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Catheter Infections (catheter + infections)
Selected AbstractsEffective interventions with chlorhexidine gluconate (CHG) to decrease hemodialysis (HD) tunneled catheter-related infectionsHEMODIALYSIS INTERNATIONAL, Issue 1 2005N. Redman Purpose:,Identify practices to reduce HD catheter access related bacteremias (ARB). Methods:,Data was collected per the CDC Dialysis Surveillance Network protocol. ARB was defined as a patient with a positive blood culture with no apparent source other than the vascular access catheter. ARB's were calculated in events per 100 patient months with 3 cohorts. Cohort 1 was observed for 12 months, Cohort 2 for the subsequent 10 months, and Cohort 3 for the final 10 months. Cohort 1 had weekly transparent dressing changes, cleansing of the skin and 5 minute soaking of the connection lines with 10% povidone-iodine (PI) solution, and HCW use of clean gloves and face shield without a mask. Cohort 2 changes consisted of thrice weekly gauze dressing changes, skin cleansing with ChloraPrep, a 2% CHG/70% isopropyl alcohol applicator, masks on the patients, adding a face mask to the shield, and application of 10% PI ointment to the exit site. Cohort 3 changes included weekly application of BioPatch (BioP), an antimicrobial dressing with CHG, sterile glove use, and replacing the PI line soaks with 4% CHG. Results:,The catheter-associated ARB rate per 100 patient months was 7.9 (17ARB/216 patient months) in Cohort 1, 8.6 (13/151) in Cohort 2, and 4.7 (5/107) in Cohort 3(p = 0.31 compared with Cohorts 1 and 2 combined). During the last 2 months, in Cohort 3, 9 catheter lumen cracks occurred, with one of the patients having a bacteremia. Conclusions:,Addition of CHG line soaks and BioP reduced tunneled catheter infections, although this is not statistically significant. The increased number of catheter lumen cracks raises concern with the use of CHG line soaks. Further investigation with use of CHG line soaks and the BioP for decreasing ARB is needed. [source] Intravenous catheter infections in pulmonary arterial hypertensionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2008S. Gaine No abstract is available for this article. [source] Use of parenteral nutrition in hospitals in the North of EnglandJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2007S. A. Hearnshaw Abstract Background, Parenteral nutrition (PN) is a costly technology used widely to provide nutrition to patients who have an inaccessible or nonfunctioning intestine. A prospective survey was designed to collect data on PN for inpatients to study the current use of PN, its complications and outcomes in the north of England. The study objectives were to use the Northern Nutrition Network to collect data from all acute hospital inpatients prospectively receiving PN, for 3 months and to provide evidence for current PN practice, and to establish whether this is in line with recognized published clinical guidelines. Methods, Using a paper-based collection tool information was recorded on aspects of PN including: total inpatient episodes, patient demographics, indications, duration, venous access used, complications, number returning to enteral feeding and mortality. The presence of a nutrition support team was also recorded. Results, Data on 193 patient PN episodes were recorded totalling 1708 patient days. The median age of the patients was 67 years. Of these, 158 (82%) were deemed to have a clear indication for PN using the indications cited in the NICE guidelines (http://www.nice.org.uk). The median duration of PN was 7 days (range 1,93). Thirty (16%) patients developed complications due to PN, 23 (12%) had catheter infections which were most common on medical wards. Thirty-nine (20%) patients died within 28 days of PN starting; no deaths were attributable to PN. A total of 118 (61%) patients returned to full enteral feeding. Only three hospitals had nutrition support teams, which had no significant effect on outcomes. Conclusions, Parenteral nutrition practice in the north of England is generally in line with current guidelines, however, only three of 15 hospitals had nutrition support teams. Eighteen per cent of patients did not have a clearly documented indication for PN and 15% developed a complication, most often a catheter-related infection. [source] Clinical and molecular epidemiology of community-acquired, healthcare-associated and nosocomial methicillin-resistant Staphylococus aureus in SpainCLINICAL MICROBIOLOGY AND INFECTION, Issue 12 2009J. Rodríguez-Baño Abstract A prospective cohort study including all new cases of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in 64 Spanish hospitals during June 2003 was performed to investigate the epidemiology of MRSA in Spain. Only patients who yielded clinical MRSA-positive samples were included. Epidemiological and clinical data for a total of 370 cases were collected. Genotyping was performed using pulsed-field gel electrophoresis and multilocus sequence typing. Panton,Valentine leukocidin genes and the staphylococcal chromosomal cassette