Factors Associated With Mortality in Patients With Catheter-related Bloodstream Infection: A Multicenter Retrospective Study.

BACKGROUND/AIM: Catheter-related bloodstream infections (CRBSI) are frequently life-threatening. Several factors have been reported to be related to CRBSI development; however, the factors associated with CRBSI mortality are unclear as they have rarely been studied. This study investigated the factors associated with mortality in patients with CRBSI, specifically focusing on nutritional factors. PATIENTS AND METHODS: This retrospective, multicenter study included in-patients with acute conditions and convalescent patients diagnosed with a CRBSI between January 2019 and December 2021 at 33 hospitals (23 general hospitals, two mixed-care hospitals, and eight convalescent hospitals). The primary outcome was death. Unadjusted and multivariable logistic regression analysis was performed to identify factors associated with mortality. RESULTS: A total of 453 patients with CRBSI were enrolled. The causes of death were analyzed for 382 (84.3%) who survived CRBSI and 71 (15.7%) who died. Multivariable analysis revealed that Candida detected in blood culture [adjusted odds ratio (aOR)=2.72, 95% confidence interval (CI)=1.15-6.41; p=0.025)], CRBSI onset within 30 days of catheter insertion (aOR=2.28, 95% CI=1.27-4.09; p=0.005), concurrent infection (aOR=2.07, 95% CI=1.19-3.60; p=0.009), low serum albumin level (aOR=1.64, 95% CI=1.02-2.63; p=0.044), and elevated C-reactive protein level (aOR=1.05, 95% CI=1.01-1.10; p=0.028) were risk factors for mortality, whereas the use of a peripherally inserted central catheter was associated with a reduced risk of CRBSI mortality (aOR=0.30, 95% CI=0.13-0.69; p=0.004). CONCLUSION: Enhanced monitoring of factors, such as candida detected in blood culture, CRBSI onset within 30 days of catheter insertion, concurrent infection, low serum albumin level, elevated C-reactive protein (CRP) level and the use of a peripherally inserted central catheter (PICC), is crucial for mitigating CRBSI severity and risk of death.

Impact of central-line-associated bloodstream infections and catheter-related bloodstream infections: a systematic review and meta-analysis.

BACKGROUND: Accurate effect estimates are needed to inform input parameters of health economic models. Central-line-associated bloodstream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs) are different definitions used for central-line bloodstream infections and may represent dissimilar patients, but previous meta-analyses did not differentiate between CLABSIs/CRBSIs. AIM: To determine outcome effect estimates in CLABSI and CRBSI patients, compared to uninfected patients. METHODS: PubMed, Embase, and CINAHL were searched from January 2000 to March 2024 for full-text studies reporting all-cause mortality and/or hospital length of stay (LOS) in adult inpatients with and without CLABSI/CRBSI. Two investigators independently reviewed all potentially relevant studies and performed data extraction. Odds ratio for mortality and mean difference in LOS were pooled using random-effects models. Risk of study bias was assessed using ROBINS-E. FINDINGS: Thirty-six studies were included. Sixteen CLABSI and 12 CRBSI studies reported mortality. The mortality odds ratios of CLABSIs and CRBSIs, compared to uninfected patients, were 3.19 (95% CI: 2.44, 4.16; I2 = 49%) and 2.47 (95% CI: 1.51, 4.02; I2 = 82%), respectively. Twelve CLABSI and eight CRBSI studies reported hospital LOS; only three CLABSI studies and two CRBSI studies accounted for the time-dependent nature of CLABSIs/CRBSIs. The mean differences in LOS for CLABSIs and CRBSIs compared to uninfected patients were 16.14 days (95% CI: 9.27, 23.01; I2 = 91%) and 16.26 days (95% CI: 10.19, 22.33; I2 = 66%), respectively. CONCLUSION: CLABSIs and CRBSIs increase mortality risk and hospital LOS. Few published studies accounted for the time-dependent nature of CLABSIs/CRBSIs, which can result in overestimation of excess hospital LOS.

Risk factors for mortality and complications in peripheral venous catheter-associated Staphylococcus aureus bacteraemia: a large multicentre cohort study.

BACKGROUND: Peripheral venous catheter-associated Staphylococcus aureus bacteraemia (PVC-SAB) is a potentially life-threatening nosocomial infection. AIM: This cohort study aims to identify the risk factors associated with its mortality and complications. METHODS: Retrospective analysis of a prospective cohort study conducted at two tertiary-care hospitals in Spain. Adult patients admitted between January 2011 and July 2019 which developed PVC-SAB during their hospital stay were included. Primary outcome was all-cause 30- and 90-day mortality. Secondary outcomes were sepsis or septic shock at the onset of bacteraemia, metastatic infection and length of hospital stay. Univariate and multivariate analyses were performed. FINDINGS: A total of 256 PVC-SAB were diagnosed in 243 patients between 2011 and 2019. Thirty-day and 90-day all-cause mortality were 18.3% and 24.2%, respectively. Lack of susceptible antibiotic administration the day after blood culture collection (odds ratio: 4.14; 95% confidence interval: 1.55-11.03; P = 0.005), sepsis and complicated bacteraemia were identified as independent risk factors for 30- and 90-day mortality; meticillin-resistant S. aureus bacteraemia was identified as an independent risk factor only for 30-day mortality and functional dependence only for 90-day mortality. Persistent bacteraemia and sepsis were associated with septic metastases, which significantly increased hospital stay, and endocarditis. A greater proportion of patients experiencing septic shock were subsequently institutionalized compared to those without. CONCLUSION: PVC-SAB remains linked to high mortality rates. Prompt administration of appropriate antibiotics is crucial for lowering mortality. A comprehensive diagnostic approach is essential, especially in patients with persistent bacteraemia and implanted cardiovascular devices, to rule out metastatic complications and endocarditis.

