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Terho K, Löyttyniemi E, Rintala E, Salanterä S. Infection prevention knowledge related to central line infections and ventilator-associated pneumonias: A survey of Finnish intensive care units. Am J Infect Control 2025; 53:690-695. [PMID: 39909080 DOI: 10.1016/j.ajic.2025.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 01/28/2025] [Accepted: 01/29/2025] [Indexed: 02/07/2025]
Abstract
BACKGROUND Health care-associated infections pose a significant risk for the patients in intensive care due to the use of medical instrumentation required for care. METHODS We conducted a cross-sectional, nationwide survey on awareness of recommended infection prevention practices involving central venous catheters and invasive ventilators in intensive care units. RESULTS A total of 810 (50% of those surveyed) nurses and physicians participated in the survey. We found that 8% of the respondents had good knowledge of infection prevention in central venous care, while 24% had good knowledge of ventilator-associated pneumonia prevention practices. DISCUSSION The overall level of knowledge measured with this nationwide survey was suboptimal. The level varied between units, and depending on individual questions for particular professions. The displayed knowledge may have partially been based on tradition rather than on up-to-date evidence-based guidelines. CONCLUSIONS Educational training in evidence-based infection prevention is needed for practical implementation to be improved.
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Affiliation(s)
- Kirsi Terho
- Infection Prevention and Control Unit, The Wellbeing Services County of Southwest Finland, Turku, Finland; Department of Nursing Science, University of Turku, Turku, Finland.
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland; Nursing Science, The Wellbeing Services County of Southwest Finland, Turku, Finland; University of Western Cape, Cape Town, South Africa
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2
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Di Nardo M, Ghafoor S, Szmit Z, Elbahlawan L, Rowan CM, Agulnik A, Asperen RWV, Zinter MS, Nellis ME, Moody K, Gawronski O, Biasucci DG, Baldelli B, Kalwak K, Cacace F, Moncada M, Mahadeo KM. International expert consensus statement on PICU admission and early critical care management for paediatric patients following haematopoietic cell transplant and immune effector cell therapy. THE LANCET. CHILD & ADOLESCENT HEALTH 2025; 9:426-438. [PMID: 40379432 DOI: 10.1016/s2352-4642(25)00091-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 02/27/2025] [Accepted: 03/12/2025] [Indexed: 05/19/2025]
Abstract
Advances in paediatric haematopoietic cell transplantation strategies using immune-effector cells (HCT-IEC) and in intensive care management have improved survival expectations for patients with malignant and non-malignant diseases. However, critical illness still complicates the clinical course for 10-35% of patients undergoing HCT-IEC because of disease-related complications or treatment-related toxicities. Given the improvement in survival for these patients in paediatric intensive care units (PICU), the European Society of Paediatric and Neonatal Intensive Care (ESPNIC), the HCT-Cancer Immunotherapy Subgroup of the Paediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, and the Paediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT) derived expert consensus statements to guide PICU admission and early critical care management of patients following HCT-IEC. 27 statements were drafted by the steering committee and subsequently voted on by 20 expert panel members with expertise in HCT and IEC. 20 statements received strong agreement and seven received weak agreement. This consensus statement serves as a guide for intensivists, haematologists, and oncologists during the challenging process of PICU admission and critical care management of patients who have undergone HCT-IEC and can serve as a basis for prioritising future research in the field.
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Affiliation(s)
- Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù, Children's Hospital, IRCCS, Rome, Italy.
| | - Saad Ghafoor
- Division of Pediatric Critical Care Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Zofia Szmit
- Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | - Lama Elbahlawan
- Division of Pediatric Critical Care Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Courtney M Rowan
- Department of Pediatrics, Division of Critical Care Medicine, Indiana University, Indianapolis, IN, USA
| | - Asya Agulnik
- Division of Pediatric Critical Care Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Roelie Wosten-Van Asperen
- Department of Pediatric Intensive Care, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Matthew S Zinter
- Division of Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA; Department of Pediatrics, Division of Allergy, Immunology, and BMT, University of California, San Francisco, San Francisco, CA, USA
| | - Marianne E Nellis
- Division of Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Karen Moody
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Orsola Gawronski
- Professional Development, Continuing Education and Nursing Research Unit, Bambino Gesù Children's Hospital, IRCCS, Roma, Lazio, Italy
| | - Daniele G Biasucci
- Department of Clinical Science and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Beatrice Baldelli
- Department of Clinical Science and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Krzysztof Kalwak
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, Wroclaw, Poland; Paediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation, Napoli, Italy
| | - Fabiana Cacace
- Stem Cell Transplantation and Cell Therapy Unit, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon, Napoli, Italy; Division of Pediatric Transplant and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
| | - Manuela Moncada
- Medical Library, Scientific Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Kris M Mahadeo
- Division of Pediatric Transplant and Cellular Therapy, Duke University Medical Center, Durham, NC, USA
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Annetta MG, Spencer TR, Pittiruti M. Puncture site versus exit site in central venous access procedures: Still a source of confusion. J Vasc Access 2025:11297298251338968. [PMID: 40365673 DOI: 10.1177/11297298251338968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2025] Open
Abstract
Two major innovations-ultrasound guidance and catheter tunneling-have transformed central venous catheterization, significantly reducing early and late complications. Ultrasound enables accurate vein selection based on anatomical and functional criteria, facilitates safer venipuncture, and broadens access to previously avoided veins (e.g. brachiocephalic, axillary). It also allows real-time guidance for wire direction, tip navigation, and the immediate diagnosis of complications. Tunneling, once exclusive to cuffed catheters, is now increasingly used for non-cuffed devices to optimize the exit site independently of the venipuncture site. This strategy reduces infection, thrombosis, and dislodgment risks by relocating exit from high-risk zones (e.g. groin, neck) to cleaner, more secure areas. Despite widespread adoption of these innovations, current guidelines often confuse puncture and exit sites, leading to outdated recommendations. For example, guidelines labeling femoral or jugular access as high-risk often fail to differentiate between venipuncture and exit locations. Ultrasound-guided femoral puncture with tunneling can yield low-thrombosis, low-infection configurations, especially with mid-thigh or abdominal exit sites. Similarly, supraclavicular puncture of the internal jugular vein with tunneling avoids the traditional high-neck exit and its associated complications. Recommendations promoting subclavian access are also problematic, as safe ultrasound access is often only feasible via supraclavicular routes, not by traditional blind infraclavicular approaches. The field must shift from old anatomical dogma to ultrasound-based, tunneled approaches tailored to each patients need. Clear distinction between venipuncture and exit sites is essential for modern, evidence-based vascular access practices.
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Affiliation(s)
- Maria Giuseppina Annetta
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Rome, Italy
| | | | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital "A. Gemelli," Rome, Italy
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Obama BM, Grant R, Harbarth S, Buetti N, Catho G. Digitalised measures for the prevention of central line-associated bloodstream infections: a scoping review. Antimicrob Resist Infect Control 2025; 14:45. [PMID: 40355970 PMCID: PMC12067738 DOI: 10.1186/s13756-025-01549-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Accepted: 03/31/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSI) increase morbidity, mortality, and healthcare costs of hospitalised patients, despite being largely preventable. While evidence-based guidelines for preventing CLABSI are well-established, the implementation of these measures remain suboptimal. Digitalization presents a promising approach to improve guideline adherence, streamline implementation processes, and ultimately reduce CLABSI rates. METHODS This scoping review aims to synthesize the available evidence on digitalised interventions for the prevention of CLABSI. A systematic search was conducted using Medline to identify studies published between January 1, 2014, and March 20, 2024, that reported on the implementation of digitalised preventive measures for CLABSI and evaluated their impact on CLABSI rates. Data extraction included study characteristics, features of the digitalised preventive measures, effectiveness in reducing CLABSI rates, and relevant process outcomes. RESULTS A systematic search yielded 263 articles, of which six studies were included. Digitalised interventions were predominantly designed for use by nurses in tertiary-level hospitals (n = 6), primarily in intensive care units (n = 5) and targeted pediatric patient populations (n = 5). These measures were often implemented as part of multimodal strategies. The digital interventions included hospital dashboards (n = 2), mobile applications (n = 2), automatic notifications of catheter days (n = 1), and e-learning modules with electronic reminders (n = 1). The most common study design was quasi-experimental without an external control group. All included studies reported a reduction in CLABSI rates, ranging from 21 to 73%. Healthcare workers generally perceived these digital interventions positively. DISCUSSION Digitalised interventions for CLABSI prevention seem to be effective in reducing infection rates, likely because of increasing compliance to established guidelines for CLABSI prevention.
