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Singh G, Rana A, Smriti. Decoding antimicrobial resistance: unraveling molecular mechanisms and targeted strategies. Arch Microbiol 2024; 206:280. [PMID: 38805035 DOI: 10.1007/s00203-024-03998-2] [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: 03/31/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
Antimicrobial resistance poses a significant global health threat, necessitating innovative approaches for combatting it. This review explores various mechanisms of antimicrobial resistance observed in various strains of bacteria. We examine various strategies, including antimicrobial peptides (AMPs), novel antimicrobial materials, drug delivery systems, vaccines, antibody therapies, and non-traditional antibiotic treatments. Through a comprehensive literature review, the efficacy and challenges of these strategies are evaluated. Findings reveal the potential of AMPs in combating resistance due to their unique mechanisms and lower propensity for resistance development. Additionally, novel drug delivery systems, such as nanoparticles, show promise in enhancing antibiotic efficacy and overcoming resistance mechanisms. Vaccines and antibody therapies offer preventive measures, although challenges exist in their development. Non-traditional antibiotic treatments, including CRISPR-Cas systems, present alternative approaches to combat resistance. Overall, this review underscores the importance of multifaceted strategies and coordinated global efforts to address antimicrobial resistance effectively.
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Affiliation(s)
- Gagandeep Singh
- Department of Biosciences (UIBT), Chandigarh University, Punjab, 140413, India
| | - Anita Rana
- Department of Biosciences (UIBT), Chandigarh University, Punjab, 140413, India.
| | - Smriti
- Department of Biosciences (UIBT), Chandigarh University, Punjab, 140413, India
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Cobo-Sánchez JL, Blanco-Mavillard I, Mancebo-Salas N, Pelayo-Alonso R, Gancedo-González Z, De Pedro-Gómez JE. Definition and clinical management of haemodialysis central venous catheter local infections (exit site and tunnel infection): An international consensus assessment. J Clin Nurs 2024; 33:559-571. [PMID: 38093579 DOI: 10.1111/jocn.16941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/12/2023] [Accepted: 11/13/2023] [Indexed: 01/19/2024]
Abstract
AIM To evaluate the relevance of signs and symptoms for the clinical identification of ESI and TI in HD-CVC, by means of international expert consensus, and to reach a consensus on a definition and clinical management (CM) for these infections. BACKGROUND A recent systematic review showed a high heterogeneity in the signs/symptoms used for determining exit site infection (ESI) and tunnel infection (TI) of haemodialysis central venous catheter (HD-CVC). DESIGN A modified Delphi ranking process was carried out between November 2020 and March 2021, consisting of four rounds using an online questionnaire with a panel of 26 experts from 12 countries. METHODS Experts responded on the level of relevance for the identification of ESI and TI, based on a list of 22 signs/symptoms obtained from a previous systematic review, using a 4-point Likert-type scale. After reaching consensus on the signs/symptoms, they followed the same method to reach consensus on the CM. The STROBE Checklist was used to report this study. RESULTS A high degree of consensus was reached to identify the presence of ESI based on nine signs/symptoms: presence of pain at the exit site (ES) during interdialysis period, with fever ≥38°C do not suspect other cause, local signs at the ES (inflammation, induration, swelling, hyperemia/erythema ≥2 cm from ES) and obvious abscess or purulent exudate at ES; and of TI. Likewise, 5 cm were agreed upon. CONCLUSION This Delphi study provides international expert consensus definitions of ESI and TI in HD-CVC, laying the groundwork for the validation of an HD-CVC ES clinical assessment scale for early identification of ESI. RELEVANCE TO CLINICAL PRACTICE In addition, this study provides a series of attitudes to consensual clinics regarding signs/symptoms of local infections in HD-CVC, which may be useful as expert opinion in clinical practice guidelines, when there is insufficient scientific evidence.
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Affiliation(s)
- José Luis Cobo-Sánchez
- Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
- Immunopathology Research Group, Marqués de Valdecilla Institute for Health Research (IDIVAL), Santander, Spain
- University Nursing School Hospital Mompía, Universidad Católica de Ávila, Mompía, Spain
| | - Ian Blanco-Mavillard
- Implementation, Research, and Innovation Unit, Hospital de Manacor, Manacor, Spain
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Noelia Mancebo-Salas
- Dirección General de Servicios Sociales, Consejería de Familia, Juventud y Política Social, Comunidad de Madrid, Madrid, Spain
| | | | | | - Joan Ernest De Pedro-Gómez
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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Ben Natan O, Stein M, Reisfeld S. Audit and feedback as a tool to increase compliance with carbapenemase-producing Enterobacteriaceae (CPE) screening and decrease CPE transmission in the hospital. Infect Control Hosp Epidemiol 2023; 44:1788-1792. [PMID: 36081188 PMCID: PMC10665877 DOI: 10.1017/ice.2022.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/29/2022] [Accepted: 08/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To increase compliance with carbapenemase-producing Enterobacteriaceae (CPE) screening through real-time audit and feedback in our hospital and decrease CPE transmissions. DESIGN A before-and-after trial, using active enhanced surveillance of CPE carriers. SETTING A 500-bed, secondary, university-affiliated hospital that serves a population of 450,000 in a northern district in Israel. METHODS The study was conducted during 2016-2019 and included patients who were admitted to the hospital and fulfilled CPE screening criteria upon admission and during prolonged hospitalizations. On January 1, 2017, the infection control team implemented a new strategy of real-time feedback toward compliance with in-hospital screening guidelines. Other infection control measurements were performed without interventions. The primary outcome was compliance with appropriate CPE screening. Secondary outcomes included CPE acquisition and compliance with hand hygiene and contact precaution practices. Data were analyzed to calculate differences between compliance with CPE screening during the study period and to test the correlation between contact precautions and hand hygiene practices according to compliance with CPE screening. RESULTS During the study period, 3,131 patients were eligible for CPE screening. We detected a statistically significant increase in compliance to CPE screening from 74% during 2017 to 92% in 2018 and 95% in 2019 (P < .0001 for both comparisons). We detected a decrease in CPE transmission from 12% in 2017 to 2% in 2019 (P < .0001). We did not find any correlation between other infection control interventions and CPE screening and acquisition. CONCLUSION Audit and feedback can improve appropriate CPE screening and may reduce CPE transmission in the hospital.
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Affiliation(s)
- Orna Ben Natan
- Infectious Diseases and Infection Control Units, Hillel Yaffe Medical Center, Hadera, Israel
| | - Michal Stein
- Pediatric Infectious Diseases Unit, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Reisfeld
- Infectious Diseases and Infection Control Units, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
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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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Falcone M, Tiseo G, Carbonara S, Marino A, Di Caprio G, Carretta A, Mularoni A, Mariani MF, Maraolo AE, Scotto R, Dalfino L, Corbo L, Macera M, Medaglia AA, d'Errico ML, Gioè C, Sgroi C, Del Vecchio RF, Ceccarelli G, Albanese A, Buscemi C, Talamanca S, Raponi G, Foti G, De Stefano G, Franco A, Iacobello C, Corrao S, Morana U, Pieralli F, Gentile I, Santantonio T, Cascio A, Coppola N, Cacopardo B, Farcomeni A, Venditti M, Menichetti F. Mortality Attributable to Bloodstream Infections Caused by Different Carbapenem-Resistant Gram-Negative Bacilli: Results From a Nationwide Study in Italy (ALARICO Network). Clin Infect Dis 2023; 76:2059-2069. [PMID: 36801828 DOI: 10.1093/cid/ciad100] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Our aim was to analyze mortality attributable to carbapenem-resistant (CR) gram-negative bacilli (GNB) in patients with bloodstream infections (BSIs). METHODS Prospective multicentric study including patients with GNB-BSI from 19 Italian hospitals (June 2018-January 2020). Patients were followed-up to 30 days. Primary outcomes were 30-day mortality and attributable mortality. Attributable mortality was calculated in the following groups: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales, metallo-β-lactamases (MBL)-producing Enterobacterales, CR-Pseudomonas aeruginosa (CRPA), CR-Acinetobacter baumannii (CRAB). A multivariable analysis with hospital fixed-effect was built to identify factors associated with 30-day mortality. Adjusted OR (aORs) were reported. Attributable mortality was calculated according to the DRIVE-AB Consortium. RESULTS Overall, 1276 patients with monomicrobial GNB BSI were included: 723/1276 (56.7%) carbapenem-susceptible (CS)-GNB, 304/1276 (23.8%) KPC-, 77/1276 (6%) MBL-producing CRE, 61/1276 (4.8%) CRPA, and 111/1276 (8.7%) CRAB BSI. Thirty-day mortality in patients with CS-GNB BSI was 13.7% compared to 26.6%, 36.4%, 32.8% and 43.2% in patients with BSI by KPC-CRE, MBL-CRE, CRPA and CRAB, respectively (P < .001). On multivariable analysis, age, ward of hospitalization, SOFA score, and Charlson Index were factors associated with 30-day mortality, while urinary source of infection and early appropriate therapy resulted protective factors. Compared to CS-GNB, MBL-producing CRE (aOR 5.86, 95% CI 2.72-12.76), CRPA (aOR 1.99, 95% CI 1.48-5.95) and CRAB (aOR 2.65, 95% CI 1.52-4.61) were significantly associated with 30-day mortality. Attributable mortality rates were 5% for KPC-, 35% for MBL, 19% for CRPA, and 16% for CRAB. CONCLUSIONS In patients with BSIs, carbapenem-resistance is associated with an excess of mortality, with MBL-producing CRE carrying the highest risk of death.
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Affiliation(s)
- Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Giusy Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Sergio Carbonara
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro," Bari, Italy
| | - Andrea Marino
- Unit of Infectious Diseases, ARNAS Garibaldi, Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanni Di Caprio
- Infectious Diseases Unit, AORN Sant' Anna e San Sebastiano, Caserta, Italy
| | - Anna Carretta
- Department of Infectious Diseases, University Hospital "Ospedali Riuniti" of Foggia, Foggia, Italy
| | - Alessandra Mularoni
- Department of Infectious Diseases, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS ISMETT), Palermo, Italy
| | - Michele Fabiano Mariani
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro," Bari, Italy
| | - Alberto Enrico Maraolo
- First Division of Infectious Diseases, Cotugno Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Riccardo Scotto
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Lidia Dalfino
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Lorenzo Corbo
- Medicina per la complessità assistenziale 1 AOU Careggi, Florence, Italy
| | - Margherita Macera
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | | | - Maria Luca d'Errico
- Department of Infectious Diseases, University Hospital "Ospedali Riuniti" of Foggia, Foggia, Italy
| | - Claudia Gioè
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone," Palermo, Italy
| | | | | | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Calogero Buscemi
- Infectious Diseases Unit, ARNAS Ospedale Civico of Palermo, Palermo, Italy
| | - Simona Talamanca
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Microbiology and Virology Unit, University Hospital Policlinico Umberto I, Rome, Italy
| | - Giuseppe Foti
- Infetious Diseases Unit, "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Giulio De Stefano
- Department of Infectious Diseases, Hospital of Potenza and Matera, Matera, Italy
| | - Antonina Franco
- Department of Infectious Diseases, Umberto I Public Hospital, Siracusa, Italy
| | - Carmelo Iacobello
- UOC Malattie Infettive, Azienda Ospedaliera per l'Emergenza, Cannizzaro, Catania, Italy
| | - Salvatore Corrao
- Department of Clinical Medicine, Internal Medicine Division, ARNAS Civico Di Cristina Benfratelli Hospital Trust, Palermo, Italy
| | | | - Filippo Pieralli
- Intermediate Care Unit, Careggi University Hospital, Florence, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Teresa Santantonio
- Department of Infectious Diseases, University Hospital "Ospedali Riuniti" of Foggia, Foggia, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties G D'Alessandro, University of Palermo, Palermo, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Bruno Cacopardo
- Unit of Infectious Diseases, ARNAS Garibaldi, Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alessio Farcomeni
- Department of Economics & Finance, University of Rome "Tor Vergata," Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Francesco Menichetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
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Cobo-Sánchez JL, Blanco-Mavillard I, Mancebo-Salas N, Moya-Mier S, González-Menéndez F, Renedo-González C, Lázaro-Otero M, Pelayo-Alonso R, Gancedo-González Z, de Pedro-Gómez JE. Early identification of local infections in central venous catheters for hemodialysis: A systematic review. J Infect Public Health 2023; 16:1023-1032. [PMID: 37178476 DOI: 10.1016/j.jiph.2023.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The use of central venous catheters (CVC) is associated with higher morbidity and mortality, related to infectious complications, contributing to poorer clinical outcomes and increased healthcare costs. According to the literature, the incidence of local infections related to CVC for hemodialysis is highly variable. This variability is related to differences in definitions of catheter-related infections. OBJECTIVE To identify signs and symptoms for determining local infections (exit site and tunnel tract infections) used in the literature in tunnelled and nontunnelled CVC for hemodialysis. DESIGN Systematic review METHODS: Structured electronic searches were conducted in five electronic databases, from 1 January 2000-31 August 2022, using key words and specific vocabulary, as well as manual searches in several journals. Additionally, vascular access clinical guidelines and infection control clinical guidelines were reviewed. RESULTS After validity analysis, we selected 40 studies and seven clinical guidelines. The definitions of exit site infection and tunnel infection used in the different studies were heterogeneous. Among the studies, seven (17,5 %) used the definitions of exit site and tunnel infection based on a clinical practice guideline. Three of the studies (7.5 %) used the Twardowski scale definition of exit site infection or a modification. The remaining 30 studies (75 %) used different combinations of signs and symptoms. CONCLUSIONS Definitions of local CVC infections are highly heterogeneous in the revised literature. It is necessary to establish a consensus regarding the definitions of hemodialysis CVC exit site and tunnel infections. REGISTRATION PROSPERO (CRD42022351097).
