Diagnosis of central venous catheter related infection in adult patients
Department of Pharmaceutical and Biological Sciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK. The Journal of infection
(Impact Factor: 4.44).
12/2005; 51(4):267-80. DOI: 10.1016/j.jinf.2005.06.007
Intravascular catheters are one of the main causes of bacteraemia and septicaemia in hospitalised patients and continue to be associated with a significant morbidity and mortality. Two main types of infections occur, they can be either localised at the catheter insertion site of systemic with a septicaemia. The clinical parameters related to these infections are presented. The laboratory diagnosis of these infections is also extensively reviewed and recommendations are made as to the most appropriate diagnostic method to be used.
Available from: Hazir Rahman
- "catheterization, type of device used and disconnection of the catheter-collecting tube junction (Bigham et al., 2009; Sofianou et al., 2000; Frasca et al., 2010). Though several reports have been documented the prevalence of CRIs (Leonidou and Gogos, 2010; Eggimann et al., 2004; Deep et al., 2004; Thongpiyapoom et al., 2004; Gikas et al., 2010; Timsit, 2007; Worthington and Elliott, 2005), however few reports are available on the shift in antimicrobial susceptibility of microorganisms associated with CRIs (Fridkin et al., 2002; Al-Hasan et al., 2011). This study has documented the distribution of catheter associated bacterial pathogens from pediatric patients and their antimicrobial "
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ABSTRACT: Catheter-related infections (CRIs) by bacterial pathogens are the frequent cause of nosocomial infections in hospitalized pediatric patients. The undertaken study was carried out at two different time duration in 2005 and 2011 to determine the changing trend in bacterial pathogens isolated from catheters and their antimicrobial susceptibility in children. Patients implanted with endotracheal tube (ETT), peritoneal dialysis catheter (PDC), urinary catheters (UC) and central venous catheters (CVC) were included in this study. The prevalence of the organism causing CRI and its antibiotic susceptibility was determined using standard microbiological assay. In the present study, the most frequent catheter colonizing bacteria in 2005 were Pseudomonas spp. 30% (n = 30) followed by Klebsiella spp. 27% (n = 27) and Escherichia coli 27% (n = 27). In contrast, the most frequently isolated pathogens in 2011 were found to be Klebsiella spp. 34.7% (n = 40), followed by E. coli 25.2% (n = 29) and Pseudomonas spp. 15.6 % (n = 18). Beside these commonly isolated pathogens, we have also isolated Acinetobacter spp. 9.57% (n = 11), Enterobacter spp. 5.21% (n = 6) and Citrobacter spp. 0.86% (n = 1) in 2011. A significant increase in the resistance of Gram negative bacteria to amikacin, co-amoxiclav, cefixime and cefpriome was documented from 2005 to 2011. On the other hand, in 2011, the resistance of Gram positive bacteria to amikacin, co-amoxiclav, fusidic acid and teicoplanin was significantly increased. The isolation of causative agents of CRIs and the antibiogram of these pathogens may be helpful for a more appropriate and optimized treatment with potential benefits for the patients as well as for the rationale antibiotic policy.
Available from: Mary Gemma Cherry
- "In the UK, approximately 200,000 CVCs are inserted each year (Worthington & Elliott 2005). The National Survey of nosocomial blood stream infections completed in 2002 recorded over 10,000 episodes of bacteraemia, with a mean rate of 0.6 bacteraemia per 1000 patient days (Health Protection Agency). "
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ABSTRACT: Up to 6000 patients per year in England acquire a central venous catheter (CVC)-related bloodstream infection (Shapey et al. 2008 ). Implementation of Department of Health guidelines through educational interventions has resulted in significant and sustained reductions in CVC-related blood stream infections (Pronovost et al. 2002), and cost (Hu et al. 2004 ).
This review aimed to determine the features of structured educational interventions that impact on competence in aseptic insertion technique and maintenance of CV catheters by healthcare workers.
We looked at changes in infection control behaviour of healthcare workers, and considered changes in service delivery and the clinical welfare of patients involved, provided they were related directly to the delivery method of the educational intervention.
A total of 9968 articles were reviewed, of which 47 articles met the inclusion criteria.
Findings suggest implications for practice: First, educational interventions appear to have the most prolonged and profound effect when used in conjunction with audit, feedback, and availability of new clinical supplies consistent with the content of the education provided. Second, educational interventions will have a greater impact if baseline compliance to best practice is low. Third, repeated sessions, fed into daily practice, using practical participation appear to have a small, additional effect on practice change when compared to education alone. Active involvement from healthcare staff, in conjunction with the provision of formal responsibilities and motivation for change, may change healthcare worker practice.
Available from: Tony Worthington
- "Microbiological diagnosis of CR-BSI following removal of a catheter is often established by the recovery of indistinguishable micro-organisms from the catheter tip and blood cultures of patients with suspected infection. The identity is usually based on microbial speciation and antibiogram profiles (O'Grady et al., 2002; Worthington & Elliott, 2005). However, recent reports suggest that cultures of colonially indistinguishable CoNS may indeed contain multiple different strains (Viedma et al., 2000; Kloos & Bannerman, 1994). "
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ABSTRACT: Microbiological diagnosis of catheter-related bloodstream infection (CR-BSI) is often based on isolation of indistinguishable micro-organisms from an explanted catheter tip and blood culture, confirmed by antibiograms. Whether phenotypic identification of coagulase-negative staphylococci (CoNS) allows an accurate diagnosis of CR-BSI to be established was evaluated. Eight patients with a diagnosis of CR-BSI had CoNS isolated from pure blood cultures and explanted catheter tips which were considered as indistinguishable strains by routine microbiological methods. For each patient, an additional three colonies of CoNS isolated from the blood and five from the catheter tip were subcultured and further characterized by antibiogram profiles, analytical profile index (API) biotyping and PFGE. PFGE distinguished more strains of CoNS compared to API biotyping or antibiograms (17, 10 and 11, respectively). By PFGE, indistinguishable micro-organisms were only isolated from pure blood and catheter tip cultures in four out of eight (50%) patients thus supporting the diagnosis of CR-BSI. In another patient, indistinguishable micro-organisms were identified in both cultures; however, other strains of CoNS were also present. The remaining three patients had multiple strains of CoNS, none of which were indistinguishable in the tip and blood cultures, thus questioning the diagnosis of CR-BSI. Phenotypic characterization of CoNS lacked discriminatory power. Current routine methods of characterizing a limited number of pooled colonies may generate misleading results as multiple strains may be present in the cultures. Multiple colonies should be studied using a rapid genotypic characterization method to confirm or refute the diagnosis of CR-BSI.
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