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1.
Br J Nurs ; 29(3): S25-S29, 2020 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-32053448

RESUMEN

Demand for vascular access devices to meet the clinical needs of patients has increased dramatically in recent years, with a disproportionate increase in the numbers of individuals requiring a central venous access device (CVAD). With this increasing number of patients becoming recipients of CVADs globally each year, the associated incidence of catheter-related bloodstream infections (CRBSIs) is also increasing. In addition, there is strong evidence to demonstrate that antimicrobial resistance is a global challenge. There is a need to change the approach to CVAD management and get back to basics through a clearer understanding of how the incidence of CRBSIs can be reduced. This includes the role of biofilm and how its development can be inhibited through the use of an effective lock solution, and the avoidance of antibiotics.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/instrumentación , Infección Hospitalaria/prevención & control , Biopelículas , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Infección Hospitalaria/epidemiología , Diseño de Equipo , Humanos , Incidencia
2.
Medicine (Baltimore) ; 99(6): e19056, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028425

RESUMEN

Despite increasing use, the exact prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PICC-CLABSI) in hospitalized patients with cancer are not elucidated.This retrospective cohort study included consecutive patients who underwent peripherally inserted central catheter (PICC) placement in 4 institutions (during 12 months in 3 hospitals and 10 months in 1 hospital). The prevalence of PICC-CLABSI was evaluated. The association between predictors and PICC-CLABSI were analyzed using Cox proportional hazards regression models and Kaplan-Meier survival analysis with log-rank tests.During the study period, 539 PICCs were inserted in 484 patients for a total of 10,841 catheter days. PICC-CLABSI occurred in 25 (5.2%) patients, with an infection rate of 2.31 per 1000 catheter days. PICC for chemotherapy (hazards ratio [HR] 11.421; 95% confidence interval (CI), 2.434-53.594; P = .019), double lumen catheter [HR 5.466; 95% CI, 1.257-23.773; P = .007], and PICC for antibiotic therapy [HR 2.854; 95% CI, 1.082-7.530; P = .019] were associated with PICC-CLABSI.PICC for chemotherapy or antibiotics, and number of catheter lumens are associated with increased risk of PICC-CLABSI in cancer patients. Careful assessment of these factors might help prevent PICC-CLABSI and improve cancer patients care.


Asunto(s)
Bacteriemia/etiología , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/efectos adversos , Neoplasias/terapia , Anciano , Bacteriemia/epidemiología , Infecciones Relacionadas con Catéteres/etiología , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Prevalencia , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo
3.
Int J Infect Dis ; 92: 197-207, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31978577

RESUMEN

OBJECTIVES: Nocardia bacteremia is a rare but severe disease associated with high mortality. This systematic review is the largest and most comprehensive review performed over the past 20 years. METHODS: A single-center retrospective review of Nocardia bacteremia was performed using hospital microbiology records from January 1, 2010 to December 31, 2017. A systematic literature review was also performed to identify cases of Nocardia bacteremia described in the NCBI PubMed database in English between January 1, 1999 and December 31, 2018. RESULTS: Four new cases of Nocardia bacteremia are described. The systematic review identified 134 cases with sufficient information available for analysis. Of the total 138 cases, the median age was 58 years (interquartile range (IQR) 44-69 years) and 70% were male. Eighty-one percent were immunocompromised (corticosteroid use (49%), hematological malignancy (20%), solid organ transplant (20%), solid organ malignancy (19%), and hematopoietic stem cell transplantation (15%)) and 29% had endovascular devices. Pulmonary infection was the most common concurrent site of clinical disease (67%). The median incubation time to the detection of Nocardia bacteremia was 4 days (IQR 3-6 days). Blood cultures were the only positive microbiological specimen in 38% of cases. The median total duration of treatment was 75 days (IQR 25-182 days). Thirty-day all-cause mortality was 28% and overall all-cause mortality was 40%. CONCLUSIONS: Nocardia bacteremia is most frequently identified in immunocompromised patients and those with intravascular devices. Although rare, it represents a serious infection with high associated overall mortality.