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Affiliation(s)
- Basilice Minka Obama
- Division of Infection Prevention and Control, WHO Collaborating Centre, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Rebecca Grant
- Division of Infection Prevention and Control, WHO Collaborating Centre, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stephan Harbarth
- Division of Infection Prevention and Control, WHO Collaborating Centre, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Niccolò Buetti
- Division of Infection Prevention and Control, WHO Collaborating Centre, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Infection Antimicrobials Modeling Evolution (IAME), INSERM, Université Paris- Cité, Paris, U 1137, France
| | - Gaud Catho
- Division of Infection Prevention and Control, WHO Collaborating Centre, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
- Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland.
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Chen J, Tang M, Han QY, Tang L, Yu TH, Zhao YP, He CW. Difficulty removing a totally implantable venous access port: A case report. World J Clin Cases 2025; 13:102457. [PMID: 40330284 PMCID: PMC11736528 DOI: 10.12998/wjcc.v13.i13.102457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 12/05/2024] [Accepted: 12/27/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port (TIVAP) used for long-term chemotherapy in a patient with breast cancer. Prolonged use of TIVAPs can result in complications such as catheter kinking, thrombosis, and adhesions between the catheter and surrounding tissues, potentially complicating their removal. CASE SUMMARY A breast cancer patient with bone metastasis presented with difficulty aspirating blood from a TIVAP that had been placed in the right internal jugular vein for 3 years. Initial removal attempts at the Department of Venous Access Center were unsuccessful, likely due to adhesions, necessitating a subsequent successful catheter extraction in a hybrid operating room. Imaging revealed no abnormalities, and the catheter was removed using a mosquito clamp to detach it from surrounding tissues. CONCLUSION This case highlights the challenges of removing TIVAPs inserted via the internal jugular vein, particularly when the catheter traverses the sternocleidomastoid muscle. Repeated neck movements might lead to significant adhesions around the catheter, complicating its removal. Careful consideration should be given during catheter placement to avoid muscle-related adhesions and facilitate smoother extraction in long-term use.
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Affiliation(s)
- Jing Chen
- Department of Nursing, Nanchang Medical College, Nanchang 330052, Jiangxi Province, China
| | - Mu Tang
- Department of Breast Surgery, Jiangxi Cancer Hospital, Nanchang 330029, Jiangxi Province, China
| | - Qin-Yuan Han
- Graduate School, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Lei Tang
- Graduate School, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Teng-Hua Yu
- Department of Breast Surgery, Jiangxi Cancer Hospital, Nanchang 330029, Jiangxi Province, China
| | - Yan-Ping Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Chong-Wu He
- Department of Breast Surgery, Jiangxi Cancer Hospital, Nanchang 330029, Jiangxi Province, China
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Christie M, Avenant T, Nembudani M, Mnqandi A, Muller C, de Villiers M, Bhikhoo Z. Insights into bloodstream infections in South African paediatric burn patients: implications for antimicrobial stewardship. BMC Infect Dis 2025; 25:362. [PMID: 40087547 PMCID: PMC11909990 DOI: 10.1186/s12879-025-10582-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2024] [Accepted: 01/30/2025] [Indexed: 03/17/2025] Open
Abstract
INTRODUCTION Bloodstream infections (BSIs) significantly contribute to the morbidity and mortality in paediatric burn patients from low- and middle-income countries; with common pathogens like Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa frequently being multidrug resistant (MDR). Due to the growing prevalence of MDR BSIs, antimicrobial stewardship needs to be improved with perhaps more targeted initial antimicrobial use. The study describes the aetiology, and timing of burn-associated BSIs and MDR infections in paediatric burn patients admitted to two paediatric surgery units in Tshwane District, South Africa. METHODS This multi-centre retrospective review analysed paediatric burn patients (ages 0-12 years) admitted between January 2020 and December 2022 to two public hospitals in Tshwane District, South Africa. Collected data was from patient records and the National Health Laboratory System TrakCare database. BSIs were defined according to the CDC criteria. RESULTS Of 245 burn patients admitted, 18.8% (n = 46) developed BSIs. From 63 positive blood cultures, the most common isolates were S. aureus (n = 19; 30%), Acinetobacter baumannii (n = 18; 29%), and P. aeruginosa (n = 10; 16%). Collectively, gram negative bacteria were responsible for most BSIs (n = 41; 65%). Candida spp accounted for 9% (n = 5). Thirty-five pathogens (56%) were MDR; this included methicillin-resistant S. aureus (MRSA) (n = 7; 11%), carbapenem-resistant A. baumannii (n = 16; 25%), and P. aeruginosa (n = 6; 10%). The median time to the first positive blood culture was 5 days (IQR: 3-12) (gram positive organisms: median: 5 days [IQR: 3-15}); gram negative organisms: median: 8 days [IQR: 4-20]; Fungal: median: 9 days [IQR: 8-27]; p-value 0.37). In the first week, S. aureus caused 32% of infections, including five MRSA cases. Gram negative bacteria dominated weeks two and three, with fungal and polymicrobial infections mainly in weeks two and four. CONCLUSION Our findings show that as gram positive and gram negative infections predominantly occurred early in the admission period, while polymicrobial infections are more frequently observed later. Consequently, initial targeted narrow-spectrum antimicrobial use is not possible. Instead, antimicrobial de-escalation should be prioritized once culture results are available. Efforts should shift from a focus on treating BSIs to preventing them through wound care and infection control measures. Broad-spectrum antibiotics should be used judiciously and quickly de-escalated to minimise antimicrobial resistance development.
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Affiliation(s)
- Michael Christie
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria, South Africa.
| | - Theunis Avenant
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria, South Africa
| | - Masindi Nembudani
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria, South Africa
| | - Anelisa Mnqandi
- Department of Paediatric Surgery, Faculty of Health Sciences, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Chris Muller
- Department of Statistics and Actuarial Science, Faculty of Economic and Management Sciences, University of Stellenbosch, Stellenbosch, South Africa
| | - Mariza de Villiers
- Department of Paediatric Surgery, Faculty of Health Sciences, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Zeenat Bhikhoo
- Department of Paediatric Surgery, Faculty of Health Sciences, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
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Zhang Q, Huo Y, Li C, Sun Q, Xi X, Sun R, Sun Q, Jiang M, Li G. Antibiotic lock therapy for the treatment of peripherally inserted central venous catheter-related bloodstream infection in patients with hematological malignancies: a single center retrospective study. Ann Hematol 2025; 104:1975-1984. [PMID: 39998671 PMCID: PMC12031872 DOI: 10.1007/s00277-025-06263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Accepted: 02/14/2025] [Indexed: 02/27/2025]
Abstract
Catheter-related bloodstream infections represent one of the most prevalent complications in patients with peripherally inserted central venous catheters (PICCs). The application of antibiotic lock therapy (ALT), particularly in patients with hematological malignancies, has not been well documented. We aim to share our experience on ALT for these patients and to evaluate its effectiveness and safety. All cases of patients with hematological malignancies who had PICC from January 2018 to October 2024 were retrospectively reviewed. Microbiologic data of PICC-related bloodstream infections (PRBSIs) were collected. A comparison was made between patients managed with ALT and those without it. Factors affecting PICC removal were also explored. A total of 45 patients experienced 67 episodes of PRBSIs, yielding an incidence rate of 2.98 per 1,000 PICC days. The median time of PRBSI onset was 42 days. Predominant pathogens included Gram-negative bacilli (49.3%) and Gram-positive cocci (35.8%). The catheter salvage rate was significantly higher at 76.5% when ALT was combined with systemic antibiotic therapy (SAT), compared to 51.5% for SAT alone (p = 0.033). 3 death events (3/34) compared with 4 death events (4/33) occurred in each therapeutic regimen (p = 0.709). Elevated procalcitonin levels (> 2ng/ml) and inadequate empirical therapy were risk factors for PICC removal; conversely, ALT served as a protective factor against it. ALT in combination with systemic antibiotics is a safe and effective approach for managing PRBSIs in patients with hematological malignancies, helping to avoid unnecessary catheter removal and could be considered in clinical practice when catheter retention is desired.
