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Intravascular Catheter (intravascular + catheter)
Selected AbstractsPathogenesis of catheter-related infections: lessons for new designsCLINICAL MICROBIOLOGY AND INFECTION, Issue 5 2002A. Pascual In the last decade, two main strategies have been employed in the prevention of catheter-related infections: the creation of anti-adhesive biomaterials using physicochemical methods, and the incorporation of antimicrobial or antiseptic agents into current polymer biomaterials. There has been limited success with the first approach. Intravascular catheters and cuffs with an antimicrobial coating have been developed in recent years. Nevertheless, preventive strategies should avoid the use of therapeutic antibiotics. Exposure to antimicrobial agents could favor the development of resistance or the expression of genes responsible for biofilm formation. The use of these catheters should be restricted to situations where the rate of infection is high despite adherence to other strategies that do not incorporate antimicrobial agents. Better knowledge of the pathogenesis of catheter-related infections will facilitate the design of new devices that avoid the use of antimicrobial agents and decrease the risk of associated bloodstream infections. This could include the use of ,biospecific polymers' coated with anti-adhesive molecules or the use of agents which might block the expression of genes controlling biofilm formation for the most prevalent pathogens. [source] Ascites in infants with severe sepsis , treatment with peritoneal drainagePEDIATRIC ANESTHESIA, Issue 12 2006ANDRZEJ PIOTROWSKI MD PhD Summary Background:, Ascites in neonates and infants is usually caused by cardiac failure and urinary or biliary tract obstruction. The objective of this study was to characterize our experience with ascites as a complication of sepsis. Methods:, We retrospectively collected and analyzed data of patients treated in the intensive care unit (ICU) of the university-based children's hospital, in whom ascites developed during nosocomial sepsis. Ten infants admitted to the ICU in the first 2 days of life developed sepsis on the mean 31.5 (±21.9) postnatal day. Gram-negative bacteria were the causative organism in nine cases, and Staphylococcus hemolyticus in one. Because of sepsis, reintubation and mechanical ventilation were necessary. All patients received broad spectrum antibiotics (including meropenem and ciprofloxacin), blood transfusions, catecholamines and intravenous immunoglobulin preparations. Ascites was observed on the median 13.5 day of sepsis (range 3,36), and severely compromised gas exchange. Continuous peritoneal drainage was applied by means of an intravascular catheter placed in the right lower abdominal quadrant. Results:, The mean drained fluid volume was 44.7 (±20.4) ml·kg,1·day,1, drainage was continued for a median of 5.5 (range 1,56) day, and enabled significant reduction of ventilator settings 24 h after its implementation. No severe complications related to drainage occurred; six of 10 babies survived. Conclusions:, Ascites can develop in infants with sepsis and cause respiratory compromise. Continuous drainage of ascitic fluid by means of an intravenous catheter is relatively safe and can improve gas exchange. [source] Antibacterial Nitric Oxide-Releasing Polyester for the Coating of Blood-Contacting Artificial MaterialsARTIFICIAL ORGANS, Issue 7 2010Amedea B. Seabra Abstract The emergence of multidrug-resistant bacteria associated with blood-contacting artificial materials is a growing health problem, which demands new approaches in the field of biomaterials research. In this study, a poly(sulfhydrylated polyester) (PSPE) was synthesized by the polyesterification reaction of mercaptosuccinic acid with 3-mercapto-1,2-propanediol and blended with poly(methyl methacrylate) (PMMA) from solution, leading to solid PSPE/PMMA films, with three different PSPE : PMMMA mass ratios. These films were subsequently S-nitrosated through the immersion in acidified nitrite solution, yielding poly(nitrosated)polyester/PMMA (PNPE/PMMA) films. A polyurethane intravascular catheter coated with PNPE/PMMA was shown to release nitric oxide (NO) in phosphate buffered saline solution (pH 7.4) at 37°C at rates of 4.6 nmol/cm2/h in the first 6 h and 0.8 nmol/cm2/h in the next 12 h. When used to coat the bottom of culture plates, NO released from these films exerted a potent dose- and time-dependent antimicrobial activity against Staphylococcus aureus and a multidrug-resistant Pseudomonas aeruginosa strains. This antibacterial effect of PSPE/PMMA films opens a new perspective for the coating of blood-contacting artificial materials, for avoiding their colonization with highly resistant bacteria. [source] Methicillin-resistant Staphylococcus aureus bacteraemia in neonatal intensive care units: an analysis of 90 episodesACTA PAEDIATRICA, Issue 6 2004Y-Y Chuang Aim: To delineate the clinical features of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in infants hospitalized at the neonatal intensive care unit. Methods: Episodes of MRSA bacteraemia in Chang Gung Children's Hospital neonatal intensive care unit from 1997 