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Bouhrour N, Nibbering PH, Bendali F. Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens. Pathogens 2024; 13:393. [PMID: 38787246 PMCID: PMC11124157 DOI: 10.3390/pathogens13050393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Medical devices such as venous catheters (VCs) and urinary catheters (UCs) are widely used in the hospital setting. However, the implantation of these devices is often accompanied by complications. About 60 to 70% of nosocomial infections (NIs) are linked to biofilms. The main complication is the ability of microorganisms to adhere to surfaces and form biofilms which protect them and help them to persist in the host. Indeed, by crossing the skin barrier, the insertion of VC inevitably allows skin flora or accidental environmental contaminants to access the underlying tissues and cause fatal complications like bloodstream infections (BSIs). In fact, 80,000 central venous catheters-BSIs (CVC-BSIs)-mainly occur in intensive care units (ICUs) with a death rate of 12 to 25%. Similarly, catheter-associated urinary tract infections (CA-UTIs) are the most commonlyhospital-acquired infections (HAIs) worldwide.These infections represent up to 40% of NIs.In this review, we present a summary of biofilm formation steps. We provide an overview of two main and important infections in clinical settings linked to medical devices, namely the catheter-asociated bloodstream infections (CA-BSIs) and catheter-associated urinary tract infections (CA-UTIs), and highlight also the most multidrug resistant bacteria implicated in these infections. Furthermore, we draw attention toseveral useful prevention strategies, and advanced antimicrobial and antifouling approaches developed to reduce bacterial colonization on catheter surfaces and the incidence of the catheter-related infections.
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Affiliation(s)
- Nesrine Bouhrour
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
| | - Peter H. Nibbering
- Department of Infectious Diseases, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Farida Bendali
- Laboratoire de Microbiologie Appliquée, Faculté des Sciences de la Nature et de la Vie, Université de Bejaia, Bejaia 06000, Algeria;
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Austin PD, Green SM, Gaisford S. Bacterial isolates from positive paired venous catheter and peripheral blood cultures taken during parenteral nutrition were the same species but different strains: A case report. Nutrition 2024; 121:112353. [PMID: 38402669 DOI: 10.1016/j.nut.2024.112353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The same microbial species isolated from blood simultaneously drawn from a central venous catheter hub and a peripheral vein (paired blood cultures) during parenteral nutrition may be assumed to represent the same strain. This case report provides an example of this assumption being incorrect along with a comparator example of it being correct. This has implications for interpretation of differential time to positivity and differential quantitative blood cultures during investigation of suspected intraluminal intravascular catheter or cannula bloodstream infection. CASE DESCRIPTION Two patients ages ≥18 y prescribed parenteral nutrition each had positive paired blood cultures that had been taken for suspected catheter bloodstream infection because of temperature spikes ≥38°C. The paired Staphylococcus epidermidis isolates from the first patient and the paired Enterococcus faecium isolates from the second patient were each tested beyond routine clinical care to establish if they could be different strains. The central and peripheral isolates of Staphylococcus epidermidis from the first patient were different strains based on hospital-reported antibiograms, genomic DNA profiles, thermograms, and weaker growth and different sizes of colonies of the central strain compared with the peripheral strain. There were no such differences for the isolates of Enterococcus faecium from the second patient. RESULTS The central and peripheral isolates of Staphylococcus epidermidis from the first patient were different strains based on hospital-reported antibiograms, genomic DNA profiles, thermograms, and weaker growth and different sizes of colonies of the central strain compared with the peripheral strain. There were no such differences for the isolates of Enterococcus faecium from the second patient. CONCLUSION This case report indicates consideration should be given to reporting whether bacteria have been identified at either species or strain level if differential time to positivity or differential quantitative blood cultures are used to define catheter or cannula bloodstream infection.
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Affiliation(s)
- Peter D Austin
- UCL School of Pharmacy, University College London, London, UK; Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Steve M Green
- Department of Microbiology and Virology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Simon Gaisford
- UCL School of Pharmacy, University College London, London, UK
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Gündogdu F, Semerci R, Bay F. Totally Implantable Venous Access Device Care Practices and Experiences of Pediatric and Adult Oncology Nurses. JOURNAL OF INFUSION NURSING 2024; 47:182-189. [PMID: 38744243 DOI: 10.1097/nan.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
This study aimed to determine the practices of nurses working in pediatric and adult oncology clinics regarding totally implantable venous access device (TIVAD) care. The descriptive study was conducted with 227 oncology nurse members of the Oncology Nursing Association. The data were collected online with a survey form, which included questions about the participants' sociodemographic characteristics, professional experience, and TIVAD implementation practices. Descriptive statistics and ꭓ2 tests were used for the analysis of the data. It was determined that 44.1% of the nurses used 0.9% NaCl for active TIVAD flushing; 15.9% of them used a positive-pressure 0.9% NaCl-filled syringe; 12.3% used antireflux connectors; 85.5% used manual positive pressure technique; and 53.7% used the pulsatile technique. A statistical difference was found between nurses' training on TIVAD care and TIVAD occlusion rate in the clinic, TIVAD infection rate, following the guidelines, and using the pulsatile technique (P < .05). This study revealed that there are differences in the practices for TIVAD care and that the recommendations in the literature/guidelines are not implemented at the desired level to ensure continuity and prevent complications.
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Affiliation(s)
- Fatma Gündogdu
- Author Affiliations: Department of Nursing, School of Health Sciences, KTO Karatay University, Konya, Türkiye (Gündogdu); School of Nursing, Koç University, İstanbul, Türkiye (Semerci); Gazi University Hospital, Ankara, Türkiye (Bay)
- Fatma Gündogdu is an assistant professor in the Department of Nursing at KTO Karatay University. She specializes in adult cancer and symptom management. Her research and teaching focus on the management of chemotherapy and radiotherapy-induced symptoms and on reducing these symptoms with nonpharmacological methods. She has been a member of the Turkish Oncology Nursing Society for 27 years and is a member of the board. Currently, she is a board member of the Oncology Nursing Association and is the coordinator of both the research and the geriatric hematologic oncology nursing working commissions. She has collaborated with the Ministry of Health in developing guidelines for the safe use of antineoplastic drugs in Türkiye. Furthermore, she pioneered the development of the chemotherapy nursing certificate program and, subsequently, the oncology nursing certificate program in Türkiye. Remziye Semerci is an assistant professor in the Department of Pediatric Nursing at Koç University. She is interested in childhood cancer and symptom management. Her research and teaching focus on the management of chemotherapy-induced symptoms and reducing these symptoms with nonpharmacological methods. She is a member of the Turkey Oncology Nursing Society; additionally, she takes a role in some commissions, including the Pediatric Oncology Group (group secretary) and Research Group (group secretary). She is a Turkish representative of the Young Cancer Nurses Network and a member of the SIOP Nursing Working Group. Figen Bay is a specialist nurse and has worked as a nurse at a university hospital for 28 years. She served as the charge nurse for the Oncology Hematology Clinic for many years. She has been a board member of the Turkish Oncology Nursing Society for 22 years and has served as the society's president for the last 6 years. Ms. Bay has attended numerous national and international congresses and courses in the field of oncology, authored several book chapters, and holds the authority responsible for the Ministry of Health-approved Oncology Nursing Certification training program. Actively involved in planning and implementing training programs nationwide, in every region and province, she aims to educate nurses in the field of oncology and to enhance the quality of oncology patient care
| | - Remziye Semerci
- Author Affiliations: Department of Nursing, School of Health Sciences, KTO Karatay University, Konya, Türkiye (Gündogdu); School of Nursing, Koç University, İstanbul, Türkiye (Semerci); Gazi University Hospital, Ankara, Türkiye (Bay)
- Fatma Gündogdu is an assistant professor in the Department of Nursing at KTO Karatay University. She specializes in adult cancer and symptom management. Her research and teaching focus on the management of chemotherapy and radiotherapy-induced symptoms and on reducing these symptoms with nonpharmacological methods. She has been a member of the Turkish Oncology Nursing Society for 27 years and is a member of the board. Currently, she is a board member of the Oncology Nursing Association and is the coordinator of both the research and the geriatric hematologic oncology nursing working commissions. She has collaborated with the Ministry of Health in developing guidelines for the safe use of antineoplastic drugs in Türkiye. Furthermore, she pioneered the development of the chemotherapy nursing certificate program and, subsequently, the oncology nursing certificate program in Türkiye. Remziye Semerci is an assistant professor in the Department of Pediatric Nursing at Koç University. She is interested in childhood cancer and symptom management. Her research and teaching focus on the management of chemotherapy-induced symptoms and reducing these symptoms with nonpharmacological methods. She is a member of the Turkey Oncology Nursing Society; additionally, she takes a role in some commissions, including the Pediatric Oncology Group (group secretary) and Research Group (group secretary). She is a Turkish representative of the Young Cancer Nurses Network and a member of the SIOP Nursing Working Group. Figen Bay is a specialist nurse and has worked as a nurse at a university hospital for 28 years. She served as the charge nurse for the Oncology Hematology Clinic for many years. She has been a board member of the Turkish Oncology Nursing Society for 22 years and has served as the society's president for the last 6 years. Ms. Bay has attended numerous national and international congresses and courses in the field of oncology, authored several book chapters, and holds the authority responsible for the Ministry of Health-approved Oncology Nursing Certification training program. Actively involved in planning and implementing training programs nationwide, in every region and province, she aims to educate nurses in the field of oncology and to enhance the quality of oncology patient care
| | - Figen Bay
- Author Affiliations: Department of Nursing, School of Health Sciences, KTO Karatay University, Konya, Türkiye (Gündogdu); School of Nursing, Koç University, İstanbul, Türkiye (Semerci); Gazi University Hospital, Ankara, Türkiye (Bay)
- Fatma Gündogdu is an assistant professor in the Department of Nursing at KTO Karatay University. She specializes in adult cancer and symptom management. Her research and teaching focus on the management of chemotherapy and radiotherapy-induced symptoms and on reducing these symptoms with nonpharmacological methods. She has been a member of the Turkish Oncology Nursing Society for 27 years and is a member of the board. Currently, she is a board member of the Oncology Nursing Association and is the coordinator of both the research and the geriatric hematologic oncology nursing working commissions. She has collaborated with the Ministry of Health in developing guidelines for the safe use of antineoplastic drugs in Türkiye. Furthermore, she pioneered the development of the chemotherapy nursing certificate program and, subsequently, the oncology nursing certificate program in Türkiye. Remziye Semerci is an assistant professor in the Department of Pediatric Nursing at Koç University. She is interested in childhood cancer and symptom management. Her research and teaching focus on the management of chemotherapy-induced symptoms and reducing these symptoms with nonpharmacological methods. She is a member of the Turkey Oncology Nursing Society; additionally, she takes a role in some commissions, including the Pediatric Oncology Group (group secretary) and Research Group (group secretary). She is a Turkish representative of the Young Cancer Nurses Network and a member of the SIOP Nursing Working Group. Figen Bay is a specialist nurse and has worked as a nurse at a university hospital for 28 years. She served as the charge nurse for the Oncology Hematology Clinic for many years. She has been a board member of the Turkish Oncology Nursing Society for 22 years and has served as the society's president for the last 6 years. Ms. Bay has attended numerous national and international congresses and courses in the field of oncology, authored several book chapters, and holds the authority responsible for the Ministry of Health-approved Oncology Nursing Certification training program. Actively involved in planning and implementing training programs nationwide, in every region and province, she aims to educate nurses in the field of oncology and to enhance the quality of oncology patient care
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Elli S, Cannizzo L, Giannini L, Romanato F, Trimarco C, Pessina M, Lucchini A, Foti G, Rondelli E. Femorally inserted central catheters with exit site at mid-thigh: A low risk alternative for central venous catheterization. J Vasc Access 2024; 25:808-812. [PMID: 36324227 DOI: 10.1177/11297298221132073] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Femorally inserted central catheters are increasingly used, especially after the COVID-19 pandemic, also thanks to widespread of tunneling techniques that allow the exit site to be moved away from the groin. METHODS In this retrospective observational study, femorally inserted catheters, with exit site at mid-thigh and the tip in Inferior vena cava or in Inferior vena cava at the junction with right atrium, have been observed and complications have been analyzed. All catheters were inserted by trained Nurses of a tertiary hospital Vascular Access Team. RESULTS In 142 catheters (126 inserted via common femoral vein and 16 inserted via superficial femoral vein) and 3060 catheter days, we observed an infection rate of 1.3 events/1000 catheter days (all of them in oncologic patients and up to 30 days of catheterization), 2 cases of thrombotic events (1.41%) and 17 cases of accidental removal (11.97%). Other rare complications, as primary malposition, tip migration, arterial pseudoaneurysm, have been recorded. The average length of catheters inserted, from the exit site to the tip, was 47.6 ± 2.4 cm. CONCLUSION The attention to the correct position of the tip, the exit site at mid-thigh and the new techniques during insertion make these femoral catheters as safe as other central vascular access devices. For this kind of central access device, a catheter at least 50 cm long is needed.
