Bacteriemias relacionadas con el uso del catéter venoso en una unidad de hemodiálisis en Cuba / Bacteremia related to the use of venous catheter in a hemodialysis unit in Cuba

Introducción: Las bacteriemias relacionadas con el uso de catéter (BRC) en pacientes con enfermedad renal crónica avanzada (ERCA) representan un importante problema sanitario. Objetivos: Estimar la incidencia de BRC en pacientes con ERCA en el Hospital Ciro Redondo García, Artemisa, Cuba; y describir su relación con el tipo de acceso vascular (AV), así como la conducta médica que se adopta después del diagnóstico. Métodos: Se realizó un estudio descriptivo entre mayo-octubre del 2019, en el que se incluyó el total de los pacientes (n = 78) de la unidad de hemodiálisis del hospital. Se recogió información acerca del tipo y tiempo de uso del AV. Ante un episodio sugerente de bacteriemia, se obtuvo una muestra de sangre para hemocultivo. Se informó la incidencia de BRC según los criterios de Bouza (2004). Resultados: La tasa de incidencia de BRC se estimó buena (1,18/1 000 días-catéter). Para las producidas por Staphylococcus aureus y por bacterias gramnegativas (Escherichia coli, Enterobacter spp., Pseudomonas spp. y Alcaligenes spp.) las tasas fueron excelentes: 0,44 y 0,88/1 000 días-catéter, respectivamente. Los catéteres venosos centrales se constataron como los AV predominantes. Se verificó que se impuso tratamiento empírico ante signos de probable BRC y este se modificó tras el diagnóstico etiológico específico, acompañado de la retirada del AV siempre que las condiciones clínicas lo permitieron. Conclusiones: Se mantienen en el servicio de hemodiálisis buenas prácticas clínicas para la prevención de BRC. Los agentes etiológicos demostrados obligan a mantener la indicación de tratamiento empírico con antibióticos de amplio espectro(AU)

Introduction: Catheter-related bacteremias (CRB) in patients with advanced chronic kidney diseases represent a major health problem. Objective: To estimate the incidence of CRB in patients with advanced chronic kidney diseases at Ciro Redondo García Hospital, Artemisa, Cuba; and to describe its relationship with the type of vascular access (VA), as well as the medical protocol adopted after diagnosis. Methods: A descriptive study was conducted between May and October 2019. All patients (n=78) in the hospital hemodialysis unit were included. Information about the type and duration of VA was collected. In the presence of an episode suggestive of bacteremia, a blood sample was obtained for blood culture. The incidence of CRB was informed according to Bouza´s criteria (2004). Results: The incidence rate of CRB was estimated good (1.18/1 000 1000 catheter-days). For those caused by Staphylococcus aureus and by gram-negative bacteria (Escherichia coli, Enterobacter spp., Pseudomonas spp. y Alcaligenes spp.), the rates were excellent: 0.44 and 0.88/1000 catheter -days, respectively. Central venous catheters were the predominant VAs. It was confirmed that empirical treatment was initiated in the presence of signs of a probable CRB, which was modified after specific etiological diagnosis, together with the withdrawal of the VA whenever the clinical conditions allowed it. Conclusions: Good clinical practices for the prevention of CBR are maintained at the hemodialysis service. The confirmed etiological agents make it necessary to continue with the indication of empirical treatment with broad-spectrum antibiotics(AU)

Bacteriemias asociadas a catéteres por Staphylococcus Aureus / Catheter-related Staphylococcus aureus bacteremia

Introducción. La bacteriemia es una complicación severa que se presenta en pacientes con catéteres de larga permanencia. Los estudios publicados en niños sobre el tema son escasos y con resultados contradictorios. Objetivo. Analizar las características clínicas y de evolución de los pacientes con bacteriemia asociada a catéter de larga permanencia por Staphylococcus aureus (BACSa). Material y métodos. Fueron analizados retrospectivamente 13 pacientes con BACSa (8 infecciones en catéter implantable y 5 en catéter semi-implantable) diagnosticadas entre 2005 y 2007. Todos los pacientes recibieron tratamiento antibiótico empírico sin remover el dispositivo inicialmente. Resultados. La mediana de edad de los niños fue de 3,2 años. La mayor parte de los niños tuvieron una enfermedad hemato-oncológica de base (85%). La celulitis fue el foco clínico de infección más frecuentemente asociado a la BACSa (70%). En el 31% de los niños se diagnosticó sepsis asociada. El 15% de los pacientes tuvieron foco clínico secundario de infección. La mediana de duración de la bacteriemia fue de 4 días. En 4 niños (38%) se tuvo que extraer el catéter. Las causas que motivaron la extracción fueron la celulitis y la sepsis. Ningún paciente tuvo recaída de la infección y dos niños fallecieron (15%). Conclusion. Los pacientes con BACSa pueden ser tratados satisfactoriamente sin extraer el catéter inicialmente. La presencia de celulitis o sepsis asociada son indicaciones para extraer el dispositivo intravascular (AU)

