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Muthukuda C, Suriyakumara V, Samarathunga T, Liyanage L, Marasinghe A. Non-tunneled haemodialysis catheter-related blood stream infections and associated factors among first time haemodialysis patients: a prospective study from a tertiary care hospital in Sri Lanka. BMC Nephrol 2024; 25:280. [PMID: 39198819 PMCID: PMC11361233 DOI: 10.1186/s12882-024-03726-4] [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: 03/12/2024] [Accepted: 08/22/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND A significant number of patients require non-tunneled haemodialysis catheters (NTHCs) in the event of an urgent need for immediate haemodialysis in developing countries. Catheter-related bloodstream infections (CRBSIs) are a major concern in haemodialysis, but there is a lack of local epidemiological data. This study aimed to determine the incidence of CRBSI, causative agents and associated risk factors in a tertiary care hospital in Sri Lanka. METHODS A prospective study was conducted at the dialysis unit of Colombo South Teaching Hospital, Sri Lanka from December 2019 to August 2020. Adult patients who had haemodialysis for the first time with NTHCs were included. RESULTS Of 149 dialysis patients (104-jugular vein and 45-femoral vein, mean age 58 ± 13.7 years, mean duration of catheterization 7.9 ± 3.4 days), the incidence of CRBSI was 13.58 per 1000 catheter days. Serum albumin levels, capillary blood sugar levels at admission, haemoglobin levels and duration of catheterization were significantly associated with CRBSI. Prescence of diabetes and patients with ESRD who started routine haemodialysis had a significantly higher risk of CRBSI. Gram-positive bacteria were the most common microorganisms associated with CRBSI (87.5%). CONCLUSIONS Our results show high rates of infection with temporary vascular catheters in Sri Lanka, mainly due to Gram-positive bacteria. Diabetes mellitus, duration of catheterisation, low serum albumin, haemoglobin level and CBS on admission were identified as significant risk factors for CRBSI. Management strategies tailored to specific centers should be established in the nation to optimise catheter care and to monitor local microbiology for appropriate empirical antimicrobial treatment.
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Affiliation(s)
| | | | - Thilina Samarathunga
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Ngo Bell EC, Chapon V, Bessede E, Meriglier E, Issa N, Domblides C, Bonnet F, Vandenhende MA. Central venous catheter-related bloodstream infections: Epidemiology and risk factors for hematogenous complications. Infect Dis Now 2024; 54:104859. [PMID: 38309647 DOI: 10.1016/j.idnow.2024.104859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/08/2023] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Central catheter-related bloodstream infections (CRBIs) can lead to severe complications, including suppurative thrombophlebitis, endocarditis, and metastatic infections. While complications due to CRBIs caused by Staphylococcus aureus (SA) are well-known, there are limited data regarding CRBIs caused by other bacteria. METHODS This 2-year retrospective single-center study of patients with CRBIs from a tertiary care hospital examined the hematogenous complications associated with CRBIs according to patient characteristics, central venous catheter (CVC) types, and causative bacteria. RESULTS All in all, 254 patients with confirmed CRBIs were included; 285 bacteria types were isolated, mainly Enterobacteriaceae (n = 94), coagulase-negative Staphylococci (CNS, n = 82), SA (n = 45), and non-fermenting Gram-negative bacteria (NGB, n = 45). Among the patients, 35 developed at least one hematogenous complication (14 %), including suppurative thrombophlebitis (n = 15), endocarditis (n = 7) and metastatic infections (n = 16). In multivariate analysis, hemodialysis, persistent bacteremia for at least 3 days, and CRBIs caused by SA were associated with increased risk for hematogenous complications, while previous curative anticoagulant treatment was associated with reduced risk. Diabetes, CVC maintenance, and hematogenous complications were associated with increased 3-month mortality. CONCLUSION A thorough investigation of hematogenous complications should be envisioned in patients with persistent bacteremia, particularly those with SA infections and those on hemodialysis.
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Affiliation(s)
| | - Virginie Chapon
- Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, F-33000 Bordeaux, France.
| | - Emilie Bessede
- Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, Hôpital Pellegrin, F-33000 Bordeaux, France.
| | - Etienne Meriglier
- Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne, Hôpital Pellegrin, INSERM, Institut Bergonié, CIC-EC 1401, F-33000 Bordeaux, France.
| | - Nahema Issa
- Centre Hospitalier Universitaire de Bordeaux, Service de Réanimation médicale, Hôpital Saint-André, F-33000 Bordeaux, France.
| | - Charlotte Domblides
- Centre Hospitalier Universitaire de Bordeaux, Service d'Oncologie médicale, Hôpital Saint-André, F-33000 Bordeaux, France.
| | - Fabrice Bonnet
- Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, F-33000 Bordeaux, France; Université de Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France.
| | - Marie-Anne Vandenhende
- Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne, Hôpital Pellegrin, INSERM, Institut Bergonié, CIC-EC 1401, F-33000 Bordeaux, France; Université de Bordeaux, INSERM, Institut Bergonié, CIC-EC 1401, F-33000 Bordeaux, France.
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Schamroth Pravda M, Maor Y, Brodsky K, Katkov A, Cernes R, Schamroth Pravda N, Tocut M, Zohar I, Soroksky A, Feldman L. Blood stream Infections in chronic hemodialysis patients - characteristics and outcomes. BMC Nephrol 2024; 25:3. [PMID: 38172734 PMCID: PMC10763456 DOI: 10.1186/s12882-023-03442-5] [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: 06/30/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Bloodstream Infections (BSI) are a major cause of death and hospitalization among hemodialysis (HD) patients. The rates of BSI among HD patients vary and are influenced by local patient and pathogen characteristics. Modifications in local infection prevention protocols in light of active surveillance of BSI has been shown to improve clinical outcomes. The aim of this study was to further explore factors associated with BSI in a contemporary cohort of HD patients at a public teaching hospital dialysis center in Israel. METHODS This was a retrospective cohort study of HD patients with a BSI in the years 2014 to 2018. The primary outcome was the occurrence of BSI. Secondary outcomes were to describe the causative pathogens of BSI, and to assess for risk factors for BSI, and mortality. RESULTS Included were 251 patients. The mean age was 68.5 ± 13.4 years, 66.9% were male. The mean time from initiation of dialysis was 34.76 ± 40.77 months, interquartile range (IQR) 1-47.5 months and the follow up period of the cohort was 25.17 ± 15.9 months. During the observation period, 44 patients (17.5%) developed 54 BSI events, while 10 of them (3.9% of the whole cohort) developed recurrent BSI events. Gram-negative microorganisms caused 46.3% of all BSI events. 31.4% of these BSI were caused by resistant bacteria. In a multivariate logistic regression analysis, patients receiving dialysis through a central line had a significantly increased risk for BSI adjusted Odds Ratio (aOR) 3.907, p = 0.005, whereas patients' weight was mildly protective (aOR 0.971, p = 0.024). CONCLUSIONS We noted an increased prevalence of gram-negative pathogens in the etiology of BSI in HD patients. Based on our findings, additional empirical antibiotics addressing gram negative bacteria have been added to our empirical treatment protocol. Our findings highlight the need to follow local epidemiology for implementing appropriate preventative measures and for tailoring appropriate empiric antibiotic therapy.
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Affiliation(s)
- Miri Schamroth Pravda
- Department of Intensive care medicine, E. Wolfson Medical Center, 62 Halochamim Street, Holon, 5822012, Israel.
- Department of Internal medicine C, E. Wolfson Medical Center, Holon, Israel.
| | - Yasmin Maor
- Department of Infectious Diseases, E. Wolfson Medical Center, Holon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Konstantin Brodsky
- Department of Internal medicine D, E. Wolfson Medical Center, Holon, Israel
| | - Anna Katkov
- Department of Nephrology and Hypertension, E. Wolfson Medical Center, Holon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Relu Cernes
- Department of Nephrology and Hypertension, E. Wolfson Medical Center, Holon, Israel
| | | | - Milena Tocut
- Department of Internal medicine C, E. Wolfson Medical Center, Holon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Zohar
- Department of Infectious Diseases, E. Wolfson Medical Center, Holon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Soroksky
- Department of Intensive care medicine, E. Wolfson Medical Center, 62 Halochamim Street, Holon, 5822012, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Feldman
- Department of Nephrology and Hypertension, E. Wolfson Medical Center, Holon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kurakado S, Matsumoto Y, Eshima S, Sugita T. Antimicrobial Tolerance in Cross-Kingdom Dual-Species Biofilms Formed by Fungi and Bacteria. Med Mycol J 2024; 65:49-57. [PMID: 39218647 DOI: 10.3314/mmj.24.004] [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] [Indexed: 09/04/2024]
Abstract
Candida albicans, the most common pathogenic fungus, can form biofilms on the surface of medical devices and often causes bloodstream infections. Biofilms have a complex structure composed of microorganisms and a surrounding extracellular matrix. Biofilms are difficult to treat because they are resistant to antifungal drugs and the host environment. Nearly one in four patients with candidemia have a polymicrobial infection. These polymicrobial biofilms, especially those comprising cross-kingdom species of fungi and bacteria, can lead to long hospital stays and high mortality rates. This review outlines the unique interactions of dual-species biofilms with Candida albicans and the clinically important bacteria Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli.
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Affiliation(s)
- Sanae Kurakado
- Department of Microbiology, Meiji Pharmaceutical University
| | | | | | - Takashi Sugita
- Department of Microbiology, Meiji Pharmaceutical University
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Valtin J, Behrens S, Ruland A, Schmieder F, Sonntag F, Renner LD, Maitz MF, Werner C. A New In Vitro Blood Flow Model for the Realistic Evaluation of Antimicrobial Surfaces. Adv Healthc Mater 2023; 12:e2301300. [PMID: 37498721 DOI: 10.1002/adhm.202301300] [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: 04/24/2023] [Revised: 06/13/2023] [Indexed: 07/29/2023]
Abstract
Device-associated bloodstream infections can cause serious medical problems and cost-intensive postinfection management, defining a need for more effective antimicrobial coatings. Newly developed coatings often show reduced bacterial colonization and high hemocompatibility in established in vitro tests, but fail in animal studies or clinical trials. The poor predictive power of these models is attributed to inadequate representation of in vivo conditions. Herein, a new single-pass blood flow model, with simultaneous incubation of the test surface with bacteria and freshly-drawn human blood, is presented. The flow model is validated by comparative analysis of a recently developed set of antiadhesive and contact-killing polymer coatings, and the corresponding uncoated polycarbonate surfaces. The results confirm the model's ability to differentiate the antimicrobial activities of the studied surfaces. Blood activation data correlate with bacterial surface coverage: low bacterial adhesion is associated with low inflammation and hemostasis. Shear stress correlates inversely with bacterial colonization, especially on antiadhesive surfaces. The introduced model is concluded to enable the evaluation of novel antimicrobial materials under in vivo-like conditions, capturing interactions between bacteria and biomaterials surfaces in the presence of key components of the ex vivo host response.
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Affiliation(s)
- Juliane Valtin
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Stephan Behrens
- Fraunhofer Institute for Material and Beam Technology IWS, 01277, Dresden, Germany
| | - André Ruland
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Florian Schmieder
- Fraunhofer Institute for Material and Beam Technology IWS, 01277, Dresden, Germany
| | - Frank Sonntag
- Fraunhofer Institute for Material and Beam Technology IWS, 01277, Dresden, Germany
| | - Lars D Renner
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Manfred F Maitz
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Carsten Werner
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
- Technische Universität Dresden, Cluster of Excellence Physics of Life, Center for Regenerative Therapies Dresden and Faculty of Chemistry and Food Chemistry, 01307, Dresden, Germany
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Nakamura K, Hayakawa K, Tsuzuki S, Ide S, Nomoto H, Nakamoto T, Yamada G, Yamamoto K, Ohmagari N. Clinical outcomes and epidemiological characteristics of bacteremia in the older Japanese population. J Infect Chemother 2023; 29:971-977. [PMID: 37355094 DOI: 10.1016/j.jiac.2023.06.015] [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: 01/25/2023] [Revised: 06/01/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The characteristics and clinical consequences of bacteremia in older people, who are highly susceptible to infections, need to be clarified. This study aimed to determine the epidemiological characteristics, prognosis, and predictors of 7-day mortality in patients with community-acquired (CA), healthcare-associated (HCA), and hospital-onset (HO) bacteremia in older adults aged ≥65 years. METHODS Patients aged ≥65 years with positive blood cultures between April 1, 2015, and March 31, 2018, were divided into three groups: pre-old (65-74 years), old (75-89 years), and super-old (≥90 years). Characteristics based on medical exposure, including CA, HCA, and HO, were also compared and factors related to mortality were identified. RESULTS Overall, 1716 episodes of bacteremia were identified in 1415 patients. Of the 1211 episodes without contamination, 32.8%, 54.3%, and 12.9% occurred in pre-old, old, and super-old patients. Central line-associated bloodstream infections were more common in pre-old patients and urinary tract infections in the old and super-old. The 7-day mortality rates in the pre-old, old, and super-old groups were 7.4%, 5.8%, and 14.2% (P = 0.002), respectively. Multivariable logistic regression showed that super-old age (adjusted odds ratio, aOR: 2.09 [1.13-3.88], P = 0.019) and HO bacteremia (aOR: 1.97 [1.18-3.28], P = 0.010) were independent risk factors for 7-day mortality. Infectious disease consultation had a protective effect on 7-day mortality (aOR: 0.59 [0.35-0.99], P = 0.047). CONCLUSIONS The epidemiology of bacteremia differs among older people; thus, they should not be treated as a single entity. A careful approach is needed for the optimal management of bacteremia in these vulnerable patients.