Asunto(s)
Bacteriemia/microbiología , Nocardiosis , Adulto , Anciano , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Bacteriemia/fisiopatología , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/patología , Infecciones Relacionadas con Catéteres/fisiopatología , Femenino , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Nocardia/fisiología , Nocardiosis/complicaciones , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiología , Nocardiosis/fisiopatología , Estudios Retrospectivos
4.
Br J Nurs ; 29(2): S24-S26, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31972108

RESUMEN

PURPOSE: Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality. METHODS: An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection. RESULTS: The 5-year preintervention period (2008-2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013-2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period. LIMITATIONS: A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable. CONCLUSIONS: This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG.


Asunto(s)
Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/prevención & control , Desinfección/métodos , Diálisis Renal/enfermería , Alcoholes/administración & dosificación , Cateterismo Venoso Central/efectos adversos , Clorhexidina/administración & dosificación , Clorhexidina/análogos & derivados , Humanos , Investigación en Evaluación de Enfermería
6.
Medicine (Baltimore) ; 99(1): e18494, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895783

RESUMEN

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.


Asunto(s)
Infecciones Relacionadas con Catéteres/mortalidad , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/efectos adversos , Catéteres de Permanencia/efectos adversos , Anciano , Bacteriemia/microbiología , Bacteriemia/mortalidad , Estudios de Casos y Controles , Francia/epidemiología , Hospitales Públicos/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Tiempo de Internación/estadística & datos numéricos , Persona de Mediana Edad , Estudios Retrospectivos
7.
BMC Neurol ; 20(1): 6, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910808

RESUMEN

OBJECTIVE: The traditional approaches for diagnosing catheter-related bloodstream infection(CRBSI) is time consuming, which could not meet the clinical requirement. Our aim was to investigate the value of serum procalcitonin(PCT) in predicting CRBSI in first-ever acute ischemic stroke patients with central venous catheters (CVCs). METHODS: This was a retrospective study. First-ever acute ischemic stroke patients hospitalized in neurological intensive care unit(NICU) of Aerospace Center Hospital and NICU of Beijing Chaoyang Hospital during January 2010 and December 2017 with clinically suspected CRBSI were enrolled. Peripheral blood white blood cell (WBC) count, neutrophils percentage(NE%), the levels of serum PCT, dwell time of catheterization and outcome of the patients were collected. According to the diagnosis of CRBSI or not, they were divided into CRBSI group and no CRBSI group. We used receiver operating characteristic curve (ROC) to evaluate the value of serum PCT levels in predicting CRBSI in patients with clinically suspected CRBSI. RESULTS: Forty-five patients with suspected CRBSI were included in this study, and 13 patients were diagnosed with CRBSI. Comparing to those in no CRBSI group, the maximum body temperature (Tmax) (p = 0.036) and the PCT levels (P = 0.013) in CRBSI group were both significantly higher. The area under ROC of the serum PCT levels and the Tmax to predict the CRBSI were 0.803 (0.95CI,0.660-0.946) and 0.680 (0.95CI,0.529-0.832) respectively. The PCT cut-off value was 0.780 ng/ml, with the sensitivity 69.23%, specificity 87.50%, positive predictive values 69.23% and negative predictive values 87.50%. CONCLUSION: It could be helpful to adopt PCT as a rapid diagnostic biomarker for first-ever acute stroke patients with suspected CRBSI.


Asunto(s)
Bacteriemia/diagnóstico , Isquemia Encefálica/complicaciones , Infecciones Relacionadas con Catéteres/diagnóstico , Polipéptido alfa Relacionado con Calcitonina/sangre , Accidente Cerebrovascular/complicaciones , Bacteriemia/sangre , Bacteriemia/complicaciones , Infecciones Relacionadas con Catéteres/sangre , Infecciones Relacionadas con Catéteres/complicaciones , Humanos , Curva ROC , Estudios Retrospectivos
8.
Int J Antimicrob Agents ; 55(3): 105875, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31926285