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Affiliation(s)
- Stefano Elli
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | | | | | | | | | - Alberto Lucchini
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Foti
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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van den Bosch CH, Frakking FNJ, Loeffen YGT, van Tinteren H, van der Steeg AFW, Wijnen MHWA, van de Wetering MD, van der Bruggen JT. The applicability of the central line-associated bloodstream infection (CLABSI) criteria for the evaluation of bacteremia episodes in pediatric oncology patients. Eur J Haematol 2024; 112:832-839. [PMID: 38294085 DOI: 10.1111/ejh.14175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND The aim of this study was to investigate the applicability of the central line-associated bloodstream infection (CLABSI) criteria of the Centers for Disease Control and Prevention in pediatric oncology patients. METHODS Bacteremia episodes from 2020 to 2022 from a prospective cohort of pediatric oncology patients with a central venous catheter were included. Episodes were classified by three medical experts following the CLABSI criteria as either a CLABSI or non-CLABSI (i.e., contamination, other infection source, or mucosal barrier injury-laboratory confirmed bloodstream infection (MBI-LCBI)). Subsequently, they were asked if and why they (dis)agreed with this diagnosis following the criteria. The primary outcome was the percentage of episodes where the experts clinically disagreed with the diagnosis given following the CLABSI criteria. RESULTS Overall, 84 bacteremia episodes in 71 patients were evaluated. Following the CLABSI criteria, 34 (40%) episodes were classified as CLABSIs and 50 (60%) as non-CLABSIs. In 11 (13%) cases the experts clinically disagreed with the diagnosis following the CLABSI criteria. The discrepancy between the CLABSI criteria and clinical diagnosis was significant; McNemar's test p < .01. Disagreement by the experts with the CLABSI criteria mostly occurred when the experts found an MBI-LCBI a more plausible cause of the bacteremia than a CLABSI due to the presence of a gram negative bacteremia (Pseudomonas aeruginosa n = 3) and/or mucositis. CONCLUSIONS A discrepancy between the CLABSI criteria and the evaluation of the experts was observed. Adding Pseudomonas aeruginosa as an MBI pathogen and incorporating the presence of mucositis in the MBI-LCBI criteria, might increase the applicability.
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Affiliation(s)
| | - Florine N J Frakking
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Yvette G T Loeffen
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Harm van Tinteren
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Marc H W A Wijnen
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Jan-Tom van der Bruggen
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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6
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Curtis K, Gough K, Krishnasamy M, Tarasenko E, Hill G, Keogh S. Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review. BMC Cancer 2024; 24:498. [PMID: 38641574 PMCID: PMC11027380 DOI: 10.1186/s12885-024-12099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation. METHODS A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data. RESULTS From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies. CONCLUSION Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.
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Affiliation(s)
- Kerrie Curtis
- Department of Nursing, University of Melbourne, Melbourne, Australia.
- Peter MacCallum Cancer Centre, Melbourne, Australia.
- Austin Health, Melbourne, Australia.
| | - Karla Gough
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | | | - Geoff Hill
- Royal Melbourne Hospital, Melbourne, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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Yu J, Yuan A, Liu Q, Wang W, Sun Y, Li Z, Meng C, Zhou Y, Cao S. Effect of preoperative immunonutrition on postoperative short-term clinical outcomes in patients with gastric cancer cachexia: a prospective randomized controlled trial. World J Surg Oncol 2024; 22:101. [PMID: 38632641 PMCID: PMC11022452 DOI: 10.1186/s12957-024-03348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/24/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Although current guidelines(ESPEN guideline: Clinical nutrition in surgery and other guidelines) recommend preoperative immunonutrition for cachectic gastric cancer patients, the strength of the recommendation is weak, and the level of evidence is low. The benefits of preoperative immunonutrition still remain controversial. PATIENTS AND METHODS 112 patients with gastric cancer cachexia were enrolled in the study and randomly assigned in a 1:1 ratio to receive either preoperative enteral immunonutrition support (IN, n = 56) or standard enteral nutrition support (SEN, n = 56). The primary endpoint was the incidence of infectious complications, and the secondary endpoints included the nutritional indicators, inflammatory markers, immune parameters, postoperative recovery and complications and gastrointestinal intolerance reactions. RESULTS The incidence of postoperative infectious complications(P = 0.040) and overall complications (P = 0.049)was significantly lower in the IN group compared to the SEN group. In terms of laboratory inflammatory indexes, patients in the IN group demonstrated significantly lower levels of white blood cells (WBC), C-reactive protein (CRP), and interleukin-6 (IL-6), as well as higher levels of lymphocytes (LYMPH) and immunoglobulin A (IgA), compared to patients in the SEN group, with statistically significant differences. In terms of clinical outcomes, the IN group had a shorter duration of antibiotic use (P = 0.048), shorter hospital stay (P = 0.018), and lower total hospital costs (P = 0.034) compared to the SEN group. The IN group also experienced significantly less weight loss after surgery (P = 0.043). CONCLUSION Preoperative administration of immunonutrition formula has a positive impact on the incidence of infectious complications in patients with gastric cancer cachexia after surgery. It improves patients' inflammatory and immune status, shortens hospital stays, and reduces healthcare costs. Preoperative use of immunonutrition may contribute to the improvement of prognosis in this high-risk population.
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Affiliation(s)
- Junjian Yu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Antai Yuan
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Qi Liu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Wei Wang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Yuqi Sun
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Zequn Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Cheng Meng
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China.
| | - Shougen Cao
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong Province, 266000, P.R. China.
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Färber J, Kaasch AJ, Schalk E. Shorter time-to-positivity and turnaround time with mycosis blood culture bottles when detecting Candida albicans. Infection 2024; 52:701-703. [PMID: 38393640 PMCID: PMC10955001 DOI: 10.1007/s15010-024-02216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Jacqueline Färber
- Medical Faculty, Institute of Medical Microbiology and Hospital Hygiene, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Achim J Kaasch
- Medical Faculty, Institute of Medical Microbiology and Hospital Hygiene, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Enrico Schalk
- Department of Hematology, Oncology and Cell Therapy, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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MacPhail A, Dendle C, Slavin M, McQuilten Z. Hospital-acquired bloodstream infections in patients with cancer: current knowledge and future directions. J Hosp Infect 2024; 148:39-50. [PMID: 38490489 DOI: 10.1016/j.jhin.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Patients with cancer experience higher rates of preventable harm from hospital-acquired bloodstream infections (haBSIs) and central-line-associated bloodstream infections (CLABSIs) compared with the general hospital population. The prevention of haBSIs and CLABSIs in patients with cancer is an urgent priority, and requires standardized surveillance and reporting efforts. The application of haBSI and CLABSI definitions, classification systems and surveillance strategies for patients with cancer is complex, and there is wide variation in clinical practice. Existing systems were not designed explicitly for patients with cancer, and have different strengths and weaknesses in the cancer setting. For these reasons, epidemiological estimates of haBSIs and CLABSIs in patients with cancer also require careful interpretation. This complexity can be a barrier to identifying appropriate targets for intervention and reducing preventable harm. This review provides an overview of key concepts and challenges in haBSI surveillance and prevention specific to patients with cancer. In addition, this review summarizes the strengths and weaknesses of commonly used surveillance definitions and denominators in the setting of cancer care; existing surveillance practice; epidemiology of haBSIs and CLABSIs; prevention strategies; and current knowledge gaps. A global collaborative effort to harmonize the surveillance of hospital-acquired infections in patients with cancer would be invaluable to improve the accuracy and utility of existing data, advance efforts to prevent hospital-acquired infections, and improve patient safety.
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Affiliation(s)
- A MacPhail
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Infectious Diseases, Monash Health, Melbourne, Australia
| | - C Dendle
- Department of Infectious Diseases, Monash Health, Melbourne, Australia; School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - M Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Z McQuilten
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Haematology, Monash Health, Clayton, Australia.
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Mareković I, Vujnović T, Radanović J, Herljević Z, Kuliš T, Pavlović M, Mucavac L, Dejanović-Bekić S, Bilić E. Bloodstream Infections in Pediatric Oncology Patients: Bacterial Pathogen Distribution and Antimicrobial Susceptibility at the University Hospital Centre Zagreb, Croatia-A 5-Year Analysis. J Pediatr Hematol Oncol 2024; 46:e156-e163. [PMID: 38237002 DOI: 10.1097/mph.0000000000002809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024]
Abstract
The epidemiology of bacterial pathogens causing bloodstream infections (BSIs) in pediatric hematology/oncology patients is changing and resistance to antimicrobial agents is globally spread. We retrospectively assessed demographic, clinical, and microbiologic data of BSIs during a 5-year period at a pediatric hematology/oncology unit from January 1, 2017, to December 31, 2021, at the University Hospital Centre Zagreb, Zagreb, Croatia. In 66 pediatric patients with malignancies, 93 BSI episodes were registered and 97 bacterial isolates were cultured. The Gram-positive versus Gram-negative ratio was 67 (69.1%) versus 30 (30.9%). Coagulase-negative staphylococci (48; 49.6%) were the most frequent isolates, followed by Enterobacterales (17; 17.5%) and Staphylococcus aureus (6; 6.2%). Multidrug resistance isolates included extended spectrum β-lactamase producers (n=3). Resistance rates to piperacillin/tazobactam, cefepime, and meropenem in Gram-negative isolates were 15.4%, 14.3%, and 0.0%, respectively. Gram-positive bacteria are the most common cause of BSI in our patients. Resistance rates to piperacillin/tazobactam and cefepime in Gram-negative isolates make meropenem a better choice for empirical antimicrobial treatment. As national and hospital data may differ, the surveillance of pathogen distribution and antimicrobial susceptibility in pediatric hematology/oncology wards is necessary to adjust empirical treatment accordingly.
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Affiliation(s)
- Ivana Mareković
- Clinical Department of Clinical Microbiology, Infection and Prevention Control, University Hospital Centre Zagreb
- Department of Medical Microbiology and Parasitology, School of Medicine University of Zagreb
| | - Tajana Vujnović
- Department of Clinical Microbiology, Andrija Štampar Teaching Institute of Public Health
| | - Jasna Radanović
- Department of Microbiology, Institute of Public Health Zagreb County
| | - Zoran Herljević
- Clinical Department of Clinical Microbiology, Infection and Prevention Control, University Hospital Centre Zagreb
| | - Tomislav Kuliš
- Department of Urology, University Hospital Centre Zagreb
| | - Maja Pavlović
- Department of Pediatrics, Division of Hematology and Oncology, University Hospital Zagreb
| | - Lucija Mucavac
- Department of Pediatrics, Division of Hematology and Oncology, University Hospital Zagreb
| | - Sara Dejanović-Bekić
- Department of Pediatrics, Division of Hematology and Oncology, University Hospital Zagreb
| | - Ernest Bilić
- Department of Pediatrics, Division of Hematology and Oncology, University Hospital Zagreb
- Department of Pediatrics, School of Medicine University of Zagreb
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11
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Zvizdic Z, Zaimovic E, Milisic E, Jonuzi A, Glamoclija U, Vranic S. The Frequency, Severity, and Risk Factors of Hickman CatheterRelated Complications in Pediatric Cancer Patients: A Single-Center Experience from Bosnia and Herzegovina. Turk Arch Pediatr 2024; 59:144-149. [PMID: 38454222 PMCID: PMC11058997 DOI: 10.5152/turkarchpediatr.2024.23179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/26/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVE This study aimed to identify the frequency, severity, and risk factors associated with Hickman catheter-related complications in children with hemato-oncological malignancies at the largest pediatric tertiary care unit in Bosnia and Herzegovina. MATERIALS AND METHODS A cross-sectional study was conducted on a cohort of pediatric cancer patients who underwent Hickman central venous catheters (CVCs) between January 2019 and December 2022. Mechanical, infectious, and thrombotic Hickman catheter-related complications were evaluated and analyzed. We also investigated possible risk factors associated with these complications. RESULTS Seventy-one Hickman CVCs were inserted in 68 children (44 boys and 24 girls) at a mean age of 6.9 ± 4.6. Forty (58.8%) children had hematological malignancies and 28 (41.2%) solid cancers. The median follow-up after Hickman CVC insertion was 190 days (95% CI [160-212]) for 12 644 catheter days. During follow-up, 10 (14.1%) mechanical, 7 (9.9%) infectious, and 1 (1.4%) thrombotic complications were recorded (0.8, 0.48, and 0.08 for mechanical, infectious, and thrombotic complications per 1000 catheter days, respectively). A slightly higher incidence of complications was recorded in children with hematological malignancies (1.59 per 1000 catheter days) compared with children with solid cancers (1.22 complications per 1000 catheter days). CONCLUSION Using Hickman CVCs for long-term venous access in infusional chemotherapy for pediatric cancer patients is safe but is associated with significant morbidity.