Analysis of factors associated with mortality due to sepsis resulting from device-related infections.

INTRODUCTION: Health care-associated infections (HAIs) contribute to morbidity and mortality and to the dissemination of multidrug-resistant organisms. Children admitted to the intensive care unit undergo invasive procedures that increase their risk of developing HAIs and sepsis. The aim of the study was to analyse factors associated with mortality due to sepsis arising from HAIs. PATIENTS AND METHODS: We conducted a case-control study in a 7-bed multipurpose paediatric intensive care unit in a tertiary care teaching hospital. The sample consisted of 90 children admitted between January 2014 and December 2018. The case group consisted of patients who died from sepsis associated with the main health care-associated infections; the control group consisted of patients who survived sepsis associated with the same infections. RESULTS: Death was associated with age less than or equal to 12 months, presence of comorbidity, congenital disease, recurrent ventilator-associated pneumonia and septic shock. In the multiple regression analysis, heart disease (OR, 12.48; CI 2.55-60.93; P = .002), infection by carbapenem-resistant bacteria (OR, 31.51; CI 4.01-247.25; P = .001), cancer (OR, 58.23; CI 4.54-746.27; P = .002), and treatment with adrenaline (OR, 13.14; CI 1.35-128.02; P = .003) continued to be significantly associated with death. CONCLUSIONS: Hospital sepsis secondary to carbapenem-resistant bacteria contributed to a high mortality rate in this cohort. Children with heart disease or neoplasia or who needed vasopressor drugs had poorer outcomes.

Risk of central line-associated bloodstream infections during COVID-19 pandemic in intensive care patients in a tertiary care centre in Saudi Arabia.

This retrospective study compared central line-associated bloodstream infection (CLABSI) rates per 1 000 central line days, and overall mortality before and during the COVID-19 pandemic in adult, paediatric, and neonatal ICU patients at King Abdul-Aziz Medical City-Riyadh who had a central line and were diagnosed with CLABSI according to the National Healthcare Safety Network standard definition. The study spanned between January 2018 and December 2019 (pre-pandemic), and January 2020 and December 2021 (pandemic). SARS-CoV-2 was confirmed by positive RT-PCR testing. The study included 156 CLABSI events and 46 406 central line days; 52 and 22 447 (respectively) in pre-pandemic, and 104 and 23 959 (respectively) during the pandemic. CLABSI rates increased by 2.02 per 1 000 central line days during the pandemic period (from 2.32 to 4.34, p < 0.001). Likewise, overall mortality rates increased by 0.86 per 1 000 patient days (from 0.93 to 1.79, p = 0.003). Both CLABSI rates (6.18 vs. 3.7, p = 0.006) and overall mortality (2.72 vs. 1.47, p = 0.014) were higher among COVID-19 patients compared to non-COVID-19 patients. The pandemic was associated with a substantial increase in CLABSI-associated morbidity and mortality.

Treatment of positive catheter tip culture without bloodstream infections in critically ill patients. A case-cohort study from the OUTCOMEREA network.

PURPOSE: This study aimed to evaluate the impact on subsequent infections and mortality of an adequate antimicrobial therapy within 48 h after catheter removal in intensive care unit (ICU) patients with positive catheter tip culture. METHODS: We performed a retrospective analysis of prospectively collected data from 29 centers of the OUTCOMEREA network. We developed a propensity score (PS) for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a 1:1 case-cohort study matched on the PS score of being adequately treated. A PS-matched subdistribution hazard model was used for detecting subsequent infections and a PS-matched Cox model was used to evaluate the impact of antibiotic therapy on mortality. RESULTS: We included 427 patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched 150 patients with an adequate antimicrobial therapy with 150 controls. In the matched population, 30 (10%) subsequent infections were observed and 62 patients died within 30 days. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day-30 was similar between treated and non-treated groups (subdistribution hazard ratio [sHR] 1.08, 95% confidence interval [CI] 0.62-1.89, p = 0.78). Using Cox proportional hazard models, the 30-day mortality risk was similar between treated and non-treated groups (HR 0.89, 95% CI 0.45-1.74, p = 0.73). CONCLUSIONS: Antimicrobial therapy was not associated with decreased risk of subsequent infection or death in short-term catheter tip colonization in critically ill patients. Antibiotics may be unnecessary for positive catheter tip cultures.

Re-hospital admission, morbidity and mortality rate in patients undergoing tunnelled catheter implantation for haemodialysis.