RESUMEN

Use of peripheral venous catheters (PVCs) is very common in hospitals. According to the literature, after a visit to the emergency department >75% of hospitalised patients carry a PVC, among which almost 50% are useless. In this study, the presence and complications of PVCs in an infectious diseases (ID) unit of a French tertiary-care university hospital were monitored. A total of 614 patients were prospectively included over a 6-month period. Among the 614 patients, 509 (82.9%) arrived in the ID unit with a PVC, of which 260 (51.1%) were judged unnecessary and were removed as soon as the patients were examined by the ID team. More than one-half of PVCs were removed within 24 h in the unit (308/509; 60.5%). PVCs were complicated for 65 (12.8%) of the 509 patients, with complications including extravasation, cutaneous necrosis, lymphangitis, phlebitis, tearing off the patient, superficial venous thrombosis and arthritis. We must therefore continue to search for unjustified PVC insertion. Alternatives to the intravenous administration route must be proposed, such as subcutaneous infusion or oral antibiotic therapy.


Asunto(s)
Cateterismo Periférico/efectos adversos , Infecciones Relacionadas con Catéteres/etiología , Vías de Administración de Medicamentos , Servicio de Urgencia en Hospital , Humanos , Flebitis/etiología
9.
An Bras Dermatol ; 95(1): 75-77, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31959512

RESUMEN

Hailey-Hailey disease, or familial benign pemphigus, is a rare bullous genodermatosis that usually presents with flaccid blisters, erosions, and maceration limited to flexural areas, resulting in increased morbidity and reduced quality of life for affected patients. The authors report an unusual case of generalized Hailey-Hailey disease with erythroderma and fatal outcome.


Asunto(s)
Dermatitis Exfoliativa/patología , Pénfigo Familiar Benigno/patología , Acantólisis/patología , Infecciones Relacionadas con Catéteres , Dermatitis Exfoliativa/complicaciones , Dermatitis Exfoliativa/tratamiento farmacológico , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Pénfigo Familiar Benigno/complicaciones , Pénfigo Familiar Benigno/tratamiento farmacológico
10.
J Vasc Access ; 21(1): 86-91, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31328625

RESUMEN

PURPOSE: In an effort to reduce catheter-related bloodstream infection's incidence rates in an intensive care unit, several evidence-based procedures recommended by the Centers for Disease Control and Prevention for centrally inserted central catheters were implemented. A failure to fully comply with the recommendation for prompt removal of the centrally inserted central catheters was attributed, mainly to the difficulties and inadequacies raised from establishing peripheral venous access. METHODS: The ultrasound-guided peripheral venous cannulation method as a supplementary intervention to the Centers for Disease Control and Prevention's recommendations was incorporated and examined during the subsequent year. RESULTS: A significant reduction on catheter-related bloodstream infection incidence rates out of the expected range was found. Centrally inserted central catheters utilization ratios were reduced by 10.7% (p < 0.05; 58%-47%) and the catheter-related bloodstream infection incidence rate was reduced by 11.7 per thousand device-days (15.9-4.16/1000 centrally inserted central catheters days (2015-2016 group, respectively)). CONCLUSION: The reduction of catheter-related bloodstream infection was higher than that described in the published literature. This probably shows that the combination of the five evidence-based procedures recommended by the Centers for Disease Control and Prevention together with that of ultrasound-guided peripheral venous cannulation method can increase the compliance with the Category IA recommendation for removal or avoidance of unnecessary placement of centrally inserted central catheters and decrease the catheter-related bloodstream infections in a more effective way, by affecting the patients' centrally inserted central catheter exposure.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/instrumentación , Cateterismo Periférico/instrumentación , Catéteres de Permanencia , Catéteres Venosos Centrales , Remoción de Dispositivos , Ultrasonografía Intervencional , Anciano , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/microbiología , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/normas , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/normas , Chipre/epidemiología , Remoción de Dispositivos/efectos adversos , Remoción de Dispositivos/normas , Diseño de Equipo , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Tiempo de Tratamiento , Resultado del Tratamiento , Ultrasonografía Intervencional/normas , Estados Unidos
11.
Support Care Cancer ; 28(1): 193-200, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31001694