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Affiliation(s)
- José Luis Cobo-Sánchez
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain; Clínica Mompía School of Nursing, Universidad Católica de Ávila, Mompía, Spain
| | - Ian Blanco-Mavillard
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Implementation, Research and Innovation Unit, Hospital de Manacor, Manacor, Spain.
| | - Noelia Mancebo-Salas
- Dirección General de Servicios Sociales. Consejería de Familia, Juventud y Política Social, Comunidad de Madrid, Madrid, Spain
| | - Susana Moya-Mier
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain
| | | | | | - Mercedes Lázaro-Otero
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain; Faculty of Nursing, Universidad de Cantabria, Santander, Spain
| | | | - Zulema Gancedo-González
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain; Escoles Universitaries Gimbernat, Nursing School, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Joan Ernest de Pedro-Gómez
- Department of Nursing and Physiotherapy, Universitat de les Illes Balears, Palma, Spain; Care, Chronicity and Evidence in Health Research Group (CurES), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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Cobo-Sánchez JL, Blanco-Mavillard I, Pelayo-Alonso R, Mancebo-Salas N, Fernandez-Fernandez I, De Pedro-Gomez JE. Validity of a catheter exit site clinical assessment scale for the early detection of exit site infections in patients on haemodialysis with a central venous catheter: protocol for a multicentre validation study in Spain (EXITA Study). BMJ Open 2022; 12:e065724. [PMID: 36691132 PMCID: PMC9454082 DOI: 10.1136/bmjopen-2022-065724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Haemodialysis patients with central venous catheter (HD-CVC) are at increased risk of exit site infections (ESIs) and catheter-related bloodstream infections, causing an increase of hospitalisation, morbidity and mortality rates. The main aim of the EXITA Study is to develop and validate an instrument for the early detection of HD-CVC ESIs. METHODS AND ANALYSIS EXITA is a multicentre prospective cohort study to validate the proposed instrument with a sample of 457 HD-CVCs: 92 in the ESI group and 365 in the non-ESI group. Sample size was calculated using Epidat V.4.2 software, with 95% and 90% expected sensitivity and specificity, respectively, an ESI incidence around 20% and 5%-10% precision range. During each haemodialysis session, the absence or presence of each item will be assessed by nurses. If any item is present, a microbiological study of pericatheter skin smears and/or exit site exudate will be carried out. HD-CVC ESI will be diagnosed when the pericatheter skin smears and/or exit site exudate culture are positive (≥15 CFU/mL by semiquantitative Maki's technique or ≥1000 CFU/mL by Cleri's technique). To validate the scale, a logistic regression analysis will be performed: the β coefficients of each of the signs/symptoms of the scale to be validated will be estimated. We will use logit function and calculate ESI probability=elogit ESI/1+elogit ESI. ETHICS AND DISSEMINATION The study has been approved by the Research Ethics Committee with Medical Products of Cantabria (approval code 2019.146). We will obtain informed consent from all participants before data collection. We will publish the study results in a peer-reviewed scientific journal.
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Affiliation(s)
- José Luis Cobo-Sánchez
- Nursing Quality, Training, Research, Development and Innovation Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Nursing Department, Escuela Universitaría de Enfermería Clínica Mompía-Universidad Católica Santa Teresa de Jesús de Ávila (UCAV), Mompía, Spain
| | - Ian Blanco-Mavillard
- Implementation, Research and Innovation Unit, Hospital de Manacor, Manacor, Spain
- Care, Chronicity and Evidence in Health Research Group (CurES), IdISBa, Palma de Mallorca, Spain
- Nursing and Physiotherapy Department, Balearic Islands University, Palma, Spain
| | - Raquel Pelayo-Alonso
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Noelia Mancebo-Salas
- Department of Nursing, Escuela Universitaria de Enfermería Cruz Roja Española, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Joan Ernest De Pedro-Gomez
- Care, Chronicity and Evidence in Health Research Group (CurES), IdISBa, Palma de Mallorca, Spain
- Nursing and Physiotherapy Department, Balearic Islands University, Palma, Spain
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Manerikar A, Watanabe S, Kandula V, Karim A, Thakkar S, Saine M, Kim SS, Garza-Castillon R, Odell DD, Bharat A, Kurihara C. Indwelling Central Venous Catheters Drive Bloodstream Infection During Veno-venous Extracorporeal Membrane Oxygenation Support. ASAIO J 2022; 68:859-864. [PMID: 34593682 PMCID: PMC8958168 DOI: 10.1097/mat.0000000000001575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Blood stream infection (BSI) is a potentially lethal complication in patients receiving extracorporeal membrane oxygenation (ECMO). It may be particularly common in patients with veno-venous ECMO due to their long hospitalization in the intensive care unit. Given that these patients have concurrent indwelling central venous catheters (CVC), it is unclear whether the ECMO circuit, CVC, or both, contribute to BSI. This study evaluated the risk factors associated with BSI in patients receiving veno-venous ECMO in a single institution study of 61 patients from 2016 through 2019. All ECMO catheters and the circuit oxygenator fluid were aseptically collected and analyzed for microorganisms at the time of decannulation. New BSI was diagnosed in 15 (24.6%) patients and increased mortality by threefold. None of the ECMO catheters or oxygenator fluid were culture positive. BSI increased with CVC use of over 8 days and was significantly lowered when CVC were exchanged by day 8 compared with patients with exchanges at later points (15.0% vs. 42.8%, p = 0.02). Median length of CVC use in the BSI-negative and BSI-positive group were 6.3 ± 5.0 and 9.4 ± 5.1, respectively (p = 0.04). In summary, BSI is a potentially lethal complication in patients receiving ECMO. Indwelling CVC, not the ECMO circuitry, is the likely contributor for BSI, and exchanging CVC by day 8 can reduce the incidence of BSI.
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Affiliation(s)
- Adwaiy Manerikar
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Satoshi Watanabe
- Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Viswajit Kandula
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Azad Karim
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Sanket Thakkar
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Mark Saine
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Samuel S. Kim
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Rafael Garza-Castillon
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - David D. Odell
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Ankit Bharat
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
- Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Chitaru Kurihara
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
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9
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Central venous catheter insertion in adult patients: a best practice implementation project. JBI Evid Implement 2020; 19:296-305. [PMID: 34491925 DOI: 10.1097/xeb.0000000000000261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS The central venous catheter (CVC) is an indispensable device in the daily practice of modern medicine. Thus, the implementation of CVC interferes with the care of a large number of patients. This project aimed to implement the best practices in the insertion of CVC in adult hospitals in Brazil. METHODS The project had three phases, including forming a team and conducting the baseline audit; identifying problems and developing strategies; and conducting a follow-up audit to assess the impact on compliance with best practices. A baseline audit was conducted at a public Hospital in Minas Gerais, Brazil, in June and July 2019. For data collection, direct observation of the procedure was performed and through the PACES (Practical Application of Clinical Evidence System) audit and feedback tool to check the compliance criteria established in the literature. After implementation, a second audit was conducted in August 2019. RESULTS During the baseline audit, the absence of adequate compliance with the criteria for using an ultrasound to insert the catheter and correct hand hygiene before the procedure was identified. Theoretical-practical training was carried out, including the use of ultrasound to perform the procedure, using an adapted mannequin. The follow-up audit showed an improvement in the compliance rate for the following audit criteria: physical assessment before the procedure (92-100%); evaluation of the most suitable vein for insertion of the catheter, avoiding the femoral vein (92-100%); correct hand hygiene before the procedure (58-100%); maintenance of asepsis throughout the procedure (83-91%) and use of ultrasound to guide venous catheterization (17-100%). CONCLUSION The current project proved that training the team can be effective in optimizing the implementation of evidence.
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10
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Chi X, Guo J, Niu X, He R, Wu L, Xu H. Prevention of central line-associated bloodstream infections: a survey of ICU nurses' knowledge and practice in China. Antimicrob Resist Infect Control 2020; 9:186. [PMID: 33198796 PMCID: PMC7667726 DOI: 10.1186/s13756-020-00833-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Central line-associated bloodstream infections (CLABSI) are largely preventable when evidence-based guidelines are followed. However, it is not clear how well these guidelines are followed in intensive care units (ICUs) in China. This study aimed to evaluate Chinese ICU nurses’ knowledge and practice of evidence-based guidelines for prevention of CLABSIs issued by the Centers for Disease Control and Prevention, US and the Department of Health UK. Method Nurses completed online questionnaires regarding their knowledge and practice of evidence-based guidelines for the prevention of CLABSIs from June to July 2019. The questionnaire consisted of 11 questions, and a score of 1 was given for a correct answer (total score = 0–11). Results A total of 835 ICU nurses from at least 104 hospitals completed the questionnaires, and 777 were from hospitals in Guangdong Province. The mean score of 11 questions related to evidence-based guidelines for preventing CLABSIs was 4.02. Individual total scores were significantly associated with sex, length of time as an ICU nurse, educational level, professional title, establishment, hospital grade, and incidence of CLABSIs at the participant’s ICU. Importantly, only 43% of nurses reported always using maximum barrier precautions, 14% of nurses reported never using 2% chlorhexidine gluconate for antisepsis at the insertion site, only 40% reported prompt removal of the catheter when it was no longer necessary, and 33% reported frequently and routinely changing catheters even if there was no suspicion of a CLABSI. Conclusion Chinese ICU nurses in Guangdong Province lack of knowledge and practice of evidence-based guidelines for the prevention of CLABSIs. National health administrations should adopt policies to train ICU nurses to prevent CLABSIs.
