Adding vortexing to the Maki technique provides no benefit for the diagnosis of catheter colonization or catheter-related bacteremia.

BACKGROUND: A previous study compared vortexing and Maki techniques for the diagnosis of catheter-related bloodstream infection (CRBSI), and concluded that vortexing was not superior to Maki method. AIM: To determine whether the combined use of vortexing and Maki techniques provides profitability versus the Maki technique for the diagnosis of catheter tip colonization (CTC) and CRBSI. METHODS: Observational and prospective study carried out in an Intensive Care Unit. Patients with suspected catheter-related infection (CRI) and with one central venous catheter for at least 7 days were included. The area under the curve (AUC) of the Maki technique, the vortexing technique and the combination of both techniques for the diagnosis of CTC and CRBSI were compared. RESULTS: We included 136 episodes of suspected CRI. We found 21 cases of CTC of which 10 were also CRBSI cases. Of the 21 CTC episodes, 18 (85.7%) were diagnosed by Maki technique and vortexing technique, 3 (14.3%) only by the technique of Maki, and none only by technique of vortexing. Of the 10 CRBSI episodes, 9 (90.0%) were diagnosed by the techniques of Maki and vortexing, 1 (10.0%) was diagnosed only by the technique of Maki, and none only by the technique of vortexing. We no found differences in the comparison of AUC between the technique of Maki and the combination of Maki and vortexing techniques for the diagnosis of CTC (P = 0.99) and CRBSI (P = 0.99). CONCLUSION: The novel finding of our study was that the combined use of vortexing and Maki techniques did not provide profitability to the technique of Maki alone to CRBSI diagnosis of.

Serum Fas levels during first week of sepsis are associated with severity and mortality.

INTRODUCTION: The aim of our study was to explore whether there is an association of serum sFas (cell death apoptosis receptor) concentrations during the first week of sepsis with sepsis severity and sepsis mortality. METHODS: In this observational study, septic patients were recruited. Serum sFas concentrations were determined on days 1, 4, and 8 of sepsis diagnosis. Thirty-day mortality was the outcome variable. RESULTS: Surviving patients (n = 181) compared to non-survivors (n = 101) presented lower serum sFas levels on day 1 (p < 0.001), day 4 (p < 0.001) and day 8 (p < 0.001), and lower SOFA on day 1 (p < 0.001), day 4 (p < 0.001) and day 8 (p < 0.001). Logistic regression analyses showed associations between 30-day mortality and serum sFas levels controlling for SOFA on day 1 (OR = 1.005; 95% CI = 1.003-1.007; p < 0.001), day 4 (OR = 1.044; 95% CI = 1.029-1.060; p < 0.001) and day 8 (OR = 1.012; 95% CI = 1.002-1.022; p = 0.02). CONCLUSIONS: The association of serum sFas concentrations during the first week of sepsis with sepsis severity and sepsis mortality were our new findings.

Association between blood caspase-9 concentrations and septic patient prognosis.

BACKGROUND: There are few data on caspase­9 (intrinsic apoptosis pathway initiating caspase) in septic patients. Higher serum caspase­9 levels in septic patients than in healthy subjects have been found. However, there are no data on the prognosis of septic patients and blood caspase­9 concentrations. Therefore, the objective of this study was to analyze the potential association between blood caspase­9 concentrations and prognosis in septic patients. METHODS: Three Spanish hospitals participated in the recruitment of septic patients admitted to intensive care units in this observational and prospective study. Serum caspase­9 concentrations were determined at the time of sepsis diagnosis. The 30-day mortality was the outcome variable. RESULTS: Higher Acute Phisiology and Chronic Health Evaluation(APACHE)-II (p < 0.001), Sepsis-related Organ Failure Assessment score (SOFA) (p < 0.001), serum lactic acid levels (p = 0.001), serum caspase­9 levels (p < 0.001), age (p < 0.001), International normalized ratio (INR) (p = 0.001), rate of septic shock (p = 0.001), Activated partial thromboplastin time (aPTT) (p = 0.03), rate of diabetes mellitus (p = 0.04), and lower platelet counts (p = 0.01) were found in non-surviving (n = 80) than in surviving patients (n = 134). Multiple logistic regression analysis showed an association between serum caspase­9 concentrations and mortality (Odds Ratio (OR) = 1.985; 95% Confidence Interval (CI) = 1.359-2.900; p < 0.001) regardless of age, SOFA, lactic acid and septic shock and history of diabetes mellitus. No significant differences were found when we compared area under ROC curves of serum caspase­9 with SOFA (p = 0.92) and with lactic acid (p = 0.59). CONCLUSIONS: The main novel finding of our study was the association between blood caspase­9 concentrations and septic patient prognosis. However, our study showed some limitations (for example, the absence of data in respect to execution of Surviving Sepsis Campaign bundles); thus, more research could be interesting to confirm our preliminary findings.

High mortality rate of septic patients with high blood granzyme B concentrations.

Granzyme B could be released from cytotoxic T lymphocytes producing apoptosis activation. The objective of our study was to determine whether an association between septic patient mortality and blood granzyme B concentrations exist. We recruited septic patients admitted in 3 Intensive Care Units. We recorded mortality at 30 days and we determined serum granzyme B concentrations at moment of sepsis diagnosis. We found higher rate of history of diabetes mellitus (P = 0.02), serum granzyme B concentrations (P < 0.001), age (P = 0.001), serum lactic acid levels (P = 0.001) and sepsis-related organ failure assessment (P < 0.001) exhibited non-surviving patients (n = 67) than surviving ones (n = 110). We found in multiple logistic regression analysis an association of serum granzyme B concentrations with mortality (odds ratio = 1.223; 95% confidence interval = 1.104-1.355; P < 0.001) controlling for diabetes mellitus, sepsis-related organ failure assessment, lactic acid and age. That we know, our study is the first reporting the existence of an association of high serum granzyme B concentrations with high septic patients mortality.