RESUMEN

PURPOSE: Some publications suggest high rates of healthcare-associated infections (HAIs) and of nosocomial pneumonia portending a poor prognosis in ICU cancer patients. A better understanding of the epidemiology of HAIs in these patients is needed. METHODS: A retrospective analysis of all the patients hospitalized for ≥ 48 h during a 12-year period in the 12-bed ICU of the Gustave Roussy hospital, monitored prospectively for ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) and for use of medical devices. RESULTS: During 3388 first stays in the ICU, 198 cases of VAP and 103 primary, 213 secondary, and 77 catheter-related BSIs were recorded. The VAP rate was 24.5/1000 ventilator days (95% confidence interval [CI] 21.2-28.0); the catheter-related BSI rate was 2.3/1000 catheter days (95% CI 1.8-2.8). The cumulative incidence during the first 25 days of exposure was 58.8% (95% CI 49.1-66.6%) for VAP, 8.9% (95% CI, 6.2-11.5%) for primary, 15.1% (95% CI 11.6-18.5%) for secondary and 5.0% (95% CI 3.2-6.8%) for catheter-related BSIs. VAP or BSIs were not associated with a higher risk of ICU mortality. CONCLUSIONS: This is the first study to report HAI rates in a large cohort of critically ill cancer patients. Although both the incidence of VAP and the rate of BSI are higher than in general ICU populations, this does not impact patient outcomes. The occurrence of device-associated infections is essentially due to severe medical conditions in patients and to the characteristics of malignancy.


Asunto(s)
Bacteriemia/epidemiología , Enfermedad Crítica/epidemiología , Neoplasias/epidemiología , Neumonía Asociada al Ventilador/epidemiología , Anciano , Bacteriemia/complicaciones , Bacteriemia/terapia , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/terapia , Estudios de Cohortes , Enfermedad Crítica/terapia , Infección Hospitalaria/epidemiología , Femenino , Humanos , Incidencia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/estadística & datos numéricos , Neoplasias/complicaciones , Neoplasias/terapia , Neumonía Asociada al Ventilador/terapia , Estudios Retrospectivos , Sepsis/epidemiología , Sepsis/terapia
12.
Support Care Cancer ; 28(1): 361-372, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31044308

RESUMEN

OBJECTIVE: This systematic review and meta-analysis aimed to provide evidence-based guidance to better understand the risk of central line-associated bloodstream infection (CLABSI) in cancer patients who received totally implantable venous access ports (TIVAPs) compared with those who received external central venous catheters (CVCs). METHODS: A systematic search of PubMed, Web of science, Embase, and the Cochrane Library was carried out from inception through Oct 2018, with no language restrictions. Trials examining the risk of CLABSI in cancer patients who received TIVAPs compared with those who received external CVCs were included. Two reviewers independently reviewed, extracted data, and assessed the risk of bias of each study. A random-effect model was used to estimate relative risks (RRs) with 95% CIs. RESULTS: In all, 26 studies involving 27 cohorts and 5575 patients reporting the incidence of CLABSI in patients with TIVAPs compared with external CVCs were included. Pooled meta-analysis of these trials revealed that TIVAPs were associated with a significant lower risk of CLABSI than were external CVCs (relative risk [RR], 0.44; 95% confidence interval [CI], 0.31-0.62; P < 0.00001), which was confirmed by trial sequential analysis for the cumulative z curve entered the futility area. Subgroup analyses demonstrated that CLABSI reduction was greatest in adult patients (RR [95% CI], 0.35 [0.22-0.56]) compared with pediatric patients who received TIVAPs (RR [95% CI], 0.55 [0.38-0.79]). CONCLUSIONS: TIVAP can significantly reduce the risk of CLABSI compared with external CVCs.


Asunto(s)
Bacteriemia/epidemiología , Bacteriemia/etiología , Infecciones Relacionadas con Catéteres/epidemiología , Catéteres Venosos Centrales/efectos adversos , Neoplasias/epidemiología , Adulto , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/estadística & datos numéricos , Catéteres Venosos Centrales/microbiología , Catéteres Venosos Centrales/estadística & datos numéricos , Humanos , Incidencia , Neoplasias/terapia , Factores de Riesgo
13.
Einstein (Sao Paulo) ; 18: eRC5063, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31553357

RESUMEN

A 65-year-old male with a history of urinary tract trauma requiring cystotomy and chronic bladder catheterization, presenting with chronic and uninvestigated changes in the color of the urine bag system, with no urine color change, and positive urine culture for Proteus mirabilis . These characteristics refer to the purple urine bag syndrome, a not weel-known condition, with a benign course in most cases, and associated with urinary tract infection in patients with chronic bladder catheterization. Although it is characterized by marked changes, it is underdiagnosed by healthcare professionals.