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Affiliation(s)
- Xiuwen Chi
- School of Nursing, Guangdong Medical University, No. 1 Xincheng Road, Songshan Lake Science and Technology Industrial Park, Dongguan, 523808, Guangdong, China.
| | - Juan Guo
- School of Nursing, Heze Medical College, Heze, 274000, Shandong, China
| | - Xiaofeng Niu
- Department of Upper Extremity Orthopedics, Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510700, Guangdong, China
| | - Ru He
- Department of Intensive Care Unit, Longgang Central District Hospital, Shenzhen, 518116, Guangdong, China
| | - Lijuan Wu
- School of Nursing, Guangdong Medical University, No. 1 Xincheng Road, Songshan Lake Science and Technology Industrial Park, Dongguan, 523808, Guangdong, China
| | - Hong Xu
- School of Nursing, Guangdong Medical University, No. 1 Xincheng Road, Songshan Lake Science and Technology Industrial Park, Dongguan, 523808, Guangdong, China
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11
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Pinelli F, Pittiruti M, Van Boxtel T, Barone G, Biffi R, Capozzoli G, Crocoli A, Elli S, Elisei D, Fabiani A, Garrino C, Graziano U, Montagnani L, Prato AP, Scoppettuolo G, Zadra N, Zanaboni C, Zerla P, Konstantinou E, Jones M, Rosay H, Simcock L, Stas M, Pepe G. GAVeCeLT-WoCoVA Consensus on subcutaneously anchored securement devices for the securement of venous catheters: Current evidence and recommendations for future research. J Vasc Access 2020; 22:716-725. [PMID: 32613887 DOI: 10.1177/1129729820924568] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Subcutaneously anchored securement devices (or subcutaneous engineered securement devices) have been introduced recently into the clinical practice, but the number of published studies is still scarce. The Italian Group of Long-Term Central Venous Access Devices (GAVeCeLT)—in collaboration with WoCoVA (World Congress on Vascular Access)—has developed a Consensus about the effectiveness, safety, and cost-effectiveness of such devices. Methods: After the definition of a panel of experts, a systematic collection and review of the literature on subcutaneously anchored securement devices was performed. The panel has been divided in two working groups, one focusing on adult patients and the other on children and neonates. Results: Although the quality of evidence is generally poor, since it is based mainly on non-controlled prospective studies, the panel has concluded that subcutaneously anchored securement devices are overall effective in reducing the risk of dislodgment and they appear to be safe in all categories of patients, being associated only with rare and negligible local adverse effects; cost-effectiveness is demonstrated—or highly likely—in specific populations of patients with long-term venous access and/or at high risk of dislodgment. Conclusion: Subcutaneously anchored securement is a very promising strategy for avoiding dislodgment. Further studies are warranted, in particular for the purpose of defining (a) the best management of the anchoring device so to avoid local problems, (b) the patient populations in which it may be considered highly cost-effective and even mandatory, (c) the possible benefit in terms of reduction of other catheter-related complications such as venous thrombosis and/or infection, and—last but not least—(d) their impact on the workload and stress level of nurses taking care of the devices.
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Affiliation(s)
- Fulvio Pinelli
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | | | | | | | | | | | - Stefano Elli
- Azienda Ospedaliera San Gerardo, Lombardia, Italy
| | | | - Adam Fabiani
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | | | - Ugo Graziano
- Santobono Pausilipon Azienda Ospedaliera Pediatrica, Napoli, Italy
| | | | - Alessio Pini Prato
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | | | - Pietro Zerla
- ASST Melegnano e della Martesana, Vizzolo Predabissi, Italy
| | | | - Matt Jones
- East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | | | - Liz Simcock
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Gilda Pepe
- University Hospital Agostino Gemelli, Rome, Italy
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12
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Bush K, Odunayo A, Hedges K, Guieu LV, Smith R, Okafor C. Peripheral Intravenous Catheter Complications in Hospitalized Cats: An Observational Pilot Study. Top Companion Anim Med 2020; 41:100456. [PMID: 32823155 DOI: 10.1016/j.tcam.2020.100456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES There is little information about complications associated with peripheral catheter use in cats. The primary objective of this study was to determine the main reason for catheter removal in cats hospitalized in the Intensive Care Unit at a university teaching hospital. The secondary objective was to describe catheter-associated complications in cats hospitalized. METHODS All feline patients with peripheral intravenous catheters admitted to the Intensive Care Unit between June and August 2017 were prospectively enrolled in this study. All catheters were evaluated at least 3 times a day per institutional Intensive Care Unit protocol. The catheters were monitored throughout the cat's hospitalization period for development of complications, including occlusion, phlebitis and extravasation. Data collected included patient signalment, reason for hospitalization, catheter size and location, number of hours the catheter remained in place, reason for removal and if the catheter was replaced once removed. RESULTS Thirty-four cats were enrolled in the study, and a total of 42 catheters were placed in those cats. Median peripheral IV catheter duration was 23.8 hours (interquartile range [IQR] 13.8-41.3 hours). The most frequent reason for catheter removal was patient discharge from the hospital (24/42, 57.1%). Overall catheter complication rate was 21.4% (9/42). Complications observed included phlebitis, extravasation, patient removal, occlusion, and edema formation. CLINICAL SIGNIFICANCE The results of this study conclude that the majority of peripheral IV catheters in cats are removed due to discharge from hospitalization. More studies with a larger population of cats are needed to see if there is a relationship between length of indwelling catheterization and risk of catheter-associated complications.
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Affiliation(s)
- Kaleigh Bush
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA.
| | - Katherine Hedges
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Liz-Valérie Guieu
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Rebecca Smith
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Chika Okafor
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
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13
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Martillo M, Zarbiv S, Gupta R, Brito A, Shittu A, Kohli-Seth R. A comprehensive vascular access service can reduce catheter-associated bloodstream infections and promote the appropriate use of vascular access devices. Am J Infect Control 2020; 48:460-464. [PMID: 31604620 DOI: 10.1016/j.ajic.2019.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 11/29/2022]
Abstract
This study describes the role of a novel vascular access service in the reduction and prevention of central line-associated bloodstream infections (CLABSIs). We conducted a retrospective analysis of data obtained over a span of 24 months after implementation of our vascular access service. We identified a progressive decline in the CLABSI rate and standardized infection ratio (SIR) in 2017 (rate, 1.75; SIR, 1.25) and in 2018 (rate, 1.037; SIR, 0.91). The reduction in CLABSIs was attributed to appropriate triage, insertion, and maintenance of vascular access devices.
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Affiliation(s)
- Miguel Martillo
- Department of Surgery, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Samson Zarbiv
- Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Camden, NJ
| | - Rohit Gupta
- Department of Surgery, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy Brito
- Department of Surgery, Institute for Critical Care Medicine, The Mount Sinai Hospital, New York, NY
| | - Atinuke Shittu
- Department of Surgery, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Roopa Kohli-Seth
- Department of Surgery, Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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14
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Kitamura H, Kubota Y, Komukai S, Yoshida H, Kaneko Y, Mihara Y, Nagasawa Z, Kawaguchi A, Aoki Y, Kimura S. Venue of catheter insertion does not significantly impact the event of central line-associated bloodstream infection in patients with haematological diseases. Infect Prev Pract 2020; 2:100050. [PMID: 34368700 PMCID: PMC8336171 DOI: 10.1016/j.infpip.2020.100050] [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: 11/15/2019] [Accepted: 02/24/2020] [Indexed: 11/22/2022] Open
Abstract
Background Central line-associated bloodstream infection (CLABSI) is a serious complication of central venous catheter (CVC) placement in patients with haematological diseases associated with neutropenia and immunosuppression. However, whether the venues where CVC are inserted influence CLABSI development remains unclear. Methods We investigated whether CVC insertion at venues with different standards of cleanliness altered the occurrence of CLABSI. We evaluated data from 279 patients (545 CVC insertions) with haematological diseases including age, sex, underlying disease, reason for insertion, insertion site, number of lumens, venue, dates of insertion and removal, complete blood counts, percentage of neutrophils and serum albumin concentrations at the time of CVC insertion. Findings Overall, 55 CLABSI events occurred during a period of 23,434 catheter days (2.35 per 1,000 catheter days). In total, 153 and 190 patients underwent 226 and 305 CVC insertions, respectively in a ward and in an operating room, respectively. Univariate analysis identified the operating room (P = 0.017), allogeneic haematopoietic stem cell transplantation (P < 0.001), triple lumen catheter (P = 0.002), haemoglobin (P = 0.019), white blood cell count (P = 0.012) and percentage of neutrophils (P = 0.012) as significant factors for the development of CLABSI. However, multivariate analysis adjusted for age, reason for insertion, insertion site, number of lumens, haemoglobin, percentage of neutrophils and platelet counts found no significant differences between the venue where CVC were inserted and CLABSI development (P = 0.158). Conclusion The venue of CVC insertion is unlikely to influence CLABSI development in patients with haematological diseases.
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Affiliation(s)
- Hiroaki Kitamura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yasushi Kubota
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.,Department of Transfusion Medicine, Saga University Hospital, Saga, Japan
| | - Sho Komukai
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Hisako Yoshida
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Yukari Kaneko
- Department of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Saga, Japan
| | - Yukiko Mihara
- Department of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Saga, Japan
| | - Zenzo Nagasawa
- Department of Medical Technology and Sciences, School of Health Sciences at Fukuoka, International University of Health and Welfare, Okawa, Japan
| | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yosuke Aoki
- Department of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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15
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Wong A, Glogolia M, Lange PW, Dale S, Chappell M, Soosay Raj T, Hanna D, Devaraja L, Williams C, Williamson J, Conyers R. A nurse-led paediatric oncology fast-track clinic proves a successful ambulatory intervention for patients. Support Care Cancer 2020; 28:4395-4403. [PMID: 31919665 DOI: 10.1007/s00520-019-05250-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 12/16/2019] [Indexed: 11/25/2022]
Abstract
AIM To assess the impact of a pilot nurse-led paediatric oncology fast-track clinic (OFTC) for complications and side effects following chemotherapy within a paediatric tertiary hospital. METHODS Prospective clinical data from the first 100 patients seen in the OFTC were compared with retrospective data of oncology patient presentations to the emergency department (ED) (over a 1-year period, n = 196) who would have been eligible for review in the OFTC. Parent and patient satisfaction of clinical care were also assessed via surveys pre- and post-OFTC implementation. RESULTS Analysis which achieved statistical difference was a reduction in the number of blood tubes taken in OFTC (average 1.9 for those discharged from clinic, 2.9 for those admitted from clinic) in comparison to those seen in the ED (average 3.2) (p = 0.0027). The average number of interventions per patient seen in the ED were 2.1 (standard deviation 1.64) compared with 1.7 (standard deviation 1.55) interventions per patient seen in the OFTC, and who were not admitted following review. This result approached statistical significance with p = 0.0963. Other results which did not meet statistical significance included a reduction in treatment times, hospital admissions and medical oncology reviews. CONCLUSION Our pilot study implementing an OFTC for the triage and assessment of chemotherapy-related complications has proven successful from an operational and consumer perspective. The clinic improved care by ensuring expedited review, more streamlined interventions, and less overall hospital admissions. The improvements in efficiency were also mirrored by increased parent and patient satisfaction.
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Affiliation(s)
- A Wong
- The Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia
| | - M Glogolia
- The Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia
| | - P W Lange
- Department of Medicine, Melbourne University, Melbourne, Australia
| | - S Dale
- The Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia
| | - M Chappell
- The Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia
| | - T Soosay Raj
- The Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia
| | - D Hanna
- The Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia
| | - L Devaraja
- Department of Paediatrics, Melbourne University, Melbourne, Australia
| | - C Williams
- The Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia.,The Paediatric Integrated Cancer Service (PICS), Melbourne, Australia
| | - J Williamson
- The Paediatric Integrated Cancer Service (PICS), Melbourne, Australia
| | - R Conyers
- The Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia. .,Department of Paediatrics, Melbourne University, Melbourne, Australia. .,Murdoch Children's Research Institute, Melbourne, Australia.
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16
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Arrieta J, Orrego C, Macchiavello D, Mora N, Delgado P, Giuffré C, García Elorrio E, Rodriguez V. 'Adiós Bacteriemias': a multi-country quality improvement collaborative project to reduce the incidence of CLABSI in Latin American ICUs. Int J Qual Health Care 2019; 31:704-711. [PMID: 31198929 DOI: 10.1093/intqhc/mzz051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 02/22/2019] [Accepted: 04/26/2019] [Indexed: 12/24/2022] Open
Abstract
QUALITY PROBLEM The incidence of central line-associated bloodstream infections (CLABSI) in Latin America has been estimated at 4.9 episodes per 1000 central line (CL) days, compared to a pooled incidence of 0.9 in the United States. CLABSI usually result from not adhering to standardized health procedures and can be prevented using evidence-based practices. INITIAL ASSESSMENT The first phase of the 'Adiós Bacteriemias' Collaborative was implemented in 39 intensive care units (ICUs) from Latin America from September 2012 to September 2013 with a 56% overall reduction in the incidence of CLABSI. CHOICE OF SOLUTION Bundles of care for the processes of insertion and maintenance of CLs have proven to be effective in the reduction of CLABSI across different settings. IMPLEMENTATION Building on the results of the first phase, we implemented a second phase of the 'Adiós Bacteriemias' Collaborative between June 2014-July 2015. We adapted the Breakthrough Series (BTS) Collaborative model to guide the adoption of bundles of care for CLABSI prevention through virtual learning sessions and continuous feedback. EVALUATION Eighty-three ICUs from five Latin American countries actively reported process and outcome measures. The overall reduction in the CLABSI incidence rate was 22% (incidence rate 0.78; 95% CI 0.65, 0.95), from 2.58 episodes per 1000 CL days at baseline to 2.02 episodes per 1000 CL days (P < 0.01) during the intervention period. LESSONS LEARNED Adiós Bacteriemias was effective in reducing the incidence of CLABSI and improving the adherence to good practices for CL insertion and maintenance processes in participating ICUs in Latin America.