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Affiliation(s)
- Qin Zhang
- Department of Hematology, No.971 Hospital of People's Liberation Army Navy, No.22 Minjiang Road, Qingdao, Shandong, 266000, China
| | - Yujia Huo
- Department of Traditional Chinese Medicine, Qingdao Special Service Sanatorium of People's Liberation Army Navy, No.1 Taipingjiao Sixth Road, Qingdao, Shandong, 266000, China
| | - Chengfei Li
- Out-patient Department of the Second Recuperation Area, Qingdao Special Service Sanatorium of People's Liberation Army Navy, No.1 Taipingjiao Sixth Road, Qingdao, Shandong, 266000, China
| | - Qinggang Sun
- Department of Hematology, No.971 Hospital of People's Liberation Army Navy, No.22 Minjiang Road, Qingdao, Shandong, 266000, China
| | - Xi Xi
- Department of Hematology, No.971 Hospital of People's Liberation Army Navy, No.22 Minjiang Road, Qingdao, Shandong, 266000, China
| | - Rui Sun
- Department of Hematology, No.971 Hospital of People's Liberation Army Navy, No.22 Minjiang Road, Qingdao, Shandong, 266000, China
| | - Qingju Sun
- Department of Clinical Laboratory, No.971 Hospital of People's Liberation Army Navy, No.22 Minjiang Road, Qingdao, Shandong, 266000, China
| | - Meijuan Jiang
- Department of Clinical Laboratory, No.971 Hospital of People's Liberation Army Navy, No.22 Minjiang Road, Qingdao, Shandong, 266000, China
| | - Guang Li
- Department of Hematology, No.971 Hospital of People's Liberation Army Navy, No.22 Minjiang Road, Qingdao, Shandong, 266000, China.
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Zhang Q, Li H, Chen L, Mu X, Li J. Establishment of a risk prediction model for peripherally inserted central catheter-related bloodstream infections based on a systematic review and meta-analysis of 20 cohorts. Worldviews Evid Based Nurs 2025; 22:e12762. [PMID: 39702882 DOI: 10.1111/wvn.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 10/23/2024] [Accepted: 11/26/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are commonly used for extended intravenous therapy but are associated with a significant risk of bloodstream infections (BSIs), which increase morbidity and healthcare costs. AIM The aim of this study was to identify patients at high risk of developing PICC-related bloodstream infections (PICC-RBSIs) to establish new and more specific targets for precise prevention and intervention. METHODS A search was conducted from the earliest available record to May 2024 among the following databases: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus, and Chinese National Knowledge Infrastructure (CNKI). Hand searching for gray literature and reference lists of included papers was also performed. We assessed the quality of the studies using the Newcastle-Ottawa Scale (NOS) checklist. Two reviewers screened all the retrieved articles, extracted the data, and critically appraised the studies. Data analysis was performed using RevMan statistical software. RESULTS A total of 20 cohort studies involving 51,907 individuals were included in the analysis. The statistically significant risk factors identified were hospital length of stay, line type (tunneled), history of PICC placement, multiple lumens, previous infections, chemotherapy, total parenteral nutrition, hematological cancers, delays in catheter care, local signs of infection (e.g., localized rashes), previous BSIs, and diabetes mellitus. Due to high heterogeneity among studies regarding previous BSIs, this factor was excluded from the final predictive model, while all other risk factors were included. CONCLUSIONS The present meta-analysis identified risk factors for PICC-RBSIs and developed a predictive model based on these findings, incorporating 10 risk factors that integrate both patient-specific and procedural factors. LINKING EVIDENCE TO ACTION Integrating the risk prediction model for PICC-RBSI into clinical guidelines and training is essential. Healthcare providers should be trained to use this model to identify high-risk patients and implement preventive measures proactively. This integration could enhance personalized care, reduce infection incidence, and improve patient outcomes. Future research should update the model with new risk factors and validate its effectiveness in diverse clinical settings.
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Affiliation(s)
- Qian Zhang
- Lung Cancer Center, West China Hospital, Sichuan University West China School of Nursing, Sichuan University, Chengdu, China
| | - Hongjuan Li
- Lung Cancer Center, West China Hospital, Sichuan University West China School of Nursing, Sichuan University, Chengdu, China
| | - Lin Chen
- Lung Cancer Center, West China Hospital, Sichuan University West China School of Nursing, Sichuan University, Chengdu, China
| | - Xinping Mu
- Department of Thoracic Oncology, West China Hospital, Sichuan University West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Junying Li
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
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Mukhopadhyay S, Kaufman DA, Saha S, Puopolo KM, Flannery DD, Weimer KED, Greenberg RG, Sanchez PJ, Eichenwald EC, Cotten CM, Stoll BJ, Laptook A. Late-Onset Sepsis Among Extremely Preterm Infants During the COVID-19 Pandemic. Pediatrics 2025; 155:e2024067675. [PMID: 39842471 PMCID: PMC11908436 DOI: 10.1542/peds.2024-067675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 11/21/2024] [Indexed: 01/24/2025] Open
Abstract
OBJECTIVES To compare incidence of late-onset sepsis (LOS) among extremely preterm infants before and during the COVID-19 pandemic. METHODS Multicenter cohort study of infants with birthweight 401 to 1000 g or gestational age 22 to 28 weeks. LOS was defined as a bacterial or fungal pathogen isolated from blood or cerebrospinal fluid culture obtained after 72 hours of age. Primary outcome was LOS incidence calculated as incidence proportion (LOS cases among all admissions) and incidence rate (LOS events/1000 patient days). A multivariable Poisson regression model was used to compare the adjusted risk of LOS incidence proportion before (1/1/18-3/31/20) and during the pandemic (4/1/20-12/31/21). An interrupted time series analysis using a generalized linear mixed model with center as a random effect was used to compare LOS incidence rates during the 2 periods. RESULTS Among 6509 eligible infants, LOS incidence proportion was not different before (18.2%) and during the pandemic (16.9%; P = .18). The adjusted relative risk (95% CI) for LOS was 0.93 (0.82-1.05) and for LOS or mortality was 0.98 (0.88-1.08) during the pandemic compared to the period before the pandemic. In the interrupted time series analysis, there was no significant change in LOS incidence rates at the start of the pandemic (0.219, 95% CI, -0.453 to 0.891) or microbiology of LOS, and change in trends of LOS incidence rates before and during the pandemic was not significant (-0.005, 95% CI, -0.025 to 0.015). CONCLUSIONS In a large multicenter study of extremely preterm infants, rates of LOS remained unchanged during the pandemic.
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Affiliation(s)
- Sagori Mukhopadhyay
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA
- Clinical Futures, CHOP Research Institute,
Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Shampa Saha
- Social, Statistical and Environmental Sciences Unit, RTI
International, Research Triangle Park, NC
| | - Karen M. Puopolo
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA
- Clinical Futures, CHOP Research Institute,
Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Dustin D. Flannery
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA
- Clinical Futures, CHOP Research Institute,
Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Pablo J. Sanchez
- Department of Pediatrics, Nationwide Children’s
Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Eric C. Eichenwald
- Division of Neonatology, Children’s Hospital of
Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA
| | | | | | - Abbot Laptook
- Department of Pediatrics, The Warren Alpert Medical School,
Brown University
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Zmejkoski DZ, Zdravković NM, Mitić DD, Marković ZM, Budimir Filimonović MD, Milivojević DD, Todorović Marković BM. Graphene Quantum Dots in Bacterial Cellulose Hydrogels for Visible Light-Activated Antibiofilm and Angiogenesis in Infection Management. Int J Mol Sci 2025; 26:1053. [PMID: 39940819 PMCID: PMC11816408 DOI: 10.3390/ijms26031053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Revised: 01/22/2025] [Accepted: 01/23/2025] [Indexed: 02/16/2025] Open
Abstract
A novel bacterial cellulose (BC)-based composite hydrogel with graphene quantum dots (BC-GQDs) was developed for photodynamic therapy using blue and green light (BC-GQD_blue and BC-GQD_green) to target pathogenic bacterial biofilms. This approach aims to address complications in treating nosocomial infections and combating multi-drug-resistant organisms. Short-term illumination (30 min) of both BC-GQD samples led to singlet oxygen production and a reduction in pathogenic biofilms. Significant antibiofilm activity (>50% reduction) was achieved against Staphylococcus aureus and Escherichia coli with BC-GQD_green, and against Pseudomonas aeruginosa with BC-GQD_blue. Atomic force microscopy images revealed a substantial decrease in biofilm mass, accompanied by changes in surface roughness and area, further confirming the antibiofilm efficacy of BC-GQDs under blue and green light, without any observed chemical alterations. Additionally, the biocompatibility of BC-GQDs was demonstrated with human gingival fibroblasts (HGFs). For the first time, in vitro studies explored the visible light-induced potential of BC-GQD composites to promote wound healing processes, showing increased migratory potential and the upregulation of eNOS and MMP9 gene expressions in HGFs. Chemical characterization revealed a 70 nm upshift in the photoluminescence emission spectra compared to the excitation wavelength. These novel photoactive BC-GQD hydrogel composites show great promise as effective agents for wound healing regeneration and infection management.