OBJECTIVE: Despite the effort to increase the proportion of patients starting dialysis on native accesses, many of them are still dialyzed on tunnelled catheter. Catheter-related complications are often serious and responsible for re-hospital admission, high morbidity and mortality. Several multicenter trials have reported results in the use of tunnelled dialysis catheter (TDC). However, few single-center studies have been published to verify the outcome from real-world experience. This study presents our center's experience in managing such patients in the context of relevant literature. METHODS: Demographics and operative data were retrospectively collected from medical charts. A prospective follow-up was performed to investigate complications, number of re-hospitalizations and mortality. Kaplan-Meier estimate was used to evaluate catheter primary patency and patients' overall survival. RESULTS: Among a total 298 haemodialysis accesses interventions, 105 patients (56 men, 53.3% and 49 women, 46.7%) with a median age of 65 years (range 32-88 years) were included in the study. All insertions were successful with an optimal blood flow achieved during the first session of dialysis in all cases. A catheter-related complication was detected in 33.3% (n=35) patients (48.6% infections; 28.6% TDC dysfunction; 14.3% local complications; 5.7% accidental catheter retractions; 2.8% catheter migrations). At a median follow-up of 10.5±8.5 months, a total of 85 patients (80.9%) was re-hospitalized, in 28 cases (26.7%) for a catheter-related cause. The median catheter patency rate was 122 days. At the last follow-up, 39 patients (37.1%) were still dialyzed on catheter, 30(28.6%) were dialyzed on an arteriovenous fistula and 7(6.7%) received a kidney transplantation. Two patients (2%) were transferred to peritoneal dialysis and two patients (2%) recover from renal insufficiency. Mortality rate was 23.8% (25 patients). Causes of death were myocardial infarction (n=13, 52%), sepsis (n=9, 36%); one patient (4%) died from pneumonia, one (4%) from uremic encephalopathy and one (4%) from massive hematemesis. CONCLUSION: TDCs may represent the only possible access in some patients, however they are burned with a high rate of complications, re-hospital admission and mortality. Results from this institutional experience are in line with previously published literature data in terms of morbidity and mortality. The present results reiterate once more that TDC must be regarded as a temporary solution while permanent access creation should be prioritized. Strict surveillance should be held in patients having TDC for the early identification of complications allowing the prompt treatment and modifying the catheter insertion site whenever needed.

Management of Home Parenteral Nutrition: Complications and Survival.

BACKGROUND AND AIMS: Parenteral nutrition (PN) has become an efficient, safe, and convenient treatment over years for patients suffering from intestinal failure. Home PN (HPN) enables the patients to have a high quality of life in their own environment. The therapy management however implies many restrictions and potentially severe lethal complications. Prevention and therapy of the latter are therefore of utmost importance. This study aims to assess and characterize the situation of patients with HPN focusing on prevalence of catheter-related complications and mortality. METHODS: Swiss multicentre prospective observational study collecting demographic, anthropometric, and catheter-related data by means of questionnaires every sixth month from 2017 to 2019 (24 months), focusing on survival and complications. Data were analysed using descriptive statistics. Logistic regression models were fitted to investigate association between infection and potential co-factors. RESULTS: Seventy adult patients (50% women) on HPN were included (≈5 patients/million adult inhabitants/year). The most common underlying diseases were cancer (23%), bariatric surgery (11%), and Crohn's disease (10%). The most prevalent indication was short bowel syndrome (30%). During the study period, 47% of the patients were weaned off PN; mortality rate reached 7% for a median treatment duration of 1.31 years. The rate of catheter-related infection was 0.66/1,000 catheter-days (0.28/catheter-year) while the rate of central venous thrombosis was 0.13/1,000 catheter-days (0.05/catheter-year). CONCLUSION: This prospective study gives a comprehensive overview of the adult Swiss HPN patient population. The collected data are prerequisite for evaluation, comparison, and improvement of recommendations to ensure best treatment quality and safety.

Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Preterm Infants With Late-Onset Infection.

Importance: Infection in neonates remains a substantial problem. Advances for this population are hindered by the absence of a consensus definition for sepsis. In adults, the Sequential Organ Failure Assessment (SOFA) operationalizes mortality risk with infection and defines sepsis. The generalizability of the neonatal SOFA (nSOFA) for neonatal late-onset infection-related mortality remains unknown. Objective: To determine the generalizability of the nSOFA for neonatal late-onset infection-related mortality across multiple sites. Design, Setting, and Participants: A multicenter retrospective cohort study was conducted at 7 academic neonatal intensive care units between January 1, 2010, and December 31, 2019. Participants included 653 preterm (<33 weeks) very low-birth-weight infants. Exposures: Late-onset (>72 hours of life) infection including bacteremia, fungemia, or surgical peritonitis. Main Outcomes and Measures: The primary outcome was late-onset infection episode mortality. The nSOFA scores from survivors and nonsurvivors with confirmed late-onset infection were compared at 9 time points (T) preceding and following event onset. Results: In the 653 infants who met inclusion criteria, median gestational age was 25.5 weeks (interquartile range, 24-27 weeks) and median birth weight was 780 g (interquartile range, 638-960 g). A total of 366 infants (56%) were male. Late-onset infection episode mortality occurred in 97 infants (15%). Area under the receiver operating characteristic curves for mortality in the total cohort ranged across study centers from 0.71 to 0.95 (T0 hours), 0.77 to 0.96 (T6 hours), and 0.78 to 0.96 (T12 hours), with utility noted at all centers and in aggregate. Using the maximum nSOFA score at T0 or T6, the area under the receiver operating characteristic curve for mortality was 0.88 (95% CI, 0.84-0.91). Analyses stratified by sex or Gram-stain identification of pathogen class or restricted to infants born at less than 25 weeks' completed gestation did not reduce the association of the nSOFA score with infection-related mortality. Conclusions and Relevance: The nSOFA score was associated with late-onset infection mortality in preterm infants at the time of evaluation both in aggregate and in each center. These findings suggest that the nSOFA may serve as the foundation for a consensus definition of sepsis in this population.