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Affiliation(s)
- Jafet Arrieta
- Institute for Healthcare Improvement, Harvard T.H. Chan School of Public Health
| | | | | | | | - Pedro Delgado
- Institute for Healthcare Improvement, Harvard T.H. Chan School of Public Health
| | | | | | - Viviana Rodriguez
- Instituto de Efectividad Clínica y Sanitaria, Hospital Alemán de Buenos Aires
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17
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Loomba G, Dhandapani M, Kaur S, Ghai S, Biswal M, Ramachandran R, Gupta KL. The Effectiveness of Personal Hygiene Practices on Non-Cuffed Central Vein Catheter-Related Infection in Patients Undergoing Hemodialysis: A Randomized Controlled Trial. Indian J Nephrol 2019; 29:267-271. [PMID: 31423061 PMCID: PMC6668307 DOI: 10.4103/ijn.ijn_92_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Infection of the internal jugular vein (IJV) catheter continues to be a common cause of death in patients with end-stage renal disease undergoing hemodialysis (HD). The present study aimed to evaluate the effectiveness of personal hygiene on the incidence of IJV catheter-related bloodstream infection (CRBSI). A randomized, controlled, parallel, and non-inferiority trial was conducted on patients initiated on maintenance HD via right IJV catheter. Patients were randomly allocated to control and intervention group via computer-generated random table. Intervention package for the intervention group included hand washing (2–4 hourly and whenever visibly dirty), feet washing (12 hourly), and axillary shave (at any point during the study, no hair growth in axilla). Patients were provided with a pamphlet and reinforced to continue package till IJV catheter was in situ. Patients were followed up twice a week for one month from the date of catheter insertion for the incidence of CRBSI. The primary outcome of the study was percentage of patients free from CRBSI. On intention-to-treat analysis, the percentage of patients without CRBSI was 53.7% and 29.3% in the intervention and control arm, respectively [P = 0.04; 25.12% (1.43–45.28%)]. Positive blood cultures were higher in control (73.3%) as compared to the intervention group (28.6%) (P = 0.19). Personal hygiene interventions are an effective method to reduce the incidence of CRBSIs among population undergoing maintenance HD via non-cuffed IJV catheter.
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Affiliation(s)
| | | | - Sukhpal Kaur
- National Institute of Nursing Education, Chandigarh, India
| | - Sandhya Ghai
- National Institute of Nursing Education, Chandigarh, India
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18
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Atkins GJ, Alberdi MT, Beswick A, Blaha JD, Bingham J, Cashman J, Chen AF, Cooper AM, Cotacio GL, Fraguas T, Gambhir A, Gromov K, Guerra E, Hooper G, Khlopas A, Kieser D, Klaber I, Kyte R, Levine B, Mont MA, Nikolaou V, Nuñez J, Overgaard S, Parvizi J, Saxena A, Sayago G, Shahcheraghi H, Sodhi N, Solomon LB, Starczak Y, Tan TL, Tarabichi M, Olivan RT, Virolainen P, Wyatt M. General Assembly, Prevention, Surgical Site Preparation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S85-S92. [PMID: 30348579 DOI: 10.1016/j.arth.2018.09.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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19
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McLellan MC. Nursing Care at the Pediatric Cardiology Ward. CONGENIT HEART DIS 2019. [DOI: 10.1007/978-3-319-78423-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Admiraal R, Boelens JJ. Pharmacotherapy in Pediatric Hematopoietic Cell Transplantation. Handb Exp Pharmacol 2019; 261:471-489. [PMID: 31375921 DOI: 10.1007/164_2019_247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hematopoietic cell transplantation (HCT) is a curative treatment option for both malignant and nonmalignant diseases. Success of the procedure mainly depends on disease control and treatment-related complications. Pharmacotherapy plays a major role in HCT and significantly impacts the outcomes. Main drug use within HCT includes conditioning, GvHD prophylaxis, and prevention/treatment of infections.Increasing evidence suggests individualized dosing in (pediatric) HCT may improve outcome. Dose individualization may result in a better predictable drug treatment in terms of safety and efficacy, including timely immune reconstitution after HCT and optimal tumor or disease control, which may result in improved survival chances.
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Affiliation(s)
- R Admiraal
- Blood and Marrow Transplantation Program, Prinses Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J J Boelens
- Stem Cell Transplantation and Cellular Therapies Pediatrics, New York, NY, USA. .,Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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21
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Margatho AS, Ciol MA, Hoffman JM, Dos Reis PED, Furuya RK, Lima DAFS, Basile-Filho A, Silveira RCCP. Chlorhexidine-impregnated gel dressing compared with transparent polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients: A pilot randomised controlled trial. Aust Crit Care 2018; 32:471-478. [PMID: 30558968 DOI: 10.1016/j.aucc.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 10/24/2018] [Accepted: 11/01/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In patients with short-term percutaneous central venous catheter (CVC), it is recommended that a dressing be applied to the catheter insertion site to prevent catheter-related infections. OBJECTIVES The objective of this study was to assess the feasibility of a randomised controlled trial to compare the efficacy of chlorhexidine-impregnated dressing with that of polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients with short-term percutaneous CVC. METHODS One hundred fifteen patients with a CVC were randomised to chlorhexidine-impregnated gel dressing (chlorhexidine gel group) or transparent polyurethane dressing (polyurethane group) between April and December 2014. Feasibility outcomes included data on eligibility, recruitment, missing data, and protocol violation. The primary outcome measure of efficacy was the presence of colonisation with the same microorganism in both the skin swab around catheter insertion site and the catheter tip. RESULTS Of 526 patients assessed for eligibility, 411 (78%) did not meet inclusion criteria, and 115 (22%) were randomised. Among participants of both groups, there were 14 missing primary outcomes of which 10 were due to failure to collect the catheter tip (a protocol violation). The final sample had 47 and 54 individuals in the chlorhexidine and polyurethane groups, respectively. Skin and catheter tip were colonised by the same microorganism for 13% of the participants in the chlorhexidine group and 8% in the polyurethane group, although the difference was not statistically significant (p = 0.51). There were no differences between the two groups for catheter tip colonisation, skin site colonisation, catheter insertion site infection, catheter-related bloodstream infection, skin irritation, and the number of unplanned dressing changes. CONCLUSIONS Our preliminary results found that a large randomised controlled trial would be feasible. This study provides valuable information that can be used to design more robust studies to prevent infection among patients with short-term percutaneous CVC when using either chlorhexidine or polyurethane dressing.
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Affiliation(s)
- Amanda S Margatho
- General and Specialized Nursing Department, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Paula E D Dos Reis
- Nursing Department, School of Health Sciences, University of Brasília, Brasília, DF, Brazil.
| | - Rejane K Furuya
- Federal Institute of Paraná, Campus Londrina, Londrina, PR, Brazil.
| | - Dennisani A F S Lima
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Anibal Basile-Filho
- Division of Intensive Care, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Renata C C P Silveira
- General and Specialized Nursing Department, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Pant J, Goudie MJ, Chaji SM, Johnson BW, Handa H. Nitric oxide releasing vascular catheters for eradicating bacterial infection. J Biomed Mater Res B Appl Biomater 2018; 106:2849-2857. [PMID: 29266734 PMCID: PMC6013312 DOI: 10.1002/jbm.b.34065] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/21/2017] [Accepted: 12/02/2017] [Indexed: 12/16/2022]
Abstract
The interaction of blood proteins with an implant surface is not only a fundamental phenomenon but is also key to several important medical complications. Plasma proteins binding on the surface of intravascular catheters can promote bacterial adhesion leading to the risk of local and systemic complications such as catheter-related blood infections (CRBIs). The incidences of CRBIs in the United States amount to more than 250,000 cases/year with an attributable mortality of up to 35% and an annual healthcare expenditure of $2.3 billion approximately. This demands the development of truly nonthrombogenic and antimicrobial catheters. In the present study, catheters were fabricated by incorporating a nitric oxide (NO) donor molecule, S-nitroso-N-acetyl-penicillamine (SNAP) in a hydrophobic medical grade polymer, Elasteon-E2As. NO offers antithrombotic and antibacterial attributes without promoting drug resistance and cytotoxicity. E2As-SNAP catheters were first coated with fibrinogen, a blood plasma protein plays a key role in clot formation and eventual bacterial adhesion to the implant surface. The suitability of the catheters for biomedical applications was tested in vitro for contact angle, NO release kinetics, inhibition of bacteria, and absence of cytotoxicity toward mammalian cells. The highly hydrophobic catheters released NO in the physiological range that inhibited >99% bacterial viability on fibrinogen-coated catheters in a 24 h study. No toxic response of E2As-SNAP catheters leachate was observed using a standard cytotoxicity assay with mouse fibroblast cells. Overall, the results showed that the E2As-SNAP catheters can inhibit viable bacteria even in the presence of blood proteins without causing a cytotoxic response. The fundamentals of this study are applicable to other blood-contacting medical devices as well. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2849-2857, 2018.
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Affiliation(s)
| | | | - Sarah M. Chaji
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Benjamin W. Johnson
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
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Abstract
The relatively young field of pediatric critical care has seen a shift from an approach with little consideration for the complications and adverse effects resulting from the procedures and medications to a more cautious approach with careful concern for the associated risks. Many senior pediatric intensivists recall a time when nearly every patient had a central venous line and arterial line; and hospital acquired infections, pressure injuries, unplanned extubations, and venous thromboemboli were expected costs of aggressive care. In addition to the morbidity and mortality associated with many of the health care-acquired conditions (HACs) in children, the attributable cost due to these HACs contributes to the unsustainable health care financial crisis. The Centers for Medicare and Medicaid Services (CMS) often penalize hospitals for HACs, and also are beginning to reimburse in a bundled fashion such that complications become the institution's burden. In children, payors and patients' families are often saddling this burden of costs attributable to HACs. The direct attributable costs per event are staggering. Payors, families, patients, and health care teams now demand a circumspect approach to care: do no harm, but how?
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Affiliation(s)
- Heather A Wolfe
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth H Mack
- Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
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24
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de Souza TH, Brandão MB, Santos TM, Pereira RM, Nogueira RJN. Ultrasound guidance for internal jugular vein cannulation in PICU: a randomised controlled trial. Arch Dis Child 2018; 103:952-956. [PMID: 29618485 DOI: 10.1136/archdischild-2017-314568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We investigated whether ultrasound guidance was advantageous over the anatomical landmark technique when performed by inexperienced paediatricians. DESIGN Randomised controlled trial. SETTING A paediatric intensive care unit of a teaching hospital. PATIENTS 80 children (aged 28 days to <14 years). INTERVENTIONS Internal jugular vein cannulation with ultrasound guidance in real time or the anatomical landmark technique. MAIN OUTCOME MEASURES Success rate, success rate on the first attempt, success rate within three attempts, puncture time, number of attempts required for success and occurrence of complications. RESULTS We found a higher success rate in the ultrasound guidance than in the control group (95% vs 61%, respectively; p<0.001; relative risk (RR)=0.64, 95% CI (CI) 0.50 to 0.83). Success on the first attempt was seen in 95% and 34% of venous punctures in the US guidance and control groups, respectively (p<0.001; RR=0.35, 95% CI 0.23 to 0.54). Fewer than three attempts were required to achieve success in 95% of patients in the US guidance group but only 44% in the control group (p<0.001; RR=0.46, 95% CI 0.32 to 0.66). Haematomas, inadvertent arterial punctures, the number of attempts and the puncture time were all significantly lower in the ultrasound guidance than in the control group (p<0.015 for all). CONCLUSIONS Critically ill children may benefit from the ultrasound guidance for internal jugular cannulation, even when the procedure is performed by operators with limited experience. TRIAL REGISTRATION NUMBER RBR-4t35tk.