Asunto(s)
Infecciones Relacionadas con Catéteres/microbiología , Reservorios Urinarios Continentes/efectos adversos , Infecciones Urinarias/microbiología , Anciano , Infecciones Relacionadas con Catéteres/patología , Humanos , Masculino , Proteus mirabilis/aislamiento & purificación , Factores de Riesgo , Síndrome , Infecciones Urinarias/patología , Orina/microbiología
14.
J Matern Fetal Neonatal Med ; 33(1): 68-72, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29886771

RESUMEN

Purpose: We conducted a prospective randomized controlled trial to compare postoperative urinary catheter removal 2 versus 12 h after elective cesarean section in terms of irritative symptoms, first void time, incidence of urinary tract infection, postoperative mobilization time, and hospitalization time.Methods: A total of 134 women admitted to Duzce University Hospital for primary or recurrent elective cesarean section were randomized into two groups. A total of 62 women were enrolled in the early group, with indwelling catheter removal 2 h after cesarean section; 74 women were enrolled in the delayed group, with catheter removal 12 h after the cesarean section. The groups were prospectively compared in terms of irritative urinary symptoms, bacteriuria, hematuria, length of hospital stay, and mobilization time.Results: Urinary frequency (p = .04), microscopic hematuria incidence (p = .04), postoperative mobilization time (p = .01), and length of hospital stay (p = .009) were significantly lower in the early group than in the delayed group. There were no significant differences in terms of bacteruria, urinary retention, dysuria, and first postoperative voiding time.Conclusions: Early removal of urinary catheters after elective cesarean section is associated with reduced mobilization time and hospital stay.


Asunto(s)
Catéteres de Permanencia , Cesárea , Remoción de Dispositivos/métodos , Cateterismo Urinario , Catéteres Urinarios/efectos adversos , Adulto , Infecciones Relacionadas con Catéteres/epidemiología , Catéteres de Permanencia/efectos adversos , Catéteres de Permanencia/estadística & datos numéricos , Cesárea/efectos adversos , Cesárea/instrumentación , Cesárea/métodos , Cesárea/estadística & datos numéricos , Remoción de Dispositivos/efectos adversos , Remoción de Dispositivos/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/instrumentación , Procedimientos Quirúrgicos Electivos/métodos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Paridad/fisiología , Cuidados Posoperatorios/efectos adversos , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Embarazo , Factores de Tiempo , Resultado del Tratamiento , Turquia/epidemiología , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/estadística & datos numéricos , Catéteres Urinarios/estadística & datos numéricos , Retención Urinaria/epidemiología , Retención Urinaria/etiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Adulto Joven
15.
Top Spinal Cord Inj Rehabil ; 25(4): 331-339, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31844385

RESUMEN

Background: Catheter-associated urinary tract infection (CAUTI) is associated with increased morbidity and mortality and influences the quality of life of patients with spinal cord injury (SCI). Objectives: This clinical review aims to highlight the unique surveillance, prevention, diagnosis, and management challenges of CAUTI in the SCI population. Methods: Narrative review of the current literature on catheter use in persons with SCI was conducted to determine gaps in knowledge and opportunities for improvement. Results: Surveillance of CAUTI is challenging in the SCI population as the ability to detect symptoms used to diagnose CAUTI (ie, suprapubic pain, dysuria) is impaired. In terms of prevention of CAUTI, current strategies refocus on appropriate catheter insertion and care and early removal of catheters, which is not always feasible for persons with SCI. Prophylactic antibiotics, nutraceuticals, and coated catheters show limited efficacy in infection prevention. Diagnosing CAUTI after SCI is challenging, often resulting in an overdiagnosis of CAUTI when truly asymptomatic bacteriuria exists. In the management of CAUTI in patients with SCI, the use of multiple antibiotics over time in an individual increases the rate of multidrug-resistant organisms; therefore, the exploration of novel non-antibiotic treatments is of importance. The patient experience should be at the center of all these efforts. Conclusion: Better diagnostic tools or biomarkers are needed to define true CAUTI in people with SCI. SCI-specific evidence to inform catheter management and CAUTI treatment guidelines is needed, with the goal to minimize catheter-related harm, reduce antibiotic resistance, and improve satisfaction and overall quality of life for SCI patients.