Six-year study on peripheral venous catheter-associated BSI rates in 262 ICUs in eight countries of South-East Asia: International Nosocomial Infection Control Consortium findings.

BACKGROUND: Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available. METHODS: Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. RESULTS: We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter-associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter-associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter-associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: Escherichia coli (22.9%), Klebsiella spp (10.7%), Pseudomonas aeruginosa (5.3%), Enterobacter spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were Staphylococcus aureus (11.4%). CONCLUSIONS: Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter-associated bloodstream infections.

Prática deliberada em ciclos rápidos aplicada em profissionais de enfermagem na punção venosa periférica / Rapid cycle deliberate practice applied to nurse technician professionals in peripheral venipuncture

Introdução: A Prática Deliberada em Ciclos Rápidos (PDCR) é uma estratégia educacional de simulação focada em promover um treinamento que permita o domínio de uma habilidade. A estratégia aplica o feedback direcionado e a oportunidade de repetição para que o participante alcance a maestria e/ou a alta performance. Estudos evidenciam melhorias significativas de habilidades dos profissionais de saúde quando treinados com PDCR em contexto de reanimação cardiopulmonar pediátrica. A partir da conjectura de que a PDCR pode ser aplicada em profissionais de saúde para melhoria de habilidades, formulou-se a hipótese que a PDCR melhora a performance técnica dos profissionais técnicos de enfermagem na punção venosa periférica (PVP) comparada ao treinamento de habilidade, que é outra estratégia mais comumente usada para ensino e capacitação profissional. Objetivos: Avaliar a PDCR como uma estratégia educacional e seu impacto na performance técnica dos profissionais técnicos de enfermagem na PVP; comparar a performance técnica dos profissionais técnicos de enfermagem na PVP após treinamento usando PDCR versus o treinamento de habilidade. Método: Estudo unicêntrico, experimental randomizado aberto, aplicado em 60 profissionais técnicos de enfermagem, divididos em dois grupos. A performance foi avaliada antes e após o treinamento, a partir do cálculo da taxa de acerto em 21 itens observados na execução do procedimento. A estratégia de treinamento do Grupo Intervenção (GI) foi a PDCR e do Grupo Controle (GC) foi o treinamento de habilidades de PVP. Resultados: O percentual global de acertos dos itens do procedimento de punção venosa periférica avaliados para o GC aumentou de 57,8% no pré-teste para 93,5% no pós-teste e o percentual de acertos para o GI aumentou de 59,4% para 96,0%. A variação da média no pré e pós-teste foi de 35,7% para GC e de 36,6% para o GI. Comparando pareadamente às taxas de acerto pré e pós-teste de cada grupo, ambos os treinamentos tiveram um efeito significativo em aumentar as taxas de acerto dos itens do procedimento de punção venosa periférica avaliados (p-valor <0,0001 para os dois grupos). Não houve diferença significativa entre as distribuições das taxas de acerto do pós-teste dos dois grupos (p-valor = 0,225). Usando a medida do tamanho de efeito dm de Cohen, o tamanho do efeito do treinamento do GC foi 2,95 e o tamanho de efeito do treinamento do GI foi 3,59. Usando a medida do tamanho de efeito Δ de Glass, o tamanho de efeito do treinamento do GC foi 2,24 e o tamanho do efeito do GI foi 2,63. Conclusão: Do ponto de vista da performance técnica, o treinamento com PDCR, assim como o treinamento de habilidades, resultou em melhorias de desempenho no procedimento de punção venosa periférica, evidenciadas pelo aumento de acertos no pós-teste em comparação com o pré-teste. Dessa forma, pode-se concluir que a PDCR pode ser aplicada como uma estratégia educacional para o treinamento da punção venosa periférica, não sendo inferior ao treinamento de habilidade. Sendo assim, pode-se interpretar que a aplicação da PDCR em contexto diferente do estudo original parece ser promissora e factível.