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Affiliation(s)
| | | | | | | | - Roberto José Negrão Nogueira
- Deparment of Pediatrics, University of Campinas (UNICAMP), Campinas, Brazil.,Department of Pediatrics, School of Medicine São Leopoldo Mandic, Campinas, Brazil
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PICC-associated infection with Escherichia hermannii: A case report and review of the literature. IDCases 2018; 13:4. [PMID: 30181953 PMCID: PMC6117949 DOI: 10.1016/j.idcr.2018.e00444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 12/04/2022] Open
Abstract
Since its identification as a unique species in 1982, Escherichia hermannii has been implicated as a pathogenic organism in very few cases of human disease. Our report discusses a case of bacteremia with Escherichia hermannii identified by Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) and RapID™ ONE analysis in a patient getting TPN through a peripherally-inserted CVC (PICC). The PICC was removed. The bloodstream infection was successfully treated with empiric piperacillin-tazobactam, which was then narrowed to trimethoprim-sulfamethoxazole based on sensitivity data for a 14 day course of antimicrobial therapy. E. hermannii’s association with bloodstream infection in patients with central venous catheters supports data implicating biofilm formation as a key pathogenic feature of E. hermannii. Of the 9 previous cases of E. hermannii infection reviewed in the literature, 4 cases occurred in immunocompromised hosts, 2 were associated with trauma or injection, 2 were associated with central lines, and only one case had no identifiable risk factor. E. hermannii appears to act as an opportunistic pathogen, causing disease in an immunocompromised host or through a central access catheter, injection, or trauma. E. hermannii likely causes catheter-related bloodstream infections in these hosts through biofilm formation, demonstrating the importance of catheter removal in addition to antimicrobial therapy in the treatment of these infections.
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26
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Wang Y, Tan X, Xi C, Phillips KS. Removal of Staphylococcus aureus from skin using a combination antibiofilm approach. NPJ Biofilms Microbiomes 2018; 4:16. [PMID: 30155267 PMCID: PMC6079078 DOI: 10.1038/s41522-018-0060-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 12/13/2022] Open
Abstract
Staphylococcus aureus (S. aureus) including methicillin resistant S. aureus (MRSA) is one of the primary microorganisms responsible for surgical site infection (SSI). Since S. aureus contamination is known to originate from the skin, eradicating it on the skin surface at surgical sites is an important intervention to reduce the chance of SSIs. Here we developed and evaluated the efficacy of a combination probiotic/brush sonication strategy for skin preparation at surgical, injection and insertion sites in medicine. A 24 h biofilm on porcine skin explants was used as a worst-case scenario for the evaluation of preparation strategies. Conventional ethanol wipes achieved 0.8~2 log reduction in viable bacteria depending on how many times wiped (x4 or x6). Brush sonication or probiotic supernatant pre-treatment alone achieved a similar reduction as ethanol wipes (1.4 and 0.7~1.4 log reduction, respectively). Notably, combining sonication and probiotic pre-treatment achieved a 4 log reduction in viable bacteria. In addition, probiotic supernatant incubation times as short as 2 h achieved the full effect of this reduction in the combined strategy. These findings suggest the promising potential of combination-format skin preparation strategies that can be developed to more effectively penetrate cracks and folds in the skin to remove biofilms. Combining brush sonication with secretions from probiotic bacteria cleans skin before surgery more effectively than ethanol wipes. Researchers in the USA, led by K. Scott Phillips at the United States Food and Drug Administration, investigated removal of Staphylococcus aureus biofilm from pig skin as a “worst case” pre-surgical scenario. This bacterium is a major cause of serious and drug-resistant surgical site infections. Brush sonication or treatment with probiotic-derived solutions were individually approximately as effective as ethanol wipes, but in combination they proved substantially more effective. The treatment with the secretions surrounding probiotic bacterial cells requires exposure for several hours, but this could be readily achieved using a pre-surgery ointment. The sonication and probiotic combination could be developed into a highly effective pre-surgical procedure, penetrating cracks and folds in the skin to remove dangerous biofilms.
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Affiliation(s)
- Yi Wang
- 1United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry and Materials Science, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA
| | - Xiaojuan Tan
- 2Department of Environmental Health Sciences, School of Public Health, University of Michigan, 6631 SPH Tower, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Chuanwu Xi
- 2Department of Environmental Health Sciences, School of Public Health, University of Michigan, 6631 SPH Tower, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - K Scott Phillips
- 1United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry and Materials Science, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA
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27
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Development of apheresis techniques and equipment designed for patients weighing less than 10 kg. Transfus Apher Sci 2018; 57:331-336. [PMID: 29945827 DOI: 10.1016/j.transci.2018.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The procedure of apheresis in pediatric patients, particularly in those with low weight (body weight<10 kg) presents an important challenge due to particularities of this group. There are no specific guidelines or enough scientific evidence to standardize the practice in this group of patients. In addition to the psychological aspect, the correct calculation of the total blood volume, the extracorporeal volume of the cell separator and an estimated decrease in hematocrit must be considered. Personalized protocols for priming of the apheresis equipment, sufficient blood flow and adequate anticoagulation are essential for patient comfort and therapeutic success. The purpose of this article is to present the results of the national study of apheresis practices in low weight group of children conducted from 2012 to 2018. Protocols and patients' data collected from various apheresis centers in Argentina were compared with the apheresis protocols around the world. Our protocols and data were similar to those in other countries; however, no detailed and specific guidelines for apheresis practices in this population of patients with unique requirements have been developed to date.
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28
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Does a Dedicated Lumen for Parenteral Nutrition Administration Reduce the Risk of Catheter-Related Bloodstream Infections? A Systematic Literature Review. JOURNAL OF INFUSION NURSING 2018; 41:122-130. [PMID: 29489708 DOI: 10.1097/nan.0000000000000270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Guidelines recommend using single-lumen central vascular access devices (CVADs) for the administration of parenteral nutrition (PN) or lipid-based solutions, or a dedicated lumen on a multilumen CVAD. Publications reviewed by the authors reported comparative rates of catheter-related bloodstream infection (CR-BSI) in patients with CVADs who received PN through a dedicated lumen compared with those who had PN administered through multilumen CVADs. Two studies included 650 patients with 1349 CVADs. CR-BSIs were equally distributed between the 2 groups. Both studies were poorly reported and had significant risk of bias. These results should be interpreted with caution.
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29
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Guzmán Ramos PJ, Fernández Pérez C, Ayllón Santiago T, Baquero Artigao MR, Ortiz‐Díez G. Incidence of and associated factors for bacterial colonization of intravenous catheters removed from dogs in response to clinical complications. J Vet Intern Med 2018; 32:1084-1091. [PMID: 29602241 PMCID: PMC5980313 DOI: 10.1111/jvim.15118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 12/21/2017] [Accepted: 02/14/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Infection rate associated with intravenous (IV) catheter placement is emerging as an important issue in small animal veterinary medicine, mostly because of the economic costs associated with these infections. Identification of possible associated factors may provide useful information for the surveillance and prevention of such infections. OBJECTIVES To determine the incidence of positive bacterial cultures obtained from IV catheters used in dogs hospitalized for at least 48 hours and removed because of clinical complication. To identify the bacteria involved and factors associated with bacterial colonization. ANIMALS One-hundred eighty-two dogs that underwent IV catheterization from January 2015 to July 2015 at the Veterinary Teaching Hospital of Alfonso X el Sabio University of Madrid were enrolled in the study. RESULTS The bacterial colonization rate of all IV catheters removed in response to clinical complications was 39.6%, the cumulative proportion of catheters that remained in place at 24, 48, and 72 hours after placement was 89.5, 78, and 59.4%, respectively. Multivariable Cox proportional hazards regression indicated significant associations for staff who performed catheterization (junior, P = .002; student, P = .034) and use of steroidal anti-inflammatory drugs (P = .036). The most frequently isolated bacterium was Acinetobacter spp. (21.7%). CONCLUSIONS AND CLINICAL IMPORTANCE The bacterial colonization incidence related to IV catheter placement was slightly higher than the incidence described in other veterinary studies. Associated factors not previously described in veterinary medicine were found. The most frequently isolated organism was Acinetobacter spp., indicating its importance as an emerging pathogen in catheter colonization.
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Affiliation(s)
- Pedro Jose Guzmán Ramos
- Hospital Clínico Veterinario de la Universidad Alfonso X el Sabio, Universidad Alfonso X el SabioMadridSpain
| | - Cristina Fernández Pérez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Hospital Universitario Clínico San Carlos (Servicio de Medicina Preventiva), Universidad Complutense de MadridMadridSpain
| | - Tania Ayllón Santiago
- Instituto Nacional de Infectología Evandro Chagas, Núcleo Operacional Centinela de Mosquitos Vetores FiocruzRío de JaneiroBrazil
- Departamento de Microbiología de la Universidad Alfonso X el SabioMadridSpain
| | | | - Gustavo Ortiz‐Díez
- Hospital Clínico Veterinario de la Universidad Alfonso X el Sabio, Universidad Alfonso X el SabioMadridSpain
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30
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Abstract
Intravascular catheters are the most common cause of nosocomially acquired bloodstream infections. Bacteria found adhering to the intraluminal surfaces of catheters are the principal source and cause of these infections. Adherent bacteria overtime are known to form multicellular communities which become encased within a three dimensional matrix of extracellular polymeric material known as biofilms, which are thought to be responsible for persistent infections. Consequently, a number of technologies have been developed to help prevent and control biofilms in intravascular catheters. One such approach involves impregnating catheter material with antimicrobial agents. Unfortunately these methods are not universally effective in preventing catheter-related biofilm infections. Technologies that utilise antimicrobials, as catheter locks have been shown to have more potential for preventing biofilm formation and reducing the incidences of catheter related bloodstream infections (CRBSI). This article discusses the significance of biofilms in intravascular catheters and determines whether the treatments available today are proving to be effective for controlling biofilms and draws attention to future avenues which are being investigated to control biofilms and therefore CRBSI.
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Affiliation(s)
- S.L. Percival
- Department of Microbiology, Leeds General Infirmary, Leeds - UK
| | - P. Kite
- Department of Microbiology, Leeds General Infirmary, Leeds - UK
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31
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Pinelli F, Cecero E, Degl'Innocenti D, Selmi V, Giua R, Villa G, Chelazzi C, Romagnoli S, Pittiruti M. Infection of totally implantable venous access devices: A review of the literature. J Vasc Access 2018; 19:230-242. [PMID: 29512430 DOI: 10.1177/1129729818758999] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Totally implantable venous access devices, or ports, are essential in the therapeutic management of patients who require long-term intermittent intravenous therapy. Totally implantable venous access devices guarantee safe infusion of chemotherapy, blood transfusion, parenteral nutrition, as well as repeated blood samples. Minimizing the need for frequent vascular access, totally implantable venous access devices also improve the patient's quality of life. Nonetheless, totally implantable venous access devices are not free from complications. Among those, infection is the most relevant, affecting patients' morbidity and mortality-both in the hospital or outpatient setting-and increasing healthcare costs. Knowledge of pathogenesis and risk factors of totally implantable venous access device-related infections is crucial to prevent this condition by adopting proper insertion bundles and maintenance bundles based on the best available evidence. Early diagnosis and prompt treatment of infection are of paramount importance. As a totally implantable venous access device-related infection occurs, device removal or a conservative approach should be chosen in treating this complication. For both prevention and therapy, antimicrobial lock is a major matter of controversy and a promising field for future clinical studies. This article reviews current evidences in terms of epidemiology, pathogenesis and risk factors, diagnosis, prevention, and treatment of totally implantable venous access device-related infections.