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Affiliation(s)
- Zlatan Zvizdic
- Department of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Emin Zaimovic
- University of Sarajevo Faculty of Medicine, Sarajevo, Bosnia and Herzegovina
- Public Health Center Breza, Breza, Bosnia and Herzegovina
| | - Emir Milisic
- Department of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Department of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Una Glamoclija
- Scientific Research Unit, Bosnalijek d.d., Sarajevo, Bosnia and Herzegovina
- Department of Biochemistry and Clinical Analysis, University of Sarajevo Faculty of Pharmacy, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- QU Health, Qatar University College of Medicine, Doha, Qatar
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12
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Bayoudh F, Giot JB, Descy J, Fontaine C, Hayette MP, Baron F, Willems E, Beguin Y, Frippiat F, Servais S. Oral minocycline as systemic therapy for uncomplicated venous access device-related bloodstream infection with coagulase-negative staphylococci after allogeneic hematopoietic cell transplantation. Curr Res Transl Med 2024; 72:103422. [PMID: 38244302 DOI: 10.1016/j.retram.2023.103422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/03/2023] [Accepted: 10/15/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Venous access device-related bloodstream infection (VAD-BSI) with coagulase-negative staphylococci (CoNS) is a common complication after allogeneic hematopoietic cell transplantation (alloHCT). Standard systemic antimicrobial therapy for uncomplicated VAD-BSI with methicillin-resistant CoNS consists of intravenous (IV) vancomycin (vanco). This requires hospitalization, needs new competent venous access, exposes patients to potential toxicity (mainly renal) and increases the risk of commensal flora dysbiosis with selection of vanco-resistant enterococci. Combined with VAD management (removal or antibiotic locks), oral minocycline (mino) has been evaluated as an alternative systemic therapy for the treatment of uncomplicated VAD-BSIs with CoNS at our center, primarily when the reference treatment with IV vanco was not possible (renal failure or allergy) or when hospitalization was refused by patients. Here, we retrospectively report our single center experience with this mino-based approach. PATIENTS AND METHODS From January 2012 to December 2020, 24 uncomplicated VAD-BSIs with CoNS in 23 alloHCT patients were treated with oral mino as systemic antibiotic therapy in combination with VAD management. VAD were implantable ports (n = 17), tunneled catheter (n = 1) or PIC-lines (n = 6). Staphylococci were S. epidermidis (n = 21) or S. haemolyticus (n = 3). Mino was administered with a loading dose of 200 mg followed by 100 mg BID for 7-14 days. For 8 VAD-BSIs, patients were initially treated with IV vanco for the first 1-3 days followed by oral mino, while 16 VAD-BSIs were treated with oral mino as the sole antimicrobial agent for systemic therapy. VAD management consisted of catheter removal (for tunneled catheters and PIC-lines, n = 7) or antibiotic locks with vanco (n = 15) or gentamicin (n = 2) administered at least 3 times a week for 14 days (for ports). RESULTS Overall, clearance of bacteremia (as assessed by negativity for the same CoNS of surveillance peripheral blood cultures drawn between day+ 3 and +30 after initiation of systemic therapy) was achieved in all but 1 patient (with port) who had persistent bacteremia at day +9. No complication such as suppurative thrombophlebitis, endocarditis, distant foci of infection or BSI-related death was observed in any patient during the 3-month period after initiation of treatment. Regarding the 17 port-BSI cases for which VAD conservative strategy was attempted, failure of 3-month VAD preservation was documented in 7/17 cases and 3-month recurrence of VAD-BSI was observed in 3/17 cases (with 1 patient with cellulitis). Treatment with mino was well tolerated except for a mild skin rash in one patient. CONCLUSION Further prospective studies are needed to evaluate efficacy and safety of this approach.
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Affiliation(s)
- Firas Bayoudh
- Department of Clinical Hematology, University Hospital of Liège, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Jean-Baptiste Giot
- Department of Infectious Disease, University Hospital of Liège, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Julie Descy
- Laboratory of Clinical Microbiology, University Hospital of Liège, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Corentin Fontaine
- Laboratory of Clinical Microbiology, University Hospital of Liège, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Marie-Pierre Hayette
- Laboratory of Clinical Microbiology, University Hospital of Liège, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Frédéric Baron
- Department of Clinical Hematology, University Hospital of Liège, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Evelyne Willems
- Department of Clinical Hematology, University Hospital of Liège, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Yves Beguin
- Department of Clinical Hematology, University Hospital of Liège, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Frédéric Frippiat
- Department of Infectious Disease, University Hospital of Liège, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Sophie Servais
- Department of Clinical Hematology, University Hospital of Liège, CHU Sart-Tilman, 4000 Liège, Belgium.
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13
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Pitiriga VC, Bakalis J, Campos E, Kanellopoulos P, Sagris K, Saroglou G, Tsakris A. Central Venous Catheters versus Peripherally Inserted Central Catheters: A Comparison of Indwelling Time Resulting in Colonization by Multidrug-Resistant Pathogens. Antibiotics (Basel) 2024; 13:89. [PMID: 38247648 PMCID: PMC10812679 DOI: 10.3390/antibiotics13010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The use of peripherally inserted central catheters (PICCs) as an alternative to central venous catheters (CVCs) has steadily risen over the last two decades. However, there is an ongoing debate regarding research evidence that supports any clear advantages or disadvantages of them compared to traditional central venous lines. The present study was conducted to compare the indwelling time of CVC and PICC placements leading to microbial colonization by multidrug-resistant microorganisms (MDROs) in critically ill patients. METHODS A single-center retrospective descriptive study was performed that reviewed the medical records of critically ill patients with colonized CVCs and PICCs who were hospitalized during a 24-month period (May 2019-May 2021). To evaluate the association between indwelling time of catheter placement and colonization rates, events were categorized into three groups, each representing a one-week time interval of catheter indwelling time: group 1: ≤7 days, group 2: 8-14 days, and group 3: >14 days. RESULTS A total of 207 hospitalized patients with colonized PICCs or CVCs were included in the study. Of these, 144 (69.5%) had a CVC placement and 63 (30.5%) had a PICC placement. The overall colonization rate (per 1.000 catheter/days) was 14.73 in the CVC and 5.67 in the PICC cohort (p = 0.003). In the group of PICCs, 12/63 (19%) of the pathogens were MDROs and 51/63 (81%) were non-MDROs, while in the group of CVCs, 86/144 (59.7%) were MDROs and 58/144 (40.3%) were non-MDROs (p < 0.001). The colonization rate in the CVC cohort, was 6.98 for group 1, 21.57 for group 2, and 21.6 for group 3 (p = 0.019). The colonization rate of MDROs was 3.27 for group 1, 14.47 for group 2, and 12.96 for group 3 (p = 0.025). Regarding the PICC cohort, the colonization rate was 1.49 for group 1, 3.19 for group 2, and 8.99 for group 3 (p = 0.047). No significant difference existed between the three groups in terms of MDRO pathogens, with the colonization rate being 0 for group 1, 0.8 for group 2, and 1.69 for group 3 (p = 0.78). Within the CVC cohort, the most common isolated microorganism was MDR Acinetobacter baumannii (n = 44; 30.6%), followed by MDR Klebsiella pneumoniae (n = 27; 18.7%). In the PICC cohort, the predominant isolated microorganism was Candida non-albicans (n = 15; 23.8%), followed by Candida albicans, coagulase-negative staphylococci, and MDR Klebsiella pneumoniae in equal numbers (n = 6; 9.5%). CONCLUSIONS Our findings show that while the indwelling time of PICC placement was longer compared to CVCs, its colonization rate was considerably lower. Furthermore, high colonization rates by microorganisms, especially MDROs, arose later during catheterization in PICCs compared to CVCs, suggesting that in terms of vascular infections, PICCs may be a safer alternative to conventional CVCs for long-term intravenous access.
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Affiliation(s)
- Vassiliki C. Pitiriga
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
| | - John Bakalis
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Elsa Campos
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Petros Kanellopoulos
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Konstantinos Sagris
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - George Saroglou
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece; (J.B.); (E.C.); (P.K.); (K.S.); (G.S.)
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
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14
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van den Bosch CH, Kops AL, Loeffen YGT, van der Steeg AFW, van de Wetering MD, Fiocco MF, Ekkelenkamp MB, Wolfs TFW. Central Venous Catheter-related Bloodstream Infections Caused by Enterobacterales in Pediatric Oncology Patients: Catheter Salvage or Removal. Pediatr Infect Dis J 2024; 43:49-55. [PMID: 37983368 PMCID: PMC10723766 DOI: 10.1097/inf.0000000000004106] [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] [Accepted: 08/24/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The aim was to determine whether salvage treatment with systemic antibiotics is a safe and effective strategy for Enterobacterales bloodstream infections (BSI) in pediatric oncology patients with a central venous catheter (CVC). METHODS A retrospective study was performed on oncology and stem cell recipient patients with a CVC and blood culture with Enterobacterales , at the Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands. Analyses were performed for all BSI and for episodes meeting central line-associated bloodstream infection (CLABSI) criteria. The cumulative incidence of an event (ie, removal, intensive care admission or death) was estimated after blood culture collection for episodes primarily treated with antibiotics. The effect of prognostic factors on the hazard of the event of interest was assessed by estimating a Cox proportional hazard regression model. RESULTS In total, 95 CVC-related Enterobacterales BSIs in 82 patients were included; 12 (13%) BSIs required immediate CVC removal and for 83 (87%) BSIs CVC salvage was attempted. The cumulative incidence of events at 60 days was 53.0% [95% confidence interval (CI): 41.7-63.1] for BSIs (n = 83), and 64.4% (95% CI: 48.3-76.7) for CLABSIs (n = 45). The events occurred after a median of 6 (Q1-Q3: 2-15) and 6 (Q1-Q3: 2-20) days for BSIs and CLABSIs, respectively. Intensive care admission after salvage treatment was required in 16% of the BSIs and CLABSIs, resulting in death in 5% and 2% of cases, respectively. No significant association between risk factors and events was found. CONCLUSIONS The cumulative incidence of an event at 60 days after salvage treatment for Enterobacterales CLABSIs and BSIs in pediatric oncology patients is high. Immediate CVC removal appears recommendable for this patient group.
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Affiliation(s)
| | - Aranka L. Kops
- From the Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands
| | - Yvette G. T. Loeffen
- Department of Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
| | | | | | - Marta F. Fiocco
- From the Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands
- Mathematical Institute, Leiden University, Leiden, the Netherlands
- Department of Biomedical Science, Section Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Miquel B. Ekkelenkamp
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Tom F. W. Wolfs
- Department of Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
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15
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Chen H, Yamane T, Haruyama T, Ishihara M, Kazahari H, Sakamoto T, Tanzawa S, Honda T, Ichikawa Y, Watanabe K, Seki N. Predictors of central line-associated bloodstream infections in cancer patients undergoing chemotherapy through implanted venous access ports: a retrospective, observational study. Transl Cancer Res 2023; 12:3538-3546. [PMID: 38192991 PMCID: PMC10774051 DOI: 10.21037/tcr-23-1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 01/10/2024]
Abstract
Background Central venous catheters (CVCs) are sometimes superior to peripheral vascular access for chemotherapy. Central line-associated bloodstream infections (CLABSIs) are an important complication of CVCs in chemotherapy. Methods A retrospective, observational study was conducted to investigate patients with implanted venous access ports (PORTs) from July 2010 to June 2021 in a teaching hospital. General conditions of the PORTs, backgrounds, and characteristics of patients were compared between CLABSI cases and uninfected cases to identify predictors of CLABSI. Results A total of 566 patients with PORTs who underwent chemotherapy were enrolled in this study, with CLABSI identified in 41 patients, for a total of 436,597 catheter-days. The median duration of PORT use was 26 vs. 494 days (P<0.001) in the CLABSI and uninfected groups, respectively. There were no significant differences in tumor classification, staging, white blood cell (WBC) count, neutrophil proportion, lymphocyte proportion, albumin, C-reactive protein (CRP), and performance status between the CLABSI and uninfected groups. Multivariable analysis showed that antibiotic usage within the previous week, total protein (TP), and immediate PORT use were independently associated with CLABSI, and their odds ratios (ORs) were 4.89 [95% confidence interval (CI): 1.67, 14.35], 1.95 (95% CI: 1.14, 3.53), and 3.13 (95% CI: 1.18, 8.30), respectively. The area under the curve (AUC) of the receiver-operating characteristic curve for TP was 0.63, and the cutoff value was 5.9 g/dL. Conclusions PORT implantation should be avoided in patients who had antibiotic treatment episodes within 1 week, especially for those with low serum TP levels.
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Affiliation(s)
- Hao Chen
- Department of Oncology, Teikyo University Hospital, Tokyo, Japan
| | - Takamasa Yamane
- Department of Oncology, Teikyo University Hospital, Tokyo, Japan
| | | | - Masashi Ishihara
- Department of Oncology, Teikyo University Hospital, Tokyo, Japan
| | - Hiroki Kazahari
- Department of Oncology, Teikyo University Hospital, Tokyo, Japan
| | | | - Shigeru Tanzawa
- Department of Oncology, Teikyo University Hospital, Tokyo, Japan
| | - Takeshi Honda
- Department of Oncology, Teikyo University Hospital, Tokyo, Japan
| | - Yasuko Ichikawa
- Department of Oncology, Teikyo University Hospital, Tokyo, Japan
| | | | - Nobuhiko Seki
- Department of Oncology, Teikyo University Hospital, Tokyo, Japan
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Penack O, Peczynski C, Boreland W, Lemaitre J, Afanasyeva K, Kornblit B, Jurado M, Martinez C, Natale A, Pérez-Simón JA, Brunello L, Avenoso D, Klein S, Ozkurt ZN, Herrera C, Wichert S, Chiusolo P, Gavriilaki E, Basak GW, Schoemans H, Koenecke C, Moiseev I, Peric Z. ECP versus ruxolitinib in steroid-refractory acute GVHD - a retrospective study by the EBMT transplant complications working party. Front Immunol 2023; 14:1283034. [PMID: 38149251 PMCID: PMC10750400 DOI: 10.3389/fimmu.2023.1283034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction Extracorporal Photophoresis (ECP) is in clinical use for steroid-refractory and steroid-dependent acute GVHD (SR-aGVHD). Based on recent Phase-III study results, ruxolitinib has become the new standard of care for SR-aGVHD. Our aim was to collect comparative data between ruxolitinib and ECP in SR-aGVHD in order to improve the evidence base for clinical decision making. Methods We asked EBMT centers if they were willing to participate in this study by completing a data form (Med-C) with detailed information on GVHD grading, -therapy, -dosing, -response and complications for each included patient. Results 31 centers responded positively (14%) and we included all patients receiving alloSCT between 1/2017-7/2019 and treated with ECP or ruxolitinib for SR-aGVHD grades II-IV from these centers. We identified 53 and 40 patients with grades II-IV SR-aGVHD who were treated with ECP and ruxolitinib, respectively. We performed multivariate analyses adjusted on grading and type of SR-aGVHD (steroid dependent vs. refractory). At day+90 after initiation of treatment for SR-aGVHD we found no statistically significant differences in overall response. The odds ratio in the ruxolitinib group to achieve overall response vs. the ECP group was 1.13 (95% CI = [0.41; 3.22], p = 0.81). In line, we detected no statistically significant differences in overall survival, progression-free survival, non-relapse mortality and relapse incidence. Discussion The clinical significance is limited by the retrospective study design and the current data can't replace prospective studies on ECP in SR-aGVHD. However, the present results contribute to the accumulating evidence on ECP as an effective treatment option in SR-aGVHD.