Introduction: Rapid Cycle Deliberate Practice (RCDP) is an educational simulation strategy that focuses on promoting simulation training that allows skill mastery achievement. The strategy applies directed feedback and opportunity for repetition until participants achieve mastery and/or high performance. Studies show significant improvements in the skills of healthcare professionals when trained with RCDP in pediatric cardiopulmonary resuscitation context. Based on the conjecture that RCDP can be applied to health professionals to improve skills, authors formulated the hypothesis that RCDP improves the technical performance of nursing technicians in peripheral venipuncture (PVP) compared to skill training, another strategy commonly used for teaching and professional training. Objectives: To evaluate RCDP as an educational strategy and its influence on the technical performance of nursing technicians in PVP; to compare the technical performance of nursing technicians in PVP after training using RCDP versus skill training. Methods: Single-center, open randomized experimental study, applied to 60 professional nursing technicians divided into two groups. Performance was evaluated before and after training, based on the calculation of the correct answer rate in 21 items observed during the procedure. The training strategy of the Intervention Group (IG) was RCDP and the Control Group (CG) was the skill training of PVP. Results: The overall percentage of correct answers for the items of the peripheral venipuncture procedure evaluated for the CG increased from 57.8% in the pre-test to 93.5% in the post-test and the percentage of correct answers for the IG increased from 59.4% to 96.0%. The mean variation in the pre and post- test was 35.7% for the CG and 36.6% for the IG. Comparing the pre and post-test hit rates of each group in parallel, both training strategies had a significant effect in increasing the hit rates of peripheral venipuncture procedure items that were evaluated (p-value <0.0001 for both groups). There was no significant difference between the distributions of the post- test hit rates of the two groups (p-value = 0.225). Using Cohen's dm effect size measure, the CG training effect size was 2.95 and the IG training effect size was 3.59. Using Glass's Δ effect size measure, the GC training effect size was 2.24 and the GI effect size was 2.63. Conclusion: From the point of view of technical performance, training with RCDP, as well as skills training, resulted in performance improvements in the peripheral venipuncture procedure, evidenced by the increase of correct answers in the post-test compared to the pre-test. Thus, the study concludes that RCDP works as an educational simulation strategy for peripheral venipuncture training since it showed not to be inferior to the skill training approach. Therefore, the application of RCDP in a different context from the original study seems to be propitious and viable.

Risk Factors for Early Port Infections in Adult Oncologic Patients.

PURPOSE: The purpose of this study was to retrospectively investigate risk factors for chest port (port) infections within 30 days of placement (early port infections) in adult oncologic patients. MATERIALS AND METHODS: This single-institution, three-center retrospective study identified 1,714 patients (868 males, 846 females; median age 60.0 years old) who underwent port placement between January 2013 and August 2017. All patients received an intravenous antibiotic prior to port placement. The median absolute neutrophil count was 5,260 cells/µL, the median white blood cell (WBC) count was 7,700 cells/µL, and the median serum albumin was 4.00 g/dL at the time of port placement. Double-lumen ports were most commonly implanted (74.85%) more frequently in an outpatient setting (72.69%). Risk factors for early port infections were elucidated using univariate and multivariate proportional subdistribution hazard regression analyses. RESULTS: A total of 20 patients (1.2%) had early port infections; 15 patients (0.9%) had positive blood cultures. The mean time to infection was 20 days (range, 9-30 days). The port-related 30-day mortality rate was 0.2% (4 of 1,714 patients). Most bloodstream infections were attributed to Staphylococcus spp. (n = 11). In multivariate analysis, hematologic malignancy (hazard ratio [HR], 2.61; 95% confidence interval (CI), 1.15-5.92.; P = .02), hypoalbuminemia (albumin <3.5 g/dL; HR, 3.52; 95% CI: 1.48-8.36; P = .004), leukopenia (WBC <3,500 cells/µL; HR, 3.00; 95% CI: 1.11-8.09; P = .03), and diabetes mellitus (HR, 3.71; 95% CI: 1.57-8.83) remained statistically significant risk factors for early port infection. CONCLUSIONS: Hematologic malignancy, hypoalbuminemia, leukopenia, and diabetes mellitus at the time of port placement were independent risk factors for early port infections.

Mortality and risk factor analysis for Candida blood stream infection: A three-year retrospective study.

BACKGROUND: The aim of this study was to evaluate the possible risk factors for mortality in adult patients with candidemia by investigating the causative agents, underlying conditions and predisposing factors. MATERIAL AND METHODS: The data including causative Candida species, predisposing factors, and underlying conditions of candidemia patients between the years 2015-2017 were collected and the impact of these factors on mortality was evaluated. Patients were divided into two groups as died (died patients within 30 days of the onset of candidemia) and survived and risk factors were evaluated for each group. RESULTS: We found 163 adult candidemia cases during the study period. Overall 30-day mortality was 40.5%. Candida parapsilosis was the most frequent causative agent (49.1%). C. parapsilosis candidemia was more common in the survived group compared with the died group (n: 49 (61.3%) vs. n: 31 (38.8%), P=0.888). Mortality rates were significantly higher in patients with dialysis (n: 27 (69.2%) vs. n: 12 (30.8%), P<0.00) and concurrent bacteremia (n: 20 (57.1%) vs. n: 15 (42.9%), P=0.024). Survival rates were significantly higher in patients with follow-up blood cultures (n: 75 (65.8%) vs. n: 39 (34.2%), P=0.013). The most important source of candidemia was catheter (49.7%), and C. parapsilosis was the most common causative agent (58%). The catheter was removed in 96.3% of these patients and the mortality rate was 38.5%. All of the patients received antifungal therapy and there was no significant difference between the effects of antifungals on mortality (n: 65 (39.9%) vs. 98 (60.1%), P=0.607). CONCLUSIONS: Dialysis and concurrent bacteremia are strong predictors of mortality in 30 days within patients with candidemia, whereas follow-up blood cultures have a protective role with lower mortality rates. In our study, the most important source of candidemia was catheter, and C. parapsilosis was the most common causative agent. The catheter was removed in almost all patients and the mortality rate was almost one third among these patients.