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Affiliation(s)
- Keiji Nakamura
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
| | - Kayoko Hayakawa
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinya Tsuzuki
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Satoshi Ide
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Hidetoshi Nomoto
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Takato Nakamoto
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Gen Yamada
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kei Yamamoto
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan
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7
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Maqbool S, Sharma R. Incidence of Central Line-Associated Bloodstream Infection in a Tertiary Care Hospital in Northern India: A Prospective Study. Cureus 2023; 15:e44501. [PMID: 37791205 PMCID: PMC10544503 DOI: 10.7759/cureus.44501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Background Central line-associated bloodstream infection is the most common hospital-acquired infection and is associated with high morbidity and mortality along with increased healthcare cost. However, studies on the incidence of nosocomial infections are very limited in India. Aims To determine the incidence of central line-associate bloodstream infection (CLABSI), microorganisms associated and their antimicrobial sensitivity profile in the medical ICU of a tertiary care hospital. Material and methods A total of 186 patients who were admitted to the medical ICU and had a non-tunneled central venous catheter (CVC) implanted at admission in the emergency department or in the medical ICU for longer than 48 hours were monitored. By examining the blood culture reports, the patients were monitored every day for the emergence of new-onset sepsis after 48 hours following CVC insertion. The data were evaluated statistically using Microsoft Excel and SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Result Out of 186 catheterized patients, 37 developed CLABSI. The incidence of CLABSI was 9.3 per 1000 catheter days and 6.7 per 1000 inpatient days with a 0.7 device utilization ratio. The most common organism isolated was Acinetobacter species (22%) followed by K. pneumoniae (16%) and E. aerogenes (16%). The highest sensitivity was displayed by polymyxin B (100%) followed by tigecycline (85.48%) and minocycline (50.82%) in Gram-negative organisms. In Gram-positive organisms, the highest sensitivity was observed in S. aureus (100%) for vancomycin, linezolid and teicoplanin whereas Enterococcus species showed linezolid (100%) followed by vancomycin (93.75%) and teicoplanin (93.75%). Conclusion The prevention of CLABSI requires knowledge of the infection rates and of the sources, the pathogens involved as well as their antimicrobial profile. Due to rising antimicrobial resistance, surveillance programs are crucial in establishing the species distribution and resistance patterns of bacteria causing BSIs and thus providing the basis for appropriate empirical therapy.
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Affiliation(s)
- Safia Maqbool
- Microbiology, Sawai Man Singh (SMS) Medical College and Hospital, Jaipur, IND
| | - Rajni Sharma
- Microbiology, Sawai Man Singh (SMS) Medical College and Hospital, Jaipur, IND
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Ben-David D, Vaturi A, Wulffhart L, Temkin E, Solter E, Carmeli Y, Schwaber MJ. Impact of intensified prevention measures on rates of hospital-acquired bloodstream infection in medical-surgical intensive care units, Israel, 2011 to 2019. Euro Surveill 2023; 28:2200688. [PMID: 37347415 PMCID: PMC10288825 DOI: 10.2807/1560-7917.es.2023.28.25.2200688] [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: 08/25/2022] [Accepted: 03/05/2023] [Indexed: 06/23/2023] Open
Abstract
BackgroundCentral line-associated bloodstream infection (CLABSI) is among the most common preventable infectious complications in patients in intensive care units (ICU). In 2011, the Israel National Center for Infection Control initiated a nationwide CLABSI prevention programme.AimTo evaluate the impact of different components of the programme on CLABSI and non-CLABSI rates in medical-surgical ICUs.MethodsWe included data collected from all 29 medical-surgical ICUs in Israel from November 2011 to December 2019. The study period was divided into three phases: I (baseline, initial CLABSI prevention guidelines introduced, initial feedback on rates provided), II (initial guidelines widely implemented, surveillance undertaken, feedback continued) and III (after implementation of additional prevention measures). Interrupted time series analysis was used to compare CLABSI and non-CLABSI rates during the three phases.ResultsThe pooled mean (SD) incidence of CLABSI per 1,000 central line-days dropped from 7.4 (0.38) in phase I to 2.1 (0.13) in phase III (p < 0.001). The incidence rate ratio (IRR) was 0.63 (95% CI: 0.51-0.79) between phases I and II, and 0.78 (95% CI: 0.59-1.02) between phases II and III. The pooled mean (SD) incidence of non-CLABSI per 1,000 patient-days declined from 5.3 (0.24) in phase I to 3.4 (0.13) in phase III (p < 0.001).ConclusionNational CLABSI prevention guidelines, surveillance and feedback resulted in significant reductions in CLABSI and non-CLABSI rates. In the wake of further interventions, significant reduction was achieved in ICUs reporting improvement in the uptake of additional prevention measures.
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Affiliation(s)
- Debby Ben-David
- National Center for Infection Control, Ministry of Health, Jerusalem, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Azza Vaturi
- National Center for Infection Control, Ministry of Health, Jerusalem, Israel
| | - Liat Wulffhart
- National Center for Infection Control, Ministry of Health, Jerusalem, Israel
| | - Elizabeth Temkin
- National Center for Infection Control, Ministry of Health, Jerusalem, Israel
| | - Ester Solter
- National Center for Infection Control, Ministry of Health, Jerusalem, Israel
| | - Yehuda Carmeli
- National Center for Infection Control, Ministry of Health, Jerusalem, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mitchell J Schwaber
- National Center for Infection Control, Ministry of Health, Jerusalem, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Barrigah-Benissan K, Ory J, Simon C, Loubet P, Martin A, Beregi JP, Lavigne JP, Sotto A, Larcher R. Clinical factors associated with peripherally inserted central catheters (PICC) related bloodstream infections: a single centre retrospective cohort. Antimicrob Resist Infect Control 2023; 12:5. [PMID: 36717942 PMCID: PMC9885663 DOI: 10.1186/s13756-023-01209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Despite their spread in daily practice, few data is available on clinical factors associated with peripherally inserted central catheter (PICC)-related bloodstream infections (PR-BSI). We aimed to assess the PR-BSI incidence, microbiology, and factors associated with PR-BSI with a focus on clinical symptoms. METHODS We conducted a retrospective cohort study in a French university hospital. We screened all PICC insertions performed from April 1st, 2018, to April 1st, 2019, and included PICC insertions in adult patients. We assessed the PR-BSI incidence, the factors associated with PR-BSI using a Cox model, and negative and positive predictive values (NPVs and PPVs) of each clinical sign for PR-BSI. RESULTS Of the 901 PICCs inserted in 783 patients (38,320 catheters days), 214 PICCs (24%) presented with a complication. The most prevalent complication was PR-BSI (1.9 per 1000 catheter days; 8.1% of inserted PICCs ). Enterobacterales (N = 27, 37%) and coagulase negative Staphylococci (N = 24, 33%), were the main microorganisms responsible for PR-BSI. Factors independently associated with occurrence of PR-BSI were fever (hazard ratio 13.21, 95% confidence interval 6.00-29.11, p < 0.001) and chills (HR 3.66, 95%CI 1.92-6.99, p < 0.001). All clinical signs and a duration of PICC maintenance ≥ 28 days, had a low PPVs (≤ 67.1%) but high NPVs (≥ 92.5%) for PR-BSI. CONCLUSIONS Monitoring of clinical signs, especially fever and chills, with caution and limitation of device maintenance duration, could improve PICC management.
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Affiliation(s)
- Koko Barrigah-Benissan
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Jerome Ory
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Claire Simon
- grid.411165.60000 0004 0593 8241Department of Pharmacy, CHU Nimes, Nimes, France
| | - Paul Loubet
- grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France ,grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Aurelie Martin
- grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Jean-Paul Beregi
- grid.411165.60000 0004 0593 8241Department of Medical Imaging, CHU Nimes, Nimes, France
| | - Jean-Philippe Lavigne
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Albert Sotto
- grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France ,grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Romaric Larcher
- Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000, Nimes, France. .,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France.
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Nanyunja D, Chothia MY, Opio KC, Ocama P, Bwanga F, Kiggundu D, Byakika-Kibwika P. Incidence, microbiological aspects and associated risk factors of catheter-related bloodstream infections in adults on chronic haemodialysis at a tertiary hospital in Uganda. IJID REGIONS 2022; 5:72-78. [PMID: 36212918 PMCID: PMC9535435 DOI: 10.1016/j.ijregi.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Abstract
Objectives The high burden of infectious complications among patients receiving haemodialysis (HD) via central venous catheters increases morbidity and mortality. This study determined the incidence of catheter-related bloodstream infections (CRBSIs), microbiological profile of causative organisms, and associated predictors in patients on chronic HD. Methods A prospective single-centre cohort study of 121 adult patients with end-stage kidney disease was conducted from October 2019 to March 2020. Antibiotic susceptibility was determined by the Kirby-Bauer disk diffusion method. Cox proportional hazards model was used to determine predictors of CRBSI. Results The mean age was 50 (standard deviation 14.9) years and the median duration of follow-up was 69 (interquartile range 23-124) days. At least one CRBSI was recorded for 41% of patients, at a rate of 5.2 infections per 1000 patient-days. Causative organisms were predominantly Gram-negative bacteria (60.3%), and 36.5% of all isolates were multi-drug resistant. Anaemia [hazard ratio (HR) 5.44, P=0.019, 95% confidence interval (CI) 1.32-22.48] and previous bloodstream infection [HR 2.47, P=0.028, 95% CI 1.10-5.54] were predictors of CRBSI. Conclusion The high incidence of CRBSI in patients on chronic HD with predominance of Gram-negative bacteria means that catheter care bundles should include Gram-negative coverage.
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Affiliation(s)
- Doreen Nanyunja
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mogamat-Yazied Chothia
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Ponsiano Ocama
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Freddie Bwanga
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Daniel Kiggundu
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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11
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How to manage central venous catheter-related bloodstream infections due to Gram-negative bacilli? Curr Opin Infect Dis 2022; 35:583-588. [PMID: 35852791 DOI: 10.1097/qco.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to review recent data evaluating the management of central venous catheter-related bloodstream infection due to Gram-negative bacilli (GNB). RECENT FINDINGS The incidence of GNB catheter-related bloodstream infection (CRBSI) has been increasing considerably in the last years, and this has raised a concern due to the high reported rate of multidrug-resistant in these infections what poses a considerable challenge for effective treatment. However, there are no specific guidelines for the management of GNB-CRBSI and optimal treatment duration has not been clearly defined. Recent studies have shown that the risk for complications is clearly different to what is stablished for Staphylococcus aureus . Therefore, a short course of antibiotic therapy might be effective once the central venous catheter (CVC) has been removed and the monitoring complications through control blood cultures or echocardiography seem to be less helpful in GNB CRBSI. SUMMARY The incidence of GNB CRBSI has been increasing considerably in the last years; this has raised a concern due to the high reported rate of MDR in these infections what poses a considerable challenge for effective treatment. However, there are no specific guidelines for the management of GNB-CRBSI and optimal treatment duration has not been clearly defined. Recent studies have shown that the risk for complications is clearly different to what is stablished for S. aureus . Therefore, a short course of antibiotic therapy might be effective once the CVC has been removed and the monitoring complications through control blood cultures or echocardiography seem to be less helpful in GNB-CRBSI.