Asunto(s)
Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones Relacionadas con Catéteres/terapia , Traumatismos de la Médula Espinal/complicaciones , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/terapia , Humanos , Calidad de Vida
16.
Medicine (Baltimore) ; 98(52): e18546, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31876752

RESUMEN

OBJECTIVE: The predictive accuracies of procalcitonin (PCT) in the diagnosis of catheter-associated bloodstream infection (CABSI) vary widely. This meta-analysis aimed to explore the predictive value of PCT for CABSI. METHODS: We searched PubMed, EMBase, Web of Science, ScienceDirect, Cochrane Library, and studies published up to 10 March 2019. Odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated to evaluate PCT predictive value using Stata 14.0 software. RESULTS: The meta-analysis was composed of 7 studies, consisting of 347 subjects. Pooled analysis demonstrated that a high PCT was significantly correlated with CABSI (pooled OR = 23.36, 95%CI 12.43-43.91, P < .001) and medium heterogenicity (I = 36.9%, P = .147). The pooled sensitivity and specificity were 85% (95%CI 0.76-0.91) and 89% (95%CI 0.68-0.97), respectively. Although Begg funnel plot (P = .007) indicated the presence of publication bias among the included studies, the stability of the pooled outcomes was verified by the trim-and-fill method. Furthermore, sensitivity analyses did not show important differences in effect estimation. CONCLUSION: PCT is an effective predictor of CABSI. However, high-quality randomized controlled trials are needed to determine whether PCT could predict CABSI.


Asunto(s)
Infecciones Relacionadas con Catéteres/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Sepsis/sangre , Biomarcadores/sangre , Infecciones Relacionadas con Catéteres/diagnóstico , Humanos , Valor Predictivo de las Pruebas , Sepsis/diagnóstico , Sepsis/etiología
17.
Rev Chilena Infectol ; 36(4): 414-420, 2019 Aug.
Artículo en Español | MEDLINE | ID: mdl-31859763

RESUMEN

Taurolidine is a broad-spectrum antiseptic used as lock therapy solution in adult and pediatric patients with long term central venous catheters (CVC) for the prevention of catheter related bloodstream infections (CRBSI). Taurolidine doesn't induce the resistant development and has only minor and brief side effects, which makes it an alternative both as a lock therapy and for the prevention of CRBSI in this group of patients.


Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres Venosos Centrales/efectos adversos , Taurina/análogos & derivados , Tiadiazinas/administración & dosificación , Humanos , Taurina/administración & dosificación
18.
Nephrol Nurs J ; 46(6): 587-590, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31872988

RESUMEN

Central venous catheter (CVC) vascular access is common among patients on hemodialysis. CVC use carries a substantial risk of central line-associated bloodstream infections (CLABSIs), costly events that place patients at a high risk of mortality. Our hospital and dialysis organization developed a cooperative strategy to reduce the rate of CLABSI among hospitalized patients on hemodialysis with a CVC. The program included the use of training and reporting tools to guide hospital staff with CLABSI prevention, as well as leadership committees to oversee the process. Fourteen CLABSIs were reported in the 17-month period prior to the implementation of the program, while no new CLABSIs occurred in the 30 months following implementation of the program. This prevention program effectively reduced the frequency of CLABSIs. Broader implementation of such programs may result in better outcomes and lower costs for hospitalized patients on hemodialysis.