Stenotrophomonas maltophilia bacteremia in children - A 10-year analysis. / Bacteriemia por Stenotrophomonas maltophilia en niños: análisis de 10 años.

Stenotrophomonas maltophilia is a multidrug-resistant, Gramnegative, and biofilm-forming pathogen. Information is limited concerning S. maltophilia bacteremia in children. Clinical data and microbiological test results collected in a tertiary children's hospital over a ten-year period were reviewed. Children 0-18 years old who had positive clinical specimen, blood and/or catheter cultures were included. We identified 20 S. maltophilia isolates from 12 pediatric patients with confirmed infections. The median age was 28 months (range: 3.1-187.3). The rate of previous use of antimicrobial therapy was 83 %. The median antibiotic number was 3 (range: 0-7) within 30 days prior to onset of S. maltophilia bacteremia. Catheter related infection was the main infectious source (66.6 %). The mortality rate was 33.3 %. The death of two non-survivors was associated with pneumonia. S. maltophilia should be considered a breakthrough agent for bacteremia in children with underlying disease exposed to broad-spectrum antibiotics during long-term hospitalization.

Stenotrophomonas maltophilia es un microorganismo gramnegativo, multirresistente. La información sobre la bacteriemia por S. maltophilia en niños es limitada. Se revisaron los datos de 10 años de un hospital de niños de alta complejidad. Se incluyó a niños de 0 a 18 años con hemocultivos o cultivos del catéter positivos. Se identificaron 20 cepas de S. maltophilia en 12 niños con infección confirmada, cuya mediana de edad fue 28 meses (intervalo: 3,1-187,3). El índice de antibioticoterapia previa fue 83 %, con una mediana de tres antibióticos (intervalo: 0­7) en los 30 días previos a la bacteriemia por S. maltophilia. La infección relacionada con el catéter fue la principal fuente de infección (8/12). La mortalidad fue de 4/12; y en dos casos, estuvo asociada con neumonía. S. maltophilia puede considerarse un agente muy invasivo productor de bacteriemia en niños con enfermedad preexistente expuestos a antibióticos durante una hospitalización prolongada.

Epidemiology and Prognosis of Intensive Care Unit-Acquired Bloodstream Infection.

Intensive care unit-acquired bloodstream infections (ICU-BSI) are frequent and are associated with high morbidity and mortality rates. We conducted this study to describe the epidemiology and the prognosis of ICU-BSI in our ICU and to search for factors associated with mortality at 28 days. For this, we retrospectively studied ICU-BSI in the ICU of the Cayenne General Hospital, from January 2013 to June 2019. Intensive care unit-acquired bloodstream infections were diagnosed in 9.5% of admissions (10.3 ICU-BSI/1,000 days). The median delay to the first ICU-BSI was 9 days. The ICU-BSI was primitive in 44% of cases and secondary to ventilator-acquired pneumonia in 25% of cases. The main isolated microorganisms were Enterobacteriaceae in 67.7% of patients. They were extended-spectrum beta-lactamase (ESBL) producers in 27.6% of cases. Initial antibiotic therapy was appropriate in 65.1% of cases. Factors independently associated with ESBL-producing Enterobacteriaceae (ESBL-PE) as the causative microorganism of ICU-BSI were ESBL-PE carriage before ICU-BSI (odds ratio [OR]: 7.273; 95% CI: 2.876-18.392; P < 0.000) and prior exposure to fluoroquinolones (OR: 4.327; 95% CI: 1.120-16.728; P = 0.034). The sensitivity of ESBL-PE carriage to predict ESBL-PE as the causative microorganism of ICU-BSI was 64.9% and specificity was 81.2%. Mortality at 28 days was 20.6% in the general population. Factors independently associated with mortality at day 28 from the occurrence of ICU-BSI were traumatic category of admission (OR: 0.346; 95% CI: 0.134-0.894; P = 0.028) and septic shock on the day of ICU-BSI (OR: 3.317; 95% CI: 1.561-7.050; P = 0.002). Mortality rate was independent of the causative organism.

The implication of intestinal bacterial translocation in central line associated blood stream infections in the pediatric population.

INTRODUCTION: Bacterial intestinal translocation plays an important role in neonatal sepsis. We aimed to elucidate the importance of such translocation in causing central line associated blood stream infection (CLABSI) in patients undergoing gastrointestinal surgery (GIS). METHODS: Using a database of pediatric patients with CLABSI, patients were divided into those who had a GI-surgery (where intestines were opened), those who had a non-GI-surgery (NGIS; all other types of surgery) and those who had no surgery (NS). Data regarding type of organisms isolated on culture, their resistance patterns, clearance of CLABSI, type of antibiotic therapy and patient demographics were collected. RESULTS: 117 CLABSIs were identified between 2011 and 2018. 26 patients had GIS, 22 had NGIS and 69 had NS. NS patients were younger. 80% of GIS and NGIS patients had a central line at the time of surgery. Coagulase-negative staphylococcus (CoNS) was the most common organism isolated (32%). CoNS was more common in GIS compared to NGIS and NS (58% vs. 9% vs. 29% respectively, p=0.04). There were no differences in the time to resolution of bacteremia, mortality rates or need to remove the central line. CONCLUSIONS: This information should help inform efforts for prevention of CLABSIs in patients undergoing GI surgery with central lines present. LEVEL OF EVIDENCE: III.