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12
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Macias-Valcayo A, Aguilera-Correa JJ, Broncano A, Parron R, Auñon A, Garcia-Cañete J, Blanco A, Esteban J. Comparative In Vitro Study of Biofilm Formation and Antimicrobial Susceptibility in Gram-Negative Bacilli Isolated from Prosthetic Joint Infections. Microbiol Spectr 2022; 10:e0085122. [PMID: 35876589 PMCID: PMC9430931 DOI: 10.1128/spectrum.00851-22] [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] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022] Open
Abstract
Prosthetic joint infections (PJIs) are typically caused by microorganisms that grow in biofilms. Traditional antimicrobial susceptibility tests are based on the study of planktonic bacteria that might lead to missing the biofilm behavior and to a treatment failure. This study was designed to analyze the antimicrobial susceptibility of clinical Gram-negative bacilli (GNB) isolates from PJIs in planktonic and sessile states and the possible relationship between antimicrobial resistance and biofilm formation. A total of 46 clinical isolates from patients with PJIs (mainly hip and knee prostheses) plus three GNB ATCC isolates were studied. The Minimal Inhibitory Concentration (MIC), minimal bactericidal concentration (MBC), minimal biofilm inhibitory concentration (MBIC), and minimal biofilm eradication concentration (MBEC) were assessed using a previously published methodology. Almost all of the GNB clinical isolates tested were biofilm forming. Pseudomonas aeruginosa was the largest biofilm-forming species. A comparison of MBIC90 versus MIC90 shows an increase higher than 1- to -2-fold dilutions in most antimicrobials studied, and MBEC90 was significantly higher than MIC90, becoming resistant to all the antimicrobial drugs tested. Higher biofilm production values were obtained in antibiotic-susceptible Escherichia coli in comparison to their resistant counterparts. However, regarding the relationships between antimicrobial resistance and biofilm formation, our analysis showed that each strain differed. A high antimicrobial resistance rate was found among the GNB studied. Moreover, almost all bacterial isolates were in vitro biofilm formers. Although there was no significant association between biofilm and antibiotic resistance, multidrug-resistant isolates were found to be greater biofilm formers than non-multidrug-resistant isolates. IMPORTANCE This study is the first one to analyze a high number of isolates of Gram-negative bacilli that are the cause of prosthetic joint infection. The analysis includes biofilm development and antimicrobial susceptibility testing of both planktonic and sessile bacteria. The obtained results support the clinical knowledge about the treatment of these bacteria when biofilms are involved.
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Affiliation(s)
- Alicia Macias-Valcayo
- Department of Clinical Microbiology, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - John-Jairo Aguilera-Correa
- Department of Clinical Microbiology, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centre for Biomedical Research Network in Infectious Diseases (CIBERINFEC), CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Antonio Broncano
- Department of Clinical Microbiology, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Raul Parron
- Centre for Biomedical Research Network in Infectious Diseases (CIBERINFEC), CIBER de Enfermedades Infecciosas, Madrid, Spain
- Department of Orthopaedic Surgery, Fundación Jiménez Díaz, Madrid, Spain
| | - Alvaro Auñon
- Centre for Biomedical Research Network in Infectious Diseases (CIBERINFEC), CIBER de Enfermedades Infecciosas, Madrid, Spain
- Department of Orthopaedic Surgery, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Antonio Blanco
- Centre for Biomedical Research Network in Infectious Diseases (CIBERINFEC), CIBER de Enfermedades Infecciosas, Madrid, Spain
- Department of Internal Medicine-Emergencies, Fundación Jiménez Díaz, Madrid, Spain
| | - Jaime Esteban
- Department of Clinical Microbiology, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centre for Biomedical Research Network in Infectious Diseases (CIBERINFEC), CIBER de Enfermedades Infecciosas, Madrid, Spain
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Costa SP, Carvalho CM. Burden of bacterial bloodstream infections and recent advances for diagnosis. Pathog Dis 2022; 80:6631550. [PMID: 35790126 DOI: 10.1093/femspd/ftac027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/07/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Bloodstream infections (BSIs) and subsequent organ dysfunction (sepsis and septic shock) are conditions that rank among the top reasons for human mortality and have a great impact on healthcare systems. Their treatment mainly relies on the administration of broad-spectrum antimicrobials since the standard blood culture-based diagnostic methods remain time-consuming for the pathogen's identification. Consequently, the routine use of these antibiotics may lead to downstream antimicrobial resistance and failure in treatment outcomes. Recently, significant advances have been made in improving several methodologies for the identification of pathogens directly in whole blood especially regarding specificity and time to detection. Nevertheless, for the widespread implementation of these novel methods in healthcare facilities, further improvements are still needed concerning the sensitivity and cost-effectiveness to allow a faster and more appropriate antimicrobial therapy. This review is focused on the problem of BSIs and sepsis addressing several aspects like their origin, challenges, and causative agents. Also, it highlights current and emerging diagnostics technologies, discussing their strengths and weaknesses.
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Affiliation(s)
- Susana P Costa
- Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.,LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.,International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga s/n, 4715-330, Braga, Portugal.,Instituto de Engenharia de Sistemas e Computadores - Microsistemas e Nanotecnologias (INESC MN) and IN - Institute of Nanoscience and Nanotechnology, Rua Alves Redol, 9 1000-029 Lisbon, Portugal
| | - Carla M Carvalho
- International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga s/n, 4715-330, Braga, Portugal
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Nakaya Y, Imasaki M, Shirano M, Shimizu K, Yagi N, Tsutsumi M, Yoshida M, Yoshimura T, Hayashi Y, Nakao T, Yamane T. Peripherally inserted central venous catheters decrease central line-associated bloodstream infections and change microbiological epidemiology in adult hematology unit: a propensity score-adjusted analysis. Ann Hematol 2022; 101:2069-2077. [PMID: 35780253 DOI: 10.1007/s00277-022-04908-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Peripherally inserted central venous catheters (PICCs) have a potential advantage in preventing central line-associated bloodstream infection (CLABSI) compared with the centrally inserted ones (CICCs). However, due to a limited number of studies with insufficient statistical evaluation, the superiority of PICCs is difficult to be generalized in adult hematology unit. We conducted a single-center retrospective study and compared the risk of CLABSI between 472 CICCs and 557 PICCs inserted in adult patients with hematological disorders through conventional multivariate models and a propensity score-adjusted analysis. The overall CLABSI incidence in CICCs and PICCs was 5.11 and 3.29 per 1000 catheter days (P = 0.024). The multivariate Cox regression analysis (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.31-0.75; P = 0.001) and Fine-Gray subdistribution analysis (HR: 0.59; 95% CI: 0.37-0.93; P = 0.023) demonstrated that PICC was independently associated with a reduced risk of CLABSI. Moreover, the stabilized inverse probability of treatment weighting analysis, which further reduced the selection bias between CICCs and PICCs, showed that PICCs significantly prevented CLABSI (HR: 0.58; 95% CI: 0.35-0.94; P = 0.029). Microbiologically, PICCs showed a significant decrease in gram-positive cocci (P = 0.001) and an increase in gram-positive bacilli (P = 0.002) because of a remarkable reduction in Staphylococci and increase in Corynebacterium species responsible for CLABSI. Our study confirmed that PICC was a superior alternative to CICC in preventing CLABSI in the adult hematology unit, while it posed a microbiological shift in local epidemiology.
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Affiliation(s)
- Yosuke Nakaya
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan.,Department of Hematology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Mika Imasaki
- Department of Infectious Diseases, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Michinori Shirano
- Department of Infectious Diseases, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan.
| | - Katsujun Shimizu
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Naoko Yagi
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Minako Tsutsumi
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan.,Department of Hematology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Masahiro Yoshida
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Takuro Yoshimura
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Yoshiki Hayashi
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Takafumi Nakao
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Takahisa Yamane
- Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
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15
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Badia-Cebada L, Peñafiel J, Saliba P, Andrés M, Càmara J, Domenech D, Jiménez-Martínez E, Marrón A, Moreno E, Pomar V, Vaqué M, Limón E, Masats Ú, Pujol M, Gasch O. Trends in the epidemiology of catheter-related bloodstream infections; towards a paradigm shift, Spain, 2007 to 2019. Euro Surveill 2022; 27:2100610. [PMID: 35551704 PMCID: PMC9101967 DOI: 10.2807/1560-7917.es.2022.27.19.2100610] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundCatheter-related bloodstream infections (CRBSI) are frequent healthcare-associated infections and an important cause of death.AimTo analyse changes in CRBSI epidemiology observed by the Infection Control Catalan Programme (VINCat).MethodsA cohort study including all hospital-acquired CRBSI episodes diagnosed at 55 hospitals (2007-2019) in Catalonia, Spain, was prospectively conducted. CRBSI incidence rates were adjusted per 1,000 patient days. To assess the CRBSI rate trend per year, negative binomial models were used, with the number of events as the dependent variable, and the year as the main independent variable. From each model, the annual rate of CRBSI diagnosed per 1,000 patient days and the incidence rate ratio (IRR) with its 95% confidence intervals (CI) were reported.ResultsDuring the study, 9,290 CRBSI episodes were diagnosed (mean annual incidence rate: 0.20 episodes/1,000 patient days). Patients' median age was 64.1 years; 36.6% (3,403/9,290) were female. In total, 73.7% (n = 6,845) of CRBSI occurred in non-intensive care unit (ICU) wards, 62.7% (n = 5,822) were related to central venous catheter (CVC), 24.1% (n = 2,236) to peripheral venous catheters (PVC) and 13.3% (n = 1,232) to peripherally-inserted central venous catheters (PICVC). Incidence rate fell over the study period (IRR: 0.94; 95%CI: 0.93-0.96), especially in the ICU (IRR: 0.88; 95%CI: 0.87-0.89). As a whole, while episodes of CVC CRBSI fell significantly (IRR: 0.88; 95%CI: 0.87-0.91), peripherally-inserted catheter CRBSI (PVC and PICVC) rose, especially in medical wards (IRR PICVC: 1.08; 95%CI: 1.05-1.11; IRR PVC: 1.03; 95% 1.00-1.05).ConclusionsOver the study, CRBSIs associated with CVC and diagnosed in ICUs decreased while episodes in conventional wards involving peripherally-inserted catheters increased. Hospitals should implement preventive measures in conventional wards.
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Affiliation(s)
- Laia Badia-Cebada
- Internal Medicine Department, Hospital Universitari Parc Taulí, Sabadell, Spain,School of Medicine, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Judit Peñafiel
- Unit of Statistics, Hospital Universitari de Bellvitge/Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Patrick Saliba
- VINCat programme: Infection Control Catalan Programme, Barcelona, Spain
| | - Marta Andrés
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Consorci de Terrassa, Spain
| | - Jordi Càmara
- Department of Microbiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain,CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
| | - Dolors Domenech
- Infection Control Nurse, Hospital Josep Trueta, Girona, Spain
| | - Emili Jiménez-Martínez
- Infection Control Nurse, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Anna Marrón
- Infectious Diseases Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Encarna Moreno
- Infection Control Nurse, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Virginia Pomar
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Montserrat Vaqué
- Infection Control Nurse, Hospital de Barcelona, Barcelona, Spain
| | - Enric Limón
- VINCat programme: Infection Control Catalan Programme, Barcelona, Spain
| | - Úrsula Masats
- Infection Control Nurse, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Miquel Pujol
- Department of Infectious diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Oriol Gasch
- School of Medicine, Universitat Autònoma de Barcelona, Sabadell, Spain,Infectious Diseases Department, Hospital Universitari Parc Taulí, Sabadell, Spain,Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
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16
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Klar K, Knaack D, Kampmeier S, Hein AK, Görlich D, Steltenkamp S, Weyland U, Becker K. Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany. CHILDREN 2022; 9:children9020190. [PMID: 35204911 PMCID: PMC8870042 DOI: 10.3390/children9020190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 11/24/2022]
Abstract
Hand hygiene is a cornerstone of infection prevention. However, few data are available for school children on their knowledge of infectious diseases and their prevention. The aim of the study was to develop and apply a standardized questionnaire for children when visiting primary schools to survey their knowledge about infectious diseases, pathogen transmission and prevention measures. Enrolling thirteen German primary schools, 493 questionnaires for grade three primary school children were included for further analyses, comprising 257 (52.1%) girls and 236 (47.9%) boys with an age range of 8–11 years. Out of 489 children, 91.2% participants indicated that they knew about human-to-human transmissible diseases. Of these, 445 children responded in detail, most frequently mentioning respiratory and gastrointestinal diseases, followed by childhood diseases. Addressing putative hygiene awareness-influencing factors, it was worrisome that more than 40.0% of the children avoided visiting the sanitary facilities at school. Most of the children (82.9%) noted that they did not like to use the sanitary facilities at school because of their uncleanliness and the poor hygienic behavior of their classmates. In conclusion, basic infection awareness exists already in primary school age children. Ideas about the origin and prevention of infections are retrievable, however, this knowledge is not always accurate and adequately contextualized. Since the condition of sanitary facilities has a strong influence on usage behavior, the child’s perspective should be given more consideration in the design and maintenance of sanitary facilities.