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Affiliation(s)
- Fulvio Pinelli
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Elena Cecero
- 2 Department of Health Science, University of Florence, Florence, Italy
| | | | - Valentina Selmi
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Rosa Giua
- 2 Department of Health Science, University of Florence, Florence, Italy
| | - Gianluca Villa
- 2 Department of Health Science, University of Florence, Florence, Italy
| | - Cosimo Chelazzi
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Romagnoli
- 1 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mauro Pittiruti
- 4 Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Lee KA, Ramaswamy RS. Intravascular access devices from an interventional radiology perspective: indications, implantation techniques, and optimizing patency. Transfusion 2018; 58 Suppl 1:549-557. [DOI: 10.1111/trf.14501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Kristen A. Lee
- Dotter Interventional Institute, Oregon Health and Science University; Portland Oregon
| | - Raja S. Ramaswamy
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis; Missouri
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33
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Association between Candida biofilm-forming bloodstream isolates and the clinical evolution in patients with candidemia: An observational nine-year single center study in Mexico. Rev Iberoam Micol 2018; 35:11-16. [DOI: 10.1016/j.riam.2017.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/19/2016] [Accepted: 01/17/2017] [Indexed: 12/29/2022] Open
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Raza S, Sanober G, Rungrotmongkol T, Azam SS. The Vitality of Swivel Domain Motion in Performance of Enzyme I of Phosphotransferase System; A Comprehensive Molecular Dynamic Study. J Mol Liq 2017. [DOI: 10.1016/j.molliq.2017.07.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Bohl CJ, Parks A. A Mnemonic for Pharmacists to Ensure Optimal Monitoring and Safety of Total Parenteral Nutrition: I AM FULL. Ann Pharmacother 2017. [DOI: 10.1177/1060028017697425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To present a guideline-derived mnemonic that provides a systematic monitoring process to increase pharmacists’ confidence in total parenteral nutrition (TPN) monitoring and improve safety and efficacy of TPN use. Data Sources: The American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines were reviewed. Additional resources included a literature search of PubMed (1980 to May 2016) using the search terms: total parenteral nutrition, mnemonic, indications, allergy, macronutrients, micronutrients, fluid, comorbidities, labs, peripheral line, and central line. Articles (English-language only) were evaluated for content, and additional references were identified from a review of literature citations. Study Selection and Data Extraction: All English-language observational studies, review articles, meta-analyses, guidelines, and randomized trials assessing monitoring parameters of TPN were evaluated. Data Synthesis: The ASPEN guidelines were referenced to develop key components of the mnemonic. Review articles, observational trials, meta-analyses, and randomized trials were reviewed in cases where guidelines did not adequately address these components. Conclusions: A guideline-derived mnemonic was developed to systematically and safely manage TPN therapy. The mnemonic combines 7 essential components of TPN use and monitoring: Indications, Allergies, Macro/Micro nutrients, Fluid, Underlying comorbidities, Labs, and Line type.
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Affiliation(s)
- Chris J. Bohl
- Concordia University Wisconsin School of Pharmacy, Mequon, WI, USA
| | - Ann Parks
- Concordia University Wisconsin School of Pharmacy, Mequon, WI, USA
- Aurora Healthcare at St Luke’s Medical Center, Milwaukee, WI, USA
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36
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Gavin NC, Button E, Keogh S, McMillan D, Rickard C. Does Parenteral Nutrition Increase the Risk of Catheter-Related Bloodstream Infection? A Systematic Literature Review. JPEN J Parenter Enteral Nutr 2017; 41:918-928. [PMID: 28654308 DOI: 10.1177/0148607117714218] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Central venous access devices (CVADs) are used for parenteral nutrition (PN) delivery. We systematically reviewed research-based publications that reported comparative rates of catheter-related bloodstream infection (CRBSI) in patients with CVADs who received PN vs those who did not receive PN therapy. MATERIALS AND METHODS The literature search included the Cochrane Library, MEDLINE, CINAHL, and PubMed up to July 14, 2015, to identity studies that compared patients with a CVAD who did and did not have PN therapy. RESULTS Eleven observational studies were identified, comprising 2854 participants with 6287 CVADs. Six studies produced significant results in favor of non-PN, 4 studies showed no evidence of a difference between PN and non-PN, and 1 study produced significant results in favor of PN when analyzed per patient with multiple CVADs. Incidence ranged from 0 to 6.6 CRBSIs per 1000 CVAD days in the PN patients and 0.39 to 3.6 CRBSIs per 1000 CVAD days in the non-PN patients. The Cochrane risk of bias assessment tool for nonrandomized studies of interventions was used. Eight studies were rated as moderate risk of bias, 2 as serious, and 1 as critical. CONCLUSION The data presented in this systematic review are not sufficient to establish whether patients receiving PN are more at risk of developing CRBSI than those who do not. Future PN studies needs to adjust for baseline imbalances and improve quality and reporting.
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Affiliation(s)
- Nicole Clare Gavin
- 1 National Health and Medical Research Council Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Nathan Campus, Griffith University, Nathan, QC, Australia.,2 Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Nathan Campus, Griffith University, Nathan, QC, Australia.,3 Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QC, Australia
| | - Elise Button
- 3 Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QC, Australia.,4 School of Nursing, Queensland University of Technology, Kelvin Grove Campus, Kelvin Grove, QC, Australia
| | - Samantha Keogh
- 1 National Health and Medical Research Council Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Nathan Campus, Griffith University, Nathan, QC, Australia.,2 Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Nathan Campus, Griffith University, Nathan, QC, Australia
| | - David McMillan
- 2 Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Nathan Campus, Griffith University, Nathan, QC, Australia.,5 Inflammation and Healing Research Cluster, University of the Sunshine Coast, Sippy Downs, QC, Australia
| | - Claire Rickard
- 1 National Health and Medical Research Council Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Nathan Campus, Griffith University, Nathan, QC, Australia.,2 Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Nathan Campus, Griffith University, Nathan, QC, Australia
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37
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Identification of plausible drug targets by investigating the druggable genome of MDR Staphylococcus epidermidis. GENE REPORTS 2017. [DOI: 10.1016/j.genrep.2017.04.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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38
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Afonso E, Blot K, Blot S. Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: a systematic review and meta-analysis of randomised crossover trials. ACTA ACUST UNITED AC 2017; 21. [PMID: 27918269 PMCID: PMC5144946 DOI: 10.2807/1560-7917.es.2016.21.46.30400] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 07/11/2016] [Indexed: 12/29/2022]
Abstract
We assessed the impact of 2% daily patient bathing with chlorhexidine gluconate (CHG) washcloths on the incidence of hospital-acquired (HA) and central line-associated (CLA) bloodstream infections (BSI) in intensive care units (ICUs). We searched randomised studies in Medline, EMBASE, Cochrane Library (CENTRAL) and Web of Science databases up to April 2015. Primary outcomes were total HABSI, central line, and non-central line-associated BSI rates per patient-days. Secondary outcomes included Gram-negative and Gram-positive BSI rates and adverse events. Four randomised crossover trials involved 25 ICUs and 22,850 patients. Meta-analysis identified a total HABSI rate reduction (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.60–0.90; p = 0.002) with moderate heterogeneity (I2 = 36%). Subgroup analysis identified significantly stronger rate reductions (p = 0.01) for CLABSI (OR: 0.50; 95% CI: 0.35–0.71; p < 0.001) than other HABSI (OR: 0.82; 95% CI: 0.70–0.97; p = 0.02) with low heterogeneity (I2 = 0%). This effect was evident in the Gram-positive subgroup (OR: 0.55; 95% CI: 0.31–0.99; p = 0.05), but became non-significant after removal of a high-risk-of-bias study. Sensitivity analysis revealed that the intervention effect remained significant for total and central line-associated HABSI. We suggest that use of CHG washcloths prevents HABSI and CLABSI in ICUs, possibly due to the reduction in Gram-positive skin commensals.
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Affiliation(s)
- Elsa Afonso
- Neonatal Intensive Care Unit, Cambridge University Hospital, Cambridge, United Kingdom.,These authors contributed equally to the manuscript
| | - Koen Blot
- These authors contributed equally to the manuscript.,Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - Stijn Blot
- Department of General Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.,Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
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Wo Y, Brisbois EJ, Wu J, Li Z, Major TC, Mohammed A, Wang X, Colletta A, Bull JL, Matzger AJ, Xi C, Bartlett RH, Meyerhoff ME. Reduction of Thrombosis and Bacterial Infection via Controlled Nitric Oxide (NO) Release from S-Nitroso- N-acetylpenicillamine (SNAP) Impregnated CarboSil Intravascular Catheters. ACS Biomater Sci Eng 2017; 3:349-359. [PMID: 28317023 PMCID: PMC5351555 DOI: 10.1021/acsbiomaterials.6b00622] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/21/2017] [Indexed: 01/15/2023]
Abstract
Nitric oxide (NO) has many important physiological functions, including its ability to inhibit platelet activation and serve as potent antimicrobial agent. The multiple roles of NO in vivo have led to great interest in the development of biomaterials that can deliver NO for specific biomedical applications. Herein, we report a simple solvent impregnation technique to incorporate a nontoxic NO donor, S-nitroso-N-acetylpenicillamine (SNAP), into a more biocompatible biomedical grade polymer, CarboSil 20 80A. The resulting polymer-crystal composite material yields a very stable, long-term NO release biomaterial. The SNAP impregnation process is carefully characterized and optimized, and it is shown that SNAP crystal formation occurs in the bulk of the polymer after solvent evaporation. LC-MS results demonstrate that more than 70% of NO release from this new composite material originates from the SNAP embedded CarboSil phase, and not from the SNAP species leaching out into the soaking solution. Catheters prepared with CarboSil and then impregnated with 15 wt % SNAP provide a controlled NO release over a 14 d period at physiologically relevant fluxes and are shown to significantly reduce long-term (14 day) bacterial biofilm formation against Staphylococcus epidermidis and Pseudonomas aeruginosa in a CDC bioreactor model. After 7 h of catheter implantation in the jugular veins of rabbit, the SNAP CarboSil catheters exhibit a 96% reduction in thrombus area (0.03 ± 0.01 cm2/catheter) compared to the controls (0.84 ± 0.19 cm2/catheter) (n = 3). These results suggest that SNAP impregnated CarboSil can become an attractive new biomaterial for use in preparing intravascular catheters and other implanted medical devices.
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Affiliation(s)
- Yaqi Wo
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Elizabeth J. Brisbois
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Jianfeng Wu
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Zi Li
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Terry C. Major
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Azmath Mohammed
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Xianglong Wang
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Alessandro Colletta
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Joseph L. Bull
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Adam J. Matzger
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Chuanwu Xi
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Robert H. Bartlett
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Mark E. Meyerhoff
- Department
of Chemistry, Department of Surgery, University of Michigan Medical
Center, Department of Environmental Health Sciences, and Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
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Olmos MAM, Vázquez MJM, Gorría MJM, González PP, Martínez IO, Chimeno IM, González EP, Bobo MTI, Núñez JEC. Effect of Parenteral Nutrition on Nutrition Status After Bariatric Surgery for Morbid Obesity. JPEN J Parenter Enteral Nutr 2017; 29:445-50. [PMID: 16224039 DOI: 10.1177/0148607105029006445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To evaluate the influence of nutrition support (parenteral nutrition [PN] vs no parenteral nutrition [nPN]) on nutrition outcome, complications, and hospital stay after bariatric surgery (BS). METHODS Sixty-seven consecutive BS patients (17 gastric bypass and 50 biliopancreatic diversion). The first 38 received PN and the next 29 did not (nPN) during the fasting postoperative (PO) period. In both groups, after fasting, a progressive oral diet was introduced. Data related to nutrition status, perioperative complications, and postsurgical hospital stay were compared. RESULTS Sixty-seven patients (58 women), mean age 39.4 +/- 11.0 years, body mass index (BMI) 50.7 +/- 6.1 kg/m(2), were included. Thirty-eight patients received PN during 8.7 +/- 2.6 days. Ingestion was initiated at a median 8 PO days in PN vs 6.5 PO days in nPN (p < .04). No significant differences between groups were found in age, final fasting serum albumin (SA), and 30 days postoperative SA, with a similar weight loss. Nonsignificant differences were found in non-catheter-related infectious complications, being mainly urinary tract infections. Catheter-related infections were present in 21.1% in the PN group and 13.8% in the nPN (p = .33). Median hospital stay after surgery was 14 +/- 10 days in PN and 12 +/- 10 days in nPN (p = .003). CONCLUSIONS (1) Nutrition status after BS PO and 30 days postsurgery was no different between PN and nPN. (2) Postsurgery hospital stay was significantly decreased in the nPN group, without a greater incidence of complications. (3) According to nutrition outcome, PN seems unnecessary at the perioperative period in BS unless there are other postsurgical complications.
