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New technology for reducing infection and resistance in the ICU

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... 66 Three other reviews assessed the potential for antimicrobial resistance with the use of M/R and overwhelmingly concluded that the use of M/R devices is unlikely to cause resistance. [68][69][70] Discussion ...
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Background Catheter infections remain one of the most persistent adverse events causing significant morbidity, economic impact and mortality. Several strategies have been proposed to reduce these infections including the use of catheters embedded with antibiotics and/or antiseptics. One reoccurring challenge is the fear that antimicrobial medical devices will induce resistance. The aim of this systematic review is to evaluate the evidence for induced antimicrobial resistance caused by exposure to antimicrobial medical devices. Methods Four electronic databases [MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus] were screened for studies published between 1983 and 2019 regarding assessment of microbial resistance with use of medical devices containing chlorhexidine, minocycline, rifampicin or combinations thereof. Development of new resistance, selection for tolerant organisms and ‘no change in resistance’ were assessed. Results Forty-four publications, grouped by study type and stratified by drug assessed, were included for analyses. The majority of studies found no change in resistance after exposure to antimicrobial medical devices (13 in vitro, 2 in vivo, 20 clinical). Development of new resistance was commonly reported with the use of rifampicin as a single agent and only reported in one study assessing the minocycline/rifampicin combination (M/R); however, the increase in MIC was well below clinical relevance. Conclusions Emergence of new resistance to combinations of M/R, minocycline/rifampicin/chlorhexidine (M/R/CH) and chlorhexidine/silver sulfadiazine (CHXSS) was rare. No clinical trials confirmed its occurrence and some refuted it. The risk of development of new resistance to these antimicrobial combinations appears more fear-based than substantiated by clinical and experimental evidence but warrants continued surveillance.
... 42 Thus, prevention of CVC-associated BSIs may not only reduce health care costs through reducing LOS and antibiotic use, but may also reduce the antibiotic pressure that is driving the selection of resistant micro-organisms in hospitals. 43 Finally, our findings are concordant with other studies that have found an increased mortality with CVC-associated BSI. 2,5,9,38,39 It is possible that the nearly 25% attributable mortality seen in this and other trials is an artifact of the measurement techniques used (ie, ASIS or other severity of illness scores calculated at ICU admission rather than at the moment of onset of CVC-associated BSI). ...
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Limited information is available on the financial impact of central venous catheter-associated bloodstream infection (BSI) in Argentina. To calculate the cost of BSIs in the intensive care department (ICU), a 5-year prospective nested case-control study was undertaken at 3 hospitals in Argentina. We studied 6 adult ICUs from 3 hospitals. In all, 142 patients with BSI and 142 control patients without BSI were matched for hospital, type of ICU, year of admission, length of stay, sex, age, and average severity of illness score. Patients' length of stay in the ICU was obtained prospectively on daily rounds. The hospitals' finance departments provided the cost of each ICU day. The hospitals' pharmacies provided the cost of antibiotics prescribed for BSIs. The mean extra length of stay for patients with BSI compared with control patients was 11.9 days, the mean extra antibiotic defined daily dose was 22.6, the mean extra antibiotic cost was $1913, the mean extra cost was $4888.42, and the excess mortality was 24.6%. In this study, patients with central venous catheter-associated BSI experienced significant prolongation of hospitalization, increased use of health care costs, and a higher attributable mortality. These findings support the need to implement preventative interventions for patients hospitalized with central venous catheters in Argentina.
... 44 Thus, prevention of CVC-associated BSI may reduce healthcare costs through reducing LOS, antibiotic use, and the antibiotic pressure that is driving the selection of resistant microorganisms in hospitals. 45 Finally, our discoveries are concordant with those of other studies that have found an increased mortality among patients with CVC-associated BSI. 2,5,9,40,41 It is possible that the 20% attributable mortality found in this and other studies is an artificial product of the measurement techniques used (ie, mean severity of illness score or other severity of illness scores calculated at ICU admission rather than at the moment of onset of CVC-associated BSI). ...
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No information is available about the financial impact of central venous catheter (CVC)-associated bloodstream infection (BSI) in Mexico. To calculate the costs associated with BSI in intensive care units (ICUs) in Mexico City. An 18-month (June 2002 through November 2003), prospective, nested case-control study of patients with and patients without BSI. Adult ICUs in 3 hospitals in Mexico City. A total of 55 patients with BSI (case patients) and 55 patients without BSI (control patients) were compared with respect to hospital, type of ICU, year of hospital admission, length of ICU stay, sex, age, and mean severity of illness score. Information about the length of ICU stay was obtained prospectively during daily rounds. The daily cost of ICU stay was provided by the finance department of each hospital. The cost of antibiotics prescribed for BSI was provided by the hospitals' pharmacy departments. For case patients, the mean extra length of stay was 6.1 days, the mean extra cost of antibiotics was US dollars 598, the mean extra hospital cost was US dollars 11,591, and the attributable extra mortality was 20%. In this study, the duration of ICU stay for patients with central venous catheter-associated BSI was significantly longer than that for control patients, resulting in increased healthcare costs and a higher attributable mortality. These conclusions support the need to implement preventive measures for hospitalized patients with central venous catheters in Mexico.
This report has three objectives. First, to provide a concise summary of the current state of mandatory reporting legislation on nosocomial infection rates. Second, to identify and briefly summarize the evidence-based patient safety practices shown to reduce catheter-related bloodstream infections. And, finally, to demonstrate the significant cost benefit hospitals may achieve by undertaking programs to prevent these device-associated infections. Specifically, the following topics are addressed: public policy, prevention strategies and their clinical impact, role of technology, and economic implications.
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To evaluate a decrease in catheter-related bloodstream infection rate in patients with antiseptic triple-lumen catheters in an intensive care unit. Retrospective review of surveillance records, patient medical records, laboratory and microbiological reports, and antibiotic administration records. Patients admitted to the intensive care unit with triple-lumen catheters. A subset of one entry per patient was extracted from 2 yrs of primary bloodstream infection surveillance data. Data collection included risk factors, laboratory and microbiological data, and insertion sites and dates of all intravascular catheters present during triple-lumen catheterization. The catheter-related bloodstream infection rate was 5.4 and 11.3 per 1000 catheter days in antiseptic and nonantiseptic triple-lumen catheter groups, respectively (p = .06). By multivariate analysis using a Cox Proportional Hazards Model, the antiseptic triple-lumen catheters were associated with a significant reduction in catheter-related bloodstream infection (p = .03). Model expansion to include intrajugular site was significant by a likelihood ratio test [2(log likelihood diff) = 4.26 P<.05 chi2(1)] The use of antiseptic triple-lumen catheters may substantially reduce catheter-related bloodstream infections in an intensive care population and may be subsequently associated with a decrease in length of stay.