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Affiliation(s)
- Kristin Klar
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (K.K.); (D.K.)
| | - Dennis Knaack
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany; (K.K.); (D.K.)
| | - Stefanie Kampmeier
- Institute of Hygiene, University Hospital Münster, 48149 Münster, Germany;
| | - Anna Katharina Hein
- Institute of Education, Westphalian Wilhelms-University of Münster, 48143 Münster, Germany; (A.K.H.); (U.W.)
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westphalian Wilhelms-University of Münster, 48149 Münster, Germany;
| | | | - Ulrike Weyland
- Institute of Education, Westphalian Wilhelms-University of Münster, 48143 Münster, Germany; (A.K.H.); (U.W.)
| | - Karsten Becker
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, 17475 Greifswald, Germany
- Correspondence: ; Tel.: +49-3834-86-5560
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Petri O, Vrenjo K, Angjeli A, Abazaj E, Kika B, Koraqi A, Daka A. Prevalence of Catheter-related Bloodstream Infection and Distribution of Multidrug Resistance Microorganisms among the Hospitalized Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Central venous catheter (VC)-related bloodstream infection (CRBSI) is associated with high rates of morbidity and mortality in critically ill patients over the world.
AIM: The aims study is to evaluate the prevalence of CRBSI and to identify some of the factors.
METHODS: This was a retrospective, observational study carried out in the tertiary care hospital “Mother Theresa,” Tirana and American Hospital, Tirana, over a period of 3 years from January 2016 to December 2018. Data were collected retrospectively from various electronic sources shared by the hospitals and linked using patients’ unique medical record numbers. A total of 170 patients with indwelling VC were included in the study. The catheters were cultured using the standard procedure. Statistical analysis version SPSS-20 software was used for calculation of data.
RESULTS: Overall 170 patients analyzed in this study, the prevalence of CRBSI results 58.8%. The positivity from the University Hospital Center (UHC) “Mother Theresa” resulted 65.1% (82/126 cases) and the positivity from American Hospitals (AH) resulted 40.91% (18/44 cases). Patients from UHC Mother Theresa were (odds ratio) 2.69 times higher in risk for CRBSI compared to patients from AH, for confidence interval 95% (1.33–5.44) p value resulted to be with strong association = 0.005. The average age resulted 59.68 ± 14.26, with minimum age 9 years old and maximum age 83 years old. The most infected age groups resulted patients with age 61–70 years old. Central VC had a higher positivity compared to other catheters types. Regarding the spectrum of bacteria implicated in CRBSI infections, Gram positive bacteria (67%) were the most predominant compared to Gram-negative bacteria (33%), but regarding the antimicrobial resistance, the Gram-negative bacteria resulted majority of multidrug resistance.
CONCLUSION: The overall prevalence of CRBSI was 58.8%. Patients from Mother Theresa Hospital have the highest prevalence compared to patients of American Hospital. Men patients were the most predominant sex; age groups 61–70 years old presented the highest positive cases with CRBSI. Staphylococcus spp., Acinetobacter spp., Proteus spp., etc., were the most common isolate. We found antimicrobial resistance almost in all bacteria, but Gram-negative bacteria resulted majority of multidrug resistance.
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Causes and Risk Factors of Hemodialysis Catheter Infection in Dialysis Patients: A Prospective Study. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.117820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Infectious central venous catheter (CVC) complications, including mortality and care and hospitalization costs, are still a major clinical concern. This study aimed to determine the prevalence of hemodialysis catheter infection and its risk factors among hemodialysis patients. Methods: The present research was a descriptive, prospective cross-sectional study on hemodialysis patients in Babol hospitals during 2020 - 21. The participants' demographic information and some relevant data on clinical variables (namely underlying diseases, cause of dialysis, and cause of catheter removal) and catheter-related variables (namely catheter location, frequency of catheter placement, and apparent signs of catheter site) were collected and recorded directly and systematically during surgery post-surgery. Results: One hundred and twenty-two patients with temporary double-lumen acute hemodialysis catheters for dialysis, including 56 women (45.9%), were included in this study, the mean age of whom was 58.9 ± 16.4 years. Twenty-two patients (18%) developed a catheter-induced systemic infection. There was no significant relationship between the catheter site and its removal inducing infection (P > 0.05). The frequencies of microorganisms causing catheter infection included gram-positive Staphylococcus epidermis (59%) and Staphylococcus aureus (31.8%). Moreover, there was no significant correlation between demographic variables and clinical history with systemic infection induced by catheterization. Conclusions: The rate of catheter-induced infection is relatively high among patients since sterile instructions were observed during catheterization; therefore, it is recommended to pay more attention to the care and dressing of the catheter site.
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Kubeček O, Paterová P, Novosadová M. Risk Factors for Infections, Antibiotic Therapy, and Its Impact on Cancer Therapy Outcomes for Patients with Solid Tumors. Life (Basel) 2021; 11:1387. [PMID: 34947918 PMCID: PMC8705721 DOI: 10.3390/life11121387] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
Infections represent a significant cause of morbidity and mortality in cancer patients. Multiple factors related to the patient, tumor, and cancer therapy can affect the risk of infection in patients with solid tumors. A thorough understanding of such factors can aid in the identification of patients with substantial risk of infection, allowing medical practitioners to tailor therapy and apply prophylactic measures to avoid serious complications. The use of novel treatment modalities, including targeted therapy and immunotherapy, brings diagnostic and therapeutic challenges into the management of infections in cancer patients. A growing body of evidence suggests that antibiotic therapy can modulate both toxicity and antitumor response induced by chemotherapy, radiotherapy, and especially immunotherapy. This article provides a comprehensive review of potential risk factors for infections and therapeutic approaches for the most prevalent infections in patients with solid tumors, and discusses the potential effect of antibiotic therapy on toxicity and efficacy of cancer therapy.
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Affiliation(s)
- Ondřej Kubeček
- Department of Oncology and Radiotherapy, Faculty of Medicine and University Hospital in Hradec Králové, Charles University, Sokolská 581, 50005 Hradec Králové, Czech Republic;
| | - Pavla Paterová
- Department of Clinical Microbiology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University, Sokolská 581, 50005 Hradec Králové, Czech Republic
| | - Martina Novosadová
- Department of Clinical Pharmacy, Hospital Pharmacy, University Hospital in Hradec Králové, Sokolská 581, 50005 Hradec Králové, Czech Republic;
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20
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Duration of antibiotic therapy in central venous catheter-related bloodstream infection due to Gram-negative bacilli. Curr Opin Infect Dis 2021; 34:681-685. [PMID: 34261908 DOI: 10.1097/qco.0000000000000763] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review recent data evaluating the duration of antibiotic therapy in central venous catheter-related bloodstream infection (CRBSI) due to Gram-negative bacilli (GNB). RECENT FINDINGS CRBSI is the most common complication associated with the use of intravascular catheters. CRBSI directly contributes to increase additional days of hospitalization, morbidity and therefore economic costs.The incidence of GNB CRBSI has been increasing considerably in the last years; this has raised a concern due to the high reported rate of multi drug resistant bacteria in these infections what poses a considerable challenge for effective treatment. However, there are no specific guidelines for management of GNB-CRBSI and optimal treatment duration has not been clearly defined.Recent studies evaluating the impact of the duration of antibiotic therapy of GNB-CRBSI have shown that short-course antibiotic therapy might be as effective as long-course therapy once the central venous catheter (CVC) has been removed. SUMMARY CRBSI due to GNB has shown a rapid increase in the last years. Current guidelines recommend antibiotic treatment for at least 7-14 days, although no randomized clinical trials have evaluated the optimal duration of antibiotic therapy for GNB-CRBSI. Recent data suggest that administration of appropriate antibiotic therapy for 7 days or less may be as well tolerated and effective as longer courses in episodes of GNB-CRBSI, once the CVC has been removed.
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21
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Dadi NCT, Radochová B, Vargová J, Bujdáková H. Impact of Healthcare-Associated Infections Connected to Medical Devices-An Update. Microorganisms 2021; 9:2332. [PMID: 34835457 PMCID: PMC8618630 DOI: 10.3390/microorganisms9112332] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 01/12/2023] Open
Abstract
Healthcare-associated infections (HAIs) are caused by nosocomial pathogens. HAIs have an immense impact not only on developing countries but also on highly developed parts of world. They are predominantly device-associated infections that are caused by the planktonic form of microorganisms as well as those organized in biofilms. This review elucidates the impact of HAIs, focusing on device-associated infections such as central line-associated bloodstream infection including catheter infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and surgical site infections. The most relevant microorganisms are mentioned in terms of their frequency of infection on medical devices. Standard care bundles, conventional therapy, and novel approaches against device-associated infections are briefly mentioned as well. This review concisely summarizes relevant and up-to-date information on HAIs and HAI-associated microorganisms and also provides a description of several useful approaches for tackling HAIs.
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Affiliation(s)
| | - Barbora Radochová
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 84215 Bratislava, Slovakia; (N.C.T.D.); (J.V.)
| | | | - Helena Bujdáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 84215 Bratislava, Slovakia; (N.C.T.D.); (J.V.)
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22
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James J, Joseph JJ, Sebastian S, Antony E, Vilapurathu JK. Jugular Venous Catheter related Stenotrophomonas maltophilia Bacteremia. Indian J Nephrol 2021; 31:205-206. [PMID: 34267450 PMCID: PMC8240928 DOI: 10.4103/ijn.ijn_193_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/22/2020] [Accepted: 07/05/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jude James
- Pharm D, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India
| | - Joel J Joseph
- Pharm D, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India
| | | | - Edwin Antony
- Pharm D, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India
| | - Jobin K Vilapurathu
- Department of Pharmacy Practice, Nirmala College of Pharmacy, Muvattupuzha, Kerala, India
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23
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Ruiz-Ruigómez M, Fernández-Ruiz M, San-Juan R, López-Medrano F, Orellana MÁ, Corbella L, Rodríguez-Goncer I, Hernández Jiménez P, Aguado JM. Impact of duration of antibiotic therapy in central venous catheter-related bloodstream infection due to Gram-negative bacilli. J Antimicrob Chemother 2021; 75:3049-3055. [PMID: 32591804 DOI: 10.1093/jac/dkaa244] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A progressive increase in the incidence of catheter-related bloodstream infection (CRBSI) due to Gram-negative bacilli (GNB) has been reported. Current guidelines recommend antibiotic treatment for at least 7-14 days, although the supporting evidence is limited. METHODS We performed a retrospective single-centre study including all patients with a definite diagnosis of GNB CRBSI from January 2012 to October 2018 in which the central venous catheter (CVC) was removed. The occurrence of therapeutic failure [clinical failure (persistence of symptoms and laboratory signs of infection), microbiological failure (persistent bacteraemia or relapse) and/or all-cause 30 day mortality] was compared between episodes receiving short [≤7 days (SC)] or long courses [>7 days (LC)] of appropriate antibiotic therapy following CVC removal. RESULTS We included 54 GNB CRBSI episodes with an overall rate of therapeutic failure of 27.8% (15/54). Episodes receiving SC therapy were more frequently due to MDR GNB [60.9% (14/23) versus 34.5% (10/29); P = 0.058] and had higher Pitt scores [median (IQR) 1 (0-4) versus 0 (0-2); P = 0.086]. There were no significant differences in the rate of therapeutic failure between episodes treated with SC or LC therapy [30.4% (7/23) versus 27.6% (8/29); OR 1.15; 95% CI 0.34-3.83; P = 0.822]. The use of SCs was not associated with increased odds of therapeutic failure in any of the exploratory models performed. CONCLUSIONS The administration of appropriate antibiotic therapy for ≤7 days may be as safe and effective as longer courses in episodes of GNB CRBSI once the CVC has been removed.