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Affiliation(s)
- Danica Z. Zmejkoski
- Vinča Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, P.O. Box 522, 11001 Belgrade, Serbia; (Z.M.M.); (M.D.B.F.); (D.D.M.)
| | - Nemanja M. Zdravković
- Scientific Institute of Veterinary Medicine of Serbia, Janisa Janulisa 14, 11107 Belgrade, Serbia;
| | - Dijana D. Mitić
- Faculty of Dental Medicine, University of Belgrade, Dr. Subotića 8, 11000 Belgrade, Serbia;
| | - Zoran M. Marković
- Vinča Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, P.O. Box 522, 11001 Belgrade, Serbia; (Z.M.M.); (M.D.B.F.); (D.D.M.)
| | - Milica D. Budimir Filimonović
- Vinča Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, P.O. Box 522, 11001 Belgrade, Serbia; (Z.M.M.); (M.D.B.F.); (D.D.M.)
| | - Dušan D. Milivojević
- Vinča Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, P.O. Box 522, 11001 Belgrade, Serbia; (Z.M.M.); (M.D.B.F.); (D.D.M.)
| | - Biljana M. Todorović Marković
- Vinča Institute of Nuclear Sciences—National Institute of the Republic of Serbia, University of Belgrade, P.O. Box 522, 11001 Belgrade, Serbia; (Z.M.M.); (M.D.B.F.); (D.D.M.)
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11
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Mathur P, Naylor AJ, Auron M, Beresian J, Tallman A, Griffith A, Seasholtz K, Manlapaz M, Zacharyasz K, Khatib R, Mishra S, Haller K, Fraser T, Holman K. Evaluating the Adequacy of Central Line-Associated Bloodstream Infection As a Quality Measure: A Cross-Sectional Analysis at a Single Tertiary Care Center. Crit Care Explor 2025; 7:e1205. [PMID: 39830835 PMCID: PMC11741216 DOI: 10.1097/cce.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2025] Open
Abstract
IMPORTANCE The current definition of central line-associated bloodstream infection (CLABSI) may overestimate the true incidence of CLABSI as it is often unclear whether the bloodstream infection (BSI) is secondary to the central line or due to another infectious source. OBJECTIVES We aimed to assess the prevalence and outcomes of central CLABSI at our institution, to identify opportunities for improvement, appropriately direct efforts for infection reduction, and identify gaps in the CLABSI definition and its application as a quality measure. DESIGN SETTING AND PARTICIPANTS Retrospective cross-sectional study of patients identified to have a CLABSI in the period 2018-2022 cared for at the value-based purchasing (VBP) units of a 1200-bed tertiary care hospital located in Cleveland, OH. Each CLABSI episode was assessed for relationship with central venous catheter (CVC), suspected secondary source of BSI, mortality associated with the CLABSI hospital encounter, and availability of infectious disease physician or primary physician documentation of infectious source. MAIN OUTCOMES AND MEASURES CLABSI episodes were classified as CVC related, CVC unrelated, and CVC relationship unclear. Mortality during the same encounter as the CLABSI event was assessed as an outcome measure. Descriptive statistics were performed. RESULTS A total of 340 CLABSI episodes occurred in adult patients in VBP units. Majority of the CLABSI, 77.5% (266), occurred in the ICU. Of the CLABSI analyzed, 31.5% (107) were classified as unrelated to the CVC; 25.0% (85) had an unclear source; 43% (148) were classified as CVC related. For CVC-related cases, Staphylococcus and Candida were the predominant organisms. For the CVC unrelated and unclear groups Enterococcus was most prevalent. The mortality rate was lowest among patients classified with a CVC-related BSI. The positive predictive value (PPV) of the Centers for Disease Control and Prevention CLABSI definition to predict a true CVC-related infection was found to be 58.0%. CONCLUSIONS AND RELEVANCE The definition of CLABSI as a surrogate for catheter-related BSI is inadequate, with a PPV of 58.0% (43.1-67.6%). Efforts should be redirected toward revising the CLABSI definition and possibly reevaluating its criteria. Resources should be assigned to further investigate and systematically prevent BSIs from secondary sources while adhering to existing CLABSI prevention bundles.
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Affiliation(s)
- Piyush Mathur
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Amanda J. Naylor
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH
- Outcomes Research Consortium, Houston, TX
| | - Moises Auron
- Outcomes Research Consortium, Houston, TX
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH
| | - Jean Beresian
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH
| | | | | | | | - Mariel Manlapaz
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH
| | | | - Reem Khatib
- Department of Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Shreya Mishra
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Kathryn Haller
- Department of Orthopedics, Cleveland Clinic, Cleveland, OH
| | - Thomas Fraser
- Department of Infectious Disease, Cleveland Clinic, Cleveland, OH
| | - Katherine Holman
- Department of Infectious Disease, Cleveland Clinic, Cleveland, OH
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Raurell-Torredà M, Zaragoza-García I, Arrogante O, Aliberch-Raurell AM, Sánchez-Chillón FJ, Torralba-Melero M, Rojo-Rojo A, Muriel-García A, Amaya Arias AC, Roldán-Merino J, Farrés-Tarafa M. Interrater reliability and agreement of the NEUMOBACT checklist about infection-prevention performance of intensive care nurses in simulation-based scenarios. PLoS One 2024; 19:e0313175. [PMID: 39739706 DOI: 10.1371/journal.pone.0313175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 10/18/2024] [Indexed: 01/02/2025] Open
Abstract
OBJECTIVE To analyse the interrater reliability of the NEUMOBACT checklist and verify whether consistent results are reproducible. METHODS A validation study with a cross-sectional design, compliant with the GRRAS checklist, among ICU nurses attending a SIMULAZERO course with an Objective Structured Clinical Evaluation simulation format, to verify transfer from theory to clinical practice of knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention. A minimum sample size of 111 pairs of nurse raters was calculated. Interrater agreement was analysed using Gwet's AC1 for each item and as a total for each of the three checklists in the NEUMOBACT instrument. RESULTS A total of 95 pairs of valid NEUMOBACT checklists were completed by 190 raters with a median age of 29 [25-35] years, 93.7% were female. At the Central Venous Catheter insertion station, Gwet's AC1 was 0.934 (95% CI [0.919-0.949]). Only 2 of the 17 items scored below 0.9. At the Endotracheal Suctioning station, Gwet's AC1 was 0.869 (95% CI [0.851-0.886]). Of the 26 items that made up this station, 16 had an agreement percentage above 0.9, a further 9 were between 0.821 and 0.884, and item 13 had a value of 0.789. At the Patient Care station, Gwet's AC1 was 0.911 (95% CI [0.896-0.927]). Of the 21 items, 17 showed an agreement percentage above 0.9 and 4 were between 0.810 and 0.894. CONCLUSIONS The interrater reliability of the NEUMOBACT checklist shows substantial agreement between pairs of raters and is therefore validated in this large sample of ICU nurses. RELEVANCE TO CLINICAL PRACTICE The NEUMOBACT checklist can be useful for assessing skills before and after training in VAP and CRB prevention measures and during debriefing (post-simulation feedback), to reinforce the scientific evidence behind actions and decisions for items that have been performed incorrectly, thus consolidating training already received.