Sonication did not provide reliability to Maki technique for catheter related bloodstream infection diagnosis / La sonicación no proporciona rentabilidad a la técnica de Maki para el diagnóstico de bacteriemia relacionada con catéter

Objective. The aim of our study was to analyze sonicationand Maki techniques for diagnosis of catheter tip colonizationand catheter-related bloodstream infection (CRBSI) on patientsadmitted to ICU.Material and methods. Observational and prospectivestudy in one Intensive Care Unit. Patients with some centralvenous catheter (CVC) at least for 7 days and catheter-relatedinfection (CRI) suspicion (new episode of fever or sepsis) wereincluded. We performed Maki technique followed by sonication of catheter tip. We compared area under the curve (AUC)of Maki, sonication, and techniques combination to diagnosiscatheter tip colonization and CRBSI.Results. We included 94 CVC from 87 CRI suspicion episodes. We found 14 cases of catheter tip colonization and 10cases of CRBSI. Of the 14 catheter tip colonization cases, 7(50.0%) were detected by Maki and sonication techniques, 6(42.9%) were detected only by Maki technique, and 1 (7.1%)was detected only by sonication technique. Of the 10 CRBSI,6 (60.0%) were detected by Maki and sonication techniques,4 (40.0%) were detected only by Maki technique, and anyonly by sonication technique. We found higher AUC in Makitechnique than in sonication technique to diagnosis of CRBSI(p=0.02) and to diagnosis of catheter tip colonization (p=0.03).No significant differences were found in AUC between Makitechnique and combination techniques for diagnosis of catheter tip colonization (p=0.32) and of CRBSI (p=0.32).Conclusion.: Sonication did not provide reliability to Makitechnique for diagnosis of catheter tip colonization and CRBSI. (AU)

Objetivo. El objetivo de nuestro estudio fue analizar lastécnicas de sonicación y Maki para el diagnóstico de la colonización de la punta del catéter y la bacteriemia relacionada conel catéter (CRBSI) en pacientes ingresados en UCI.Material y método. Estudio observacional y prospectivoen una Unidad de Cuidados Intensivos. Se incluyeron pacientescon algún catéter venoso central (CVC) insertado al menos durante 7 días y sospecha de sospecha de infección relacionadacon el catéter (IRC) (nuevo episodio de fiebre o sepsis). Se realizó técnica de Maki y posteriormente sonicación de la puntadel catéter. Comparamos áreas bajo la curva (AUC) de Maki,sonicación y combinación de técnicas para el diagnóstico decolonización de la punta del catéter y de CRBSI.Resultados. Se incluyeron 94 CVC de 87 episodios de sospecha de IRC. Encontramos 14 casos de colonización de la puntadel catéter y 10 casos de CRBSI. De los 14 casos de colonizaciónde la punta del catéter, 7 (50,0%) fueron detectados por Maki ytécnicas de sonicación, 6 (42,9%) fueron detectados solo por latécnica de Maki y 1 (7,1%) fue detectado solo por la técnica desonicación. De los 10 CRBSI, 6 (60,0%) fueron detectados portécnicas de Maki y sonicación, 4 (40,0%) fueron detectados solopor la técnica de Maki, y ninguno solo por la técnica de sonicación. Encontramos mayor AUC con Maki que en la sonicaciónpara el diagnóstico de CRBSI (p=0.02) y para el diagnóstico decolonización de la punta del catéter (p=0.03). No encontramosdiferencias significativas en AUC entre Maki technique y combinación de técnicas para el diagnóstico de CRBSI (p=0.32) y parael diagnóstico de colonización de la punta del catéter (p=0.32).Conclusiones. La sonicación no proporcionó rentabilidada la técnica de Maki para el diagnóstico de colonización de lapunta del catéter y CRBSI. (AU)

Skin insertion site culture for the prediction of primary bloodstream infection.

PURPOSE: Previous studies have analyzed the capability of skin insertion site culture to predict catheter-related bloodstream infection (CRBSI). However, there has been not analyzed its capability to predict primary bloodstream infection (PBSI), that include CRBSI and bloodstream infection of unknown origin (BSIUO). The novel objective of our study was to determine the capability of insertion skin site culture to predict CRBSI and primary bloodstream infection (PBSI), that include CRBSI and bloodstream infection of unknown origin (BSIUO). MATERIAL AND METHODS: Observational and prospective study in one Intensive Care Unit. Patients with some central venous catheter (CVC) at least during 7 days and suspected catheter-related infection (CRI) (new episode of fever or sepsis) were included. Cultures of insertion skin site, paired blood samples, catheter-tip, and other clinical samples were taken. Capability of insertion skin site culture to predict CRBSI and PBSI was determined. RESULTS: We included 108 CVC from 96 CRI suspicion episodes. The causes that motivated CRI suspicion were 20 (18.5%) PBSI, 44 (40.7%) other infections, and 44 (40.7%) unknown. Among the 20 PBSI, 11 (55%) were CRBSI and 9 (45%) were BSIUO. Negative predictive value of insertion skin site culture to predict CRBSI was 95% (87-98%) and to predict PBSI was 85% (76-91%). CONCLUSIONS: The new finding of our study was that skin insertion site culture had a good negative predicted valued for the prediction of CRBSI and PBSI.