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Affiliation(s)
- María Ruiz-Ruigómez
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain
| | - Rafael San-Juan
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain
| | - María Ángeles Orellana
- Department of Microbiology, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain
| | - Laura Corbella
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain
| | - Isabel Rodríguez-Goncer
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain
| | - Pilar Hernández Jiménez
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid, Spain
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24
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Changing epidemiology of catheter-related bloodstream infections in neutropenic oncohematological patients. PLoS One 2021; 16:e0251010. [PMID: 33930068 PMCID: PMC8087001 DOI: 10.1371/journal.pone.0251010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background We aimed to describe the epidemiology of catheter-related bloodstream infections (CRBSIs) in onco-hematological neutropenic patients during a 25-year study period, to evaluate the risk factors for Gram-negative bacilli (GNB) CRBSI, as well as rates of inappropriate empirical antibiotic treatments (IEAT) and mortality. Materials/Methods All consecutive episodes of CRBSIs were prospectively collected (1994–2018). Changing epidemiology was evaluated comparing five-year time spans. A multivariate regression model was built to evaluate risk factors for GNB CRBSIs. Results 482 monomicrobial CRBSIs were documented. The proportion of CRBSIs among all BSIs decreased over time from 41.2% to 15.8% (p<0.001). CRBSIs epidemiology has been changing: the rate of GNB increased over time (from 11.9% to 29.4%; p<0.001), as well as the absolute number and rate of multidrug-resistant (MDR) GNB (from 9.5% to 40.0%; p = 0.039). P. aeruginosa increased and comprised up to 40% of all GNB. Independent factors related with GNB-CRBSIs were: longer duration of in-situ catheter (OR 1.007; 95%CI 1.004–1.011), older age (OR 1.016; 95%CI 1.001–1.033), prior antibiotic treatment with penicillins (OR 2.716; 95%CI 1.306–5.403), and current antibiotic treatment with glycopeptides (OR 1.931; 95%CI 1.001–3.306). IEATs were administered to 30.7% of patients, with the highest percentage among MDR P. aeruginosa (76.9%) and S. maltophillia (92.9%). Mortality rate was greater among GNB than GPC-CRBSI (14.4% vs 5.4%; p = 0.002), with mortality increasing over time (from 4.5% to 11.2%; p = 0.003). Conclusion A significant shift towards GNB-CRBSIs was observed. Secondarily, and coinciding with an increasing number of GNB-MDR infections, mortality increased over time.
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25
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Mandolfo S, Anesi A, Rognoni V. The epidemiology of central venous catheter-related bloodstream infection in our renal units is changing. J Vasc Access 2021; 23:328-329. [PMID: 33499702 DOI: 10.1177/1129729821990222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent reports have shown an increase in the rate of Gram-negative bacteremia in several settings, including catheter-related bloodstream infections (CRBSI). To analyze if the epidemiology of CRBSI is also changing in hemodialysis patients, we revisited the etiology of CRBSIs in our renal unit over 8 years. During the observed periods, 149 episodes of CRBSIs were reported and the CRBSI incidence rate, ranged between 0.67 and 0.82 episodes/1000 tCVC days. Of these 149 episodes, 84 (56.3%) were due to Gram-positive bacteria, 62 (41.6%) to Gram-negative bacteria, and 3 (2.1%) to polymicrobial flora, no episodes of fungi were found. There was a trend, but not statistically significative, increase over time in the number of Gram-negative CRBSIs among the total CRBSIs, rising from 37.8% in the first period to 41.2% in the second period and to 44.3% in the last period, with a parallel decrease in the percentage of Gram-positive CRBSIs (from 59.5% to 56.9% and subsequently to 54.1%). Between Gram-negative, we reported an intensification of CRBSI due to Enterobacterales, particularly Escherichia coli. Among the Gram-negative, we have isolated germs rarely reported in the literature, such as Burkholderia cepacia, Pantoea agglomerans, and Rhizobium radiobacter. Regarding Gram-positive bacteria, a triplicate incidence of Staphylococcus aureus was reported with MRSA accounting for 42% in the third period. Among the Gram-positive bacteria, we reported two episodes of Kocuria kristinae and two of Bacillus spp.Our data demonstrated that the epidemiology of CRBSI in the same center, will change over time and Gram-negative strains are an increasing cause of CRBSI. The limitation of the present report is that statistical significance has not been reached, probably due to the limited number of CRBSI. New bacteria, both Gram-negative and Gram-positive, are emerging. Collaboration with the Microbiology Department appears essential to an appropriate diagnosis.
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Affiliation(s)
| | - Adriano Anesi
- Unit of Microbiology, Ospedale Maggiore Lodi, Lodi, Italy
| | - Vanina Rognoni
- Unit of Microbiology, Ospedale Maggiore Lodi, Lodi, Italy
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26
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Böll B, Schalk E, Buchheidt D, Hasenkamp J, Kiehl M, Kiderlen TR, Kochanek M, Koldehoff M, Kostrewa P, Claßen AY, Mellinghoff SC, Metzner B, Penack O, Ruhnke M, Vehreschild MJGT, Weissinger F, Wolf HH, Karthaus M, Hentrich M. Central venous catheter-related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2021; 100:239-259. [PMID: 32997191 PMCID: PMC7782365 DOI: 10.1007/s00277-020-04286-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022]
Abstract
Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter-related infections (CRIs). Moreover, CRIs prolong hospitalization, cause an excess in resource utilization and treatment cost, often delay anti-cancer treatment, and are associated with a significant increase in mortality in cancer patients. We therefore summoned a panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and updated our previous guideline on CRIs in cancer patients. After conducting systematic literature searches on PubMed, Medline, and Cochrane databases, video- and meeting-based consensus discussions were held. In the presented guideline, we summarize recommendations on definition, diagnosis, management, and prevention of CRIs in cancer patients including the grading of strength of recommendations and the respective levels of evidence. This guideline supports clinicians and researchers alike in the evidence-based decision-making in the management of CRIs in cancer patients.
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Affiliation(s)
- Boris Böll
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Enrico Schalk
- Department of Hematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Center, Magdeburg, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Justin Hasenkamp
- Clinic for Hematology and Oncology, University Medicine Göttingen, Georg-August-University, Göttingen, Germany
| | - Michael Kiehl
- Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany
| | - Til Ramon Kiderlen
- Department of Hematology, Oncology and Palliative Care, Vivantes Clinic Neukoelln, Berlin, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philippe Kostrewa
- Department of Hematology and Oncology, Campus Fulda, Philipps-University Marburg, Fulda, Germany
| | - Annika Y Claßen
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Sibylle C Mellinghoff
- Department I of Internal Medicine, Hematology and Oncology, Intensive Care Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Bernd Metzner
- Department of Hematology and Oncology, University Hospital Oldenburg, Oldenburg, Germany
| | - Olaf Penack
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ruhnke
- Department of Hematology and Oncology, Helios Klinikum Aue, Aue, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Weissinger
- Department of Hematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Hans-Heinrich Wolf
- Department III of Internal Medicine, Hematology, Oncology and Hemostaseology, Südharzklinikum, Nordhausen, Germany
| | - Meinolf Karthaus
- Department of Hematology, Oncology & Palliative Care, Klinikum Neuperlach, Munich, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany
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Pitiriga V, Kanellopoulos P, Bakalis I, Kampos E, Sagris I, Saroglou G, Tsakris A. Central venous catheter-related bloodstream infection and colonization: the impact of insertion site and distribution of multidrug-resistant pathogens. Antimicrob Resist Infect Control 2020; 9:189. [PMID: 33261661 PMCID: PMC7708904 DOI: 10.1186/s13756-020-00851-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Placement of central-venous catheters (CVCs) is an essential practice in the management of hospitalized patients, however, insertion at the commonly used sites has often the potential of inducing major complications. Neverthelss, the impact of specific site central line catheter insertion on catheter-associated bloodstream infections (CLABSIs) has not been clarified yet in the literature. OBJECTIVE The aim of the study was to compare CLABSIs and catheter colonization rates among the three catheter insertion sites: subclavian (SC), internal jugular (IJ) and femoral (FEM) in hospitalized patients. Moreover, to analyze the distribution of pathogens and their antimicrobial resistance profiles at these three sites, concurrently. METHODS We performed a retrospective analysis of data collected prospectively from all catheterized patients at a tertiary care Greek hospital from May 2016 to May 2018. Data was collected on 1414 CVCs and 13,054 CVC-days. RESULTS Τhe incidence of CLABSIs among the three sites was as follows: SC:5.1/1000 catheter/days, IJ: 3.73/1000 catheter/days and FEM: 6.93/1000 catheter/days (p = 0.37). The incidence of colonization was as follows: SC:13.39/1000 catheter/days; IJ:7.34/ 1000 catheter/days; FEM:22.91/1000 catheter/days (p = 0.009). MDROs predominated in both CLABSIs and tip colonizations (59.3 and 61%, respectively) with Acinetobacter baumanii being the predominant pathogen (16/59, 27.1% and 44/144, 30.5%, respectively). The incidence of CLABSIs due to multidrug-resistant organisms (MDROs) was as follows: SC:3.83/1000 catheter days; IJ:1.49/1000 catheter days; FEM:5.86/1000 catheter days (p = 0.04). The incidence of tip colonization by MDROs among the 3 sites was as follows: SC:8.93/1000 catheter/days; IJ:4.48/1000 catheter/days; FEM:12.79/1000 catheter/days (p = 0.06). There was no significant difference in the type of pathogen isolated among site groups for both CLABSIs and tip colonizations. CONCLUSIONS FEM site of catheter insertion was associated with a higher rate of bloodstream infection and catheters' colonization compared to IJ and SC sites. Furthermore, this survey highlights the changing trend of the distribution of frequent pathogens and resistance patterns towards MDR Gram-negative pathogens, underscoring the need for consistent monitoring of antimicrobial resistance patterns of these specific infections.
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Affiliation(s)
- Vassiliki Pitiriga
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
| | - Petros Kanellopoulos
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547, Athens, Greece
| | - Ioannis Bakalis
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547, Athens, Greece
| | - Elsa Kampos
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547, Athens, Greece
| | - Ioannis Sagris
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547, Athens, Greece
| | - George Saroglou
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece.
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Balikci E, Yilmaz B, Tahmasebifar A, Baran ET, Kara E. Surface modification strategies for hemodialysis catheters to prevent catheter-related infections: A review. J Biomed Mater Res B Appl Biomater 2020; 109:314-327. [PMID: 32864803 DOI: 10.1002/jbm.b.34701] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/21/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022]
Abstract
Insertion of a central venous catheter is one of the most common invasive procedures applied in hemodialysis therapy for end-stage renal disease. The most important complication of a central venous catheter is catheter-related infections that increase hospitalization and duration of intensive care unit stay, cost of treatment, mortality, and morbidity rates. Pathogenic microorganisms, such as, bacteria and fungi, enter the body from the catheter insertion site and the surface of the catheter can become colonized. The exopolysaccharide-based biofilms from bacterial colonies on the surface are the main challenge in the treatment of infections. Catheter lock solutions and systemic antibiotic treatment, which are commonly used in the treatment of hemodialysis catheter-related infections, are insufficient to prevent and terminate the infections and eventually the catheter needs to be replaced. The inadequacy of these approaches in termination and prevention of infection revealed the necessity of coating of hemodialysis catheters with bactericidal and/or antiadhesive agents. Silver compounds and nanoparticles, anticoagulants (e.g., heparin), antibiotics (e.g., gentamicin and chlorhexidine) are some of the agents used for this purpose. The effectiveness of few commercial hemodialysis catheters that were coated with antibacterial agents has been tested in clinical trials against catheter-related infections of pathogenic bacteria, such as Staphylococcus aureus and Staphylococcus epidermidis with promising results. Novel biomedical materials and engineering techniques, such as, surface micro/nano patterning and the conjugation of antimicrobial peptides, enzymes, metallic cations, and hydrophilic polymers (e.g., poly [ethylene glycol]) on the surface, has been suggested recently.