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Affiliation(s)
- Olaf Penack
- Medical Clinic, Department for Haematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
- EBMT Transplant Complications Working Party, Paris, France
| | - Christophe Peczynski
- EBMT Transplant Complications Working Party, Paris, France
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR-S 938, Sorbonne University, Paris, France
| | - William Boreland
- EBMT Transplant Complications Working Party, Paris, France
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR-S 938, Sorbonne University, Paris, France
| | - Jessica Lemaitre
- EBMT Transplant Complications Working Party, Paris, France
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR-S 938, Sorbonne University, Paris, France
| | - Ksenia Afanasyeva
- Department of Haematology, First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | - Brian Kornblit
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - Manuel Jurado
- Department of Haematology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Carmen Martinez
- Department of Hematology, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Jose Antonio Pérez-Simón
- Department of Hematology, University Hospital Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Lucia Brunello
- Department of Haematology, SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Daniele Avenoso
- Department of Haematology, Kings’ College Hospital, London, United Kingdom
| | - Stefan Klein
- Department of Haematology, Universitaetsmedizin, Mannheim, Germany
| | - Zubeyde Nur Ozkurt
- Department of Haematology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Concha Herrera
- Servicio de Hematología Hospital Universitario Reina Sofía, IMIBIC, University of Cordoba, Cordoba, Spain
| | - Stina Wichert
- Department of Haematology, Skane University Hospital, Lund, Sweden
| | - Patrizia Chiusolo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore-Roma, Rome, Italy
| | - Eleni Gavriilaki
- Department of Haematology, Papanicolaou G. Hospital, Thessaloniki, Greece
| | - Grzegorz W. Basak
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, Oncology and Internal Medicine, The Medical University of Warsaw, Warsaw, Poland
| | - Hélène Schoemans
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Christian Koenecke
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Ivan Moiseev
- Department of Haematology, First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | - Zinaida Peric
- EBMT Transplant Complications Working Party, Paris, France
- Department of Haematology, University Hospital Centre Zagreb, Zagreb, Croatia
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17
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Annetta MG, Elli S, Marche B, Pinelli F, Pittiruti M. Femoral venous access: State of the art and future perspectives. J Vasc Access 2023:11297298231209253. [PMID: 37953601 DOI: 10.1177/11297298231209253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
In the past 5 years, non-dialysis femoral venous access has changed in terms of indications, techniques of insertion, and expected incidence of complications. To the traditional non-emergency indication for femoral catheters-obstruction of the superior vena cava-many other indications have been added, both in intensive and non-intensive care. The insertion technique has evolved, thanks to ultrasound guided venipuncture, tunneling, and ultrasound based intraprocedural tip location. Insertion of femorally inserted central catheters may be today regarded as a procedure with an extremely low intraprocedural and post-procedural risk. The risk of infection is reduced by the possibility of the exit site at mid-thigh, by the use of cyanoacrylate glue for sealing the exit site, and by appropriate intraprocedural strategies of infection prevention. The risk of catheter-related thrombosis is low, due to several concomitant strategies: a proper match between vein diameter and catheter caliber; an accurate intraprocedural assessment of tip location by ultrasound and/or intracavitary ECG; the consistent use of ultrasound guided venipuncture and micro-introducer kits; an adequate stabilization of the catheter at the exit site. The risk of mechanical complications and the risk of lumen occlusion are minimized when using polyurethane, power injectable catheters. All these novelties have brought a revolution in the field of femoral venous access, so that this route may be considered as safe and effective as other approaches to central venous catheterization.
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Affiliation(s)
| | - Stefano Elli
- ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Bruno Marche
- Vascular Access Team, Fondazione Policlinico Universitario "A Gemelli," Roma, Italy
| | - Fulvio Pinelli
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mauro Pittiruti
- Vascular Access Team, Fondazione Policlinico Universitario "A Gemelli," Roma, Italy
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Meschiari M, Kaleci S, Monte MD, Dessilani A, Santoro A, Scialpi F, Franceschini E, Orlando G, Cervo A, Monica M, Forghieri F, Venturelli C, Ricchizzi E, Chester J, Sarti M, Guaraldi G, Luppi M, Mussini C. Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study. Antimicrob Resist Infect Control 2023; 12:126. [PMID: 37957773 PMCID: PMC10644555 DOI: 10.1186/s13756-023-01332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Vancomycin-resistant enterococcus (VRE) was the fastest growing pathogen in Europe in 2022 (+ 21%) but its clinical relevance is still unclear. We aim to identify risk factors for acquired VRE rectal colonization in hematological patients and evaluate the clinical impact of VRE colonization on subsequent infection, and 30- and 90-day overall mortality rates, compared to a matched control group. METHODS A retrospective, single center, case-control matched study (ratio 1:1) was conducted in a hematological department from January 2017 to December 2020. Case patients with nosocomial isolation of VRE from rectal swab screening (≥ 48 h) were matched to controls by age, sex, ethnicity, and hematologic disease. Univariate and multivariate logistic regression compared risk factors for colonization. RESULTS A total of 83 cases were matched with 83 controls. Risk factors for VRE colonization were febrile neutropenia, bone marrow transplant, central venous catheter, bedsores, reduced mobility, altered bowel habits, cachexia, previous hospitalization and antibiotic treatments before and during hospitalization. VRE bacteraemia and Clostridioides difficile infection (CDI) occurred more frequently among cases without any impact on 30 and 90-days overall mortality. Vancomycin administration and altered bowel habits were the only independent risk factors for VRE colonization at multivariate analysis (OR: 3.53 and 3.1; respectively). CONCLUSIONS Antimicrobial stewardship strategies to reduce inappropriate Gram-positive coverage in hematological patients is urgently required, as independent risk factors for VRE nosocomial colonization identified in this study include any use of vancomycin and altered bowel habits. VRE colonization and infection did not influence 30- and 90-day mortality. There was a strong correlation between CDI and VRE, which deserves further investigation to target new therapeutic approaches.
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Affiliation(s)
- Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy.
| | - Shaniko Kaleci
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Martina Del Monte
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Andrea Dessilani
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Antonella Santoro
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Francesco Scialpi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Gabriella Orlando
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Adriana Cervo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Morselli Monica
- Section of Hematology, Department of Surgical and Medical Sciences, AOU Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Forghieri
- Section of Hematology, Department of Surgical and Medical Sciences, AOU Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Venturelli
- Clinical Microbiology Laboratory, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Enrico Ricchizzi
- Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, Viale Aldo Moro 21, Bologna, 40127, Italy
| | - Johanna Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, 41121, Italy
| | - Mario Sarti
- Clinical Microbiology Laboratory, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Giovanni Guaraldi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Mario Luppi
- Section of Hematology, Department of Surgical and Medical Sciences, AOU Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
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García-Aroca MA, Fernández-de Miguel JM, Franceschi MAD, Fernández-Vaquero MA, Meléndez-Salinas DA, Piñero-Merino M, Álvarez-Avello JM. Inhalation anesthesia without any intravenous management for pediatric proton beam therapy. Paediatr Anaesth 2023; 33:946-954. [PMID: 37526245 DOI: 10.1111/pan.14739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Proton beam therapy is an oncological treatment, argued to be an appropriate tumor irradiation technique for childhood solid tumors. Due to its duration and the need for immobility, many children require anesthesia for proton therapy sessions. As not many centers in the world provide this therapy, there is little published research about pediatric anesthesia for these cases, and the available data suggest a preference for intravenous anesthesia or combined intravenous and inhalation anesthesia. We conducted this study with the aim of describing and analyzing the inhalation anesthetic management of children undergoing proton therapy at our medical center, comparing our results with studies that have followed different anesthetic protocols. METHODS We reviewed two major databases (Web of Science and Scopus) to find papers that had addressed, to date, anesthesia for pediatric proton therapy. To describe our anesthetic management, we included all pediatric patients treated with proton therapy under anesthesia in our center between June 2020 and August 2021. The characteristics of the patients, their diagnoses, treatments, airway management, drugs administered, duration of induction, and recovery from anesthesia, and adverse effects where all recorded. All anesthesiologists followed a strict anesthetic protocol based only on inhalational anesthesia with sevoflurane delivered via laryngeal mask airway. RESULTS Of the total of 1082 papers found in Web of Science and Scopus on pediatric proton therapy, 11 have addressed its anesthetic management, using intravenous or combined intravenous and inhalation anesthesia. Between June 2020 and August 2021, 31 children were anesthetized in our center to receive proton therapy under inhalational anesthesia (total number of sessions: 873). The mean anesthesia induction time was 4.1 min (SD = 0.7, 95% CI [3.9, 4.4]). The mean anesthesia recovery time was 13.8 min (SD = 4.1, 95% CI [12.3, 15.3]). The percentage of non-serious adverse effects was 0.7% (Clopper-Pearson 95% CI [0.3, 1.5]). The percentage of serious adverse effects was 0.1% (Clopper-Pearson 95% CI [0, 0.6]), without statistically significant difference with other published works with different anesthetic approaches. CONCLUSION Inhalation anesthesia without any intravenous management for pediatric proton therapy is, in our experience, an effective technique with a complication rate similar to other anesthetic approaches.
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Affiliation(s)
- Miguel A García-Aroca
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
| | | | | | | | | | - María Piñero-Merino
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
| | - José M Álvarez-Avello
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
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Dang F, Zhai T, Ding N, Gao J, Li R, Li H, Ran X. Development and Validation of a Questionnaire to Measure ICU Nurses' Knowledge, Attitudes, and Practices Related to Central Line Bloodstream Infection Practices. J Nurs Care Qual 2023; 38:E59-E65. [PMID: 36917825 PMCID: PMC10442122 DOI: 10.1097/ncq.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Currently, there is no instrument available to assess intensive care unit (ICU) nurses' knowledge, attitudes, and practices (KAP) of central line-associated bloodstream infection (CLABSI) prevention practices. PURPOSE To develop and validate a CLABSI questionnaire to measure ICU nurses' KAP (CLABSI-KAP-Q). METHODS Data were collected from 255 nurses at 4 hospitals in Gansu Province, China. Questions on the CLABSI-KAP-Q were generated through a review of the literature, interviews with nurses, and multiple rounds of content validity evaluation by experts. The validity and reliability of the CLABSI-KAP-Q were assessed with exploratory factor analysis, confirmatory factor analysis, internal consistency, and correlation coefficients. RESULTS The final version of the CLABSI-KAP-Q consisted of 32 items. The reliability was represented by a Cronbach α of 0.946, while the test-retest reliability was 0.945. The overall content validity was 0.95. CONCLUSIONS The CLABSI-KAP-Q is shown to be valid and reliable and recommended for use in clinical practice.
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Affiliation(s)
- Fangping Dang
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Tiantian Zhai
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Nannan Ding
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Jing Gao
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Rao Li
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Huiju Li
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Xingwu Ran
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
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21
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Knitter S, Noltsch AR, Pesthy S, Beierle AS, Krenzien F, Schöning W, Andreou A, Pratschke J, Schmelzle M. Postoperative infectious complications are associated with diminished overall survival of patients undergoing resection for colorectal liver metastases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106920. [PMID: 37121813 DOI: 10.1016/j.ejso.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Postoperative infectious complications (PIC) remain one of the most common complications after surgery. The influence of PIC on long-term survival for patients after liver surgery for colorectal liver metastases (CRLM) needs further investigation. METHODS Data of patients who underwent liver resection for CRLM between 2012 and 2017 at the Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin were evaluated. Overall survival (OS) was stratified according to the development of PIC. Independent predictors of PIC and diminished survival were identified using regression models. RESULTS Of 270 patients, eighty-four (31%) patients developed PIC including intraabdominal infections (n = 51, 61%), cholangitis (n = 5, 6%), pneumonia (n = 12, 14%), wound infections (n = 28, 33%), urinary tract infections (n = 5, 6%), or central line-associated bloodstream infections (n = 4, 5%). PIC were associated with a significantly diminished five-year OS (30% vs. 43%, p = 0.008). Age >65 years (p = 0.016, hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.2-4.0), comorbidity (p = 0.019, HR [95% CI] = 2.4 [1.2-4.9]), simultaneous resection of primary tumor (p = 0.005, HR [95% CI] = 4.3 [1.6-11.9]), biliary drainage (p < 0.001, HR [95% CI] = 4.1 [2.0-8.5]), and length of procedure ≥272 min (p = 0.012, HR [95% CI] = 2.2 [1.2-4.1]) were independent predictors for the development of PIC. Body-mass index (BMI) > 30 kg/m2 (p = 0.002, HR [95% CI] = 2.4 [1.4-4.0]), postoperative major complications (p = 0.003, HR [95% CI] = 2.2 [1.3-3.8]), and 3- or 4-MRGN bacteria (p = 0.001, HR [95% CI] = 7.7 [2.2-27.3]) were independently associated with diminished OS. CONCLUSIONS PIC are associated with diminished OS after resection for CRLM. Age >65 years, comorbidities, simultaneous resection of the primary tumor, and biliary drainages were identified as independent risk factors for the development of PIC. High BMI, postoperative major morbidity and 3-/4-MRGN bacteria were independently predictive of worse OS. These factors need to be considered in perioperative management for patients with CRLM.