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Affiliation(s)
- Marta Raurell-Torredà
- Department of Fundamental and Clinical Care Nursing, Hospitalet del Llobregat, Universitat de Barcelona, Campus de Bellvitge, Barcelona, Spain
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Mental Health, Psychosocial and Complex Nursing Care Research Group-2021 SGR 01083, Spain
| | - Ignacio Zaragoza-García
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense Madrid, Madrid, Spain
- Care Research Group (Invecuid), 12 de Octubre Hospital Institute of Health Research (imas12), Madrid, Spain
| | - Oscar Arrogante
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense Madrid, Madrid, Spain
- Research Nursing Group of Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Anna María Aliberch-Raurell
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Department of Critical Care, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Francisco Javier Sánchez-Chillón
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Simulation Centre, Hospital 12 de Octubre, Madrid, Spain
| | - Martín Torralba-Melero
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Department of Critical Care, Hospital General Universitario de Albacete, Albacete, Spain
| | - Andrés Rojo-Rojo
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
- Department of Nursing, Universidad Católica de Murcia, Campus de los Jerónimos, Guadalupe, Murcia, Spain
| | - Alfonso Muriel-García
- Biostatistics Unit, Department of Nursing and Physiotherapy, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Universidad de Alcalá, Madrid, Spain
| | - Ana Carolina Amaya Arias
- Division of Non-Communicable Diseases, Ministry of Health and Social Protection, Bogotá, Colombia
| | - Juan Roldán-Merino
- Mental Health, Psychosocial and Complex Nursing Care Research Group-2021 SGR 01083, Spain
- Department of Nursing, Sant Joan de Déu Teaching Campus, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Mariona Farrés-Tarafa
- Department of Fundamental and Clinical Care Nursing, Hospitalet del Llobregat, Universitat de Barcelona, Campus de Bellvitge, Barcelona, Spain
- Simulation Group of the Spanish Society for Intensive Care and Coronary Unit Nursing (SEEIUC), Madrid, Spain
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13
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Boulet N, Pensier J, Occean BV, Peray PF, Mimoz O, Rickard CM, Buetti N, Lefrant JY, Muller L, Roger C. Central venous catheter-related infections: a systematic review, meta-analysis, trial sequential analysis and meta-regression comparing ultrasound guidance and landmark technique for insertion. Crit Care 2024; 28:378. [PMID: 39563416 PMCID: PMC11577744 DOI: 10.1186/s13054-024-05162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 11/06/2024] [Indexed: 11/21/2024] Open
Abstract
BACKGROUND During central venous catheterization (CVC), ultrasound (US) guidance has been shown to reduce mechanical complications and increase success rates compared to the anatomical landmark (AL) technique. However, the impact of US guidance on catheter-related infections remains controversial. This systematic review and meta-analysis aimed to compare the risk of catheter-related infection with US-guided CVC versus AL technique. METHODS A systematic search on MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases was conducted until July 31, 2024. Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSI) comparing US-guided versus AL-guided CVC placement were included. The primary outcome was a composite outcome including all types of catheter-related infection: catheter-related bloodstream infections (CRBSIs), central line-associated bloodstream infections (CLABSIs), catheter colonization, or any other type of reported infection. The secondary outcomes included individual infection types and mortality at day-28. Subgroup analyses based on study type and operator experience were also performed. RESULTS Pooling twelve studies (8 RCTs and 4 NRSI), with a total of 5,092 CVC procedures (2072 US-guided and 3020 AL-guided), US-guided CVC was associated with a significant reduction in catheter-related infections compared with the AL technique (risk ratio (RR) = 0.68, 95% confidence interval (CI) 0.53-0.88). In the RCT subgroup, the pooled RR was 0.65 (95% CI 0.49-0.87). This effect was more pronounced in procedures performed by experienced operators (RR = 0.60, 95% CI 0.41-0.89). In inexperienced operators, the infection risk reduction was not statistically significant. The pooled analysis of CRBSIs and CLABSIs also favored US guidance (RR = 0.65, 95% CI 0.48-0.87). CONCLUSION US-guided CVC placement significantly reduces the risk of catheter-related infections compared to the AL technique, particularly when performed by experienced operators. Trial registration PROSPERO CRD42022350884. Registered 13 August 2022.
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Affiliation(s)
- Nicolas Boulet
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Joris Pensier
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, Montpellier, France
| | - Bob-Valéry Occean
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, Univ Montpellier, Nimes, France
| | - Pascale Fabbro Peray
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, Univ Montpellier, Nimes, France
| | - Olivier Mimoz
- INSERM U1070, Université de Poitiers, and Service des Urgences Adultes & SAMU 86, CHU de Poitiers, Poitiers, France
| | - Claire M Rickard
- Metro North Health and The University of Queensland, Brisbane, Australia
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland
- Infection Antimicrobials Modeling Evolution (IAME) U 1137, INSERM, Université Paris-Cité, Paris, France
| | - Jean-Yves Lefrant
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Laurent Muller
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
| | - Claire Roger
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France
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14
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Cosme V, Massart N, Reizine F, Machut A, Vacheron CH, Savey A, Friggeri A, Lepape A. Central venous catheter-related infection: does insertion site still matter? A French multicentric cohort study. Intensive Care Med 2024; 50:1830-1840. [PMID: 39287649 DOI: 10.1007/s00134-024-07615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE We aim to evaluate the association between central venous catheter (CVC) insertion site and microbiological CVC complications in a nationwide cohort. METHODS This study was conducted using the healthcare-associated infection surveillance cohort "REA-REZO" involving 193 intensive care units (ICUs). All CVC inserted and removed during the same ICU stay between January 1st 2018 and December 31st 2022 were eligible but only those whose tips were sent for microbiological analysis were included. Primary objective was to describe CVC insertion sites and subsequent catheter-related bloodstream infection (CRBSI). RESULTS Out of 126,997 CVCs, 71,314 were not sent for tip culture, and only 55,663 CVCs were included, (30,548 in internal jugular [IJ], 14,423 in femoral and 10,692 in subclavian [SC] sites). The incidence of CRBSI was 0.7 [0.6-0.8] in the IJ site, 0.7 [0.6-0.9] in the femoral site, and 0.6 [0.4-0.7] CRBSI per 1000 CVC days in the SC site (p = 0.248). The multivariable Poisson regression model showed no differences of CRBSI incidence rates between the three insertion sites. Microorganisms observed in CRBSI were coagulase-negative Staphylococci (27.9%), Enterobacterales (27.5%), non-fermenting Gram-negative Bacilli (10.4%), Candida sp. (16.9%), and Staphylococcus aureus (16.9%). CONCLUSION Low CRBSI incidence rates were reported. CRBSI incidences rates were similar in the three insertion sites. Uncertainty remains due to potential selection bias since many CVCs had to be excluded.
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Affiliation(s)
- Vincent Cosme
- Service de Réanimation Polyvalente, Centre Hospitalier de Saint Brieuc, Saint-Brieuc, France
| | - Nicolas Massart
- Service de Réanimation Polyvalente, Centre Hospitalier de Saint Brieuc, Saint-Brieuc, France.
| | - Florian Reizine
- Service de Réanimation Polyvalente, Centre Hospitalier de Vannes, Vannes, France
| | - Anaïs Machut
- REA-REZO Infections et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
| | - Charles-Hervé Vacheron
- REA-REZO Infections et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- Département d'Anesthésie Médecine Intensive Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Anne Savey
- REA-REZO Infections et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Arnaud Friggeri
- REA-REZO Infections et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- Département d'Anesthésie Médecine Intensive Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Alain Lepape
- REA-REZO Infections et Antibiorésistance en Réanimation, Hôpital Henry Gabrielle, Saint-Genis-Laval, France
- Département d'Anesthésie Médecine Intensive Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- PHE3ID, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, CNRS Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
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15
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Kim J, Keum H, Albadawi H, Zhang Z, Graf EH, Cevik E, Oklu R. Multi-Functional Biomaterial for the Treatment and Prevention of Central Line-Associated Bloodstream Infections. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2405805. [PMID: 39148150 PMCID: PMC11567798 DOI: 10.1002/adma.202405805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/01/2024] [Indexed: 08/17/2024]
Abstract
Central venous catheters are among the most used medical devices in hospitals today. Despite advances in modern medicine, catheter infections remain prevalent, causing significant morbidity and mortality worldwide. Here, SteriGel is reported, which is a multifunctional hydrogel engineered to prevent and treat central line-associated bloodstream infections (CLABSI). The mechanical properties of SteriGel are optimized to ensure appropriate gelation kinetics, bio-adhesiveness, stretchability, and recoverability to promote durability upon application and to provide persistent protection against infection. In vitro assays demonstrated that SteriGel exhibits long-term antimicrobial efficacy and has bactericidal effects against highly resistant patient-derived pathogens known to be frequently associated with CLABSI. SteriGel outperformed Biopatch, which is a clinically used device for CLABSI, in ex vivo cadaver studies that simulate clinical scenarios. Furthermore, SteriGel has biocompatible, pro-healing, and anti-inflammatory properties in vitro and in a rat subcutaneous injection model, suggesting a potential synergistic effect in the prevention and treatment of CLABSI. SteriGel is a multifunctional adherent biomaterial with potent antimicrobial effects for sustained sterility while promoting healing of the catheter incision site to protect against infection.