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Affiliation(s)
- M A Martínez Olmos
- Endocrinology and Nutrition, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Spain.
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41
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Harron K, Mok Q, Dwan K, Ridyard CH, Moitt T, Millar M, Ramnarayan P, Tibby SM, Muller-Pebody B, Hughes DA, Gamble C, Gilbert RE. CATheter Infections in CHildren (CATCH): a randomised controlled trial and economic evaluation comparing impregnated and standard central venous catheters in children. Health Technol Assess 2016; 20:vii-xxviii, 1-219. [PMID: 26935961 DOI: 10.3310/hta20180] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Impregnated central venous catheters (CVCs) are recommended for adults to reduce bloodstream infection (BSI) but not for children. OBJECTIVE To determine the effectiveness of impregnated compared with standard CVCs for reducing BSI in children admitted for intensive care. DESIGN Multicentre randomised controlled trial, cost-effectiveness analysis from a NHS perspective and a generalisability analysis and cost impact analysis. SETTING 14 English paediatric intensive care units (PICUs) in England. PARTICIPANTS Children aged < 16 years admitted to a PICU and expected to require a CVC for ≥ 3 days. INTERVENTIONS Heparin-bonded, antibiotic-impregnated (rifampicin and minocycline) or standard polyurethane CVCs, allocated randomly (1 : 1 : 1). The intervention was blinded to all but inserting clinicians. MAIN OUTCOME MEASURE Time to first BSI sampled between 48 hours after randomisation and 48 hours after CVC removal. The following data were used in the trial: trial case report forms; hospital administrative data for 6 months pre and post randomisation; and national-linked PICU audit and laboratory data. RESULTS In total, 1859 children were randomised, of whom 501 were randomised prospectively and 1358 were randomised as an emergency; of these, 984 subsequently provided deferred consent for follow-up. Clinical effectiveness - BSIs occurred in 3.59% (18/502) of children randomised to standard CVCs, 1.44% (7/486) of children randomised to antibiotic CVCs and 3.42% (17/497) of children randomised to heparin CVCs. Primary analyses comparing impregnated (antibiotic and heparin CVCs) with standard CVCs showed no effect of impregnated CVCs [hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.37 to 1.34]. Secondary analyses showed that antibiotic CVCs were superior to standard CVCs (HR 0.43, 95% CI 0.20 to 0.96) but heparin CVCs were not (HR 1.04, 95% CI 0.53 to 2.03). Time to thrombosis, mortality by 30 days and minocycline/rifampicin resistance did not differ by CVC. Cost-effectiveness - heparin CVCs were not clinically effective and therefore were not cost-effective. The incremental cost of antibiotic CVCs compared with standard CVCs over a 6-month time horizon was £1160 (95% CI -£4743 to £6962), with an incremental cost-effectiveness ratio of £54,057 per BSI avoided. There was considerable uncertainty in costs: antibiotic CVCs had a probability of 0.35 of being dominant. Based on index hospital stay costs only, antibiotic CVCs were associated with a saving of £97,543 per BSI averted. The estimated value of health-care resources associated with each BSI was £10,975 (95% CI -£2801 to £24,751). Generalisability and cost-impact - the baseline risk of BSI in 2012 for PICUs in England was 4.58 (95% CI 4.42 to 4.74) per 1000 bed-days. An estimated 232 BSIs could have been averted in 2012 using antibiotic CVCs. The additional cost of purchasing antibiotic CVCs for all children who require them (£36 per CVC) would be less than the value of resources associated with managing BSIs in PICUs with standard BSI rates of > 1.2 per 1000 CVC-days. CONCLUSIONS The primary outcome did not differ between impregnated and standard CVCs. However, antibiotic-impregnated CVCs significantly reduced the risk of BSI compared with standard and heparin CVCs. Adoption of antibiotic-impregnated CVCs could be beneficial even for PICUs with low BSI rates, although uncertainty remains whether or not they represent value for money to the NHS. Limitations - inserting clinicians were not blinded to allocation and a lower than expected event rate meant that there was limited power for head-to-head comparisons of each type of impregnation. Future work - adoption of impregnated CVCs in PICUs should be considered and could be monitored through linkage of electronic health-care data and clinical data on CVC use with laboratory surveillance data on BSI. TRIAL REGISTRATION ClinicalTrials.gov NCT01029717. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katie Harron
- Institute of Child Health, University College London, London, UK
| | - Quen Mok
- Great Ormond Street Hospital, London, UK
| | - Kerry Dwan
- Medicines for Children Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Colin H Ridyard
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Tracy Moitt
- Medicines for Children Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | | | | | | | - Berit Muller-Pebody
- Healthcare Associated Infection and Antimicrobial Resistance (HCAI & AMR) Department, National Infection Service, Public Health England, London, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Carrol Gamble
- Medicines for Children Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Ruth E Gilbert
- Institute of Child Health, University College London, London, UK
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Richardson IP, Sturtevant R, Heung M, Solomon MJ, Younger JG, VanEpps JS. Hemodialysis Catheter Heat Transfer for Biofilm Prevention and Treatment. ASAIO J 2016; 62:92-9. [PMID: 26501916 DOI: 10.1097/mat.0000000000000300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Central line-associated bloodstream infections (CLABSIs) are not easily treated, and many catheters (e.g., hemodialysis catheters) are not easily replaced. Biofilms (the source of infection) on catheter surfaces are notoriously difficult to eradicate. We have recently demonstrated that modest elevations of temperature lead to increased staphylococcal susceptibility to vancomycin and significantly soften the biofilm matrix. In this study, using a combination of microbiological, computational, and experimental studies, we demonstrate the efficacy, feasibility, and safety of using heat as an adjuvant treatment for infected hemodialysis catheters. Specifically, we show that treating with heat in the presence of antibiotics led to additive killing of Staphylococcus epidermidis with similar trends seen for Staphylococcus aureus and Klebsiella pneumoniae. The magnitude of temperature elevation required is relatively modest (45-50°C) and similar to that used as an adjuvant to traditional cancer therapy. Using a custom-designed benchtop model of a hemodialysis catheter, positioned with tip in the human vena cava as well as computational fluid dynamic simulations, we demonstrate that these temperature elevations are likely achievable in situ with minimal increased in overall blood temperature.
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Affiliation(s)
- Ian P Richardson
- From the *Department of Emergency Medicine, †Division of Nephrology, Department of Internal Medicine, and ‡Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan
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[Incidence of catheter-related infection incidence and risk factors in patients on total parenteral nutrition in a third level hospital]. CIR CIR 2016; 85:104-108. [PMID: 27422799 DOI: 10.1016/j.circir.2016.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/20/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Central venous catheters are devices used for therapeutic, diagnostic, and monitoring purposes. Complications associated with central venous catheter use include those related to their insertion, rupture and displacement of the catheter, occlusion, thrombosis, and infection. Of these the latter is important due to the high morbidity and mortality it causes in the patients, and total parenteral nutrition increases the risk. The aim of this study is determine the incidence and risk factors associated with catheter-related infection in patients on parenteral nutrition. MATERIAL AND METHODS A retrospective, observational, and cross-sectional study was conducted, by analysing patients on total parenteral nutrition who developed a catheter-related infection in a 6-month period. Multiple variables were studied, looking for significance. A statistically significant relationship was considered with a p<0.05. RESULTS The study consisted of 85 patients, of whom 52% were women and 48% men. The median age was 54 years. The most frequent diagnosis was enterocutaneous fistula. Catheter associated infection was present in 19% of patients. The most frequent microorganisms found were Staphyloccocus sp. (44%) and Candida sp. (25%). Median time between central venous catheter insertion and infection was 78±64 days. There was a significance between days with a central venous catheters and infection development (p=0.014). Infection developed in 81% of patients on whom surgery was performed (p<0.05) CONCLUSION: It was found that patients with a longer use of a central venous catheter (p=0.014) and those who were operated on in conjunction with total parenteral nutrition (p<0.05) were more prone to develop a catheter-associated infection.
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Royaux E, Polis I, Boyen F, Van Ham L, de Rooster H. No evidence that medicinal honey reduces bacterial skin colonisation at a peripheral catheter insertion site in dogs. J Small Anim Pract 2016; 57:374-8. [PMID: 27385624 DOI: 10.1111/jsap.12501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 02/01/2016] [Accepted: 02/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine whether topical exit-site application of medicinal honey at the catheter insertion place reduces bacterial skin colonisation. MEASUREMENTS AND RESULTS Dogs were selected at random and divided into the honey or the control group. When the catheter was removed, an area of approximately 3×3 cm of the skin at the insertion site was sampled with a sterile cotton swab. The catheter stayed in place for a median of 84 hours. Out of 46 patients, 6 patients in the honey group and 5 out of 54 patients in the control group had a positive skin culture at the time of catheter removal (P=0·547). Infection was clinically suspected in 1 of those 11 dogs; catheter-associated complications were observed in 8 additional dogs that did not have a positive skin culture. CLINICAL SIGNIFICANCE Few catheter-associated complications were observed. Extra attention to hygiene by working with a standardised catheter placement and handling protocol might have resulted in this low incidence. In this study topical application of a medicinal honey did not reduce bacterial skin colonisation at the insertion site of peripheral catheters in dogs.
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Affiliation(s)
- E Royaux
- Department of Small Animal Medicine and Clinical Biology, Ghent University, St. Pietersnieuwstraat 33, Ghent, 9000, Belgium
| | - I Polis
- Department of Small Animal Medicine and Clinical Biology, Ghent University, St. Pietersnieuwstraat 33, Ghent, 9000, Belgium
| | - F Boyen
- Department of Pathology, Bacteriology and Avian Diseases, Ghent University, St. Pietersnieuwstraat 33, Ghent, 9000, Belgium
| | - L Van Ham
- Department of Small Animal Medicine and Clinical Biology, Ghent University, St. Pietersnieuwstraat 33, Ghent, 9000, Belgium
| | - H de Rooster
- Department of Small Animal Medicine and Clinical Biology, Ghent University, St. Pietersnieuwstraat 33, Ghent, 9000, Belgium
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Rubinson L, Wu AW, Haponik EE, Diette GB. Why Is It That Internists Do Not Follow Guidelines for Preventing Intravascular Catheter Infections? Infect Control Hosp Epidemiol 2016; 26:525-33. [PMID: 16018427 DOI: 10.1086/502579] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractBackground and Objective:High morbidity of CVC-related infections has led to national guidelines for their prevention. Despite recommendations for the use of maximal barrier precautions (mask, sterile gloves, gown, and large drape) and skin antisepsis with 2% Chlorhexidine gluconate during CVC insertion, internists in the United States are not implementing these practices frequently. This study sought to identify and characterize the obstacles to and potential opportunities for improving adherence.Design:Cross-sectional survey.Participants:One thousand randomly selected physician-members of the American College of Physicians-American Society of Internal Medicine.Methods:Several potential determinants of adherence to maximal barrier precautions were assessed, including awareness of, agreement with, and ability to implement the recommendation, as well as the practice and training characteristics of the respondents. Factors influencing antiseptic selection were also recorded.Results:Of 526 respondents, 178 (34%) had recently inserted CVCs. Clinician experience and subspecialty, awareness of CDC guidelines, and external influences (eg, time to collect equipment) did not affect maximal barrier precautions adherence. The only independent predictor of adherence was high outcome expectancy for the use of large sterile drapes (OR, 5.3; CI95, 2.2-12.6). Availability had the greatest influence on internists' selection of specific antiseptic agents, whereas cost was the least important determinant.Conclusions:Despite established efficacy, use of maximal barrier precautions and Chlorhexidine gluconate is low among internists. Because improved adherence to these practices will require increased outcome expectancy for maximal barrier precautions and availability of Chlorhexidine gluconate, targeting these areas through focused education and systems modifications is essential (Infect Control Hosp Epidemiol2005;26:525-533).