to 1999 were reviewed for incidence, predisposing factors, clinical presentations, treatment and outcome. Results: Ninety episodes of MRSA bacteraemia were identified. The overall rate of MRSA bacteraemia was 1.05 per 1000 patient days during the 3-y period. Most of the patients were premature infants (76%), with prior operation or invasive procedures (39%), had an indwelling intravascular catheter (79%) and exposure to antibiotic therapy (96%). A localized cutaneous infection was found in 53.3% of the episodes. The most common clinical diagnoses were catheter-related infections (54.4%), skin and soft tissue infections (21.1%), bacteraemia without a focus (20%) and pneumonia (16.7%). Metastatic infection occurred in 18% of these infants. Among the patients treated with vancomycin for ±14d, 88.7% did not develop any complications, and 11.3% developed a recurrence. Conclusions: MRSA is an established pathogen in our NICU. MRSA bacteraemia in the neonates predominantly presented as catheter-related infections, and metastatic infections were not infrequently seen. In uncomplicated MRSA bacteraemia, treatment with vancomycin for ±14 d seems to be adequate. [source] Septicaemia due to glucose non-fermenting, Gram-negative bacilli other than Pseudomonas aeruginosa in childrenACTA PAEDIATRICA, Issue 3 2002S Ladhani Bloodstream infections due to non-fermenting Gram-negative bacilli other than Pseudomonas aeruginosa (NF-GNB) are uncommon in children but their incidence is reported to be increasing. The aim of this study was to determine the characteristics of such infections in children in a London teaching hospital. All paediatric patients with positive NF-GNB blood cultures and clinical evidence of sepsis between July 1995 and June 2000 were included in the study. A total of 10278 blood cultures was performed, of which 356 (3.5%) represented clinically significant episodes of bacteraemia. Of these, 12 (0.1%) were due to NF-GNB. Nine of the 12 (75%) patients were receiving haemodialysis for end-stage renal failure (ESRF). Only one patient was receiving immunosuppressive therapy and none was neutropenic or had any malignancy. An intravascular catheter was identified as the focus of infection in all 12 cases. Stenotrophomonas maltophilia was the most common organism isolated (67%). Six patients were successfully treated with antibiotics alone. Four others received antibiotics, but also required line removal, and two patients responded to line removal without the need for antibiotics. Conclusion: An association was found between ESRF and NF-GNB infections, possibly related to the requirement for long-term catheters for dialysis. Antibiotic treatment alone was only successful in half the cases of catheter-related NF-GNB septicaemia, while removal of the infected catheter ensured complete cure in the cases where antibiotic treatment alone did not suffice. [source] Prevention and control of biofilm-based medical-device-related infectionsFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 3 2010Iolanda Francolini Abstract Biofilms play a pivotal role in healthcare-associated infections, especially those related to the implant of medical devices, such as intravascular catheters, urinary catheters and orthopaedic implants. This paper reviews the most successful approaches for the control and prevention of these infections as well as promising perspectives for the development of novel devices refractory to microbial adhesion, colonization and biofilm formation. [source] Treatment of Candida infection in patients with infected pancreatic necrosisBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2000G. Farkas Background The purpose of this review was to determine the incidence of Candida infection in patients with infected pancreatic necrosis, to determine the most frequent risk factors and to assess the best treatment approach for disseminated candidal infections. Methods Of 145 patients with infected pancreatic necrosis identified, 30 (21 per cent) were infected with C. albicans. Risk factors identified in patients with Candida infection included the presence of necrotic tissue, and the use of broad-spectrum antibiotics, intravascular catheters and parenteral nutrition. Results With one exception, all cases involved mixed bacterial and fungal infections. The positive fungal result was obtained either during or after operation. Sixteen of the 30 patients displayed fungal colonization, while the other 14 had disseminated fungal infection. There were two deaths in the disseminated group, but none in the colonization group. In both fatal cases, flucytosine was applied. When fluconazole was used against disseminated fungal infection, no death was noted. Recently, prophylactic fluconazole has also been used in 20 patients with infected pancreatic necrosis, with no evidence of fungal infection after operation. Conclusion The combination of adequate surgical treatment with effective antibiotics and early antifungal therapy is the ideal management approach for infected pancreatic necrosis with Candida infection. Fluconazole may be regarded as an efficient drug for the prophylaxis of candidiasis. © 2000 British Journal of Surgery Society Ltd [source] | ||||||||||