To determine the number of colony-forming units (CFU) that best correlates with catheter-related infections (CRI) in newborns.
This was a prospective study of semiquantitative cultures of catheter tips obtained from newborns in the neonatal unit at Faculdade de Medicina de Botucatu, state of São Paulo, Brazil. The microorganisms isolated from catheter and peripheral blood cultures were identified and submitted to a drug susceptibility test. The optimal cutoff point was determined by the receiver operating characteristic (ROC) curve.
A total of 85 catheters obtained from 63 newborns were studied. Staphylococcus epidermidis was the predominant species in the catheters (75%). Eight of 11 (72.7%) CRI episodes were associated with coagulase-negative staphylococci, six of which were of the S. epidermidis type. ROC curve analysis indicated that the optimal cutoff point for the diagnosis of CRI was 122 CFU.
The cutoff point of 122 CFU correlated best with the diagnosis of CRI in newborns.
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to investigate the rates of success and of complications of percutaneous subclavian central venous catheterization in children and adolescents and to identify factors associated with them.
This was a study of a series of 204 percutaneous subclavian central venous catheterizations of children and adolescents, using polyvinyl chloride catheters (Intracath(R)), at the Instituto Materno-Infantil Professor Fernando Figueira between December 1, 2003 and April 30, 2004. An analysis was performed of variables related to the patient, such as age, and of variables related to the procedure, such as success/failure, type of anesthesia, complications, who performed the procedure and the number of attempts needed.
Overall, 89.2% of catheterizations were successful. Percentage success rates were significantly greater when percutaneous subclavian central venous catheterization was performed with the child sedated (94%). Around 43.2% of subclavian catheterizations progressed with complications related to insertion of the catheter; however, complications of greater severity were observed in just 3.5% of cases. There were a greater number of complications related to percutaneous subclavian central venous catheterizations performed by a first-year resident (58.8%), who performed a significantly greater percentage of procedures on children younger than 1 year and who also made a greater number of attempts per patient.
The chance of success was greater when patients were sedated for catheterization. There was a greater chance of complications related to insertion of the catheter when percutaneous subclavian central venous catheterization was performed by less experienced physicians, and it would be prudent to designate those central venous catheterizations that present greater risk to surgeons with greater experience.
Jornal de Pediatria 02/2007; 83(1):64-70. DOI:10.2223/JPED.1583 · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to examine central venous catheter (CVC)-related nosocomial blood stream infection risks of umbilical venous, percutaneous and Broviac catheters, as well as variations in CVC use and CVC-related risk for nosocomial blood stream infection in the neonatal intensive care unit (NICU).
A cohort study was performed based on 19,507 infants admitted to 17 NICUs in the Canadian Neonatal Network from January, 1996, through October, 1997. Information on these subjects was prospectively collected by trained abstractors. Incidence of infection was measured as infection episodes per 1000 patient days. The risk ratio (RR) of CVC use for nosocomial blood stream infection was calculated as the infection rate during catheter days divided by the infection rate during noncatheter days. Using a Poisson regression model we examined the adjusted RR of CVC use for nosocomial blood stream infection, controlling for patient characteristics and illness severity at admission. Interinstitutional variations in CVC-related infection risks were examined by stratified analyses.
CVC were used in 22.5% of patients. The incidence of nosocomial blood stream infection was 2.9 per 1000 noncatheter days, 7.2 per 1000 umbilical venous catheter days, 13.1 per 1000 percutaneous catheter days and 12.1 per 1000 Broviac catheter days. The RR for nosocomial blood stream infection, adjusted for differences in patient characteristics and admission illness severity, was 2.5 for umbilical venous catheter, 4.6 for percutaneous catheter and 4.3 for Broviac catheter (P < 0.05). There were significant (P < 0.05) risk-adjusted variations in CVC-related infection risks among NICUs.
CVC use increased the risk of nosocomial blood stream infection. The risk of nosocomial blood stream infection in percutaneous and Broviac catheters was 70 to 80% higher than in umbilical venous catheters. There was significant variation in CVC-related infection risks among Canadian NICUs.
[Show abstract][Hide abstract] ABSTRACT: We evaluated a semiquantitative culture technic for identifying infection due to intravenous catheters: rolling the catheter segment across blood agar. This method was compared to broth culture. Of 250 catheters studied, 225 (90%) had low-density colonization on semiquantitative culture (less than 15 colonies on the plate) although 49 (19.6%) of these grew some organisms in broth or on the plate. None of these catheters led to septicemia. Twenty-five catheters (10%) grew greater than or equal to 15 colonies by the semiquantitative technic; most gave confluent growth. Septicemia originated from four of these catheters (P = 0.008). Of 37 catheters exposed to bacteremias from distant foci of infection, four yielded matching growth in broth, whereas none were concordant with the blood isolate on semiquantitative culture. Local inflammation was associated with high-density colonization semiquantitative culture (P less than 0.001). The semiquantitative technic distinguishes infection (greater than or equal to 15 colonies) from contamination and is more specific in diagnosis of catheter-related septicemia than culture of the catheter in broth.
New England Journal of Medicine 07/1977; 296(23):1305-9. DOI:10.1056/NEJM197706092962301 · 55.87 Impact Factor
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