted into 135 patients. In the group treated with the regular cap, the CRP rate was 60% compared with 7% in the group treated with the needleless cap (P <.001). Consequently, the number of catheter replacements was decreased from 1.9 on average to 1.3 (P <.001). In both phases, patients who developed phlebitis had a statistically significant longer mean hospitalization period (P <.001), as were patients in the regular cap group (P <.01). The use of needleless connectors was found to be associated with a significant reduction of CRP in peripheral veins in a surgery department setting. The decreased morbidity resulted in a lower number of catheter replacements and duration of hospitalization.

Peripheral Intravenous Catheters – “They Don’t Get No Respect”

BackgroundOver 300 million peripheral intravenous catheters (PIV) are used yearly in the United States resulting in up to 146,000 cases of bloodstream infection. Despite their importance, relatively little effort has been invested in understanding their use and minimizing their risk.MethodsA series of point-prevalence surveys were conducted over a 10 week period on all inpatient units at the Nebraska Medical Center, a 689-bed academic medical center, to ascertain patterns of intravascular catheter use, securement techniques, dressing integrity, and evidence of phlebitis.ResultsAll inpatient units were surveyed at least three times by specially-trained observers resulting in assessments of 1,217 patients: 87 (7%) had no IV access, 667 (55%) had PIV only, 395 (32%) had central venous catheters (CVC) only, and 68 (6%) had both PIV and CVC. Not surprisingly, patients in the ICU were more likely to have a CVC than patients cared for on the ward (P < 0.001). PIV were located in the following anatomic sites: hand (27.1%), wrist (16.5%), forearm (26%), antecubital (25.1%), upper arm (3.9%), foot (0.5%) and other (0.9%). 99% of PIVs were covered with a transparent dressing. Only 1% of PIVs were dressed with gauze and tape and 6.5% were further covered with occlusive wraps. In addition, some PIVs were secured with tape (58.5%) or a device (9.2%). Secondary anchors, tape, or foam pads, were used to secure the IV tubing in 60.2% of patients. PIV dressing condition was assessed and 46.8% had significant edge lift and 21.5% had blood or fluid under the dressing. 24% of the PIV dressings had an application date noted. Patients in the ICU were more likely to have a PIV dressing application date noted on the dressing than ward patients (31% vs 23%, respectively, P = 0.047). Five percent of PIVs exhibited signs of phlebitis.ConclusionPIVs and other vascular access devices are nearly universal in hospitalized patients. There is great variability in the anatomic location of PIVs and in the manner they are dressed and secured – resulting in an opportunity for standardization and risk reduction.Disclosures All authors: No reported disclosures.

Right atrial aspergilloma mimicking atrial mixomax

Infective endocarditis is a serious but relatively rare infection that is associated with high morbidity and mortality rates. Aspergillus endocarditis is an uncommon entity and invasive cardiac aspergillosis is a severe and extremely life threatening disease. Prolonged use of intravascular catheters, anatomical cardiac conditions, exposure to multiple broad-spectrum antibiotics, intravenous drug abuse, and previous history of surgery are the most common risk factors of fungemia and fungal endocarditis. Diagnosis is based on the isolation of etiologic agents from cardiac and blood samples or specimens from other sterile sites or positive histopathological findings of pathologic specimens. Echocardiographic findings of endocardial involvement can lead to diagnosis. Echocardiographically, differencial diagnosis of tumor extensions, especially myxoma, atipically located bacterial vegetations, thrombus or fungal masses is very difficult as thrombi and infective verrus can mimic myxomas. Treatment of fungal endocarditis only with antifungal agents is generally unsuccessful and additional surgical intervention is usually required. In this case report we present an fungal endocarditis caused by Aspergillus species that mimicked an atrial myxoma echocardiographically in a patient who had a history of treatment with wide spectrum antibiotics for a long time. We suggest that patients who had broad spectrum antibiotic treatment for a long time should be scanned for fungal infections and if intracardiac mass is determined, fungal endocarditis should be considered in differential diagnosis.

Achromobacter Bacteremia in Patients With Cancer

Background Achromobacter species are Gram-negative waterborne bacteria that occasionally cause bacteremia primarily in immunocompromised hosts. Cancer patients have increased risk due to their use of intravascular catheters and immunosuppression from neoplasm, chemotherapy, and prolonged steroids. In this study, we investigated the clinical characteristics of cancer patients with Achromobacter bacteremia and identified risk factors, outcomes, and susceptibility patterns in this selective population. Methods We retrospectively reviewed all cases of Achromobacter bacteremia occurring from March 2010 to March 2015 at Moffitt Cancer Center. Data collected included age, sex, comorbidities, underlying malignancy, neutropenia status, prior bacteremia, treatment course, and patterns of susceptibilities of the isolates. We also reviewed outcomes such as discharge disposition and death. Results Eleven patients were identified with positive blood cultures for Achromobacter species. Central venous catheters were infected in 9 patients (82%), and 2 patients had recurrent bacteremia, which resolved after removal of the catheter. Eight (73%) patients had a history of prior bacteremia. Patients were treated with meropenem (n = 4), piperacillin/tazobactam (n = 3), cefepime, ceftazidime, and trimethoprim-sulfamethoxazole (TMP-SMX). The isolates were susceptible to meropenem (8 of 8 isolates), piperacillin/tazobactam (10 of 10), ceftazidime (7 of 7), and TMP-SMX (8 of 8). Most of isolates were resistant to aminoglycosides and fluoroquinolones. Conclusions The major predisposing factors for Achromobacter bacteremia were infected intravascular catheters and prior history of bacteremia. Infections can be treated with piperacillin/tazobactam, a carbapenem, or TMP-SMX. Compared with other studies, we observed similar risk factors and morbidity but with a higher rate of intravascular catheter infections.