Asunto(s)
Bacteriemia , Infecciones Relacionadas con Catéteres , Cateterismo Venoso Central , Catéteres Venosos Centrales , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Humanos , Diálisis Renal
19.
PLoS One ; 14(12): e0227248, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31887197

RESUMEN

Effective and safe practices during extracorporeal membrane oxygenation (ECMO) including infection precautions and securement of lines (cannulas and circuits) are critical to prevent life-threatening patient complications, yet little is known about the practices of bedside clinicians and data to support best practice is lacking. Therefore, the aim of this study was to identify and describe common line-related practices for patients supported by peripheral ECMO worldwide and to highlight any gaps for further investigation. An electronic survey was conducted to examine common line practices for patients managed on peripheral ECMO. Responses were obtained from 45 countries with the majority from the United States (n = 181) and United Kingdom (n = 32). Standardised infection precautions including hand hygiene, maximal barrier precautions and skin antisepsis were commonplace for cannulation. The most common antisepsis strategies included alcohol-based chlorhexidine gluconate (CHG) for cannula insertion (53%) and maintenance (54%), isopropyl alcohol on circuit access ports (39%), and CHG-impregnated dressings to cover insertion sites (36%). Adverse patient events due to line malposition or dislodgement were reported by 34% of respondents with most attributable to ineffective securement. Centres 'always' suturing peripheral cannula sites were more likely to experience a cannula adverse event than centres that 'never' sutured (35% [95% CI 30, 41] vs 0% [95% CI 0, 28]; Chi-square 4.40; p = 0.04) but this did not meet the a priori significance level of <0.01. An evidence-based guideline would be beneficial to improve ECMO line management according to 78% of respondents. Evidence gaps were identified for antiseptic agents, dressing products and regimens, securement methods, and needleless valves. Future research addressing these areas may provide opportunities for consensus guideline development and practice improvement.


Asunto(s)
Cánula/efectos adversos , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Periférico/efectos adversos , Oxigenación por Membrana Extracorpórea/efectos adversos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Antiinfecciosos Locales/administración & dosificación , Cánula/microbiología , Infecciones Relacionadas con Catéteres/etiología , Cateterismo Periférico/instrumentación , Cateterismo Periférico/normas , Desinfectantes/administración & dosificación , Desinfección/métodos , Desinfección/estadística & datos numéricos , Oxigenación por Membrana Extracorpórea/instrumentación , Oxigenación por Membrana Extracorpórea/normas , Adhesión a Directriz/estadística & datos numéricos , Higiene de las Manos/estadística & datos numéricos , Humanos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Encuestas y Cuestionarios/estadística & datos numéricos
20.
Infect Immun ; 88(1)2019 12 17.
Artículo en Inglés | MEDLINE | ID: mdl-31611275

RESUMEN

Catheter-associated urinary tract infections (CAUTIs) are common hospital-acquired infections and frequently polymicrobial, which complicates effective treatment. However, few studies experimentally address the consequences of polymicrobial interactions within the urinary tract, and the clinical significance of polymicrobial bacteriuria is not fully understood. Proteus mirabilis is one of the most common causes of monomicrobial and polymicrobial CAUTI and frequently cocolonizes with Enterococcus faecalis, Escherichia coli, Providencia stuartii, and Morganella morganii P. mirabilis infections are particularly challenging due to its potent urease enzyme, which facilitates formation of struvite crystals, catheter encrustation, blockage, and formation of urinary stones. We previously determined that interactions between P. mirabilis and other uropathogens can enhance P. mirabilis urease activity, resulting in greater disease severity during experimental polymicrobial infection. Our present work reveals that M. morganii acts on P. mirabilis in a contact-independent manner to decrease urease activity. Furthermore, M. morganii actively prevents urease enhancement by E. faecalis, P. stuartii, and E. coli Importantly, these interactions translate to modulation of disease severity during experimental CAUTI, predominantly through a urease-dependent mechanism. Thus, products secreted by multiple bacterial species in the milieu of the catheterized urinary tract can directly impact prognosis.


Asunto(s)
Antibiosis , Infecciones Relacionadas con Catéteres/patología , Coinfección/patología , Morganella morganii/crecimiento & desarrollo , Proteus mirabilis/enzimología , Ureasa/metabolismo , Infecciones Urinarias/patología , Animales , Infecciones Relacionadas con Catéteres/microbiología , Coinfección/microbiología , Modelos Animales de Enfermedad , Enterococcus faecalis/crecimiento & desarrollo , Escherichia coli/crecimiento & desarrollo , Ratones , Proteus mirabilis/crecimiento & desarrollo , Providencia/crecimiento & desarrollo , Infecciones Urinarias/microbiología
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