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Affiliation(s)
- Jinjoo Kim
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Hyeongseop Keum
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Hassan Albadawi
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Zefu Zhang
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Erin H. Graf
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, Arizona 85054, USA
| | - Enes Cevik
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Rahmi Oklu
- The Laboratory for Patient-Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
- Division of Vascular & Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, Arizona 85054, USA
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16
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de Grooth HJ, Hagel S, Mimoz O. Central venous catheter insertion site and infection prevention in 2024. Intensive Care Med 2024; 50:1897-1899. [PMID: 39347806 DOI: 10.1007/s00134-024-07664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024]
Affiliation(s)
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
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17
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Shan A, Santos-Sebastián M, Saavedra-Lozano J. Lock Therapy for Treatment and Prevention of Catheter-related Infections. Pediatr Infect Dis J 2024; 43:e358-e362. [PMID: 38986007 DOI: 10.1097/inf.0000000000004457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Affiliation(s)
- Adriana Shan
- From the Sección de Enfermedades Infecciosas Pediátricas, Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Mar Santos-Sebastián
- Sección de Enfermedades Infecciosas Pediátricas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERINFEC, Madrid, Spain
| | - Jesús Saavedra-Lozano
- Seccón de Enfermedades Infecciosas Pediátricas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERINFEC, Universidad Complutense de Madrid, Madrid, Spain
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18
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Pinelli F, Pittiruti M, Annetta MG, Barbani F, Bertoglio S, Biasucci DG, Bolis D, Brescia F, Capozzoli G, D'Arrigo S, Deganello E, Elli S, Fabiani A, Fabiani F, Gidaro A, Giustivi D, Iacobone E, La Greca A, Longo F, Lucchini A, Marche B, Romagnoli S, Scoppettuolo G, Selmi V, Vailati D, Villa G, Pepe G. A GAVeCeLT consensus on the indication, insertion, and management of central venous access devices in the critically ill. J Vasc Access 2024:11297298241262932. [PMID: 39097780 DOI: 10.1177/11297298241262932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024] Open
Abstract
Central venous access devices are essential for the management of critically ill patients, but they are potentially associated with many complications, which may occur during or after insertion. Many evidence-based documents-consensus and guidelines-suggest practical recommendations for reducing catheter-related complications, but they have some limitations. Some documents are not focused on critically ill patients; other documents address only some special strategies, such as the use of ultrasound; other documents are biased by obsolete concepts, inappropriate terminology, and lack of considerations for new technologies and new methods. Thus, the Italian Group of Venous Access Devices (GAVeCeLT) has decided to offer an updated compendium of the main strategies-old and new-that should be adopted for minimizing catheter-related complications in the adult critically ill patient. The project has been planned as a consensus, rather than a guideline, since many issues in this field are relatively recent, and few high-quality randomized clinical studies are currently available, particularly in the area of indications and choice of the device. Panelists were chosen between the Italian vascular access experts who had published papers on peer-reviewed journals about this topic in the last few years. The consensus process was carried out according to the RAND/University of California at Los Angeles (UCLA) Appropriateness Methodology, a modification of the Delphi method, that is, a structured process for collecting knowledge from groups of experts through a series of questionnaires. The final document has been structured as statements which answer to four major sets of questions regarding central venous access in the critically ill: (1) before insertion (seven questions), (2) during insertion (eight questions), (3) after insertion (three questions), and (4) at removal (three questions).
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Affiliation(s)
- Fulvio Pinelli
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | - Mauro Pittiruti
- Department of Surgery, Policlinico Universitario "A.Gemelli," Rome, Italy
| | | | - Francesco Barbani
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | | | - Daniele G Biasucci
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University, Rome, Italy
| | - Denise Bolis
- Intensive Care Unit, Hospital "A.Manzoni," Lecco, Italy
| | - Fabrizio Brescia
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Giuseppe Capozzoli
- Department of Anesthesiology, Hospital of Bolzano, Lehr-Krankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
| | - Sonia D'Arrigo
- Department of Anesthesia and Intensive Care, Policlinico Universitario "A.Gemelli," Rome, Italy
| | - Elisa Deganello
- Anaesthesia and Intensive Care, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Stefano Elli
- Vascular Access Team, Fondazione "San Gerardo dei Tintori," Monza, Italy
| | - Adam Fabiani
- Cardiac Surgery Intensive Care Unit, Vascular Access Team, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Fabio Fabiani
- Unit of Anesthesia and Intensive Care Medicine, Vascular Access Team, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences, University of Milan, "Luigi Sacco" Hospital, Milan, Italy
| | - Davide Giustivi
- Post-Anesthesia Care Unit and Vascular Access Team, Lodi, Italy
| | - Emanuele Iacobone
- Anesthesia and Intensive Care, Hospital of Macerata, Macerata, Italy
| | - Antonio La Greca
- Department of Surgery, Policlinico Universitario "A.Gemelli," Rome, Italy
| | | | - Alberto Lucchini
- Adult and Pediatric Intensive Care Unit, Fondazione "San Gerardo dei Tintori," Monza, Italy
| | - Bruno Marche
- Department of Hematology, Policlinico Universitario "A.Gemelli," Rome, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | | | - Valentina Selmi
- Vascular Access Team, Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | - Davide Vailati
- Department of Anesthesia and Intensive Care, Melegnano Hospital, Milano, Italy
| | - Gianluca Villa
- Department of Anesthesia and Critical Care, University of Florence, "Careggi" Hospital, Florence, Italy
| | - Gilda Pepe
- Department of Surgery, Policlinico Universitario "A.Gemelli," Rome, Italy
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19
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Ryder M, Battle J. Choice of needleless connector technology as a risk reduction strategy for catheter related bloodstream infection, mortality, and cost: A secondary data analysis. J Vasc Access 2024:11297298241261951. [PMID: 39097791 DOI: 10.1177/11297298241261951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024] Open
Abstract
OBJECTIVE To compare relative risk (RR) of central line-associated bloodstream infection (CLABSI) between hospitals using Clave needleless connector technologies (NCT) and comparator hospitals using non-Clave NCT. And, to estimate avoided CLABSIs, mortality, and cost savings. BACKGROUND Needleless connectors, while protective against needlestick injury, have long been implicated as a potential risk for CLABSI. Significant RR reduction of CLABSI among the many NCT has not been clinically demonstrated. METHODS The U.S. Healthcare-Associated Infections database was accessed for CLABSI data for calendar year 2019 via the Centers for Medicare and Medicaid Services website. This dataset was merged with the Clave NCT manufacturer's 2019 database to identify hospitals purchasing Clave NCT (MicroClave™, NanoClave™, Clave Neutron™, Clave™, Microclave™ Clear) and non-Clave NCT comparator hospitals. Sub-analysis of Clave NCT hospitals included: (1) Clave NCT mixed-use and (2) Clave high-volume use hospitals. The standardized infection ratio (SIR) was generated to estimate CLABSI RR after adjusting for intern/resident-to-bed-ratio (IRB), care location, and hospital demographics. Using the RR, avoided CLABSIs, mortality, and cost savings were calculated. RESULTS A total of 2987 eligible hospitals (1288 Clave NCT, 1699 non-Clave NCT) with 17,452,575 central line-days were evaluated. All three Clave NCT hospital groups showed a statistically significant reduction in RR compared to the non-Clave NCT hospitals. The RR in Clave NCT hospitals was 0.93, a 7% decrease in CLABSI risk (p = 0.02). In the Clave NCT subgroups, mixed-use hospitals RR was 0.93, a 7% reduction (p = 0.04), while the Clave NCT high-volume hospitals experienced a 19% reduction, RR 0.81 (p = 0.04). An estimated 563 CLABSIs and 84 related deaths were avoided with use of Clave NCT and $27,095,231 in cost savings. CONCLUSION The use of the Clave NCT, in and of itself, is an effective risk reduction strategy for CLABSI prevention, reduced mortality, and substantial cost savings.