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Affiliation(s)
- Elif Balikci
- Department of Tissue Engineering, University of Health Sciences Turkey, Istanbul, 34668, Turkey
| | - Bengi Yilmaz
- Department of Tissue Engineering, University of Health Sciences Turkey, Istanbul, 34668, Turkey.,Department of Biomaterials, University of Health Sciences Turkey, Istanbul, 34668, Turkey
| | - Aydin Tahmasebifar
- Department of Tissue Engineering, University of Health Sciences Turkey, Istanbul, 34668, Turkey.,Department of Biomaterials, University of Health Sciences Turkey, Istanbul, 34668, Turkey
| | - Erkan Türker Baran
- Department of Tissue Engineering, University of Health Sciences Turkey, Istanbul, 34668, Turkey.,Department of Biomaterials, University of Health Sciences Turkey, Istanbul, 34668, Turkey
| | - Ekrem Kara
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Recep Tayyip Erdogan University, Rize, 53100, Turkey
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Surapat B, Montakantikul P, Malathum K, Kiertiburanakul S, Santanirand P, Chindavijak B. Microbial epidemiology and risk factors for relapse in gram-negative bacteria catheter-related bloodstream infection with a pilot prospective study in patients with catheter removal receiving short-duration of antibiotic therapy. BMC Infect Dis 2020; 20:604. [PMID: 32807092 PMCID: PMC7430115 DOI: 10.1186/s12879-020-05312-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background Infectious Diseases Society of America (IDSA) guidelines suggest 7–14 days’ duration of antibiotic treatment for uncomplicated Gram-negative bacteria (GNB) catheter-related bloodstream infection (CRBSI). The objectives of this study were to review microbial epidemiology, to determine rate and risk factors for relapse, and to compare clinical outcomes in patients receiving long- versus short-duration antibiotic therapy. Methods A retrospective phase 1 study was conducted between January 2010 and October 2016 to review microbial epidemiology and to determine the incidence of and risk factors for relapse in patients with GNB CRBSI, according to the IDSA guidelines diagnostic criteria. In phase 2 of the study, patients without risk factors for relapse between November 2016 and October 2017 were prospectively recruited to receive antibiotic therapy for 7 days after catheter removal. Matched patients from the retrospective phase 1 study who had received antibiotic therapy for ≥14 days were selected as a phase 2 control group to compare outcomes. Results In phase 1, three most common pathogens identified among 174 cases were Pseudomonas aeruginosa (22.0%), Klebsiella pneumoniae (16.7%), and Stenotrophomonas maltophilia (13.4%). Eighty-nine episodes of infection occurred while patients were receiving antibiotic therapy. Of 140 cases, the relapse rate was 6.4%. Catheter retention was the only risk factor strongly associated with relapse (odds ratio = 145.32; 95% confidence interval 12.66–1667.37, P < 0.001). In phase 2, 11 patients with catheter removal were prospectively recruited to receive short-duration therapy. The number of patients with relapse receiving long- or short-duration therapy was 1 (3%) and 0 (0%), respectively (P = 1.000). Conclusions For the management of patients with uncomplicated GNB CRBSI, empiric broad-spectrum antibiotic therapy with adequate coverage of P. aeruginosa should be chosen. Catheter removal should be performed to prevent relapse and shortening the duration of treatment could be considered. Trial registration Thai Clinical Trial Registry: TCTR20190914001. Retrospectively registered on 13 September 2019.
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Affiliation(s)
- Bhitta Surapat
- Department of Pharmacy, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kumthorn Malathum
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasisopin Kiertiburanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pitak Santanirand
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Busba Chindavijak
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
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30
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Wang JR, Huang JY, Hu W, Cai XY, Hu WH, Zhu Y. Bloodstream infections in patients undergoing extracorporeal membrane oxygenation. Pak J Med Sci 2020; 36:1171-1176. [PMID: 32968375 PMCID: PMC7501021 DOI: 10.12669/pjms.36.6.2882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: We aimed to evaluate the incidence, risk factors, and prognosis of bloodstream infections (BSIs) during extracorporeal membrane oxygenation (ECMO) treatment in a Chinese population. Methods: Patients receiving ECMO treatment from January 2013 to August 2019 were retrospectively studied. The incidence of BSIs was calculated. The clinical characteristics between patients with a BSI (BSI group) and without a BSI (non-BSI group) Results: Among 69 included patients, 19 (27.5%) developed at least one BSI. Gram-negative bacteria (73.7%) were mainly responsible for the BSIs, with Klebsiella pneumoniae (6/19, 31.5%) ranking as the top related pathogen. The BSI group had a greater proportion of methicillin-resistant Staphylococcus aureus (MRSA) prophylactic regimens (52.6% vs. 26.0%, P = 0.036), a higher pre-ECMO Sequential Organ Failure Assessment (SOFA) score (11 vs. 8, P = 0.008), more applications of continuous renal replacement therapy (CRRT) during ECMO (63.1% vs. 36.1%, P = 0.042). Longer ECMO support duration, period of ventilator use before ECMO weaning and hospital stay were observed in the BSI group. The SOFA score (OR: 1.174; 95% CI: 1.039–1.326; P = 0.010) was an independent risk factor for BSIs. Conclusion: BSIs during ECMO therapy frequently involve Gram-negative bacteria. Stringent care and monitoring should be provided for patients with high SOFA scores.
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Affiliation(s)
- Jian-Rong Wang
- Jian-rong Wang, MS. Department of Critical Care Medicine, The Affiliated Hangzhou Hospital of Nanjing Medical University, Zhejiang, China
| | - Jin-Yu Huang
- Jin-yu Huang, MD. Department of Cardiology, The Affiliated Hangzhou Hospital of Nanjing Medical University, Zhejiang, China
| | - Wei Hu
- Wei Hu, MS. Department of Critical Care Medicine, The Affiliated Hangzhou Hospital of Nanjing Medical University, Zhejiang, China
| | - Xue-Ying Cai
- Xue-ying Cai, MS. Department of Critical Care Medicine, The Affiliated Hangzhou Hospital of Nanjing Medical University, Zhejiang, China
| | - Wei-Hang Hu
- Wei-hang Hu, MS. Department of Critical Care Medicine, Zhejiang Hospital, Zhejiang, China
| | - Ying Zhu
- Ying Zhu, MS. Department of Critical Care Medicine, The Affiliated Hangzhou Hospital of Nanjing Medical University, Zhejiang, China
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Risk factors associated with bloodstream infection among patients colonized by multidrug-resistant Acinetobacter baumannii: A 7-year observational study in a general hospital. Am J Infect Control 2020; 48:581-583. [PMID: 31540833 DOI: 10.1016/j.ajic.2019.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/23/2022]
Abstract
We studied bloodstream infection by multidrug-resistant Acinetobacter baumannii among patients in a medical intensive care unit. Over a 7-year period, 47 of 441 colonized patients developed a bloodstream infection.. Endotracheal intubation (odds ratio [OR], 5.88), ventilator support (OR, 3.70), and central venous catheterization (OR, 3.48) were identified as risk factors.
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Rteil A, Kazma JM, El Sawda J, Gharamti A, Koubar SH, Kanafani ZA. Clinical characteristics, risk factors and microbiology of infections in patients receiving chronic hemodialysis. J Infect Public Health 2020; 13:1166-1171. [PMID: 32276873 DOI: 10.1016/j.jiph.2020.01.314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/09/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The infectious complications in hemodialysis patients are still among the main reasons for their increased morbidity and mortality. The possible reasons behind this might be due to impairments in the host defense mechanisms, comorbidities, invasive procedures and pathogenicity of the infecting organisms. With the increased incidence of bacteremia in hemodialysis patients and the overt use of antibiotics, we have witnessed a rise in the number of new multidrug resistant (MDR) strains in those patients. AIM We aim to determine the epidemiology, risk factors and complications of infections in patients receiving chronic hemodialysis, particularly bloodstream infections. METHODS This is a retrospective case-control study involving patients undergoing hemodialysis at a tertiary care center. We studied the prevalence of infectious complications among those patients as well as the responsible agent in each respective infectious episode and the risk factors associated with bacteremia. FINDINGS 46.6% of the studied population had at least one documented episode of infection. The most common were blood and respiratory infections (33.2% and 32.7% respectively). Among patients with bacteremia, coagulase-negative Staphylococcus was the predominant pathogen (49% of cases), followed by Staphylococcus aureus and Escherichia coli. Mortality was higher in patients who had MDR bacteremia, and in those who had mechanical ventilation or intensive care unit (ICU) admission. CONCLUSION Due to the alarming increase in the incidence of infection among hemodialysis patients and its strong association with mortality, further studies are needed to look for risk factors associated with infection and for ways to control those risk factors.
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Affiliation(s)
- Ali Rteil
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jamil M Kazma
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jack El Sawda
- Divison of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amal Gharamti
- Divison of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sahar H Koubar
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina A Kanafani
- Divison of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Clinical characteristics of peripheral venous catheter-associated gram-negative bloodstream infection among patients with malignancy. PLoS One 2020; 15:e0228396. [PMID: 31999762 PMCID: PMC6992193 DOI: 10.1371/journal.pone.0228396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/14/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Previous studies have suggested that peripheral venous catheter is a significant source of gram-negative bacteraemia in patients with malignancy. We aimed to identify risk factors and develop a clinical prediction rule for the involvement of gram-negative organisms in peripheral venous catheter-associated bloodstream infections (PVC-BSIs) among patients with malignancy. METHODS This retrospective cohort study was conducted at a 700-bed cancer hospital in Japan. Consecutive patients diagnosed with PVC-BSI based on clinical and microbiological criteria were included in this study. Based on clinical and microbiological characteristics of PVC-BSIs in cancer patients, a logistic regression model for predicting gram-negative organisms as causative organisms in PVC-BSIs was then developed. RESULTS Of the 99 patients included in our cohort, 60 patients (60.6%) had gram-negative PVC-BSIs. The median age of patients with PVC-BSIs was 67 years (interquartile range [IQR], 59-74 years), and the median Pitt bactearemia score was 1 (IQR, 0-3). The median duration of catherization was 5 days (IQR, 4-7 days) and 70 patients (70.7%) received peripheral parenteral nutrition that contained amino acids. On multivariable analysis, age ≥65 years (odds ratio [OR], 3.07; 95% confidence interval [CI], 1.10-8.62), showering (OR, 3.15; 95% CI, 1.07-9.26), Pitt bacteraemia score ≥2 points (OR, 6.96; 95% CI, 2.52-19.2), and use of peripheral parenteral nutrition (OR, 0.31; 95% CI, 0.10-0.98) were independent predictors for gram-negative PVC-BSIs among all PVC-BSIs. The simplified PVC-GN scores established to predict gram-negative PVC-BSIs had a optimism-corrected c-index of 0.775. CONCLUSION Gram-negative bacteria were more commonly responsible for PVC-BSI than Gram-positive bacteria among cancer patients in this cohort. Involvement of Gram-negative bacteria in PVC-BSIs could be predicted with readily available clinical variables.
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Khodare A, Kale P, Pindi G, Joy L, Khillan V. Incidence, Microbiological Profile, and Impact of Preventive Measures on Central Line-associated Bloodstream Infection in Liver Care Intensive Care Unit. Indian J Crit Care Med 2020; 24:17-22. [PMID: 32148344 PMCID: PMC7050171 DOI: 10.5005/jp-journals-10071-23325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and objectives Central line-associated bloodstream infection (CLABSI) is among one of the preventable healthcare-associated infections (HAIs). The data for the CLABSI rate in liver care intensive care unit (LCICU) patients are scarce, so the present study was conducted to ascertain the CLABSI rate, the microbiological profile, and the impact of preventive measures for reduction of infection. Materials and methods This is a prospective observational study done on LCICU patients during the period of January 2017–December 2018. We followed up patients on the central venous catheter for the development of CLABSI as a part of routine surveillance of HAIs. The impact of introduction and implementation of the CLABSI bundle to reduce the CLABSI rate was analyzed and the microbiological profile of infection was determined. Results During the study period, the total number of patients admitted in LCICU were 1,336 (648 in 2017 and 688 in 2018) and a total of 995 central lines were inserted for various indications. A total of 57 patients were meeting the CLABSI criteria among 7,324 central line catheter days of surveillance. In year 2017, rate of CLABSI was 11.78/1,000 catheter days and after implementation of the bundle in 2018 the rate reduced to 3.99/1,000 catheter days. Gram-negative organisms (86%) predominated with Pseudomonas aeruginosa being the most common pathogen (19.3%). Out of 49 isolates of gram-negative bacilli (GNB), 40 (81.6%) were multidrug resistant (MDR) and 9 (18.4%) were pan-drug resistant. Conclusion We found significant reduction in the CLABSI rate after implementation of the bundle of care. Gram-negative bacilli were the most common pathogen in our study and antimicrobial resistance was very high, which suggest hospital environment as a source of infection. Clinical significance Knowledge of the microbiological profile and the preventive strategy of CLABSI is essential for prevention and timely initiation of the most appropriate anti-infective therapy, if it happens. How to cite this article Khodare A, Kale P, Pindi G, Joy L, Khillan V. Incidence, Microbiological Profile, and Impact of Preventive Measures on Central Line-associated Bloodstream Infection in Liver Care Intensive Care Unit. Indian J Crit Care Med 2020;24(1):17–22.