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Affiliation(s)
- Sebastian Knitter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany.
| | - Alina Roxana Noltsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Sina Pesthy
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Anika Sophie Beierle
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Felix Krenzien
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Wenzel Schöning
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Andreas Andreou
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Johann Pratschke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Moritz Schmelzle
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
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Itoh K, Tsutani H, Mitsuke Y, Iwasaki H. Potential additional effects of iron chelators on antimicrobial- impregnated central venous catheters. Front Microbiol 2023; 14:1210747. [PMID: 37608951 PMCID: PMC10442153 DOI: 10.3389/fmicb.2023.1210747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Affiliation(s)
- Kazuhiro Itoh
- Department of Internal Medicine, National Hospital Organization Awara Hospital, Awara, Japan
- Division of Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan
| | - Hiroshi Tsutani
- Department of Internal Medicine, National Hospital Organization Awara Hospital, Awara, Japan
| | - Yasuhiko Mitsuke
- Department of Internal Medicine, National Hospital Organization Awara Hospital, Awara, Japan
| | - Hiromichi Iwasaki
- Division of Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan
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Liu L, Liu Z, Wang J, Cheng M, Xie Y, Wang W, Ma C, Zhang L, Song Z, Zhang Y. Exploring risk factors for totally implantable venous access devices (TIVADs)-related thrombotic occlusion in the off-treatment period. Sci Rep 2023; 13:10767. [PMID: 37402879 DOI: 10.1038/s41598-023-37902-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
Totally implantable venous access devices (TIVADs) have been widely used for many years in the management of patients suffering from cancer. Thrombotic occlusion is the most common functional complication in the off-treatment period. This study aims to investigate the incidence of and risk factors for TIVADs-related thrombotic occlusion in patients with breast cancer. The clinical data of 1586 eligible patients with breast cancer with TIVADs at the Fourth Affiliated Hospital of Hebei Medical University from 1 January 2019 to 31 August 2021 were analysed. Thrombotic occlusion was confirmed by angiography with signs of partial or total occlusion. Thrombotic occlusion occurred in 96 (6.1%) cases. Multivariable logistic regression analysis showed that the insertion site of the catheter (P = 0.004), size of the catheter (P < 0.001), and indwelling time (P < 0.001) were significant factors for thrombotic occlusion. Insertion in the right internal jugular vein, smaller catheter size and shorter indwelling time can lower the incidence of thrombotic occlusion in breast cancer patients with TIVADs in the off-treatment period.
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Affiliation(s)
- Lei Liu
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei Province, China
| | - Zhanlun Liu
- Hebei Province Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei Province, China
| | - Jianxin Wang
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei Province, China
| | - Meng Cheng
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei Province, China
| | - Yanli Xie
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei Province, China
| | - Weina Wang
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei Province, China
| | - Cuicui Ma
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei Province, China
| | - Lina Zhang
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei Province, China
| | - Zhenchuan Song
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei Province, China.
| | - Yanshou Zhang
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei Province, China
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Joslyn D, Saber DA, Miles P. Predictors of Central Vascular Access Device Bloodstream Infections in Patients With Acute Leukemia and Neutropenia: A Retrospective Case-Control Chart Review. JOURNAL OF INFUSION NURSING 2023; 46:139-148. [PMID: 37104689 DOI: 10.1097/nan.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Central vascular access devices (CVADs) are standard for the treatment of leukemia. The objectives of this study were to examine predictors for central line-associated bloodstream infection (CLABSI) and causative microorganisms. A retrospective case/control design was used to examine electronic health records (EHRs) of patients with acute leukemia, a CVAD, and neutropenia. Variables were examined for differences between those who developed bacteremia (cases: n = 10) and those who did not (controls: n = 13). Variables included conditions of health (eg, patient history, laboratory results at the time of nadir, nutritional intake during hospitalization, and CVAD care practices). Fisher exact and Mann-Whitney U tests were used for comparison. Nine organisms were identified, including viridans group streptococci (20%) and Escherichia coli (20%). No statistical differences in variables were found between groups. However, over 50% of the nutritional intake data was missing due to lack of documentation. These findings indicate that further study is needed to examine barriers for electronic documentation. The data collection site found opportunities to improve patient care that included education regarding the daily care of CVADs, collaboration with nutritional services to ensure accurate assessments, and coordination with clinical information systems to improve clinical documentation compliance.
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Affiliation(s)
- Delight Joslyn
- Northern Light Eastern Maine Medical Center, Bangor, Maine (Ms Joslyn, Dr Saber, Ms Miles); University of Maine School of Nursing and University of Maine Senator George J. Mitchell Center for Sustainability Solutions, Orono, Maine (Dr Saber)
- Delight Joslyn, MSN, RN, OCN®, CRNI®, CPHON, is a staff nurse III at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 28 years in various capacities at the medical center to include prior experience as manager of infusion services. Her most recent roles include bedside nurse, charge nurse, and staff nurse III. In her capacity as staff nurse III, her responsibilities include staff education and participation in quality and performance projects such as central line-associated bloodstream infection prevention. She has held certification in oncology nursing for over 10 years and the designation of Certified Registered Nurse Infusion (CRNI) since 2015. Deborah A. Saber, PhD, RN, CCRN-K, is an associate professor at the University of Maine School of Nursing and the director of nursing research and evidence-based practice at Northern Light Eastern Maine Medical Center. She received her BSN from Vanderbilt University, MS in nursing administration from DePaul University, and PhD in nursing from the University of Central Florida. As a registered nurse (RN), she spent 25 years in clinical practice in a variety of intensive care units (eg, surgical, medical, pediatric). As the director of nursing research, she assists nursing staff in conducting research and evidence-based practice projects. Her field of research has focused on the nursing work environment, and health care waste resulting from food and solid waste, which has resulted in the publication of articles in peer reviewed journals and presentations at both regional and international conferences. Patricia Miles, MSN, RN, OCN®, is a nurse manager at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 22 years in various capacities on the oncology unit to include bedside nurse, charge nurse, and nurse manager. In her capacity as nurse manager, her responsibilities include oversight of quality and performance improvement on the unit. She has held certification in oncology nursing for 20 years
| | - Deborah A Saber
- Northern Light Eastern Maine Medical Center, Bangor, Maine (Ms Joslyn, Dr Saber, Ms Miles); University of Maine School of Nursing and University of Maine Senator George J. Mitchell Center for Sustainability Solutions, Orono, Maine (Dr Saber)
- Delight Joslyn, MSN, RN, OCN®, CRNI®, CPHON, is a staff nurse III at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 28 years in various capacities at the medical center to include prior experience as manager of infusion services. Her most recent roles include bedside nurse, charge nurse, and staff nurse III. In her capacity as staff nurse III, her responsibilities include staff education and participation in quality and performance projects such as central line-associated bloodstream infection prevention. She has held certification in oncology nursing for over 10 years and the designation of Certified Registered Nurse Infusion (CRNI) since 2015. Deborah A. Saber, PhD, RN, CCRN-K, is an associate professor at the University of Maine School of Nursing and the director of nursing research and evidence-based practice at Northern Light Eastern Maine Medical Center. She received her BSN from Vanderbilt University, MS in nursing administration from DePaul University, and PhD in nursing from the University of Central Florida. As a registered nurse (RN), she spent 25 years in clinical practice in a variety of intensive care units (eg, surgical, medical, pediatric). As the director of nursing research, she assists nursing staff in conducting research and evidence-based practice projects. Her field of research has focused on the nursing work environment, and health care waste resulting from food and solid waste, which has resulted in the publication of articles in peer reviewed journals and presentations at both regional and international conferences. Patricia Miles, MSN, RN, OCN®, is a nurse manager at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 22 years in various capacities on the oncology unit to include bedside nurse, charge nurse, and nurse manager. In her capacity as nurse manager, her responsibilities include oversight of quality and performance improvement on the unit. She has held certification in oncology nursing for 20 years
| | - Patricia Miles
- Northern Light Eastern Maine Medical Center, Bangor, Maine (Ms Joslyn, Dr Saber, Ms Miles); University of Maine School of Nursing and University of Maine Senator George J. Mitchell Center for Sustainability Solutions, Orono, Maine (Dr Saber)
- Delight Joslyn, MSN, RN, OCN®, CRNI®, CPHON, is a staff nurse III at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 28 years in various capacities at the medical center to include prior experience as manager of infusion services. Her most recent roles include bedside nurse, charge nurse, and staff nurse III. In her capacity as staff nurse III, her responsibilities include staff education and participation in quality and performance projects such as central line-associated bloodstream infection prevention. She has held certification in oncology nursing for over 10 years and the designation of Certified Registered Nurse Infusion (CRNI) since 2015. Deborah A. Saber, PhD, RN, CCRN-K, is an associate professor at the University of Maine School of Nursing and the director of nursing research and evidence-based practice at Northern Light Eastern Maine Medical Center. She received her BSN from Vanderbilt University, MS in nursing administration from DePaul University, and PhD in nursing from the University of Central Florida. As a registered nurse (RN), she spent 25 years in clinical practice in a variety of intensive care units (eg, surgical, medical, pediatric). As the director of nursing research, she assists nursing staff in conducting research and evidence-based practice projects. Her field of research has focused on the nursing work environment, and health care waste resulting from food and solid waste, which has resulted in the publication of articles in peer reviewed journals and presentations at both regional and international conferences. Patricia Miles, MSN, RN, OCN®, is a nurse manager at Northern Light Eastern Maine Medical Center on an inpatient acute care medical-surgical unit with a primary specialty focus in respiratory and oncology care. She received her BSN and MS in nursing education from the University of Maine School of Nursing. As a registered nurse, she has spent 22 years in various capacities on the oncology unit to include bedside nurse, charge nurse, and nurse manager. In her capacity as nurse manager, her responsibilities include oversight of quality and performance improvement on the unit. She has held certification in oncology nursing for 20 years
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Picardi M, Giordano C, Della Pepa R, Pugliese N, Esposito M, Abagnale DP, Giannattasio ML, Lisi D, Lamagna M, Grimaldi F, Muccioli Casadei G, Ciriello M, Persico M, Gargiulo G, Pane F. Intravascular Complications of Central Venous Catheterization by Insertion Site in Acute Leukemia during Remission Induction Chemotherapy Phase: Lower Risk with Peripherally Inserted Catheters in a Single-Center Retrospective Study. Cancers (Basel) 2023; 15:cancers15072147. [PMID: 37046808 PMCID: PMC10093126 DOI: 10.3390/cancers15072147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
The basilic/brachial (BBV), internal jugular (IJV), and subclavian veins (SCV) are commonly used as central venous catheter (CVC) sites. A BBV approach [peripherally inserted central catheter (PICC)] is increasingly used for short- to intermediate-term CVCs for acute leukemias undergoing cytotoxic intensive regimens. In this retrospective study, the catheterization of the BBV, IJV, and SCV in patients with previously untreated acute leukemia was assessed. The primary outcome was the composite incidence of catheter-related symptomatic deep-vein thrombosis (sDVT) and bloodstream infection (BSI) from catheterization up to 30 days later. In a 10-year period, 336 CVC were inserted in the BBV (n = 115), IJV (n = 111), and SCV (n = 110) in 336 patients suffering from AML (n = 201) and ALL (n = 135) and undergoing induction chemotherapy. The primary outcome events were 8, 20, and 27 in the BBV, SCV and IJV cohorts (2.6, 6.9, and 9.6 per 1000 catheter-days, respectively; p = 0.002). The primary outcome risk was significantly higher in the IJV-cohort than in the BBV-cohort (HR, 3.6; 95% CI, 1.6 to 7.9; p = 0.001) and in the SCV-cohort than in the BBV-cohort (HR, 2.6; 95% CI, 1.2 to 5.9; p = 0.02). PICC was a valid CVC for the induction chemotherapy of acute leukemia for the lowest risk of sDVT and BSI.
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Affiliation(s)
- Marco Picardi
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Claudia Giordano
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Roberta Della Pepa
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Novella Pugliese
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Maria Esposito
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Davide Pio Abagnale
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Maria Luisa Giannattasio
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Dario Lisi
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Martina Lamagna
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Francesco Grimaldi
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Giada Muccioli Casadei
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Mauro Ciriello
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Marcello Persico
- Department of General Surgery, Endocrinology, Orthopaedics, and Rehabilitations, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Gianpaolo Gargiulo
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Fabrizio Pane
- Hematology Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Via Sergio Pansini, 5, 80131 Naples, Italy
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Hentrich M, Böll B, Teschner D, Panse J, Schmitt T, Naendrup JH, Schmidt-Hieber M, Neitz J, Fiegle E, Schalk E. Impact of the insertion site of central venous catheters on central venous catheter-related bloodstream infections in patients with cancer: results from a large prospective registry. Infection 2023:10.1007/s15010-023-02029-4. [PMID: 37016194 DOI: 10.1007/s15010-023-02029-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Overall, insertion of central venous catheter (CVC) into femoral veins (FV) has been shown to be associated with a higher risk of infection compared with subclavian and internal jugular (IJV/SCV) CVC, but no data are available on the impact of the FV insertion site on the CVC-related bloodstream infections (CRBSI) risk in patients with cancer. The objective of the study is to compare CRBSI rates and incidences of FV with those of internal jugular and subclavian vein (IJV/SCV CVC) as observed in the prospective SECRECY registry. METHODS SECRECY is an ongoing observational, prospective, clinical CRBSI registry active in six departments of hematology/oncology in Germany. Each case of FV CVC was matched at a ratio of 1:1 to a case with IJV/SCV CVC. The propensity score was estimated using a multivariable logistic regression model adjusting for age, sex, cancer type, and duration of indwelling catheter. RESULTS Of 4268 CVCs included in this analysis, 52 (1.2%) were inserted into the FV and 4216 (98.8%) into the IJV/SCV. 52 cases of FV CVC were matched with 52 IJV/SCV CVC. There was no significant difference in the CRBSI rate (3.8% vs. 9.6%), the CRBSI incidence (5.7 vs. 14.2/1000 CVC days), and the median CVC time (5.5 vs. 5 days) between the FV and the IJV/SCV group. CONCLUSION Based on this data, inserting FV CVCs in patients with cancer does, at least in the short-term, not appear to be associated with an increased risk of CRBSI as compared to IJV/SCV CVC.
