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Koppitz J, Ascherl RG, Thome UH, Pulzer F. Incorporating anti-infective drugs into peripherally inserted catheters does not reduce infection rates in neonates. Front Pediatr 2024; 11:1255492. [PMID: 38250594 PMCID: PMC10796449 DOI: 10.3389/fped.2023.1255492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose This study assesses whether peripherally inserted central venous catheters (PICC), impregnated with anti-infective drugs, reduce the rate of infections in neonates compared with unimpregnated catheters. Methods A retrospective analysis was conducted on electronic patient records of neonates born between August 2014 and May 2020, who had PICCs inserted, either standard (S-PICC) or with anti-infective drugs (A-PICC). Catheter-related bloodstream infections (CRBSI) were diagnosed based on clinical symptoms, laboratory results, and mentioning of infection in the patient record. Data on dwell time, mechanical ventilation, insertion site, maximum C-reactive protein (CRP) concentration, and anti-infective drug use were analyzed. Results A total of 223 PICCs were included. The infection rates were A-PICC (18.9%) and S-PICC (12.5%), which were not significantly different (p = 0.257). A-PICCs had significantly longer dwell times than S-PICCs (median 372 vs. 219 h, p = 0.004). The time to infection was not different between the groups (p = 0.3). There were also no significant differences in maximum CRP, insertion site abnormalities, or anti-infective drug use between the groups. Conclusion This retrospective study did not find a significant reduction in infection rates by using PICCs containing anti-infective drugs in neonates. Current antibiotic impregnations do not seem to be effective in preventing blood stream infections.
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Affiliation(s)
- Julia Koppitz
- Neonatologie, Universitätsklinikum Leipzig, Leipzig, Germany
- Kinder- und Jugendklinik, Universitätsmedizin Rostock, Rostock, Germany
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Razak A, Alhaidari OI, Ahmed J. Interventions for reducing late-onset sepsis in neonates: an umbrella review. J Perinat Med 2023; 51:403-422. [PMID: 36303465 DOI: 10.1515/jpm-2022-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Neonatal sepsis is one of the leading causes of neonatal deaths in neonatal intensive care units. Hence, it is essential to review the evidence from systematic reviews on interventions for reducing late-onset sepsis (LOS) in neonates. METHODS PubMed and the Cochrane Central were searched from inception through August 2020 without any language restriction. Cochrane reviews of randomized clinical trials (RCTs) assessing any intervention in the neonatal period and including one or more RCTs reporting LOS. Two authors independently performed screening, data extraction, assessed the quality of evidence using Cochrane Grading of Recommendations Assessment, Development and Evaluation, and assessed the quality of reviews using a measurement tool to assess of multiple systematic reviews 2 tool. RESULTS A total of 101 high-quality Cochrane reviews involving 612 RCTs and 193,713 neonates, evaluating 141 interventions were included. High-quality evidence showed a reduction in any or culture-proven LOS using antibiotic lock therapy for neonates with central venous catheters (CVC). Moderate-quality evidence showed a decrease in any LOS with antibiotic prophylaxis or vancomycin prophylaxis for neonates with CVC, chlorhexidine for skin or cord care, and kangaroo care for low birth weight babies. Similarly, moderate-quality evidence showed reduced culture-proven LOS with intravenous immunoglobulin prophylaxis for preterm infants and probiotic supplementation for very low birth weight (VLBW) infants. Lastly, moderate-quality evidence showed a reduction in fungal LOS with the use of systemic antifungal prophylaxis in VLBW infants. CONCLUSIONS The overview summarizes the evidence from the Cochrane reviews assessing interventions for reducing LOS in neonates, and can be utilized by clinicians, researchers, policymakers, and consumers for decision-making and translating evidence into clinical practice.