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MESH Headings
- Anti-Infective Agents, Local/administration & dosage
- Antisepsis/standards
- Attitude of Health Personnel
- Awareness
- Catheterization, Central Venous/adverse effects
- Catheterization, Central Venous/standards
- Catheterization, Central Venous/statistics & numerical data
- Chlorhexidine/administration & dosage
- Chlorhexidine/analogs & derivatives
- Clinical Competence/standards
- Cross Infection/etiology
- Cross Infection/prevention & control
- Cross-Sectional Studies
- Education, Medical, Continuing
- Equipment Contamination/prevention & control
- Guideline Adherence/standards
- Health Knowledge, Attitudes, Practice
- Health Services Needs and Demand
- Humans
- Infection Control/standards
- Internal Medicine/education
- Internal Medicine/standards
- Multivariate Analysis
- Practice Guidelines as Topic
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/statistics & numerical data
- Surveys and Questionnaires
- United States
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Affiliation(s)
- Lewis Rubinson
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
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A Quality Improvement Intervention to Reduce Indwelling Tunneled Pleural Catheter Infection Rates. Ann Am Thorac Soc 2016; 12:847-53. [PMID: 25871702 DOI: 10.1513/annalsats.201411-511oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The indwelling tunneled pleural catheter has altered the management of patients with dyspnea related to malignant pleural effusions. However, indwelling tunneled pleural catheter placement does not remain free from risk. The most commonly reported risk is infection. OBJECTIVES The aim of this paper is to describe our continuous quality improvement program for infection rate recognition, the process changes implemented for improvement, and subsequent outcomes. METHODS All patients undergoing indwelling tunneled pleural catheter placement at The Johns Hopkins Medical Institutions between May 2009 and April 2014 were identified. The primary outcome was the incidence of infection within the preintervention and intervention cohorts. Intervention was identified as use of preoperative antibiotics, full sterile draping, and limiting placement to a single defined location. MEASUREMENTS AND MAIN RESULTS A total of 225 indwelling tunneled pleural catheter placements were performed in 201 patients during the study period, and the overall infection rate was 5.8%. During the preintervention period, 134 placements were performed, and 91 placements occurred during the intervention period. A preintervention infection rate was identified as 8.2%, with a significant decrease to 2.2% (P = 0.049) within the intervention cohort. CONCLUSIONS The use of a continuous quality improvement program to review indwelling tunneled pleural catheter practices can result in the identification of infectious complications and lead to implementation of measures to improve patient outcomes.
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47
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Falcone M, Russo A, Iacovelli A, Restuccia G, Ceccarelli G, Giordano A, Farcomeni A, Morelli A, Venditti M. Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Clin Microbiol Infect 2016; 22:444-50. [PMID: 26850826 DOI: 10.1016/j.cmi.2016.01.016] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/15/2016] [Accepted: 01/23/2016] [Indexed: 01/05/2023]
Abstract
The aim of this study was to identify factors associated with mortality in intensive care unit patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) septic shock. A retrospective analysis of intensive care unit patients with KPC-Kp infection and septic shock observed in a large teaching hospital from November 2010 to December 2014 was performed. A total of 111 patients were included in the study. The most frequent source of infection was unknown-focus bacteraemia in 53 patients (47.7%). The rate of resistance to colistin was 51.3%; 30-day mortality was reported for 44 patients (39.6%). Surviving patients were more frequently treated with an initial therapy (within 24 hours) including two or more antibiotics displaying in vitro activity against the isolated KPC-Kp strain (41.8 vs. 18.1%, p 0.01) and were also more likely to receive a definitive therapy including two or more in vitro active antibiotics (85.1 vs. 15.9%, p <0.001). Cox regression analysis revealed that a colistin-containing antibiotic regimen (hazard ratio (HR) 0.21, confidence interval (CI) 95% 0.05-0.72, p <0.001), use of two or more in vitro active antibiotics as definite therapy (HR 0.08, CI 95% 0.02-0.21, p <0.001) and control of removable source of infection (HR 0.14, CI 95% 0.04-0.25, p <0.001) were associated with favourable outcome; colistin resistance (HR 8.09, CI 95% 3.14-11.23, p 0.001) and intra-abdominal source of infection (HR 2.92, CI 95% 2.11-4.12, p 0.002) were associated with death. In conclusion, use of a definitive therapy with at least two antibiotics displaying in vitro activity against the KPC-Kp isolates was the most important determinant of favourable outcome, whilst isolation of colistin-resistant strains was associated with death in septic patients with KPC-Kp infection.
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Affiliation(s)
- M Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - A Russo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - A Iacovelli
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - G Restuccia
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - G Ceccarelli
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - A Giordano
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - A Farcomeni
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - A Morelli
- Department of Anesthesiology and Intensive Care, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - M Venditti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
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Arterial Catheter Use in the ICU: A National Survey of Antiseptic Technique and Perceived Infectious Risk. Crit Care Med 2016; 43:2346-53. [PMID: 26262949 DOI: 10.1097/ccm.0000000000001250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Recent studies have shown that the occurrence rate of bloodstream infections associated with arterial catheters is 0.9-3.4/1,000 catheter-days, which is comparable to that of central venous catheters. In 2011, the Centers for Disease Control and Prevention published new guidelines recommending the use of limited barrier precautions during arterial catheter insertion, consisting of sterile gloves, a surgical cap, a surgical mask, and a small sterile drape. The goal of this study was to assess the attitudes and current infection prevention practices used by clinicians during insertion of arterial catheters in ICUs in the United States. DESIGN An anonymous, 22-question web-based survey of infection prevention practices during arterial catheter insertion. SETTING Clinician members of the Society of Critical Care Medicine. SUBJECTS Eleven thousand three hundred sixty-one physicians, nurse practitioners, physician assistants, respiratory therapists, and registered nurses who elect to receive e-mails from the Society of Critical Care Medicine. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 1,265 responses (11% response rate), with 1,029 eligible participants after exclusions were applied. Only 44% of participants reported using the Centers for Disease Control and Prevention-recommended barrier precautions during arterial catheter insertion, and only 15% reported using full barrier precautions. The mean and median estimates of the incidence density of bloodstream infections associated with arterial catheters were 0.3/1,000 catheter-days and 0.1/1,000 catheter-days, respectively. Thirty-nine percent of participants reported that they would support mandatory use of full barrier precautions during arterial catheter insertion. CONCLUSIONS Barrier precautions are used inconsistently by critical care clinicians during arterial catheter insertion in the ICU setting. Less than half of clinicians surveyed were in compliance with current Centers for Disease Control and Prevention guidelines. Clinicians significantly underestimated the infectious risk posed by arterial catheters, and support for mandatory use of full barrier precautions was low. Further studies are warranted to determine the optimal preventive strategies for reducing bloodstream infections associated with arterial catheters.
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49
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In situ diagnostic methods for catheter related bloodstream infection in burns patients: A pilot study. Burns 2016; 42:434-40. [PMID: 26778703 DOI: 10.1016/j.burns.2015.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/20/2015] [Accepted: 07/09/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND One of the most common and potentially fatal complications in critically ill burns patients is catheter related bloodstream infection (CR-BSI). Lack of in situ diagnostic techniques requires device removal if CR-BSI is suspected with 75-85% of catheters withdrawn unnecessarily. AIMS To assess the sensitivity, specificity and accuracy of two in situ diagnostic methods for CR-BSI in an adult ICU burns population: Differential Time to Positivity (DTP) and Semi-Quantitative Superficial Cultures (SQSC). METHODS Both arterial (AC) and central venous (CVC) catheters were studied. On clinicians' suspicion of CR-BSI, the CVC and AC were removed. Superficial semi-quantitative cultures were taken by removing the dressings and swabbing within a 3cm radius of the CVC and AC insertion sites, as well as inside each hub of the CVC and AC. Peripheral blood was taken for qualitative culture and the catheter tip sent for semi-quantitative culture. DTP was considered positive if culture of lumen blood became positive at least 120min before peripheral blood with an identical pathogen. Superficial and tip cultures were identified as positive if ≥15 CFUs were grown. CR-BSI was confirmed when both catheter tip culture and peripheral blood culture were positive with the same micro-organism. RESULTS Sixteen patients (88% male) with an APACHE II score of 22.0 (7.3) were enrolled. The mean age was 45.7 (16.9) years with mean total burn surface area 32.9 (19.4)%. Fifty percent had airway burns. ICU stay was 19.9 (11.1) days. All 16 survived ICU discharge with a hospital survival of 93%. There were 20 episodes of CR-BSI in these 16 patients. For these 20 episodes the exposure time (line days) was 113.15. The CR-BSI rate was 15.6 per 1000 catheter days (95% CI 1.9-56.4). For diagnosis of CR-BSI in either AC and CVC, SQSC had a sensitivity of 50% [95% CI 3-97], specificity 83.3% [95% CI 67-93], PPV 14.3 [95% CI 1-58], NPV 96.8 [95% CI 81-100], accuracy of 81.6% [95%CI 65-92] and diagnostic odds ratio 5.0 [95% CI 0.3-91.5]. To diagnose tip colonisation (>15CFU), sensitivity of SQSC was 75% [95% CI 22-99], specificity 88.2% [95%CI 72-96], PPV 42.7 [95% CI 12-80], NPV96.8% [95% CI 81-100], accuracy 86.8% [95% CI 71-95] and diagnostic odds ratio 22.5 [95% CI 1.9-271.9]. For combined DTP blood cultures, sensitivity for CR-BSI was 50% [95% CI 3-97], with specificity 97% [95% CI 82-100], PPV 50% [5% CI 3-97%], NPV 97% [95% CI 82-100], accuracy 94.3% 95% CI 79-99] and diagnostic odds ratio 32 [95% CI 1.1-970.8]. CONCLUSION Both DTP and SQSC displayed high specificity, NPV and accuracy in a population of adult burns patients. These features may make these tests useful for ruling out CR-BSI in this patient group. This study was limited by a low number of events and further research is required.
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50
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Falcone M, Russo A, Iraci F, Carfagna P, Goldoni P, Vullo V, Venditti M. Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection. Antimicrob Agents Chemother 2016; 60:252-7. [PMID: 26482315 PMCID: PMC4704211 DOI: 10.1128/aac.01927-15] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/15/2015] [Indexed: 01/25/2023] Open
Abstract
We determined the incidence, risk factors, and outcomes of bloodstream infections (BSI) subsequent to Clostridium difficile infection (CDI). We performed a retrospective study of all patients with definite diagnosis of CDI admitted from January 2014 to December 2014 in two large hospitals in Rome. Two groups of patients were analyzed: those with CDI and subsequent BSI (CDI/BSI(+)) and those with CDI and no evidence of primary BSI (CDI/BSI(-)). Data about clinical features, microbiology, treatments, and mortality were obtained. Overall, 393 cases of CDI were included in the final analysis: 72 developed a primary nosocomial BSI, while 321 had CDI without microbiological and clinical evidence of BSI. Etiologic agents of BSI were Candida species (47.3%), Enterobacteriaceae (19.4%), enterococci (13.9%), and mixed infections (19.4%). In multivariate analysis, ribotype 027 status (odds ratio [OR], 6.5), CDI recurrence (OR, 5.5), severe CDI infection (OR, 8.3), and oral vancomycin at >500 mg/day (OR, 3.1) were recognized as factors independently associated with the development of nosocomial BSI. Thirty-day mortality from CDI diagnosis was higher for patients of the CDI/BSI(+) group than for the controls (38.9 versus 13.1%; P < 0.001). Among patients of the CDI/BSI(+) group, mortality attributable to primary BSI was as high as 57%. Our findings suggest that severe CDI is complicated by the development of nosocomial BSI. Candida species and enteric bacteria appear to be the leading causative pathogens and are associated with poor outcomes.
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Affiliation(s)
- Marco Falcone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Russo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Federica Iraci
- Faculty of Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Paola Goldoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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