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Affiliation(s)
- Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, University of Munich, Nymphenburger Str. 163, 80634, Munich, Germany.
| | - Boris Böll
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Daniel Teschner
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jens Panse
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Timo Schmitt
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the, Johannes Gutenberg University Mainz, Mainz, Germany
- Hamm Hospital Nahetal, Bad Kreuznach, Germany
| | - Jan-Hendrik Naendrup
- Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Martin Schmidt-Hieber
- Clinic of Hematology, Oncology, Pneumology and Nephrology, Carl-Thiem Hospital Cottbus, Cottbus, Germany
| | - Julia Neitz
- Department of Hematology and Oncology, Red Cross Hospital Munich, University of Munich, Nymphenburger Str. 163, 80634, Munich, Germany
| | - Eva Fiegle
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Enrico Schalk
- Department of Hematology and Oncology, Medical Center, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
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Lightheart E, Guyton M, Gilmar C, Tuzio J, Ziegler M, Kucharczuk C. Preventing Central Line Bloodstream Infections: An Interdisciplinary Virtual Model for Central Line Rounding and Consultation. PATIENT SAFETY 2023. [DOI: 10.33940/med/2023.3.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: Central line–associated bloodstream infections (CLABSI) account for many harms suffered in healthcare and are associated with increased costs and disease burden. Central line rounds, like medical rounds, are a multidisciplinary bedside assessment strategy for all active central lines on a unit. In-person line rounds in this 144-bed oncology acute care setting are challenging due to a variety of unchangeable factors. The aim was to develop a process for addressing concerning central lines in this context.
Methods: The project team designed a HIPAA-protected, text-based process for assessing central lines for risk factors contributing to infection. Staff initiated a consultation via a virtual platform with an interdisciplinary team composed of oncology and infectious diseases experts. The virtual discussion included recommendations for a line-related plan of care.
Results: The number of consultations averaged about five per month, with 27.4% resulting in the central line being removed, which is believed to have contributed to an overall reduction in infection rates. The CLABSI standardized infection ratio, a risk-adjusted measure which accounts for patient acuity and volumes, improved from 0.85 prior to the intervention (November 2020–October 2021) to 0.57 after the intervention (November 2021–August 2022), a 33% reduction.
Conclusion: A virtual process for central line consultation and interdisciplinary planning was effective and, in this setting, perhaps optimal. This type of process could be applied to nearly any aspect of clinical care where teams are solving problems in an environment with complex geography and relationships.
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Rabelo BS, de Alvarenga KAF, Miranda JWFB, Fagundes TP, Cancela CSP, de Castro Romanelli RM, de Sá Rodrigues KE. Risk factors for catheter-related infection in children with cancer: A systematic review and meta-analysis. Am J Infect Control 2023; 51:99-106. [PMID: 35577057 DOI: 10.1016/j.ajic.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023]
Abstract
RATIONALE To understand the risk factors for catheter-related infection during treatment of pediatric cancer is essential to implement measures to prevent its occurrence. BACKGROUND We performed a comprehensive systematic review of the literature with meta-analysis to identify and synthesize the main risk factors for catheter-related infection in children undergoing oncological treatment. METHODS Systematic searches were conducted in Medline, Embase, Lilacs, and BVS (Biblioteca Virtual em Saúde) until January 2022, following PRISMA guidelines. The search was not limited to language or dates. Risk factors were divided into host-related, assistance-related, and catheter types. We also describe the most common pathogens. RESULTS Thirteen studies were included in the review. Diagnosis of hematological neoplasm, the intensity of treatment, blood transfusion in the 4-7 days before the infection, type of long-term catheters (tunneled externalized catheters, double lumen, greater diameter), inpatient treatment, and a longer period of hospitalization were the most consistent risk factors. Metanalysis showed that neutropenia at the moment of catheter placement is not a risk factor for central-line-associated bloodstream infections, however, there is high heterogeneity between studies. Staphylococcus epidermidis was the most common pathogen reported. CONCLUSIONS Understanding risk factors is an essential step to reduce morbidity and mortality of catheter-related infection. Education for preventive measures, reduction of hospitalization, wisely choosing the most adequate type of catheter, and the best moment for catheter insertion may reduce the occurrence of catheter-related infection.
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Affiliation(s)
- Bruna Salgado Rabelo
- Hospital das Clínicas, Universidade Federal de Minas Gerais/EBSERH, Belo Horizonte, MG, Brazil
| | | | | | | | - Camila Silva Peres Cancela
- Hospital das Clínicas, Universidade Federal de Minas Gerais/EBSERH, Belo Horizonte, MG, Brazil; Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Roberta Maia de Castro Romanelli
- Hospital das Clínicas, Universidade Federal de Minas Gerais/EBSERH, Belo Horizonte, MG, Brazil; Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Karla Emília de Sá Rodrigues
- Hospital das Clínicas, Universidade Federal de Minas Gerais/EBSERH, Belo Horizonte, MG, Brazil; Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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How to manage central venous catheter-related bloodstream infections due to Gram-negative bacilli? Curr Opin Infect Dis 2022; 35:583-588. [PMID: 35852791 DOI: 10.1097/qco.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to review recent data evaluating the management of central venous catheter-related bloodstream infection due to Gram-negative bacilli (GNB). RECENT FINDINGS The incidence of GNB catheter-related bloodstream infection (CRBSI) has been increasing considerably in the last years, and this has raised a concern due to the high reported rate of multidrug-resistant in these infections what poses a considerable challenge for effective treatment. However, there are no specific guidelines for the management of GNB-CRBSI and optimal treatment duration has not been clearly defined. Recent studies have shown that the risk for complications is clearly different to what is stablished for Staphylococcus aureus . Therefore, a short course of antibiotic therapy might be effective once the central venous catheter (CVC) has been removed and the monitoring complications through control blood cultures or echocardiography seem to be less helpful in GNB CRBSI. SUMMARY 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 MDR in these infections what poses a considerable challenge for effective treatment. However, there are no specific guidelines for the management of GNB-CRBSI and optimal treatment duration has not been clearly defined. Recent studies have shown that the risk for complications is clearly different to what is stablished for S. aureus . Therefore, a short course of antibiotic therapy might be effective once the CVC has been removed and the monitoring complications through control blood cultures or echocardiography seem to be less helpful in GNB-CRBSI.
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Moriyama K, Ando T, Kotani M, Tokumine J, Nakazawa H, Motoyasu A, Yorozu T. Risk factors associated with increased incidences of catheter-related bloodstream infection. Medicine (Baltimore) 2022; 101:e31160. [PMID: 36281147 PMCID: PMC9592381 DOI: 10.1097/md.0000000000031160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We have implemented several preventive measures to reduce central line-associated bloodstream infection (CLABSI) in the general intensive care unit (ICU) of a university hospital in Japan. Here, we analyzed the factors associated with CLABSI in patients with central venous catheter (CVC) insertions and evaluated the effects of our implemented preventive measures. From July 2013 to June 2018, data was collected from the medical records of 1472 patients with 1635 CVC insertions, including age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, duration of ICU stay, duration of catheter insertion, insertion site, and mechanical ventilation status. During weekly conferences, a surveillance team comprising intensive care and infection control doctors and nurses determined the patients' CLABSI status. The analyzed factors were compared between CLABSI and central line patients without bloodstream infection. Multivariate analysis revealed three factors associated with CLABSI. Adjusted odds ratios with 95% confidence intervals were as follows: duration of ICU stay, 1.032 (1.019-1.044); duration of catheter insertion, 1.041 (1.015-1.066); and APACHE II score, 1.051 (1.000-1.105). The prominent risk factors were associated with the severity of the initial condition and exacerbation of the clinical condition of the patients during their stays in the ICU. Further strategies to reduce CLABSI must be developed.
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Affiliation(s)
- Kiyoshi Moriyama
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tadao Ando
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Mariko Kotani
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Akira Motoyasu
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
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Joseph A, Lafarge A, Mabrouki A, Abdel-Nabey M, Binois Y, Younan R, Azoulay E. Severe infections in recipients of cancer immunotherapy: what intensivists need to know. Curr Opin Crit Care 2022; 28:540-550. [PMID: 35950720 DOI: 10.1097/mcc.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Given the increased number of cancer patients admitted in the ICU and the growing importance of immunotherapy in their therapeutic arsenal, intensivists will be increasingly confronted to patients treated with immunotherapies who will present with complications, infectious and immunologic. RECENT FINDINGS Apart from their specific immunologic toxicities, cancer immunotherapy recipients also have specific immune dysfunction and face increased infectious risks that may lead to intensive care unit admission. SUMMARY Chimeric antigen receptor T-cell therapy is associated with profound immunosuppression and the risks of bacterial, fungal and viral infections vary according to the time since infusion.Immune checkpoint blockers are associated with an overall favorable safety profile but associations of checkpoint blockers and corticosteroids and immunosuppressive drugs prescribed to treat immune-related adverse events are associated with increased risks of bacterial and fungal infections.The T-cell engaging bispecific therapy blinatumomab causes profound B-cell aplasia, hypogammaglobulinemia and neutropenia, but seems to be associated with fewer infectious adverse events compared with standard intensive chemotherapy.Lastly, intravesical administration of Bacillus Calmette-Guérin (BCG) can lead to disseminated BCGitis and severe sepsis requiring a specific antibiotherapy, often associated with corticosteroid treatment.
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Affiliation(s)
- Adrien Joseph
- Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Public Assistance Hospitals of Paris, Paris, France
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Gao T, Zhu X, Zeng Q, Li X, Luo M, Yu C, Hu L, He J, Li Y, Yang Z, Yang H, Huang X, Gu X, Liu Z. Peripherally inserted central catheter-related bloodstream infections in patients with hematological malignancies: A retrospective 7-years single-center study. Am J Infect Control 2022; 50:1171-1177. [PMID: 35108580 DOI: 10.1016/j.ajic.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES We sought to investigate the nature and incidence of bloodstream infection complications and to identify the risk factors of central catheter-related bloodstream infections (CRBSI). METHODS During the study period, 291 consecutive patients with hematological malignancies who underwent PICC placement were retrospectively enrolled. We analyzed the covariates that were specified a priori for their association with CRBSI through multivariate Cox proportional hazards regression models. The association between each predictor and the related outcome was expressed using hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). RESULTS Of 391 peripherally inserted central catheter (PICCs) were inserted in 291 patients for a total of 63,714 catheter days during 7 years, with an infection rate of 0.71/1,000 catheter days. Among the patients with hematological malignancies, those with acute leukemia were prone to CRBSI. Having previous bloodstream infection (BSI) (HR 18.139; 95% CI, 8.19-40.174; P < .0001), the number of PICCs insertions (HR 4.695; 95% CI, 1.842-11.967; P = .001) (twice), (HR 6.794; 95% CI, 1.909-24.181; P = .003) (≥3 times) were significantly associated with CRBSI. Not accompanied by chronic comorbidities (HR 0.34; 95% CI, 0.131-0.887; P = .028) and longer duration of PICC use (days) (HR 0.997; 95% CI, 0.994-0.999; P = .008) might be protective factors preventing CRBSI. CONCLUSIONS Our finding suggests that previous BSI and a higher number of PICC insertions are associated with an increased risk of CRBSI. A lack of chronic comorbidities may help prevent CRBSI.
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Affiliation(s)
- Tianqi Gao
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangding Zhu
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qingli Zeng
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaozhen Li
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Man Luo
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Changhui Yu
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Liwen Hu
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing He
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yaohe Li
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhiwen Yang
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huifang Yang
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohua Huang
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuekui Gu
- Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Zenghui Liu
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Hematology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Changing the Buffer in Buffered Lidocaine. JOURNAL OF INFUSION NURSING 2022; 45:245-251. [PMID: 36112871 DOI: 10.1097/nan.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hospitalized patients require venous access for procedures, treatments, or therapies. The use of lidocaine for pain relief during central vascular access device (CVAD) insertion is a standard of practice. Lidocaine buffered with sodium bicarbonate has been shown to provide significantly more pain relief in the sensation of pain upon injection. Shortages of lidocaine with bicarbonate provided an opportunity to explore other options to provide pain relief during CVAD insertion. The PICO question for this project was: In adult patients requiring CVAD insertion, how does lidocaine buffered with bicarbonate compare with lidocaine buffered with saline in minimizing pain with lidocaine injection? This study assessed how lidocaine buffered with bicarbonate compares with lidocaine buffered with saline in minimizing pain with lidocaine injection. Sixty patients received the buffered lidocaine before having a peripherally inserted central catheter inserted. Thirty patients received lidocaine buffered with bicarbonate and 30 patients received lidocaine buffered with saline. Pain and vasoconstriction were the 2 outcomes monitored during the project. Although the trial was only 2 wk due to the urgency of the rollout, the pilot was able to offer clinicians the opportunity to compare the 2 products. The saline-buffered lidocaine provided comparable pain relief compared with the lidocaine buffered with bicarbonate. The clinicians also measured the amount of vasoconstriction caused by the 2 products with similar outcomes.