mec (SCCmec) were identified in representative isolates. MRSA was considered to be nosocomially acquired in 202 cases (55%), healthcare-associated (HCA) in 139 cases (38%), community-acquired (CA) in three cases, and of uncertain mode of acquisition in 26 (7%) cases. The pooled population-based rate was 2.31 cases/100 000 population/month, and the pooled nosocomial rate was 0.21 cases/1000 hospital stays (20.2% of S. aureus). Peripheral vascular disease, respiratory tract infections, catheter infections, bloodstream infections and crude mortality were more frequent among HCA cases, whereas neoplasia and urinary tract infections were more frequent among nosocomially acquired cases. Two clones related to the paediatric clone ST5-IV accounted for 71% of the isolates; EMRSA-16 has emerged in two different geographical areas. Only one isolate belonged to the formerly predominant Iberian clone. The three CA isolates were related to the USA300 clone. SCCmec type IV was the most frequent type in nosocomial and HCA isolates. The epidemiology of MRSA has changed in Spain; outpatients with previous healthcare contact represent a very important reservoir of MRSA, and community isolates are emerging. [source] Performance indicators and the public reporting of healthcare-associated infection ratesCLINICAL MICROBIOLOGY AND INFECTION, Issue 10 2008H. Humphreys Abstract Surveillance of healthcare-associated infections (HCAIs) makes evident the importance of the quality of patient care, and the increasing demand for public reporting of HCAI surveillance data and related quality indicators is thus not surprising. However, there is little evidence that public reporting results in improved patient care. Debate continues about which HCAI-related indicators are the best measures of performance and thus the most appropriate for public reporting. Suitable indicators should allow improvements leading to better patient outcomes, and should be comparable among hospitals and countries. Appropriate examples include central vascular catheter infections, surgical prophylaxis and surgical site infections. [source] Intravenous catheter infections associated with bacteraemia: a 2-year study in a University HospitalCLINICAL MICROBIOLOGY AND INFECTION, Issue 5 2004M. Paragioudaki Abstract The aim of this retrospective study was to assess the incidence and aetiology of central and peripheral venous catheter (C/PVC) infections during a 2-year period (1999,2000) and to determine the susceptibility of isolated microorganisms to various antimicrobial agents. Catheter tips were processed using the semiquantitative method and blood cultures were performed with the BacT/Alert automated system. Antibiotic susceptibilities were performed by disk agar diffusion and MICs were determined by Etest, according to NCCLS standards. During the study period, samples from 1039 C/PVC infections were evaluated, yielding 384 (37.0%) positive cultures. Blood cultures were also available from 274 patients, of which 155 (56.6%) yielded the same microorganism as from the catheter. No bloodstream infections were detected in 104 C/PVC-positive cases. Methicillin-resistant coagulase-negative staphylococci were the most frequent isolates, followed by Gram-negative bacteria, especially Pseudomonas aeruginosa. Resistance to glycopeptides among staphylococci and enterococci was not detected, whereas 60% of Gram-negative bacilli were resistant to ,-lactams. [source] The ,-lactam-sensitive d,d -carboxypeptidase activity of Pbp4 controls the l,d and d,d transpeptidation pathways in Corynebacterium jeikeiumMOLECULAR MICROBIOLOGY, Issue 3 2009Marie Lavollay Summary Corynebacterium jeikeium is an emerging nosocomial pathogen responsible for vascular catheters infections, prosthetic endocarditis and septicemia. The treatment of C. jeikeium infections is complicated by the multiresistance of clinical isolates to antibiotics, in particular to ,-lactams, the most broadly used class of antibiotics. To gain insight into the mechanism of ,-lactam resistance, we have determined the structure of the peptidoglycan and shown that C. jeikeium has the dual capacity to catalyse formation of cross-links generated by transpeptidases of the d,d and l,d specificities. Two ampicillin-insensitive cross-linking enzymes were identified, LdtCjk1, a member of the active site cysteine l,d -transpeptidase family, and Pbp2c, a low-affinity class B penicillin-binding protein (PBP). In the absence of ,-lactam, the PBPs and the l,d -transpeptidase contributed to the formation of 62% and 38% of the cross-links respectively. Although LdtCjk1 and Pbp2C were not inhibited by ampicillin, the participation of the l,d -transpeptidase to peptidoglycan cross-linking decreased in the presence of the drug. The specificity of LdtCjk1 for acyl donors containing a tetrapeptide stem accounts for this effect of ampicillin since the essential substrate of LdtCjk1 was produced by an ampicillin-sensitive d,d -carboxypeptidase (Pbp4Cjk). Acquisition and mutational alterations of pbp2C accounted for high-level ,-lactam resistance in C. jeikeium. [source] | ||||||||||