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Affiliation(s)
- Abdul Razak
- Monash Newborn, Monash Children's Hospital, Department of Paediatrics, Monash University, Clayton, VIC 3168, Australia
- Division of Neonatology, Department of Pediatrics, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Omar Ibrahim Alhaidari
- Division of Neonatology, Department of Pediatrics, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, ON, Canada
| | - Javed Ahmed
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, ON, Canada
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Chen YN, Hsu JF, Chu SM, Lai MY, Lin C, Huang HR, Yang PH, Chiang MC, Tsai MH. Clinical and Microbiological Characteristics of Neonates with Candidemia and Impacts of Therapeutic Strategies on the Outcomes. J Fungi (Basel) 2022; 8:jof8050465. [PMID: 35628721 PMCID: PMC9148079 DOI: 10.3390/jof8050465] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Neonatal candidemia is associated with significant morbidities and a high mortality rate. We aimed to investigate the clinical characteristics of Candida bloodstream infections in neonates and the impact of therapeutic strategies on the outcomes. We identified all the neonates with candidemia from a medical center in Taiwan over an 18-year period (2003−2021) and analyzed them. Clinical isolates were confirmed by DNA sequencing, and antifungal susceptibility testing was performed. The prognostic factors associated with clinical treatment failure (30-day, all-cause mortality and persistent candidemia > 72 h after antifungal agents) and in-hospital mortality were analyzed using logistic regression modeling. A total of 123 neonates with 139 episodes of candidemia were included in the study. The median (IQR) gestational age and birth weight of the neonates with candidemia were 29.0 (26.0−35.0) weeks and 1104.0 (762.0−2055) g, respectively. The most common Candida spp. was Candida albicans (n = 57, 41.0%), followed by C. parapsilosis (n = 44, 31.7%), Candida guilliermondii (n = 12, 8.6%), and C. glabrata (n = 11, 7.9%). The overall susceptibility to fluconazole was 81.3%, and the resistant rates against other antifungal agents were less than 3%. The cumulative mortality rate at 7 and 30 days after the first episode of candidemia was 11.3% and 32.3%, respectively. The overall in-hospital mortality rate was 42.3%. The treatment outcomes did not change over the study period and were not affected by delayed initiation of antifungal agents. Multivariate analysis showed that delayed catheter removal (odds ratio [OR], 5.54; 95% confidence interval [CI]: 1.93−15.86, p = 0.001), septic shock (OR, 7.88; 95% CI: 2.83−21.93, p < 0.001), and multiple chronic comorbidities (OR, 8.71; 95% CI: 1.82−41.81, p = 0.007) were independently associated with the final in-hospital mortality. We concluded that the overall mortality of neonatal candidemia has remained consistently high over the past decade. Prompt early catheter removal and an aggressive treatment strategy for neonatal candidemia with septic shock would be critical to improving patient outcomes.
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Affiliation(s)
- Yu-Ning Chen
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Mei-Yin Lai
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Chih Lin
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Hsuan-Rong Huang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Peng-Hong Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Ming-Chou Chiang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (Y.-N.C.); (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
| | - Ming-Horng Tsai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (C.L.); (P.-H.Y.)
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan
- Correspondence: ; Tel.: +886-5-691-5151 (ext. 2879); Fax: +886-5-691-3222
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Tran VL, Greenberg J, Nuibe A. Evaluating the Incidence of Sepsis Post-Central Catheter Removal When Using Prophylactic Vancomycin in the Neonatal Intensive Care Unit. J Pediatr Pharmacol Ther 2021; 26:728-733. [PMID: 34588937 DOI: 10.5863/1551-6776-26.7.728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/14/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE With no consensus, the practice of using prophylactic antibiotics prior to central venous catheter (CVC) removal in NICU patients remains controversial. The objective of this study was to compare the incidence of sepsis post-CVC removal in those who received a dose of vancomycin prophylactically with those who did not. METHODS This single-center, retrospective chart review included NICU patients who had CVCs removed. Patients were excluded if they had a confirmed or suspected infection at the time of CVC removal or if the indwelling CVC was removed prior to 30 days from insertion. Primary outcome was the occurrence of a sepsis evaluation within 72 hours from CVC removal. Secondary outcomes included the development of acute kidney injury, source and identification of positive cultures, time to onset of suspected or confirmed sepsis, and the appropriate administration of intravenous vancomycin. RESULTS Eighty-two CVC removals received prophylactic vancomycin (P-VAN), and 22 CVCs did not receive prophylactic vancomycin (NP-VAN) prior to CVC removal. There were no significant differences in patient demographics between groups and median duration of indwelling CVC. Two clinical sepsis evaluations occurred in the P-VAN group compared with none in the NP-VAN group. Of all the P-VAN CVC removals, 45 (55%) received vancomycin appropriately. There were no statistical differences in all evaluated secondary outcomes. CONCLUSIONS Vancomycin administered prophylactically prior to CVC removal did not reduce the number of subsequent clinical sepsis evaluations or infections in NICU patients.