Introduction: Bacteremia is a severe complication in patients with long-term catheters. Studies on this subject in children are scarce and results are contradictory. Objective: To analyze clinical features and evolution of patients with long-term catheter-related Staphylococcus aureus bacteremia (CRBSa). Material and Methods: 13 patients with CRBSa (8 infections in implantable catheters and 5 in semi-implantable catheters) diagnosed between 2005 and 2007 were retrospectively analyzed. All patients were empirically treated with antibiotics initially without removing the device. Results: The mean age of the children was 3.2 years. The majority of the children had an underlying oncohematologic disease (85%). Cellulitis was the most-frequent clinical focus of infection associated to CRBSa (70%). In 31% of the children associated sepsis was diagnosed. Fifteen percent of the patients had a secondary focus of infection. The median duration of bacteremia was 4 days. In 4 children (38%) the catheter had to be removed. Reasons for catheter-removal were cellulitis and sepsis. None of the patients had a relapse of the infection and two patients died (15%). Conclusion: Patients with CRBSa may be adequately treated without initially removing the catheter. Associated cellulitis or sepsis is an indication to remove the intravascular device (AU)

Central Venous Catheter-Related Microbacterium Bacteremia Identified by 16S ribosomal RNA Gene Sequencing / 대한임상미생물학회지

We describe here a case of central venous catheter (CVC)-related bacteremia caused by Microbacterium species in a 14-year-old patient, who had received chemotherapy for acute lymphoblastic leukemia. All nine blood cultures obtained from admission day 2 to day 62 yielded the same yellow-pigmented coryneform rod. Both Vitek 2 (bioMerieux, USA) and MicroScan (Dade Behring, USA) identified the isolate as Micrococcus species, and the API Coryne (bioMerieux, France) identified the isolate as Rhodococcus or Brevibacterium species. However, the 16S rRNA gene sequence showed a 99% identity with Microbacterium species. The bacteremia was recurrent or persistent over 60 days despite alternate systemic antibiotic therapy, but blood culture became negative after an addition of teicoplanin lock therapy for eradicating CVC-related bacteremia. This represents the first report of CVC-related Microbacterium bacteremia cured by antibiotic lock therapy in Korea.

Treatment of Catheter-related Bacteremia with an Antibiotic Lock Protocol in Hemodilaysis Patients / 대한신장학회잡지

BACKGROUND: Catheter-related bacteremia is a frequent complication among hemodialysis patients using a tunneled cuffed catheter. The standard therapy of catheter-related bacteremia involves both systemic antibiotics and catheter replacement. This study was performed to evaluate the effect of antibiotic lock therapy in conjugation with systemic antibiotics without catheter removal on catheter-related bacteremia. METHODS: Thirty six chronic hemodialysis patients with tunneled cuffed catheter were monitored for infection between July 2001 and July 2005. We analyzed the efficacy of antibiotic lock protocol compared with systemic antibiotics alone. RESULTS: Twenty-nine episodes of catheter-related bacteremia occurred in 27 patients during the study periods. The incidence of catheter-related bacteremia was 1.5 episodes/1000 catheter-days. A single gram-positive coccus grew in the 16 cases (55.2 %), and gram-negative organisms grew in the 69 cases (31.0%). Sixteen of 18 patients (88.9%) treated with antibiotic lock protocol had successful catheter salvage versus only 6 of the 11 patients (54.5%) treated with systemic antibiotics alone (p=0.05). Three patients with Burkholderia pickettii and a patient with Acinetobactor calcoaceticus-baumannii complex were treated with antibiotic lock protocol with systemic ciprofloxacin and imipenem, respectively. CONCLUSION: This study suggests that antibiotic lock protocol in eradicating catheter-related bacteremia is effective treatment without requiring catheter replacement.

Prevention of Uncuffed Hemodialysis Catheter-Related Bacteremia (CRB) Using Antibiotic Lock Technique (ALT): A Randomized Controlled Trial / 대한신장학회잡지

BACKGROUND: Because of the rate of infection, NKF-K/DOQI guidelines recommended that uncuffed catheter (UC) should be used for no longer than 3 weeks. However, from data of the Dialysis Outcomes and Practice Patterns Study (DOPPS), it was recognized that 48% of new HD patients in US and 75 % in Europe use UC as temporary access. ALT has been recommended as a prevention of CRB in these patients. We prospectively evaluated the efficacy of catheter-restricted filling with Antibiotic Lock Solution in preventing CRB. METHODS: One hundred twenty new hemodialysis patients requiring temporary catheter while waiting for placement and maturation of an arteriovenous fistula were enrolled. Patients were excluded if they had clinical or microbiological evidence of infection or already received antibiotics. Patients with uncuffed, right internal jugular vein catheter were randomly assigned to receive either antibiotic-heparin lock solution (cefazolin 10 mg/mL, gentamicin 5 mg/ mL, heparin 1, 000 unit/mL) or heparin lock solution (heparin 1, 000 unit/mL) as a catheter lock solution during interdialytic period. The end point of the trial was CRB. RESULTS: CRB developed in seven (11.7%) patients receiving heparin lock solution (S. aureus 2, S. epidermidis 5) whereas one patient receiving ALT had S. aureus bacteremia. CRB rates per 1, 000 catheter-days were 0.44 in the ALT group versus 3.12 in the heparin lock solution group (p=0.031). Kaplan-Meier analysis also showed CRB-free catheter survival is longer in ALT group. CONCLUSION: These results showed that ALT could be an effective strategy for the reduction of CRB rate in hemodialysis patients with UC.