Bloodstream infections and patient survival with tunneled-cuffed catheters for hemodialysis: A single-center observational study.

BACKGROUND: In hemodialysis patients, a tunneled-cuffed permanent catheter is mandatory when the arteriovenous fistula is not feasible. The major risks of the use of tunneled-cuffed permanent catheter are bloodstream infections. The aim of this study is to analyze bloodstream infections from tunneled-cuffed permanent catheter in hemodialysis patients. METHODS: An observational prospective study was carried out and 79 hemodialysis patients with tunneled-cuffed permanent catheter were enrolled. Patients were divided into those with bloodstream infections from tunneled-cuffed permanent catheter and those without. Their clinical and laboratory characteristics were compared. An original tunneled-cuffed permanent catheter lock therapy sequence was carried out combined with systemic antibiotic therapy. In case of antibiotic resistance, the tunneled-cuffed permanent catheter was removed. RESULTS: The patients affected by bloodstream infections from tunneled-cuffed permanent catheter were 16/79 (20.3%). The bloodstream infection from tunneled-cuffed permanent catheter's incidence rate was 0.52 per 1000 catheter days. Twenty-three bloodstream infections from tunneled-cuffed permanent catheter were found in 16/79 patients who used tunneled-cuffed permanent catheter. Staphylococcus aureus was the cause of bloodstream infection from tunneled-cuffed permanent catheter in 35% of the cases and Staphylococcus epidermidis in 30% of the cases. Risk factors were infection located in other organs and the presence of peripheral obstructive arterial disease. CONCLUSION: The enrolled cohort showed a reduced bloodstream infection from tunneled-cuffed permanent catheter incidence rate in comparison with the reference value (1 per 1000 catheter days). To reduce the number of bloodstream infections from tunneled-cuffed permanent catheter, hand hygiene and asepsis management of the tunneled-cuffed permanent catheter during the connection to the extracorporeal circuit and an original tunneled-cuffed permanent catheter lock therapy sequence seem to be the most efficient measures. Infections of other organs and the presence of peripheral obstructive arterial disease are the most important risk factors for bloodstream infections from tunneled-cuffed permanent catheter.

Risk Factors, Length of Stay and In-Hospital Mortality of Methicillin-Resistant Staphylococcus aureus Infections: A Case-Control Study.

INTRODUCTION: The emergence of strains of methicillin-resistant Staphylococcus aureus is a serious therapeutic challenge in healthcare provision. With this study, we aimed to investigate the risk factors and clinical outcomes (mortality and length of hospital stay) associated with methicillin-resistant Staphylococcus aureus infections in patients admitted to a district hospital in Portugal. MATERIAL AND METHODS: A case-control study was performed in 96 cases and 122 controls, selected, respectively, as function of antibiotic resistance or sensitivity to methicillin. Data were obtained through consultation of clinical records and subjected to multivariate statistical analysis. RESULTS: We identified the following independent risk factors for the occurrence of methicillin-resistant Staphylococcus aureus infection: urinary catheter (aOR = 10.62, 95% CI 3.66 - 30.78), prior use of antibiotics in the last 30 days (aOR = 5.60, 95% CI 2.15 - 14.62), exposure to 5 - 7 days of hospitalization (aOR = 4.99, 95% CI 1.20 - 20.79) or to ≥ 8 days (aOR = 5.34, 95% CI 1.18 - 24.22), chronic obstructive pulmonary disease (aOR = 4.27, 95% CI 1.64 - 11.13) and recent hospitalization (aOR = 2.66, 95% CI 1.14 - 6.23). Compared to infections due to methicillin-susceptible Staphylococcus aureus, we found increased probability of having a longer hospital stay (aHR = 1.74, 95% CI 1.11 - 2.71) and in-hospital mortality was significantly higher (p = 0.001) between patients infected by methicillin-resistant Staphylococcus aureus. DISCUSSION: The results demonstrate that methicillin resistance is associated with an increased clinical risk to patients infected by Staphylococcus aureus, in particular, a raised mortality and prolonged hospitalization. CONCLUSION: Our study underlines the additional burden imposed by methicillin resistance in Staphylococcus aureus infections. This highlights an urgent need to reinforce and optimize prevention, control, timely detection and effective treatment strategies for multidrug--resistant Staphylococcus aureus strains.