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20
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Roche S. Long-term intravenous devices: a narrative review of their placement. Curr Opin Anaesthesiol 2024; 37:400-405. [PMID: 38841917 DOI: 10.1097/aco.0000000000001387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW This review summarizes the latest findings and recommendations about the characteristics, indications and use of peripheral and central long-term venous access devices.The various complications inherent in these devices are becoming better known, and their contributing factors determined, which could make it possible to reduce their incidence. RECENT FINDINGS Some measures are integrated into recommendations for good practice, such as appropriate selection of devices, the preferential use of the thinnest catheters, and cyanoacrylate glue and dressings impregnated with chlorhexidine. SUMMARY Improving understanding of the phenomena leading to infectious and thrombotic complications, as well as better knowing the differences between intravenous devices and their respective indications, should lead to improvement of in-hospital and out-of-hospital care.
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Affiliation(s)
- Sabine Roche
- Department of anesthesia and resuscitation, hospital Pitié-Salpêtrière, Paris, France
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21
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Zang F, Liu J, Wen Y, Jin X, Yang Y, Li L, Di J, Tang H, Wu J, Liu J, Liu H, Huang J, Zhang J, Li S, Yang L, Wang X, Geng S, Xing H, Xie J, Hua J, Xue X, Zhao Y, Ouyang L, Song P, Zhuang G, Chen W. Adherence to guidelines and central-line-associated bloodstream infection occurrence during insertion and maintenance of intravascular catheters: evidence from 20 tertiary hospitals. J Hosp Infect 2024; 150:17-25. [PMID: 38838743 DOI: 10.1016/j.jhin.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE To investigate adherence to intravascular catheter (IVC) insertion and maintenance guidelines in Chinese tertiary hospitals. METHODS A cross-sectional questionnaire survey of adult inpatients with IVC placements was conducted from July to September 2022 in 20 tertiary hospitals in China. One clinical staff member from each department in each hospital was assigned to participate in the survey. Questionnaires were uniformly collected and reviewed after three months. RESULTS This study included 1815 cases (62.69%) of central venous catheter, 471 cases (16.27%) of peripherally inserted central catheter, 461 cases (15.92%) of PORT, and 147 cases (5.08%) of haemodialysis catheter insertions. Statistically significant differences in compliance were observed across the four IVC types, specifically in relation to the insertion checklist, standard operating procedure, and insertion environment (P<0.05). Practice adherence during IVC maintenance differed significantly across the four IVC types in aspects such as availability of IVC maintenance verification forms, daily scrubbing of the catheterized patients, and catheter connection methods (P<0.05). A total of 386 (13.34%) patients developed fever, 1086 (37.53%) were treated with therapeutic antibiotics, 16 (0.55%) developed central-line-associated bloodstream infections, two (0.07%) developed local skin infections, and six (0.21%) developed deep vein thrombosis. CONCLUSIONS Adherence to guidelines regarding insertion and maintenance differed across the four IVC types; there is a gap between the recommended measures and the actual operation of the guidelines. Therefore, it is necessary to further enhance training and develop checklists to prevent central-line-associated bloodstream infections.
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Affiliation(s)
- F Zang
- Department of Infection Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - J Liu
- Department of Infection Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Y Wen
- Department of Infection Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - X Jin
- Department of Infection Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Y Yang
- Department of Infection Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - L Li
- Department of Infection Management, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - J Di
- Department of Infection Management, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - H Tang
- Department of Infection Management, Qidong People's Hospital, Nantong, Jiangsu, China
| | - J Wu
- Department of Infection Management, Suqian First People's Hospital, Suqian, Jiangsu, China
| | - J Liu
- Department of Infection Management, Lianyungang First People's Hospital, Lianyungang, Jiangsu, China
| | - H Liu
- Department of Infection Management, Wuxi Second People's Hospital, Wuxi, Jiangsu, China
| | - J Huang
- Department of Infection Management, Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - J Zhang
- Department of Infection Management, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - S Li
- Department of Infection Management, Huaian First People's Hospital, Huaian, Jiangsu, China
| | - L Yang
- Department of Infection Management, Changzhou Second People's Hospital, Changzhou, Jiangsu, China
| | - X Wang
- Department of Infection Management, Zhenjiang First People's Hospital, Zhenjiang, Jiangsu, China
| | - S Geng
- Department of Infection Management, Nantong First People's Hospital, Nantong, Jiangsu, China
| | - H Xing
- Department of Infection Management, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - J Xie
- Department of Infection Management, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - J Hua
- Department of Infection Management, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - X Xue
- Department of Infection Management, Yancheng First People's Hospital, Yancheng, Jiangsu, China
| | - Y Zhao
- Department of Infection Management, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
| | - L Ouyang
- Department of Infection Management, Xuzhou First People's Hospital, Xuzhou, Jiangsu, China
| | - P Song
- Department of Infection Management, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - G Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiao tong University Health Science Center, Xi'an, Shaanxi, China
| | - W Chen
- Department of Infection Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiao tong University Health Science Center, Xi'an, Shaanxi, China.
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22
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Hoke LM, Mathen GC, Beckett E. Reducing Central Line-Associated Bloodstream Infections With a Multipronged Nurse-Driven Approach. Crit Care Nurse 2024; 44:27-36. [PMID: 39084669 DOI: 10.4037/ccn2024493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND Despite implementation of central catheter bundles, central line [catheter]-associated bloodstream infections (CLABSIs) remain a preventable hospital-acquired infection. LOCAL PROBLEM A new population of patients with pulmonary artery catheters was introduced to the cardiac progressive care unit, increasing central catheter days, device use, and CLABSI rate. METHODS A quality improvement project was conducted. Nursing staff implemented a standardized central catheter rounding process 3 days a week to critically assess all central catheter dressings, deter-mine the necessity of each central catheter, and educate patients on the importance of keeping central catheter dressings clean, dry, and intact. Data were collected during central catheter rounds for each patient, entered in an electronic survey tool via mobile devices, and analyzed. RESULTS From July 2019 through June 2022, a total of 2692 rounds were conducted for 707 individual patients with 3064 central catheters. Main interventions were dressing management, monitoring insertion site bleeding that extended beyond edges of the chlorhexidine gluconate pad, treating patients' allergies to products, and maintaining sustainability within the unit. Central catheter rounds decreased the CLABSI rate from 1.86 to 0.0 despite the continued increase in central catheter days. CONCLUSIONS Central catheter dressing assessment, intervention, and education help reduce CLABSIs. Central catheter rounds are an important adjunct to the CLABSI bundle. A central catheter dressing management algorithm helps nurses decide when to change a dressing and which type of dressing to use.
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Affiliation(s)
- Linda M Hoke
- Linda M. Hoke is a unit-based clinical nurse specialist and serves on the cardiac progressive care unit's nurse leadership team at the Hospital of the University of Pennsylvania, Philadelphia
| | - Gracy C Mathen
- Gracy C. Mathen is a nurse educator on the cardiac progressive care unit at the Hospital of the University of Pennsylvania
| | - Ellen Beckett
- Ellen Beckett is a clinical nurse on the cardiac progressive care unit at the Hospital of the University of Pennsylvania
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23
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Wales R, McCormick W, Matteo ABD, Del Pozo JL, Has P, Mermel LA. Impact of Catheter-Drawn Blood Cultures on Patient Management: A Multicenter, Retrospective Cohort Study. Open Forum Infect Dis 2024; 11:ofae339. [PMID: 38962523 PMCID: PMC11221777 DOI: 10.1093/ofid/ofae339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024] Open
Abstract
Background Nosocomial bloodstream infections associated with intravascular catheters pose significant financial burden, morbidity, and mortality. There is much debate about whether or not blood cultures should be drawn through central venous catheters, and while guidelines advocate for catheter-drawn cultures when catheter infection is suspected, there is variable practice in this regard. Methods We performed a retrospective cohort study assessing episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures in tertiary care hospitals in the United States and Spain. Results We identified 143 episodes in 122 patients meeting inclusion criteria. Thirty percent of such episodes revealed growth of potential pathogens such as Staphylococcus aureus. Overall, 21% of follow-up percutaneously-drawn blood cultures obtained within 48 hours revealed growth of the same microbe after an episode of positive catheter-drawn blood cultures with negative concomitant percutaneously-drawn cultures (33% when potential pathogens were isolated; 16% when common skin contaminants were isolated). Patients with cultures growing pathogenic organisms were more likely to receive targeted antimicrobial therapy and have their catheters removed sooner. Conclusions Many episodes of positive catheter-drawn blood cultures with concomitant negative percutaneously-drawn cultures lead to growth from percutaneously-drawn follow-up blood cultures. Thus, such initial discordant results should not be disregarded. Our findings advocate for a nuanced approach to blood culture interpretation, emphasizing the value of catheter-drawn blood cultures in clinical decision making and management.