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Jansen SJ, Lopriore E, Beek MT, Veldkamp KE, Steggerda SJ, Bekker V. The road to zero nosocomial infections in neonates-a narrative review. Acta Paediatr 2021; 110:2326-2335. [PMID: 33955065 PMCID: PMC8359829 DOI: 10.1111/apa.15886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022]
Abstract
Aim Nosocomial infections (NI) in neonates are associated with prolonged hospitalisation, adverse neurodevelopmental outcome and high mortality. Over the past decade, numerous prevention strategies have resulted in significant reductions in NI rates. In this review, we aim to provide an overview of current NI rates from large, geographically defined cohorts. Methods PubMed, Web of Science, EMBASE and Cochrane Library were searched for evidence regarding epidemiology and prevention of NI in neonates. Extracted studies were synthesised in a narrative form with experiential reflection. Results Despite the abundance of geographically defined incidence proportions, an epidemiological overview of NI is difficult to provide, given the lack of consensus definition for neonatal NI and different baseline populations being compared. Successful prevention efforts have focused on implementing evidence‐based practices while eliminating outdated strategies. The most promising model for reduction in infection rates is based on quality improvement (QI) collaboratives and benchmarking, involving identification and implementation of best practices, selection of measurable outcomes and fostering a sense of community and transparency. Conclusion The preventative rather than curative approach forms the new paradigm for reducing the burden of neonatal infections. Despite progress achieved, continued work towards improved prevention practices is required in the strive towards zero NIs.
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Affiliation(s)
- Sophie J. Jansen
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
| | - Enrico Lopriore
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
| | - Martha T. Beek
- Department of Medical Microbiology Leiden University Medical Center (LUMC Leiden The Netherlands
| | - Karin Ellen Veldkamp
- Department of Medical Microbiology Leiden University Medical Center (LUMC Leiden The Netherlands
| | - Sylke J. Steggerda
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
| | - Vincent Bekker
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
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Huang P, Zhou Q, Lin Q, Lin L, Wang H, Chen X, Jiang S, Fu H, Deng Y. Complement C3a induces axonal hypomyelination in the periventricular white matter through activation of WNT/β-catenin signal pathway in septic neonatal rats experimentally induced by lipopolysaccharide. Brain Pathol 2020; 30:495-514. [PMID: 31622511 PMCID: PMC8018074 DOI: 10.1111/bpa.12798] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/10/2019] [Indexed: 02/05/2023] Open
Abstract
Neuroinflammation is thought to play a pivotal role in the pathogenesis of periventricular white matter (PWM) damage (PWMD) induced by neonatal sepsis. Because the complement cascade is implicated in inflammatory response, this study was carried out to determine whether C3a is involved in PWMD, and, if so, whether it would induce axonal hypomyelination. Furthermore, we explored if C3a would act through its C3a receptor (C3aR) and thence inhibit maturation of oligodendrocyte precursor cells (OPCs) via the WNT/β-catenin signal pathway. Sprague Dawley (SD) rats aged 1 day were intraperitoneally injected with lipopolysaccharide (LPS) (1 mg/kg). C3a was upregulated in activated microglia and astrocytes in the PWM up to 7 days after LPS injection. Concomitantly, enhanced C3aR expression was observed in NG2+ oligodendrocytes (OLs). Myelin proteins including CNPase, PLP, MBP and MAG were significantly reduced in the PWM of 28-day septic rats. The number of PLP+ and MBP+ cells was markedly decreased. By electron microscopy, myelin sheath thickness was thinner and the average g-ratios were higher. This was coupled with an increase in number of NG2+ cells and decreased number of CC1+ cells. Olig1, Olig2 and SOX10 protein expression was significantly reduced in the PWM after LPS injection. Very strikingly, C3aRa administration for the first 7 days could reverse the above-mentioned pathological alterations in the PWM of septic rats. When incubated with C3a, expression of MBP, CNPase, PLP, MAG, Olig1, Olig2, SOX10 and CC1 in primary cultured OPCs was significantly downregulated as opposed to increased NG2. Moreover, WNT/β-catenin signaling pathway was found to be implicated in inhibition of OPCs maturation and differentiation induced by C3a in vitro. As a corollary, it is speculated that C3a in the PWM of septic rats is closely associated with the disorder of OPCs differentiation and maturation through WNT/β-catenin signaling pathway, which would contribute ultimately to axonal hypomyelination.