Nationwide study on the use of intravascular catheters in internal medicine departments

The use of intravascular catheters (IVCs) in intensive care units (ICUs) has been well assessed in recent years. However, a high proportion of these devices are placed in patients outside the ICU, particularly in internal medicine departments (IMDs), where data on the quality of care are scarce. To assess the use and management of IVCs in IMDs in Spain. We performed a point prevalence study of all adult inpatients on 47 IMDs from hospitals of different sizes on one day in June 2013. A local co-ordinator was appointed to assess patients and collect data from each site. Out of the 2080 adult patients hospitalized on the study day, 1703 (81.9%) had one or more IVCs (95.4% of which were peripheral devices). Infection was detected at the insertion site in 92 catheters (5.0%); 87 patients (5.2%) had signs of sepsis, but only one case was considered to be catheter-related. The local co-ordinators estimated that 19% of the catheters in place were no longer necessary. A daily record of the need for a catheter was available in only 40.6% of cases. Our study shows clear opportunities for improvement regarding catheter use and care in Spanish IMDs. Strategies similar to those applied in ICUs should be implemented in IMDs.

Healthcare-associated infections in Northern Russia: Results of ten point-prevalence surveys in 2006–2010

Background and objectiveStatistics on healthcare-associated infections (HAIs) in Russia is scarce and has been considered to suffer from underreporting. We assessed the prevalence and changes in the prevalence of HAIs over 5 years and identified factors associated with acquiring HAIs in the pediatric hospital in Arkhangelsk, Northern Russia. Materials and methodsTen cross-sectional studies were conducted in the Arkhangelsk regional pediatric hospital biannually during 2006–2010. We used a standardized protocol, including the criteria of HAI proposed by the Centers for Disease Control and Prevention. Binary logistic regression was applied to study factors associated with HAI. ResultsAltogether, 3264 inpatients were enrolled in the study and 347 of them had HAI (11.2%). The prevalence of HAI per survey ranged from 7.1% (95% CI: 4.8%–10.4%) to 16.7% (95% CI: 13.1%–21.2%). The most prevalent HAIs were upper respiratory tract infections 5.1% (95% CI: 4.4%–5.9%), followed by urinary tract infections, 1.5% (95% CI: 1.2%–2.0%), and acute gastroenteritis, 1.4% (95% CI: 1.1%–1.9%). Compared to infants, children aged 5–9 years (OR=0.7, 95% CI: 0.4–1.0), 10–14 years (OR=0.4, 95% CI: 0.3–0.7), and ≥15 years (OR=0.3, 95% CI: 0.2–0.5) were less likely to have HAI. Neutropenia (OR=1.5, 95% CI: 1.0–2.3) and use of intravascular catheter(s) (OR=1.8, 95% CI: 1.1–3.0) were positively associated with HAI. ConclusionsThe observed prevalence of HAIs is within the range reported in several other European countries. We do not recommend generalizing our findings to other Russian settings given considerable variations between regions in both socio-economic situation and conditions of medical facilities.

A prevalence survey of intravascular catheter use in a general hospital.

Survey of intravascular catheter management is an essential step in the control and prevention of catheter-related infection. In recent years, most surveillance studies only included catheters from intensive care units (ICUs). Data regarding the level of care and adherence to international guidelines in a whole general institution are scarce. Our objective was to evaluate the care situation of intravascular catheters in our adult units of a General Hospital. We surveyed adults hospitalized in non-psychiatric/maternity wards. In a week, a nurse visited all the adult hospitalized patients. Data were registered in a protocol that included variables, such as no. of catheters, location of catheter, type of catheter, date of placement and the need of an indication of each catheter in the visit day. We included in the study a total of 753 adult patients. Of them, 653 (86.7%) had one or more inserted catheters at the moment of the study visit (total: 797 catheters). Of all the catheters, 144 (18.0%) were central venous catheters and 653 (81.9%) were peripheral lines. The hospitalization units where the patients were admitted were ICU, 52 (6.9%); and non-ICU, 601 (92.0%). There were 183 (22.9%) catheters with no need to remain in place in the day of the study. Overall, we found 464 (71.0%) patients with one or more opportunities for catheter care improvement. A rapid survey of the care situation of intravascular catheters is feasible and easy to do with our methodology. The data show great opportunity for improvement, mainly in the non-ICU areas.

Spontaneous Neonatal Thrombosis

Neonatal thrombosis is associated with infection, inflammation, impaired liver function, congenital heart disease, inherited thrombophilia, and in particular the use of intravascular catheters [1–3...