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Affiliation(s)
- Rebecca Wales
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Winston McCormick
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Andrés Blanco-Di Matteo
- Division of Infectious Diseases, Clínica Universidad de Navarra, Pamplona, Spain
- Division of Infectious Diseases, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - José L Del Pozo
- Division of Infectious Diseases, Clínica Universidad de Navarra, Pamplona, Spain
- Division of Infectious Diseases, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Phinnara Has
- Lifespan Biostatistics Department, Providence, Rhode Island, USA
| | - Leonard A Mermel
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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24
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Bracey A, Sherman MH. Midline Catheters Are the Optimal Vascular Access Device For Managing Septic Shock in the Emergency Department. Ann Emerg Med 2024; 83:605-606. [PMID: 38456868 DOI: 10.1016/j.annemergmed.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 01/01/2024] [Accepted: 01/09/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Alexander Bracey
- Department of Emergency Medicine, Albany Medical Center, Albany, NY
| | - Michael H Sherman
- Department of Emergency Medicine, University of Massachusetts, Worcester, MA
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25
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Prabhahar A, Vijaykumar NA, Selvam S, Ramchandran R, Sethi J, Pannu AK, Sharma N. Characteristics and Prognosis of Infectious Disease Emergencies in Patients with Chronic Kidney Disease in India. Indian J Crit Care Med 2024; 28:601-606. [PMID: 39130395 PMCID: PMC11310683 DOI: 10.5005/jp-journals-10071-24731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/20/2024] [Indexed: 08/13/2024] Open
Abstract
Objectives Chronic kidney disease (CKD) significantly increases the risk of infectious diseases (IDs), leading to heightened morbidity and mortality. However, there remains a lack of detailed, region-specific studies. This study investigates the clinical spectrum, etiologies, outcomes, and baseline predictors of mortality of ID emergencies in CKD patients in North India. Methods This retrospective study was conducted at the Postgraduate Institute of Medical Education and Research, Chandigarh, from January 2021 to December 2022. It included patients aged ≥13 years with CKD and IDs admitted to the Acute Care and Emergency Medicine Unit. Results We enrolled 248 patients (mean age 50 years, 58.1% males). About 60% had CKD stage 5, and 46% were on maintenance hemodialysis. Diabetic kidney disease was the predominant etiology (38.7%). The principal IDs were pneumonia (27.4%), urinary tract infection (UTI) (21.4%), sepsis of unknown primary focus (15.7%), tuberculosis (8.1%), and multisite infections (7.7%). Patients commonly have atypical clinical presentation, e.g., absence of fever and nonspecific symptoms such as shortness of breath and altered mental status. An emergence of multidrug-resistant organisms, e.g., Enterococcus faecium for UTI and Stenotrophomonas maltophilia for catheter-related bloodstream infections, was noted.In-hospital mortality rate was 33.5%, higher with multisite infections (58%) and pneumonia (47%). A low baseline Glasgow coma scale (GCS) was an independent predictor of mortality [odds ratio (OR) 0.786, 95% confidence interval (CI) 0.693-0.891, p-value <0.001]. Conclusion Effective management and early intervention are needed to improve outcomes in CKD patients with ID emergencies, given the high mortality and atypical clinical presentations. How to cite this article Prabhahar A, Vijaykumar NA, Selvam S, Ramchandran R, Sethi J, Pannu AK, et al. Characteristics and Prognosis of Infectious Disease Emergencies in Patients with Chronic Kidney Disease in India. Indian J Crit Care Med 2024;28(6):601-606.
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Affiliation(s)
- Arun Prabhahar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Niranjan A Vijaykumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Suresh Selvam
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Raja Ramchandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Jasmine Sethi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Ashok K Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Navneet Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
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26
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Teja B, Bosch NA, Diep C, Pereira TV, Mauricio P, Sklar MC, Sankar A, Wijeysundera HC, Saskin R, Walkey A, Wijeysundera DN, Wunsch H. Complication Rates of Central Venous Catheters: A Systematic Review and Meta-Analysis. JAMA Intern Med 2024; 184:474-482. [PMID: 38436976 DOI: 10.1001/jamainternmed.2023.8232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Importance Central venous catheters (CVCs) are commonly used but are associated with complications. Quantifying complication rates is essential for guiding CVC utilization decisions. Objective To summarize current rates of CVC-associated complications. Data Sources MEDLINE, Embase, CINAHL, and CENTRAL databases were searched for observational studies and randomized clinical trials published between 2015 to 2023. Study Selection This study included English-language observational studies and randomized clinical trials of adult patients that reported complication rates of short-term centrally inserted CVCs and data for 1 or more outcomes of interest. Studies that evaluated long-term intravascular devices, focused on dialysis catheters not typically used for medication administration, or studied catheters placed by radiologists were excluded. Data Extraction and Synthesis Two reviewers independently extracted data and assessed risk of bias. Bayesian random-effects meta-analysis was applied to summarize event rates. Rates of placement complications (events/1000 catheters with 95% credible interval [CrI]) and use complications (events/1000 catheter-days with 95% CrI) were estimated. Main Outcomes and Measures Ten prespecified complications associated with CVC placement (placement failure, arterial puncture, arterial cannulation, pneumothorax, bleeding events requiring action, nerve injury, arteriovenous fistula, cardiac tamponade, arrhythmia, and delay of ≥1 hour in vasopressor administration) and 5 prespecified complications associated with CVC use (malfunction, infection, deep vein thrombosis [DVT], thrombophlebitis, and venous stenosis) were assessed. The composite of 4 serious complications (arterial cannulation, pneumothorax, infection, or DVT) after CVC exposure for 3 days was also assessed. Results Of 11 722 screened studies, 130 were included in the analyses. Seven of 15 prespecified complications were meta-analyzed. Placement failure occurred at 20.4 (95% CrI, 10.9-34.4) events per 1000 catheters placed. Other rates of CVC placement complications (per 1000 catheters) were arterial canulation (2.8; 95% CrI, 0.1-10), arterial puncture (16.2; 95% CrI, 11.5-22), and pneumothorax (4.4; 95% CrI, 2.7-6.5). Rates of CVC use complications (per 1000 catheter-days) were malfunction (5.5; 95% CrI, 0.6-38), infection (4.8; 95% CrI, 3.4-6.6), and DVT (2.7; 95% CrI, 1.0-6.2). It was estimated that 30.2 (95% CrI, 21.8-43.0) in 1000 patients with a CVC for 3 days would develop 1 or more serious complication (arterial cannulation, pneumothorax, infection, or DVT). Use of ultrasonography was associated with lower rates of arterial puncture (risk ratio [RR], 0.20; 95% CrI, 0.09-0.44; 13.5 events vs 68.8 events/1000 catheters) and pneumothorax (RR, 0.25; 95% CrI, 0.08-0.80; 2.4 events vs 9.9 events/1000 catheters). Conclusions and Relevance Approximately 3% of CVC placements were associated with major complications. Use of ultrasonography guidance may reduce specific risks including arterial puncture and pneumothorax.
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Affiliation(s)
- Bijan Teja
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nicholas A Bosch
- The Pulmonary Center, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Calvin Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiago V Pereira
- Clinical Trial Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paolo Mauricio
- The Pulmonary Center, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Michael C Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashwin Sankar
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Division of Cardiology, Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Refik Saskin
- ICES Central, University of Toronto, Toronto, Ontario, Canada
| | - Allan Walkey
- Division of Health Systems Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- ICES Central, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Hannah Wunsch
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
- Sunnybrook Research Institute, Toronto, Ontario, Canada
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O'Grady NP. Prevention of Central Line-Associated Bloodstream Infections. Reply. N Engl J Med 2023; 389:2308. [PMID: 38091550 DOI: 10.1056/nejmc2312283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
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