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Affiliation(s)
- Peixian Huang
- Department of Critical Care and EmergencyGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhou510080GuangdongChina
| | - Qiuping Zhou
- Department of Critical Care and EmergencyGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhou510080GuangdongChina
- School of MedicineSouth China University of TechnologyGuangzhou510006GuangdongChina
| | - Qiongyu Lin
- Department of critical care medicineJieyang People's HospitalJieyang522000GuangdongChina
| | - Lanfen Lin
- Department of Critical Care and EmergencyGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhou510080GuangdongChina
- Department of critical care medicineGuangdong Second Provincial General HospitalGuangzhou510317GuangdongChina
| | - Huifang Wang
- Department of Critical Care and EmergencyGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhou510080GuangdongChina
- Affiliated South China HospitalSourthern Medical University (Guangdong Provincial People's Hospital)Guangzhou510515GuangdongChina
| | - Xuan Chen
- Department of Critical Care and EmergencyGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhou510080GuangdongChina
- Shantou University Medical CollegeShantou5105063GuangdongChina
| | - Shuqi Jiang
- Department of Critical Care and EmergencyGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhou510080GuangdongChina
- School of MedicineSouth China University of TechnologyGuangzhou510006GuangdongChina
| | - Hui Fu
- Department of AnatomyWuhan University School of Basic Medical SciencesWuhan430072HubeiChina
| | - Yiyu Deng
- Department of Critical Care and EmergencyGuangdong Provincial People's Hospital, Guangdong Academy of Medical SciencesGuangzhou510080GuangdongChina
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Prediction of Nonelective Central Venous Catheter Removal in Medically Complex Neonates. Pediatr Qual Saf 2019; 4:e179. [PMID: 31572882 PMCID: PMC6708650 DOI: 10.1097/pq9.0000000000000179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/30/2019] [Indexed: 12/27/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Central venous catheters (CVCs) are essential to neonatal care but associated with significant morbidity. Nonelective CVC removal (NER) is an inadequately studied outcome associated with increased morbidity, infant and family stress, and cost. This study describes prevalence and predictors of NER in infants admitted to a level IV neonatal intensive care unit and NER variation between peripherally inserted central catheters (PICCs), cutdown PICCs, and surgical CVCs. Methods: In this study, we include patient and catheter data for infants admitted to a level IV neonatal intensive care unit (2010–2015). Demographic and clinical characteristics were compared using 1-way analysis of variance (ANOVA), Kruskal-Wallis, and chi-square tests for continuous, non-normally distributed continuous, and categorical variables, respectively. The association between NER due to complication and infant and catheter characteristics was assessed using generalized linear mixed models. Results: Patient and catheter characteristics vary significantly by catheter type. The overall rate of NER is 15% (17% PICCs, 13% cutdown PICCs, and 19% surgical CVCs). The most common indications for NER are catheter breakage, blood stream infection(BSI)/central line-associated blood stream infection(CLABSI), catheter malposition, mechanical obstruction, and extravasation. Birth weight, patient diagnosis, catheter dwell time, and concurrent catheters are associated with increased odds of NER. Conclusions: Patient risk factors and potentially modifiable catheter characteristics, including catheter dwell time and concurrent catheters, are associated with increased NER. As NER is associated with a broad spectrum of adverse outcomes, we propose a quality improvement strategy to risk stratify patients and reduce exposure to high-risk, modifiable catheter characteristics.
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