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Panse J, Tölle D, Fiegle E, Naendrup JH, Schmidt-Hieber M, Böll B, Hentrich M, Teschner D, Schalk E. Scheduled removal of central venous catheters (CVC) to prevent CVC-related bloodstream infections in patients with hematological disease or autologous stem cell transplantation: a registry-based randomized simulation-study. Ann Hematol 2022; 101:2317-2324. [PMID: 35978182 PMCID: PMC9463193 DOI: 10.1007/s00277-022-04958-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/13/2022] [Indexed: 12/02/2022]
Abstract
Although not generally recommended, scheduled central venous catheter (CVC) removal is sometimes carried out in order to reduce the CVC-related bloodstream infection (CRBSI) incidence. We conducted a simulation for scheduled CVC removal within the multicenter CRBSI registry (SECRECY). Non-tunneled jugular and subclavian CVC in patients with hematological disease or with germ cell tumors (including patients receiving autologous stem cell transplantation [SCT]) were included. Cases were randomized in a 1:1:1:1 ratio to either a simulated, scheduled CVC removal after 7, 14, and 21 days, or to non-simulated, unscheduled CVC removal (control group). The primary endpoint was definitive CRBSI incidence for a scheduled CVC removal after 14 days (dCRBSI-D14rmv). Among other, secondary endpoints were definite CRBSI incidence for a scheduled removal after 7 days (dCRBSI-D7rmv) and 21 days (dCRBSI-D21rmv). Data on 2984 CVC were included. Patients’ median age was 59 (range 16–95) years, 58.8% being male. The vast majority (98.4%) were patients with hematological malignancies. Jugular veins were the main insertion site (93.2%). dCRBSI-D14rmv was 3.10/1000 CVC days as compared to 4.15/1000 CVC days in the control group (p = 0.23). There was a significant difference between dCRBSI-D7rmv (0.86/1000 CVC days) and controls (p < 0.001), but not between dCRBSI-D21rmv (4.10/1000 CVC days) and controls (p = 0.96). Our data suggest that in patients with hematological diseases or autologous SCT recipients scheduled CVC removal after 14 days does not result in a lower CRBSI incidence compared to unscheduled removal. Trial registration: DRKS00006551, 2014/09/29, retrospectively registered.
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Affiliation(s)
- Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
| | - Daniela Tölle
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Eva Fiegle
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany
| | - Jan-Hendrik Naendrup
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany.,Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Martin Schmidt-Hieber
- Clinic of Hematology, Oncology, and Pneumology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Boris Böll
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Germany.,Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany
| | - Daniel Teschner
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Enrico Schalk
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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Yang L, Xu X, Liu Q. Establishment of a Risk Prediction Model for Pulmonary Infection in Patients with Advanced Cancer. Appl Bionics Biomech 2022; 2022:6149884. [PMID: 35677196 PMCID: PMC9170436 DOI: 10.1155/2022/6149884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Based on clinical data, the risk prediction model of pulmonary infection in patients with advanced cancer was established to predict the risk of pulmonary infection in patients with advanced cancer, and intervention measures were given in advance. Methods The clinical data of 2755 patients were divided into infection group and control group according to whether they were complicated with lung infection. 1609 patients' data from January 2016 to December 2018 served as the training set, and 1166 patients' data from January 2019 to December 2020 served as the testing set. Demographics, whether the primary cancer was lung cancer, lung metastasis, the pathological classification of lung cancer patients, the number of metastases, history of surgery, history of chemotherapy, history of radiotherapy, history of central venous catheterization, history of hypertension, diabetes, and whether with myelosuppression were recorded. The presence of concurrent pulmonary infection was recorded and defined as the primary outcome variable. Stepwise forward algorithms were applied to informative predictors based on Akaike's information criterion. Multivariable logistic regression analysis was used to develop the nomogram. An independent testing dataset was used to validate the nomogram. Receiver-operating characteristic curves and the Hosmer-Lemeshow test were used to assess model performance. Results The sample included 2755 patients with advanced cancer. An independently validated dataset included 1166 patients with advanced cancer. In the training dataset, gender, age, lung cancer as primary cancer, the pathological classification of lung cancer patients, history of chemotherapy, history of radiation therapy, history of surgery, the number of metastases, presence of central venous catheterization, and myelosuppression were identified as predictors and assembled into the nomogram. The area under curve demonstrated adequate discrimination in the validation dataset (0.77; 95% confidence interval, 0.74 to 0.79). The nomogram was well calibrated, with a Hosmer-Lemeshow χ 2 statistic of 12.4 (P = 0.26) in the testing dataset. Conclusions The present study has proposed an effective nomogram with potential application in facilitating the individualized prediction of risk of pulmonary infection in patients with advanced cancer.
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Affiliation(s)
- Liangliang Yang
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
- Department of Critical Care Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Xiaolong Xu
- Department of Critical Care Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Qingquan Liu
- Department of Critical Care Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
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A Revolutionary, Proven Solution to Vascular Access Concerns: A Review of the Advantageous Properties and Benefits of Catheter Securement Cyanoacrylate Adhesives. JOURNAL OF INFUSION NURSING 2022; 45:154-164. [PMID: 35537003 DOI: 10.1097/nan.0000000000000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intravascular catheters are widely used among hospitals; however, their failure rates are high, up to 50%, when secured by traditional techniques, such as tape and gauze. The use of catheter securement cyanoacrylate adhesives provides a unique approach to the issues surrounding the use of traditional securement techniques for vascular access devices by providing significant securement strength, barrier properties, antibacterial properties, hemostatic properties, and flexibility. The purpose of this research was to perform a thorough and systematic review of the current literature existing regarding the use of cyanoacrylate adhesive for the care and maintenance of vascular access devices.
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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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Liu G, Cao S, Liu X, Li Z, Tian Y, Zhang X, Zhong H, Zhou Y. Effect of perioperative probiotic supplements on postoperative short-term outcomes in gastric cancer patients receiving neoadjuvant chemotherapy: A double-blind, randomized controlled trial. Nutrition 2022; 96:111574. [DOI: 10.1016/j.nut.2021.111574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023]
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Rockholt MM, Thorarinsdottir HR, Lazarevic V, Rundgren M, Kander T. Central venous catheter-related complications in hematologic patients: An observational study. Acta Anaesthesiol Scand 2022; 66:473-482. [PMID: 34907524 DOI: 10.1111/aas.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 07/20/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The frequency of central venous catheter (CVC)-related complications in hematologic patients has previously been studied but some uncertainty remains. Therefore, this observational cohort study was designed primarily to investigate mechanical and infectious complications related to CVC insertion in hematologic patients and secondarily to identify factors associated with these complications. METHODS Documented data on CVC insertions in all adult hematologic patients who received a CVC from 2013 to 2019 at a University Hospital in Sweden were retrospectively collected. RESULTS A total of 589 CVC insertions in 387 patients were included. The prevalence of moderate and severe mechanical complications, predominantly comprising grades 2-4 bleeding, was 11%. Preprocedural coagulopathy, number of needle passes, and arterial puncture were all independently associated with grades 2-4 bleeding. The incidence of suspected catheter-related infections (sCRI) was 3.7/1000 catheter days. Higher body mass index and male gender were independently associated with sCRI. CONCLUSIONS Patients with hematologic malignancies have a high risk of both grades 2-4 bleeding and sCRI after CVC insertion. This underlines the importance of optimizing the conditions at the insertion and also of daily inspections, evaluation of future needs, and extra precautions to avoid sCRI in these susceptible patients.
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Affiliation(s)
- Mika M. Rockholt
- Department of Intensive and Perioperative Care Skåne University Hospital Lund Sweden
- Department of Clinical Sciences Lund University Lund Sweden
| | - Hulda R. Thorarinsdottir
- Department of Intensive and Perioperative Care Skåne University Hospital Lund Sweden
- Department of Clinical Sciences Lund University Lund Sweden
| | - Vladimir Lazarevic
- Department of Clinical Sciences Lund University Lund Sweden
- Department of Hematology, Oncology and Radiation Physics Skåne University Hospital Lund Sweden
- Stem Cell Centre Lund University Lund Sweden
| | - Malin Rundgren
- Department of Intensive and Perioperative Care Skåne University Hospital Lund Sweden
- Department of Clinical Sciences Lund University Lund Sweden
| | - Thomas Kander
- Department of Intensive and Perioperative Care Skåne University Hospital Lund Sweden
- Department of Clinical Sciences Lund University Lund Sweden
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Zhang H, Li Y, Zhu N, Li Y, Fu J, Liu J. Comparison of peripherally inserted central catheters (PICCs) versus totally implantable venous-access ports in pediatric oncology patients, a single center study. Sci Rep 2022; 12:3510. [PMID: 35241771 PMCID: PMC8894364 DOI: 10.1038/s41598-022-07584-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
To compare the efficacy of peripherally inserted central catheters (PICCs) and totally implantable venous-access ports (TIVAPs) for chemotherapy of pediatric patients with malignant tumors. A total of 96 children with malignant tumors who received catheterization of PICCs or TIVAPs for chemotherapy from May 2020 to May 2021 in Department of Pediatric Oncology of Qilu Hospital of Shandong University were selected. Then, the pathological features of disease, the age of children, the indwelling time, the incidence of postoperative complications, and the satisfaction degree were compared between the two groups. The age of children in the TIVAP group was younger than that in the PICC group (P < 0.05). The indwelling time in the TIVAP group was 7.2 ± 2.757 months,which was significantly longer than 5.65 ± 2.058 months in the PICC group (P < 0.05). The incidence of postoperative complications in the TIVAP group without systemic or local infection was markedly lower than that in the PICC group (P < 0.05). The satisfaction degree of patients in the TIVAP group without unsatisfied was markedly higher than that in the PICC group (P < 0.05). TIVAPs may be the first choice for chemotherapy of children with malignant tumors.
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Affiliation(s)
- Hong Zhang
- Department of Pediatrics, Qilu Hospital, Shandong University, No.107, West of Wenhua Road, 250012, Jinan, People's Republic of China
| | - Yumei Li
- Department of Pediatrics, Qilu Hospital, Shandong University, No.107, West of Wenhua Road, 250012, Jinan, People's Republic of China
| | - Nannan Zhu
- Department of Pediatrics, Qilu Hospital, Shandong University, No.107, West of Wenhua Road, 250012, Jinan, People's Republic of China
| | - Yanfang Li
- Department of Pediatrics, Qilu Hospital, Shandong University, No.107, West of Wenhua Road, 250012, Jinan, People's Republic of China
| | - Jinqiu Fu
- Department of Pediatrics, Qilu Hospital, Shandong University, No.107, West of Wenhua Road, 250012, Jinan, People's Republic of China.
| | - Jing Liu
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China
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Luman A, Quencer KB, Kaufman C. Pre-Procedure Thrombocytopenia and Leukopenia Association with Risk for Infection in Image-Guided Tunneled Central Venous Catheter Placement. Tomography 2022; 8:627-634. [PMID: 35314629 PMCID: PMC8938799 DOI: 10.3390/tomography8020052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/20/2022] Open
Abstract
Placement of image-guided tunneled and non-tunneled large-bore central venous catheters (CVCs) are common procedures in interventional radiology. Although leukopenia and/or thrombocytopenia are common at the time of placement, the roles these factors may have in subsequent catheter-related infection have yet to be investigated. A single-institution retrospective review was performed in patients who underwent CVC placement in interventional radiology between 11/2018–6/2019. The electronic medical record was used to obtain demographics, procedure details, pre-placement laboratory values, and the subsequent 90-day follow-up. A total of 178 tunneled and non-tunneled CVCs met inclusion criteria during this time period. White blood cell (WBC) and platelet counts were found to be significant risk factors for subsequent infection. Administration of pre-procedure antibiotics was not found to be a significant factor for subsequent infection (p = 0.075). Leukopenia and thrombocytopenia at the time of CVC placement are both risk factors of line infection for tunneled large-bore CVCs. This should lead to the consideration of using a non-tunneled CVC when clinically feasible, or the delayed placement of these catheters until counts recover.
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Affiliation(s)
- Abigail Luman
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA;
| | - Keith B. Quencer
- Department of Radiology and Imaging Sciences, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA;
| | - Claire Kaufman
- Department of Radiology and Imaging Sciences, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA;
- Correspondence:
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Snapper H, Cheshire WP. Oral and intravenous hydration in the treatment of orthostatic hypotension and postural tachycardia syndrome. Auton Neurosci 2022; 238:102951. [PMID: 35123367 DOI: 10.1016/j.autneu.2022.102951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/07/2021] [Accepted: 01/25/2022] [Indexed: 01/21/2023]
Abstract
Hydration with water and salt is the mainstay of treatment for autonomic nervous system disorders that impair orthostatic tolerance. The goal is to expand intravascular volume to compensate for the downward displacement of blood volume that occurs when standing and thereby sustain cerebral perfusion and restore quality of life. Despite strong consensus recommendations for salt supplementation as standard treatment of these disorders, published evidence of benefit is relatively weak, and no randomized clinical trials have occurred. This review summarizes the physiological rationale for hydration and evaluates the literature on oral and intravenous hydration in the treatment of neurogenic orthostatic hypotension, postural tachycardia syndrome, and recurrent vasovagal syncope. We conclude that oral salt replacement is indicated for treatment of neurogenic orthostatic hypotension because these patients have excessive renal sodium excretion, and for treatment of chronic orthostatic intolerance because these patients are often hypovolemic. As not all patients are able to tolerate sufficient oral hydration, there is also a role for intravenous volume-loading in severe cases of postural tachycardia syndrome. We offer guidance, based on review of the literature and the clinical judgment of a cardiologist and neurologist with experience treating autonomic disorders, regarding the option of ongoing intravenous hydration for treatment of severe, refractory cases of postural tachycardia syndrome.