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Affiliation(s)
- Arvind Khodare
- Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Pratibha Kale
- Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Girisha Pindi
- Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Lejo Joy
- Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikas Khillan
- Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India
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Effect of Clinically Meaningful Antibiotic Concentrations on Recovery of Escherichia coli and Klebsiella pneumoniae Isolates from Anaerobic Blood Culture Bottles with and without Antibiotic Binding Resins. J Clin Microbiol 2019; 57:JCM.01344-19. [PMID: 31533981 DOI: 10.1128/jcm.01344-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 12/29/2022] Open
Abstract
Blood cultures are routinely collected in pairs of aerobic and anaerobic bottles. Artificial sterilization of Gram-negative bacteria in aerobic bottles containing clinically meaningful antibiotic concentrations has previously been observed. This study assessed recovery from anaerobic bottles with and without antibiotic binding resins. We studied the recovery of Escherichia coli and Klebsiella pneumoniae when exposed to meropenem, imipenem, cefepime, cefazolin, levofloxacin, and piperacillin-tazobactam in resin-containing BacT/Alert FN Plus and BD Bactec Plus anaerobic/F bottles as well as resin-free BacT/Alert SN and BD Bactec standard anaerobic bottles. Bottles were inoculated with bacteria and whole blood containing peak, midpoint, or trough concentrations and incubated for up to 120 hours in their respective detection systems. In E. coli resin-containing bottles, recovery was observed in 10/24 (42%), 17/24 (71%), and 18/24 (75%) (P = 0.034) of those exposed to peak, midpoint, and trough concentrations, respectively. In K. pneumoniae resin-containing bottles, recovery was observed in 8/16 (50%), 10/16 (63%), and 10/16 (63%) (P = 0.710), respectively. No growth was detected in bottles containing cefepime regardless of concentration, while recovery was observed in the presence of all concentrations of cefazolin and piperacillin-tazobactam. Recovery in bottles with meropenem and imipenem was more frequently observed in BacT/Alert FN Plus bottles compared with Bactec Plus bottles. Resin-free bottles demonstrated significantly lower recovery than bottles containing binding resin. Clinical concentrations of certain antibiotics can adversely affect detection of E. coli and K. pneumoniae in anaerobic blood culture bottles. Obtaining blood cultures immediately before a dose and utilizing resin-containing anaerobic bottles will maximize the likelihood of recovery.
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Changing epidemiology of bloodstream infection in a 25-years hematopoietic stem cell transplant program: current challenges and pitfalls on empiric antibiotic treatment impacting outcomes. Bone Marrow Transplant 2019; 55:603-612. [PMID: 31570779 DOI: 10.1038/s41409-019-0701-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 01/28/2023]
Abstract
We aimed to describe epidemiology changes in bloodstream infections (BSI) episodes in hematopoietic stem cell transplant (HSCT) recipients throughout a 25-year period (1993-2017), comparing five-year time spans, and we evaluate their impact on inappropriate empirical antibiotic treatment (IEAT) and mortality. During the study period, 1164 BSI episodes were documented in patients undergoing HSCT (71.6% allogenic and 29% autologous). A significant decrease in gram-positive cocci (GPC) and increase in gram-negative bacilli (GNB) were observed (p < 0.001). Among GP, coagulase-negative staphylococci (CoNS) significantly decreased whereas rising E. faecium BSI was documented. Among GNB, E. coli, Pseudomonas aeruginosa and K. pneumoniae rates increased. Multidrug-resistant (MDR) GNB, especially ESBL-E. coli and MDR-P. aeruginosa, emerged in 2008 and has gradually increased. IEAT against MDR-P. aeruginosa, but not in other MDR-GNB, augmented throughout the study period. Overall, 30-day and related mortality rates were 12.7% and 7.7% respectively, both increasing over time (p < 0.001 and p = 0.025). In GNB, 30-day and related mortality were 18.5% and 12.8%, respectively, increasing over time (p < 0.001 and p = 0.004). To conclude, important BSI epidemiological changes were described in a 25-year period. Concerning increase in IEAT for P. aeruginosa infections and rising 30-day mortality rate were documented.
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Reitzel RA, Rosenblatt J, Chaftari AM, Raad II. Epidemiology of Infectious and Noninfectious Catheter Complications in Patients Receiving Home Parenteral Nutrition: A Systematic Review and Meta-Analysis. JPEN J Parenter Enteral Nutr 2019; 43:832-851. [PMID: 31172542 DOI: 10.1002/jpen.1609] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/03/2019] [Indexed: 12/14/2022]
Abstract
Patients receiving parenteral nutrition (PN) as their primary source of nutrition are at high risk for both infectious and noninfectious catheter complications (catheter-related infections, catheter occlusion, and venous thrombosis). The aim of this review was to synthesize and evaluate what is known about catheter complications and prevention strategies in the PN population. Three electronic databases (Medline, Embase, and CINAHL) were screened for studies published between January 2012 and February 2019 regarding infectious and noninfectious catheter complications in patients receiving PN. Rates of infectious and noninfectious catheter complications, prevalence of causative pathogens, potential risk factors, and prevention strategies via the use of antimicrobial lock therapy (ALT) were assessed. Fifty-three catheter complication studies and 12 ALT studies were included. Studies were grouped by definition of complication: catheter-related bloodstream infections (CRBSI) or central line-associated bloodstream infections (CLABSI). Random effects summary rates per 1000 catheter days were 0.85 CRBSI episodes (95% CI 0.27-2.64) and 1.65 CLABSI episodes (95% CI 1.09-2.48). Use of taurolidine or ethanol ALT was efficacious in reducing infectious catheter complications; however, several studies had concerns for adverse mechanical complications. Potential risk factors for catheter complications were highly varied and often contradictory between studies. The rates of catheter complications were higher among catheterized patients receiving PN compared with nationally reported rates of complications in all catheterized patients. Risk factors for catheter complications need to be better understood for targeted prophylactic use of ALT. Future studies are warranted; however, they should be conducted using more standardized definitions and criteria.
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Affiliation(s)
- Ruth A Reitzel
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joel Rosenblatt
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Menaker J, Galvagno S, Rabinowitz R, Penchev V, Hollis A, Kon Z, Deatrick K, Amoroso A, Herr D, Mazzeffi M. Epidemiology of blood stream infection in adult extracorporeal membrane oxygenation patients: A cohort study. Heart Lung 2019; 48:236-239. [DOI: 10.1016/j.hrtlng.2019.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/04/2019] [Accepted: 01/13/2019] [Indexed: 12/12/2022]
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Karnatak R, Rupp ME, Cawcutt K. Innovations in Quality Improvement of Intravascular Catheter-Related Bloodstream Infections. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2019. [DOI: 10.1007/s40506-019-0180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2019; 42:5-36. [PMID: 29406956 DOI: 10.1016/j.medin.2017.09.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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Buetti N, Lo Priore E, Atkinson A, Widmer AF, Kronenberg A, Marschall J. Catheter-related infections: does the spectrum of microbial causes change over time? A nationwide surveillance study. BMJ Open 2018; 8:e023824. [PMID: 30580270 PMCID: PMC6307612 DOI: 10.1136/bmjopen-2018-023824] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To estimate the incidence and epidemiology of catheter-related bloodstream infections (CRBSIs) on a national scale by using prospective epidemiological data from the Swiss Antibiotic Resistance Surveillance System (ANRESIS). DESIGN Observational study. SETTING National surveillance from 2008 to 2015 of acute hospitals in Switzerland. PARTICIPANTS We included acute Swiss hospitals that sent blood cultures and catheter tip culture results on a regular basis during the entire study period to the ANRESIS database. OUTCOME MEASURE A catheter-related bloodstream infection (termed 'modified CRBSI', mCRBSI) was defined as isolating the same microorganism with identical antibiogram from ≥1 blood cultures (performed ±7 days around the catheter removal) as the one recovered from the catheter tip. Incidence rates of mCRBSI were calculated per 1000 admissions. RESULTS From 2008 to 2015, the mCRBSI incidence rate decreased from 0.83 to 0.58 episodes/1000 admissions (-6% per year, p<0.001). Coagulase-negative staphylococci, Staphylococcus aureus and fungi all exhibited decreasing trends, while rates of enterococci and Gram-negative bacteria remained stable. CONCLUSIONS The overall incidence of mCRBSI in Switzerland is decreasing; however, the incidence of mCRBSI due to Enterococci and Gram-negative micro-organisms did not change over time. These pathogens may grow in importance in catheter-related infections, which would have clinical implications for the choice of empirical treatment.
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Affiliation(s)
- Niccolò Buetti
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
| | - Elia Lo Priore
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
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Short-Term Peripheral Venous Catheter-Related Bloodstream Infections: Evidence for Increasing Prevalence of Gram-Negative Microorganisms from a 25-Year Prospective Observational Study. Antimicrob Agents Chemother 2018; 62:AAC.00892-18. [PMID: 30126952 DOI: 10.1128/aac.00892-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/13/2018] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to describe the etiology and outcome of short-term peripheral venous catheter (PVC)-related bloodstream infections (PVCRBSI) in a 25-year period (1992 to 2016) and to identify predictive factors of Gram-negative PVCRBSI. This was a prospective observational study including all episodes of PVCRBSI. A multivariate logistic regression model adjusted for calendar year was built to explore factors associated with a Gram-negative bacterial etiology. Over the study period, 711 episodes of PVCRBSI were identified. Incidence rate of PVCRBSI increased from 0.06 to 0.13 episodes/1,000 patient-days. A Gram-negative bacterial etiology was demonstrated in 162 (22.8%) episodes. There was a significant increase in the proportion of Gram-negative infections (22.6% in 1992 to 1996 versus 33.2% in 2012 to 2016). Independent predictive factors of Gram-negative PVCRBSI were the following: being in the hospital for more than 7 days with a catheter in situ for more than 3 days (adjusted odds ratio [aOR], 1.80; 95% confidence interval [CI], 1.20 to 2.69), surgery in the previous month (aOR, 2.39; 95% CI, 1.40 to 4.09), and antimicrobial treatment with beta-lactams (aOR, 1.80; 95% CI, 1.16 to 2.78). In conclusion, we reported an increase in the prevalence of Gram-negative PVCRBSI over the last 25 years. Factors associated with a Gram-negative bacterial etiology were being in the hospital for more than 7 days with a catheter in situ for more than 3 days, having undergone surgery, and having received antimicrobial treatment with beta-lactams.
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Puerta-Alcalde P, Cardozo C, Suárez-Lledó M, Rodríguez-Núñez O, Morata L, Fehér C, Marco F, Del Río A, Martínez JA, Mensa J, Rovira M, Esteve J, Soriano A, Garcia-Vidal C. Current time-to-positivity of blood cultures in febrile neutropenia: a tool to be used in stewardship de-escalation strategies. Clin Microbiol Infect 2018; 25:447-453. [PMID: 30096417 DOI: 10.1016/j.cmi.2018.07.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVES We aimed to describe the current time-to-positivity (TTP) of blood cultures in individuals with onco-haematological diseases with febrile neutropenia. We assessed the probability of having a multidrug-resistant Gram-negative bacilli (MDR-GNB) bloodstream infection (BSI) 24 h after cultures were taken, to use this information for antibiotic de-escalation strategies. METHODS BSI episodes were prospectively collected (2003-2017). When a patient experienced more than one BSI, only one episode was randomly chosen. Time elapsed from the beginning of incubation to a positive reading was observed; TTP was recorded when the first bottle had a positive result. RESULTS Of the 850 patient-unique episodes, 323 (38%) occurred in acute leukaemia, 185 (21.8%) in non-Hodgkin's lymphoma and 144 (16.9%) in solid neoplasms. Coagulase-negative staphylococci (225; 26.5%), Escherichia coli (207; 26.1%), Pseudomonas aeruginosa (136; 16%), Enterococcus spp. (81; 9.5%) and Klebsiella pneumoniae (67; 7.9%), were the most frequent microorganisms isolated. MDR-GNB were documented in 126 (14.8%) episodes. Median TTP was 12 h (interquartile range 9-16.5 h). Within the first 24 h, 92.1% of blood cultures were positive (783/850). No MDR-GNB was positive over 24 h. Of the 67 (7.9%) episodes with a TTP ≥24 h, 25 (37.3%) occurred in patients who were already receiving active antibiotics against the isolated pathogen. Most common isolations with TTP ≥24 h were coagulase-negative staphylococci, candidaemia and a group of anaerobic GNB. CONCLUSIONS Currently, the vast majority of BSI in individuals with onco-haematological diseases with febrile neutropenia have a TTP <24 h, including all episodes caused by MDR-GNB. Our results support reassessing empiric antibiotic treatment in neutropenic patients at 24 h, to apply antibiotic stewardship de-escalation strategies.