Introdução: A emergência de estirpes de Staphylococcus aureus resistentes à meticilina constitui um sério desafio terapêutico na prestação de cuidados de saúde. Com esta investigação, pretendeu-se estudar os fatores de risco e os resultados clínicos (mortalidade e tempo de internamento) associados a infeções por Staphylococcus aureus resistentes à meticilina em doentes internados numa unidade hospitalar em Portugal. Material e Métodos: Realizou-se um estudo caso-controlo. Integraram o estudo 96 casos e 122 controlos, selecionados, respetivamente, em função da resistência ou sensibilidade antibiótica à meticilina. Os dados obtidos, por consulta de registos clínicos, foram alvo de análise estatística multivariada. Resultados: Identificaram-se os seguintes fatores de risco independentes para desenvolvimento de infeção por Staphylococcus aureus resistentes à meticilina: cateter urinário (aOR = 10,62, IC 95% 3,66 ­ 30,78), antibioterapia nos últimos 30 dias (aOR = 5,60, IC 95% 2,15 ­ 14,62), exposição a cinco a sete dias de internamento (aOR = 4,99, IC 95% 1,20 ­ 20,79) ou a oito ou mais dias (aOR = 5,34, IC 95% 1,18 ­ 24,22), doença pulmonar obstrutiva crónica (aOR = 4,27, IC 95% 1,64 ­ 11,13) e internamento hospitalar recente (aOR = 2,66, IC 95% 1,14 ­ 6,23). Comparativamente a infeções por Staphylococcus aureus sensíveis à meticilina, constatou-se uma probabilidade acrescida de prolongamento do internamento (aHR = 1,74, IC 95% 1,11 ­ 2,71) e uma mortalidade intra-hospitalar significativamente superior (p = 0,001) em doentes infetados por Staphylococcus aureus resistentes à meticilina. Discussão: Os resultados demonstram que a resistência à meticilina se encontra associada a um risco clínico acrescido para os doentes infetados por Staphylococcus aureus, com tradução no aumento da mortalidade e no prolongamento do tempo de internamento. Conclusão: Este estudo salienta a sobrecarga adicional associada à resistência à meticilina em infeções por Staphylococcus aureus. Urge, portanto, reforçar e optimizar estratégias de controlo, prevenção, deteção atempada e tratamento efetivo de estirpes multirresistentes de Staphylococcus aureus.

Can vancomycin lock therapy extend the retention time of infected long-term catheters?

We assessed the success rate of vancomycin catheter lock therapy (VLT) in combination with systemic antimicrobials in patients with staphylococcal catheter-related bloodstream infection (C-RBSI). Over a 6-year period, we retrospectively collected clinical and microbiological data from patients with long-term central venous catheters and staphylococcal C-RBSI who were treated with systemic antimicrobials and VLT. We then assessed the success rate of VLT based on two criteria: 1) catheter retention time> 3 months and 2) catheter in place until end of use. We found 217 staphylococcal C-RBSI episodes, 115 (53.0%) of which were managed with conservative therapy. Of these, 76 (66.1%) were treated with VLT (85.5% coagulase-negative staphylococci and 14.5% Staphylococcus aureus). The success rate of VLT was 42.1% with criterion 1 and 71.1% with criterion 2. We did not find statistically significant differences between success and failure in the majority of the clinical data recorded. We only found differences for crude mortality in criterion 1 and for parenteral nutrition in criterion 2. The success of catheter retention using VLT was moderate, reaching slightly more than 70% when the catheter was kept in place until the end of use.

Early mortality attributable to PICC-lines in 4 public hospitals of Marseille from 2010 to 2016 (Revised V3).

INTRODUCTION: Peripherally inserted central catheters (PICC-line) are devices inserted through peripheral venous access. In our institution, this technology has been rapidly adopted by physicians in their routine practice. Bacteremia on catheters remains an important public health issue in France. However, the mortality attributable to bacteremia on PICC-line remains poorly evaluated in France and in the literature in general. We report in our study an exhaustive inventory of bacteremia on PICC-line and their 30 days mortality, over a 7 years period. MATERIAL AND METHODS: From January 2010 to December 2016, we retrospectively matched PICC-line registers of the radiology department, blood culture records of the microbiology laboratory and medical records from the Hospital Information Systems. RESULTS: The 11,334 hospital stays during which a PICC-line was inserted were included over a period of 7 years. Among them, 258 episodes of PICC-line-associated bacteremia were recorded, resulting in a prevalence of 2.27%. Hematology units: 20/324 (6.17%), oncology units: 55/1375 (4%) and hepato-gastro-enterology units: 42/1142 (3.66%) had the highest prevalence of PICC-line related bacteremia. The correlation analysis, when adjusted by exposure and year, shows that the unit profile explains 72% of the variability in the rate of bacteremia with a P = .023. Early bacteremia, occurring within 21 days of insertion, represented 75% of cases. The crude death ratio at 30 days, among patients PICC-line associated bacteremia was 57/11 334 (0.50%). The overall 30-day mortality of patients with PICC-line with and without bacteremia was 1369/11334 (12.07%). On day 30, mortality of patients with bacteremia associated PICC-line was 57/258 or 22.09% of cases, compared to a mortality rate of 1311/11076, or 11.83% in the control group (P < .05, RR 2.066 [1.54-2.75]). Kaplan-Meier survival analysis revealed a statistically significant excess mortality between patients with PICC-line associated bacteremia and PICC-line carriers without bacteremia (P < .0007, hazard ratio 1.89 [1307-2709]). CONCLUSION: Patients with PICC-line associated bacteremia have a significant excess mortality. The implementation of a PICC-line should remain the last resort after a careful assessment of the benefit/risk ratio by a senior doctor.