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Affiliation(s)
- Howard Snapper
- Department of Cardiology, Wellstar Healthcare System, Marietta, GA 30060, USA.
| | - William P Cheshire
- Division of Autonomic Disorders, Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
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Heidenreich D, Hansen E, Kreil S, Nolte F, Jawhar M, Hecht A, Hofmann W, Klein SA. The insertion site is the main risk factor for central venous catheter-related complications in patients with hematologic malignancies. Am J Hematol 2022; 97:303-310. [PMID: 34978721 DOI: 10.1002/ajh.26445] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/16/2021] [Accepted: 12/17/2021] [Indexed: 12/20/2022]
Abstract
Central venous catheters (CVC) placed either via the internal jugular vein (IJV) or the subclavian vein (SCV) are routinely used in patients with hematologic malignancies. In this retrospective study, we systematically compared CVC-associated complications for both insertion sites, IJV and SCV. Between January 2011 and June 2013, all consecutive patients (n = 87) were included with at least one CVC (n = 153; n = 94 IJV; n = 59 SCV) at our institution due to induction/consolidation for AML/ALL or autologous hematopoietic cell transplantation (HCT). Primary study endpoints were central line-associated (CLABSI), catheter-related (CRBSI) blood stream infections and local inflammation (LI) at the insertion site. CRBSI occurred earlier and more frequently in the IJV- versus the SCV-group with an incidence rate of CRBSI at day 15 of 10% versus 0% (p = .04) and a rate of CRBSI per 1000 CVC days of 5.7 versus 1.2. In addition, CLABSI was detected more often in IJV- compared to SCV-CVC (26% vs. 8%, p = .009). Conversely, LI occurred more frequently and earlier in SCV- versus IJV-CVC (88% vs. 56%, p < .0001) with a median time to LI of 9 versus 14 days (p < .0001). The strongest risk factor for the endpoints CRBSI, CLABSI, and LI was the insertion site. However, SCV insertion was a risk factor for LI (p = .001, HR: 2.0), insertion in the IJV a risk factor for CLABSI (p = .044, HR: 2.7) and CRBSI (p = .036, HR: 5.4). These results demonstrate a differential effect of the insertion site of CVC in neutropenic patients with a significantly reduced frequency of CVC-related blood stream infections in SCV-CVC.
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Affiliation(s)
- Daniela Heidenreich
- Department of Hematology and Oncology University Hospital Mannheim, Heidelberg University Mannheim Germany
| | - Eleonore Hansen
- Department of Hematology and Oncology University Hospital Mannheim, Heidelberg University Mannheim Germany
| | - Sebastian Kreil
- Department of Hematology and Oncology University Hospital Mannheim, Heidelberg University Mannheim Germany
| | - Florian Nolte
- Department of Hematology and Oncology University Hospital Mannheim, Heidelberg University Mannheim Germany
| | - Mohamad Jawhar
- Department of Hematology and Oncology University Hospital Mannheim, Heidelberg University Mannheim Germany
| | - Anna Hecht
- Department of Hematology and Oncology University Hospital Mannheim, Heidelberg University Mannheim Germany
| | - Wolf‐Karsten Hofmann
- Department of Hematology and Oncology University Hospital Mannheim, Heidelberg University Mannheim Germany
| | - Stefan A. Klein
- Department of Hematology and Oncology University Hospital Mannheim, Heidelberg University Mannheim Germany
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Schalk E, Hentrich M. Real-World Data. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:134. [PMID: 35506295 PMCID: PMC9160419 DOI: 10.3238/arztebl.m2022.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Enrico Schalk
- *Medizinische Fakultät, Klinik für Hämatologie und Onkologie Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Marcus Hentrich
- **Abteilung für Innere Medizin III – Hämatologie und Onkologie Rotkreuzklinikum München, Munich, Germany
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Postoperative Rather Than Preoperative Neutropenia Is Associated With Early Catheter-related Bloodstream Infections in Newly Diagnosed Pediatric Cancer Patients. Pediatr Infect Dis J 2022; 41:133-139. [PMID: 34596627 DOI: 10.1097/inf.0000000000003315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relationship of early catheter-related bloodstream infections (CRBSIs) with perioperative neutropenia and antibiotic prophylaxis is not well established. We sought to evaluate perioperative factors associated with early CRBSIs in newly diagnosed pediatric cancer patients, particularly hematologic indices and antibiotic use. METHODS We retrospectively reviewed national registry records of newly diagnosed pediatric cancer patients with port-a-caths inserted using standardized perioperative protocols where only antibiotic use was not regulated. Thirty-day postoperative CRBSI incidence was correlated with preoperative factors using logistic regression and with postoperative blood counts using linear trend analysis. RESULTS Among 243 patients, 17 CRBSIs (7.0%) occurred at median 14 (range, 8-28) postoperative days. Early CRBSIs were significantly associated with cancer type [acute myeloid leukemia and other leukemias (AML/OLs) vs. solid tumors and lymphomas (STLs): odds ratio (OR), 5.09; P = 0.0036; acute lymphoblastic leukemia vs. STL: OR 0.83; P = 0.0446] but not preoperative antibiotics, absolute neutrophil counts and white blood cell counts. Thirty-day postoperative absolute neutrophil counts and white blood cell trends differed significantly between patients with acute lymphoblastic leukemia and STLs (OR 0.83, P < 0.05) and between AML/OLs and STLs (OR 5.09, P < 0.005), with AML/OL patients having the most protracted neutropenia during this period. CONCLUSIONS Contrary to common belief, low preoperative absolute neutrophil counts and lack of preoperative antibiotics were not associated with higher early CRBSI rates. Instead, AML/OL patients, particularly those with prolonged neutropenia during the first 30 postoperative days, were at increased risk. Our findings do not support the use of empirical preoperative antibiotics and instead identify prolonged postoperative neutropenia as a major contributing factor for early CRBSI.
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Risk Factors for Infections, Antibiotic Therapy, and Its Impact on Cancer Therapy Outcomes for Patients with Solid Tumors. Life (Basel) 2021; 11:life11121387. [PMID: 34947918 PMCID: PMC8705721 DOI: 10.3390/life11121387] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
Infections represent a significant cause of morbidity and mortality in cancer patients. Multiple factors related to the patient, tumor, and cancer therapy can affect the risk of infection in patients with solid tumors. A thorough understanding of such factors can aid in the identification of patients with substantial risk of infection, allowing medical practitioners to tailor therapy and apply prophylactic measures to avoid serious complications. The use of novel treatment modalities, including targeted therapy and immunotherapy, brings diagnostic and therapeutic challenges into the management of infections in cancer patients. A growing body of evidence suggests that antibiotic therapy can modulate both toxicity and antitumor response induced by chemotherapy, radiotherapy, and especially immunotherapy. This article provides a comprehensive review of potential risk factors for infections and therapeutic approaches for the most prevalent infections in patients with solid tumors, and discusses the potential effect of antibiotic therapy on toxicity and efficacy of cancer therapy.
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Dadi NCT, Radochová B, Vargová J, Bujdáková H. Impact of Healthcare-Associated Infections Connected to Medical Devices-An Update. Microorganisms 2021; 9:2332. [PMID: 34835457 PMCID: PMC8618630 DOI: 10.3390/microorganisms9112332] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 01/12/2023] Open
Abstract
Healthcare-associated infections (HAIs) are caused by nosocomial pathogens. HAIs have an immense impact not only on developing countries but also on highly developed parts of world. They are predominantly device-associated infections that are caused by the planktonic form of microorganisms as well as those organized in biofilms. This review elucidates the impact of HAIs, focusing on device-associated infections such as central line-associated bloodstream infection including catheter infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and surgical site infections. The most relevant microorganisms are mentioned in terms of their frequency of infection on medical devices. Standard care bundles, conventional therapy, and novel approaches against device-associated infections are briefly mentioned as well. This review concisely summarizes relevant and up-to-date information on HAIs and HAI-associated microorganisms and also provides a description of several useful approaches for tackling HAIs.
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Affiliation(s)
| | - Barbora Radochová
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 84215 Bratislava, Slovakia; (N.C.T.D.); (J.V.)
| | | | - Helena Bujdáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 84215 Bratislava, Slovakia; (N.C.T.D.); (J.V.)
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Kim TH, Choi YW, Ahn MS, Choi YS, Lee HW, Jeong SH, Kang SY, Choi JH, Park JS, Lee HY. Early removal of central venous catheter may not impact the in-hospital mortality in patients with acute leukemia. Ann Hematol 2021; 100:2825-2830. [PMID: 34591161 DOI: 10.1007/s00277-021-04673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/15/2021] [Indexed: 11/24/2022]
Abstract
Central venous catheters (CVCs) are generally required for chemotherapy in patients with acute leukemia, but catheter-related infection is one of the common causes of neutropenic fever. We investigated the in-hospital mortality according to early removal of CVCs and the factors influencing the mortality in patients with acute leukemia undergoing remission induction chemotherapy. This study retrospectively analyzed the hospital record data of 278 patients with acute leukemia treated with non-tunneled CVCs and remission induction chemotherapy in a single institution. Bloodstream infection was more common (p < 0.0001) and median peak C-reactive protein (CRP) levels after neutropenic fever were significantly higher (23.3 vs. 14.5 mg/dl, p = 0.003) in the group with early removal than in the group with maintenance of the CVC. Multivariate analysis of the patients revealed a significant decrease in the mortality with female gender (odds ratio (OR): 0.19, 95% confidence interval (CI): 0.06-0.54, p = 0.002) and a significant increase in the mortality according to the peak CRP (OR 1.12, 95% CI: 1.07-1.17, p < 0.0001). By contrast, early removal of the CVC had no significant effect on the mortality (OR = 1.16, 95% CI: 0.54-2.47, p = 0.706) in univariate analysis. Furthermore, subsequent bloodstream infection after clinical decision for maintenance or early removal of the CVC was confirmed more frequently in the group with early removal (early removal, 22.6%; maintenance, 7.6%, p < 0.0001). Early removal of the CVC had no benefit regarding the mortality and prophylaxis of bloodstream infection in patients with acute leukemia undergoing remission induction chemotherapy. Therefore, maintaining a CVC for as long as possible may be considered, if catheter-related bloodstream infection is not strongly suspected.
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Affiliation(s)
- Tae-Hwan Kim
- Department of Hematology-Oncology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Gyeonggi-do, South Korea
| | - Yong Won Choi
- Department of Hematology-Oncology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Gyeonggi-do, South Korea
| | - Mi Sun Ahn
- Department of Hematology-Oncology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Gyeonggi-do, South Korea
| | - Yoon Seok Choi
- Department of Hematology-Oncology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Gyeonggi-do, South Korea
| | - Hyun Woo Lee
- Department of Hematology-Oncology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Gyeonggi-do, South Korea
| | - Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Gyeonggi-do, South Korea
| | - Seok Yun Kang
- Department of Hematology-Oncology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Gyeonggi-do, South Korea
| | - Jin-Hyuk Choi
- Department of Hematology-Oncology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Gyeonggi-do, South Korea
| | - Joon Seong Park
- Department of Hematology-Oncology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Gyeonggi-do, South Korea.
| | - Hyun Young Lee
- Department of Statistics, Clinical Trial Center, Ajou University Medical Center, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Gyeonggi-do, South Korea
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Jo S, Kang HM, Kim SK, Lee JW, Chung NG, Cho B, Jeong DC, Park YJ. Source Identification of Klebsiella pneumoniae Causing Six Episodes of Recurrent Sepsis in an Adolescent That Underwent Hematopoietic Stem Cell Transplantation. Pathogens 2021; 10:pathogens10091123. [PMID: 34578155 PMCID: PMC8468436 DOI: 10.3390/pathogens10091123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/20/2022] Open
Abstract
Septicemia or bacteremia is one of the leading causes of death worldwide. Long-term tunneled central venous catheters (CVCs) are usually placed in children undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT) for underlying hemato–oncologic malignancies. However, catheter-related complications have been reported frequently, and there is high morbidity and mortality related to catheter-line-associated bloodstream infections (CLABSIs). We report a rare case of six episodes of recurrent K. pneumoniae sepsis within a 6-month period in a 12-year-old male adolescent that underwent HSCT for acute lymphoblastic leukemia, despite treatment with susceptible antibiotics. The patient received extensive diagnostic evaluations to find the hidden source; however, failure to discover the primary source led to multiple recurrences. Through enterobacterial repetitive intergenic consensus (ERIC)-PCR, we were able to identify the relationship between the six episodes and recognize the source of bacteremia.
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Affiliation(s)
- Suejung Jo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Hyun Mi Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
- Correspondence: ; Tel.: +82-2-2258-6273; Fax: +82-2-537-4544
| | - Seong Koo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Nack-Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Dae Chul Jeong
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.J.); (S.K.K.); (J.W.L.); (N.-G.C.); (B.C.); (D.C.J.)
| | - Yeon-Joon Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
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