Intravascular catheter infections.

Guy's and St Thomas' Hospital, London SE1 7EH, UK.
The Journal of hospital infection (Impact Factor: 3.01). 09/2009; 73(4):323-30. DOI: 10.1016/j.jhin.2009.05.008
Source: PubMed

ABSTRACT Formerly an under-appreciated iatrogenic infection, catheter-related bloodstream infections (CRBSIs) are now the focus of considerable preventive strategies. Although robust clinical definitions remain elusive due to the difficulty in identifying the focus of infection in hospitalised patients, surveillance definitions are proving useful to monitor and compare institutional rates of CRBSI and to target infection control resources. New catheter-sparing diagnostic techniques have been developed, that are probably most applicable to assessment of infection in stable ambulatory patients with single long-term tunnelled catheters rather than acutely unwell hospitalised patients. There is an impressive body of evidence that can be used to support implementation, surveillance and audit of basic infection control practices that should help institutions reduce CRBSI rates. The introduction of preventive antimicrobial strategies at the catheter site has been recommended by international guidelines, yet there remains justifiable concern about long-term selection of resistant organisms. This has not been adequately addressed in current studies. Economic analyses require data on the clinical effect of CRBSIs to adequately assess the benefit; such data are scarce, owing to the difficulty in assessing the contribution from comorbidities, with consequential conflicting results. Overall, institutions can justifiably first assess the benefit of a sustained programme of re-enforcing basic infection control practice on CRBSI before assessing whether the introduction of additional preventive antimicrobial strategies are likely to have any benefit.

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    ABSTRACT: Parenteral nutrition is widely used in critically ill patients receiving nutritional support. Several previous studies associated the use of parenteral nutrition with the development of bloodstream infections. This study compared bloodstream infections in critical care patients receiving parenteral nutrition (PN) prepared via conventional compounding versus premixed multichamber bags. Records in the Premier Perspective™ database for all in patients ≥ 18 years of age, with a minimum 3-day intensive care unit stay, who received PN between 2005 and 2007 were analyzed (n = 15,328). Statistical analysis of data, grouped according to preparation method, compared differences in both observed bloodstream infection rates and adjusted rates, using logistic regression to examine the impact of hospital and patient baseline characteristics. Patients receiving compounded parenteral nutrition had longer intensive care unit stays (11.3 vs. 9.1 days) and longer hospital stays (22.6 vs. 19.4 days); both P < .001. After adjusting for baseline differences, the probability for bloodstream infections was 19% higher when using compounded parenteral nutrition vs. multichamber bags (29.6 vs. 24.9%; odd ratio = 1.29; 95% confidence interval = 1.06-1.59). In this retrospective review of a large patient database the adjusted probability of bloodstream infection was significantly lower in patients receiving multichamber bags than compounded parenteral nutrition. These findings need to be investigated further in high quality observational studies and prospective clinical trials.
    Clinical nutrition (Edinburgh, Scotland) 05/2012; 31(5):728-34. · 3.27 Impact Factor
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    ABSTRACT: In recent years, healthcare associated infections (HAIs), and central line-associated bloodstream infections in particular (CLABSI), are being viewed as “preventable” events. It has been estimated that up to 70 % of CLABSI episodes may be preventable with the implementation of evidence-based strategies pretending to reach the zero incidence. The most effective procedures, which have demonstrated to reduce significantly CLABSI rates, are preventive bundles, which consists of a set of measures to be carried out during both catheter insertion and maintenance. These measures are mainly the following: implementing continuous education and training of healthcare personnel workers, using maximal sterile barrier precautions during insertion, performing skin disinfection with 2 % alcoholic chlorhexidine, avoiding the femoral site, and removing unnecessary catheters. However, these strategies have been performed mainly in the intensive care units (ICUs) with much less emphasis and efforts in non-ICU wards. There is also a need to introduce other novel strategies to reduce the CLABSI rates such as using catheter lock antiseptic solutions, using antiseptic impregnated sponges and dressings, designating a surveillance nurse to monitor central lines, or keeping a record of the insertion and maintenance procedures using a checklist.
    Current Treatment Options in Infectious Diseases. 03/2013; 6(1).
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    ABSTRACT: Parenteral nutrition (PN) is associated with an increased risk of developing bloodstream infections (BSIs) but the impact of the PN delivery system upon BSI rates remains unclear. This was an international, multicenter, prospective, randomized, open-label, controlled trial that investigated the differences of BSIs associated with 2 different PN systems. Patients were randomly allocated in a 2:1:1 ratio to receive either PN delivered by a multichamber bag (MCB group), or by compounded PN made with olive oil (COM1 group) or with MCT/LCT (COM2 group). Blood cultures were performed to evaluate the incidence of BSIs, and catheter use data was collected to calculate CLAB and central venous catheter device use ratio (CVC-DUR). Secondary outcomes included the development of severe sepsis/septic shock, number of intensive care unit (ICU) and hospital days, and all-cause mortality at Day 28. 406 patients were included: 202 in the MCB group, 103 in the COM1 group, and 101 in the COM2 group. Baseline characteristics were well balanced between the 3 groups, BSIs were significantly higher in patients receiving compounded PN (46 BSIs for COM1+COM2 vs 34 BSIs for MCB; p = 0.03).CLAB was higher in patients receiving compounded PN (13.2 for COM1+COM2 vs 10.3 for MCB; p < 0.0001). No differences were observed for the secondary outcomes. Compounded PN was associated with a higher incidence of BSIs and CLABs, suggesting that the use of MCB PN may play a role in reducing the incidence of BSIs in patients who receive PN. Trial registration number: NCT00798681.
    Journal of Parenteral and Enteral Nutrition 01/2012; 36(5):574-86. · 3.14 Impact Factor


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