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Affiliation(s)
- P Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - C Cardozo
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - M Suárez-Lledó
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - O Rodríguez-Núñez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - L Morata
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - C Fehér
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - F Marco
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | - A Del Río
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - J A Martínez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - J Mensa
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - M Rovira
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - J Esteve
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - A Soriano
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - C Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain.
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Ang H, Sun X. Risk factors for multidrug-resistant Gram-negative bacteria infection in intensive care units: A meta-analysis. Int J Nurs Pract 2018; 24:e12644. [PMID: 29575345 DOI: 10.1111/ijn.12644] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/09/2018] [Accepted: 02/10/2018] [Indexed: 12/18/2022]
Abstract
AIMS To identify the risk factors for multidrug-resistant Gram-negative bacteria systematically and provide suggestions and an evidence-base for clinical measures. BACKGROUND With the increase in the social population, changes in human behaviour and ecosystems, as well as economic development, bacteria have gradually produced drug resistance genes. These have swept through intensive care units causing high mortality. METHODS Relevant literature which included case-control and cohort studies published from January 1999 to March 2017 were searched in the Cochrane Library, PubMed, Web of Science, and Medline. Meta-analysis was performed by using StataSE version 12.0 software. RESULTS Eighteen studies of 235 publications were eligible. Male gender (OR 1.40, 95%CI 1.09, 1.80), having an operative procedure (OR 1.31, 95%CI 1.10, 1.56), a central venous catheter (OR 1.22, 95%CI 1.01, 1.48), mechanical ventilation (OR 1.25, 95%CI 1.07, 1.46), previous antibiotic therapy (OR 1.66, 95%CI 1.41, 1.96), length of ICU stay (weighted mean difference 8.18, 95%CI 0.27, 16.10), and types of health-associated infections were the identified risk factors for multidrug-resistant Gram-negative bacterial infection in intensive care units; moreover, diabetes mellitus was not. CONCLUSION Six risk factors were associated with multidrug-resistant Gram-negative bacterial infection in intensive care units. Antimicrobial stewardship, infection control, and medical staff prevention care are needed.
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Affiliation(s)
- Hui Ang
- Medical School, Yangtze University, Jingzhou, Hubei, China
| | - Xuan Sun
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Lee YM, Moon C, Kim YJ, Lee HJ, Lee MS, Park KH. Clinical impact of delayed catheter removal for patients with central-venous-catheter-related Gram-negative bacteraemia. J Hosp Infect 2018; 99:106-113. [PMID: 29330016 DOI: 10.1016/j.jhin.2018.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gram-negative bacteria are increasingly the cause of catheter-related bloodstream infection (CRBSI), and the prevalence of multi-drug-resistant strains is rising rapidly. This study evaluated the impact of delayed central venous catheter (CVC) removal on clinical outcomes in patients with Gram-negative CRBSI. METHODS Between January 2007 and December 2016, patients with Gram-negative bacteraemia and CVC placement, from two tertiary care hospitals, were included retrospectively. Cases with CVC removal more than three days after onset of bacteraemia or without CVC removal were classified as having delayed CVC removal. RESULTS In total, 112 patients were included. Of these, 78 had CRBSI (43 definite and 35 probable) and 34 had Gram-negative bacteraemia from another source (non-CRBSI). Enterobacteriaceae were less common pathogens in patients with CRBSI than in patients with non-CRBSI (11.5% vs 41.3%; P<0.001). Delayed CVC removal was associated with increased 30-day mortality (40.5% vs 11.8%; P=0.01) in patients with Gram-negative CRBSI; this was not seen in patients with non-CRBSI (25.0% vs 14.3%; P>0.99). Delayed CVC removal [odds ratio (OR) 6.8], multi-drug-resistant (MDR) Gram-negative bacteraemia (OR 6.3) and chronic renal failure (OR 11.1) were associated with 30-day mortality in patients with CRBSI. The protective effect of early CVC removal on mortality was evident in the MDR group (48.3% vs 18.2%; P=0.03), but not in the non-MDR group (11.1% vs 0%; P=0.43). CONCLUSION CVCs should be removed early to improve clinical outcomes in patients with Gram-negative CRBSI, especially in settings where MDR isolates are prevalent.
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Affiliation(s)
- Y-M Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - C Moon
- Department of Infectious Diseases, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Y J Kim
- Department of Laboratory Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - H J Lee
- Department of Laboratory Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - M S Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - K-H Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
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The epidemiology, antibiograms and predictors of mortality among critically-ill patients with central line-associated bloodstream infections. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:401-410. [PMID: 28943144 DOI: 10.1016/j.jmii.2017.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/14/2017] [Accepted: 08/22/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND/PURPOSE For high risk of central line-associated bloodstream infections (CLABSIs) in patients of intensive care units (ICUs) and scarcely epidemiology and therapeutic recommendations in Asia, we aimed to evaluate the annual change in epidemiology, antibiogram, and risk factors for 14-day mortality. METHODS A retrospective study of ICUs patients with CLABSIs at a medical center in Taiwan (2010-2016), where central line care bundle implemented since 2014, by reviewing clinical data, pathogens, and the antibiogram. RESULTS Gram-negative bacteria (59.3%) were main microorganisms of CLABSIs, and 9.0% of all GNB were MDROs. Acinetobacter spp., Enterobacter spp., and Stenotrophomonas maltophilia were the most frequently isolated. In multivariate analysis, malignancy, inadequate empirical antimicrobial therapy, inadequate definite antimicrobial therapy, and infection by fungi or multidrug-resistant organisms (MDROs) were associated with 14-day mortality (all p < 0.05). The CLABSI incidence rate decreased from 5.54 to 2.18 per 1000 catheter-day (from 2014 to 2015) with improved compliance to care bundle. Carbapenem and aminoglycoside were suitable empirical drugs in the hospital setting when GNB is predominant for CLABSI. Significant decreasing susceptibility of ampicillin/sulbactam in Enterobacter spp. (36.7%-0.0%), and ampicillin/sulbactam (12.5%-0.0%), ceftazidime (100.0%-52.9%), and tigecycline (87.5%-35.3%) in Serratia marcescens. CONCLUSION We identified Gram-negative bacteria as leading pathogens of CLABSIs in a Taiwan medical center, and good compliance to care bundle is associated with reduced CLABSI incidence rate. Malignancy, infection by MDROs or fungi, inadequate empirical or definite antimicrobial therapy are significant factors for 14-day mortality.
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Zboromyrska Y, De la Calle C, Soto M, Sampietro-Colom L, Soriano A, Alvarez-Martínez MJ, Almela M, Marco F, Arjona R, Cobos-Trigueros N, Morata L, Mensa J, Martínez JA, Mira A, Vila J. Rapid Diagnosis of Staphylococcal Catheter-Related Bacteraemia in Direct Blood Samples by Real-Time PCR. PLoS One 2016; 11:e0161684. [PMID: 27571200 PMCID: PMC5003366 DOI: 10.1371/journal.pone.0161684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 08/10/2016] [Indexed: 11/18/2022] Open
Abstract
Catheter-related bacteremia (CRB) is an important cause of morbidity and mortality among hospitalized patients, being staphylococci the main etiologic agents. The objective of this study was to assess the use of a PCR-based assay for detection of staphylococci directly from blood obtained through the catheter to diagnose CRB caused by these microorganisms and to perform a cost-effectiveness analysis. A total of 92 patients with suspected CRB were included in the study. Samples were obtained through the catheter. Paired blood cultures were processed by standard culture methods and 4 ml blood samples were processed by GeneXpert-MRSA assay for the detection of methicillin-susceptible (MSSA) or methicillin-resistant (MRSA) Staphylococcus aureus, and methicillin-resistant coagulase-negative staphylococci (MR-CoNS). Sixteen CRB caused by staphylococci were diagnosed among 92 suspected patients. GeneXpert detected 14 out of 16 cases (87.5%), including 4 MSSA and 10 MR-CoNS in approximately 1 hour after specimen receipt. The sensitivity and specificity of GeneXpert were 87.5% (CI 95%: 60.4-97.8) and 92.1% (CI 95%: 83-96.7), respectively, compared with standard culture methods. The sensitivity of GeneXpert for S. aureus was 100%. Regarding a cost-effectiveness analysis, the incremental cost of using GeneXpert was of 31.1€ per patient while the incremental cost-effectiveness ratio of GeneXpert compared with blood culture alones was about 180€ per life year gained. In conclusion, GeneXpert can be used directly with blood samples obtained through infected catheters to detect S. aureus and MR-CoNS in approximately 1h after sampling. In addition, it is cost-effective especially in areas with high prevalence of staphylococcal CRB.
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Affiliation(s)
- Yuliya Zboromyrska
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Cristina De la Calle
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marcelo Soto
- Health Technology Assessment Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laura Sampietro-Colom
- Health Technology Assessment Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Míriam José Alvarez-Martínez
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Manel Almela
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Francesc Marco
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ruth Arjona
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Nazaret Cobos-Trigueros
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José Mensa
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Aurea Mira
- CDB, Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Jordi Vila
- Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, University of Barcelona, Barcelona, Spain
- * E-mail:
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Benito N, Franco M, Ribera A, Soriano A, Rodriguez-Pardo D, Sorlí L, Fresco G, Fernández-Sampedro M, Dolores Del Toro M, Guío L, Sánchez-Rivas E, Bahamonde A, Riera M, Esteban J, Baraia-Etxaburu JM, Martínez-Alvarez J, Jover-Sáenz A, Dueñas C, Ramos A, Sobrino B, Euba G, Morata L, Pigrau C, Coll P, Mur I, Ariza J. Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study. Clin Microbiol Infect 2016; 22:732.e1-8. [PMID: 27181408 DOI: 10.1016/j.cmi.2016.05.004] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/24/2016] [Accepted: 05/03/2016] [Indexed: 02/05/2023]
Abstract
It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in the microbial aetiology. We hypothesized that the frequency of antimicrobial-resistant organisms in PJIs has increased in the recent years. We performed a cohort study in 19 hospitals in Spain, from 2003 to 2012. For each 2-year period (2003-2004 to 2011-2012), the incidence of microorganisms causing PJIs and multidrug-resistant bacteria was assessed. Temporal trends over the study period were evaluated. We included 2524 consecutive adult patients with a diagnosis of PJI. A microbiological diagnosis was obtained for 2288 cases (90.6%). Staphylococci were the most common cause of infection (1492, 65.2%). However, a statistically significant rising linear trend was observed for the proportion of infections caused by Gram-negative bacilli, mainly due to the increase in the last 2-year period (25% in 2003-2004, 33.3% in 2011-2012; p 0.024 for trend). No particular species contributed disproportionally to this overall increase. The percentage of multidrug-resistant bacteria PJIs increased from 9.3% in 2003-2004 to 15.8% in 2011-2012 (p 0.008), mainly because of the significant rise in multidrug-resistant Gram-negative bacilli (from 5.3% in 2003-2004 to 8.2% in 2011-2012; p 0.032). The observed trends have important implications for the management of PJIs and prophylaxis in joint replacements.
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Affiliation(s)
- N Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
| | - M Franco
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Spain
| | - A Ribera
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - A Soriano
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Clínic Universitari, Barcelona, Spain
| | - D Rodriguez-Pardo
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - L Sorlí
- Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain
| | - G Fresco
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Fernández-Sampedro
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Valdecilla, Santander, Spain
| | - M Dolores Del Toro
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - L Guío
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Cruces, Bilbao, Spain
| | - E Sánchez-Rivas
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Bahamonde
- Department of Internal Medicine-Infectious Diseases, Hospital el Bierzo, León, Spain
| | - M Riera
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit, Department of Infectious Diseases, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - J Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - J Martínez-Alvarez
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Jover-Sáenz
- Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - C Dueñas
- Department of Internal Medicine, Hospital Universitario de Burgos, Burgos, Spain
| | - A Ramos
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - B Sobrino
- Department of Infectious Diseases, Hospital Regional Universitario Málaga, Málaga, Spain
| | - G Euba
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - L Morata
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Clínic Universitari, Barcelona, Spain
| | - C Pigrau
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Coll
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - I Mur
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - J Ariza
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
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[Clinical significance and prognosis of isolation of Candida spp. in venous catheters]. Med Clin (Barc) 2016; 146:94-5. [PMID: 26049961 DOI: 10.1016/j.medcli.2015.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/15/2015] [Accepted: 04/23/2015] [Indexed: 11/23/2022]
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