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1.
Cochrane Database Syst Rev ; 1: CD012899, 2021 01 27.
Artículo en Inglés | MEDLINE | ID: mdl-33501650

RESUMEN

BACKGROUND: Patients with chronic kidney disease (CKD) who require urgent initiation of dialysis but without having a permanent dialysis access have traditionally commenced haemodialysis (HD) using a central venous catheter (CVC). However, several studies have reported that urgent initiation of peritoneal dialysis (PD) is a viable alternative option for such patients. OBJECTIVES: This review aimed to examine the benefits and harms of urgent-start PD compared to HD initiated using a CVC in adults and children with CKD requiring long-term kidney replacement therapy. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 25 May 2020 for randomised controlled trials through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. For non-randomised controlled trials, MEDLINE (OVID) (1946 to 11 February 2020) and EMBASE (OVID) (1980 to 11 February 2020) were searched. SELECTION CRITERIA: All randomised controlled trials (RCTs), quasi-RCTs and non-RCTs comparing urgent-start PD to HD initiated using a CVC. DATA COLLECTION AND ANALYSIS: Two authors extracted data and assessed the quality of studies independently. Additional information was obtained from the primary investigators. The estimates of effect were analysed using random-effects model and results were presented as risk ratios (RR) with 95% confidence intervals (CI). The GRADE framework was used to make judgments regarding certainty of the evidence for each outcome. MAIN RESULTS: Overall, seven observational studies (991 participants) were included: three prospective cohort studies and four retrospective cohort studies. All the outcomes except one (bacteraemia) were graded as very low certainty of evidence given that all included studies were observational studies and few events resulting in imprecision, and inconsistent findings. Urgent-start PD may reduce the incidence of catheter-related bacteraemia compared with HD initiated with a CVC (2 studies, 301 participants: RR 0.13, 95% CI 0.04 to 0.41; I2 = 0%; low certainty evidence), which translated into 131 fewer bacteraemia episodes per 1000 (95% CI 89 to 145 fewer). Urgent-start PD has uncertain effects on peritonitis risk (2 studies, 301 participants: RR 1.78, 95% CI 0.23 to 13.62; I2 = 0%; very low certainty evidence), exit-site/tunnel infection (1 study, 419 participants: RR 3.99, 95% CI 1.2 to 12.05; very low certainty evidence), exit-site bleeding (1 study, 178 participants: RR 0.12, 95% CI 0.01 to 2.33; very low certainty evidence), catheter malfunction (2 studies; 597 participants: RR 0.26, 95% CI: 0.07 to 0.91; I2 = 66%; very low certainty evidence), catheter re-adjustment (2 studies, 225 participants: RR: 0.13; 95% CI 0.00 to 18.61; I2 = 92%; very low certainty evidence), technique survival (1 study, 123 participants: RR: 1.18, 95% CI 0.87 to 1.61; very low certainty evidence), or patient survival (5 studies, 820 participants; RR 0.68, 95% CI 0.44 to 1.07; I2 = 0%; very low certainty evidence) compared with HD initiated using a CVC. Two studies using different methods of measurements for hospitalisation reported that hospitalisation was similar although one study reported higher hospitalisation rates in HD initiated using a catheter compared with urgent-start PD. AUTHORS' CONCLUSIONS: Compared with HD initiated using a CVC, urgent-start PD may reduce the risk of bacteraemia and had uncertain effects on other complications of dialysis and technique and patient survival. In summary, there are very few studies directly comparing the outcomes of urgent-start PD and HD initiated using a CVC for patients with CKD who need to commence dialysis urgently. This evidence gap needs to be addressed in future studies.


Asunto(s)
Catéteres Venosos Centrales , Tratamiento de Urgencia/métodos , Diálisis Renal/métodos , Insuficiencia Renal Crónica/terapia , Tiempo de Tratamiento , Bacteriemia/epidemiología , Bacteriemia/prevención & control , Sesgo , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Tratamiento de Urgencia/efectos adversos , Tratamiento de Urgencia/instrumentación , Tratamiento de Urgencia/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Estudios Observacionales como Asunto/estadística & datos numéricos , Diálisis Peritoneal/efectos adversos , Diálisis Peritoneal/instrumentación , Diálisis Peritoneal/métodos , Diálisis Peritoneal/mortalidad , Peritonitis/epidemiología , Diálisis Renal/efectos adversos , Diálisis Renal/instrumentación , Diálisis Renal/mortalidad , Insuficiencia Renal Crónica/mortalidad
2.
Medicine (Baltimore) ; 100(2): e24156, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33466189

RESUMEN

ABSTRACT: Patients with colorectal cancer (CRC) treated with curative intent surgery undergo continuous fluorouracil (5-FU) infusion-based chemotherapy using totally implantable central venous port system (TICVPS) in cases with high risk of recurrence. Approximately 30% of patients relapse after therapy completion, especially within 2 years. Hence, many patients with high risk CRC keep the TICVPS for 6 to 24 months after treatment with regular intervals of TICVPS flushing. However, little is known about the proper interval duration of the port. The aim of this study is to investigate whether a 3 months extended interval is safe and if port maintenance is feasible.A retrospective cohort was compiled of patients with CRC who underwent curative intent surgery and perioperative chemotherapy using TICVPS between 2010 and 2017. The primary end point was TICVPS maintenance rate, including maintenance of TICVPS for at least 6 months, planned TICVPS removal after 6 months, and regaining the use of TICVPS at the time of recurrence.A total of 214 patients with CRC underwent curative intent treatments during the study period. Among them, 60 patients were excluded, including 6 patients for early recurrence within 3 months and 54 patients with violation of flushing interval. Finally, 154 patients were analyzed. Mean flushing interval was 98.4 days (95% confidence interval [CI], 96.2-100.6; range, 60-120). In December 2018, 35 patients kept the TICVPS, 92 patients had planned removal, 25 patients reused the TICVPS, and 2 patients had to unexpectedly remove the TICVPS due to site infection and pain. Thus, the functional TICVPS maintenance rate was 98.8% (152/154). Thirty-eight patients relapsed, and 30 patients were treated with intravenous chemotherapy. Among them, 25 patients (83.3%) reused the maintained TICVPS without a reinsertion procedures.Our study demonstrated that 3-month interval access and flushing is safe and feasible for maintaining TICVPS during surveillance of patients with CRC. An extended interval up to 3 months can be considered because it is compatible with CRC surveillance visit schedules.


Asunto(s)
Cateterismo Venoso Central/normas , Catéteres Venosos Centrales/tendencias , Quimioterapia/instrumentación , Adulto , Anciano , Antineoplásicos/uso terapéutico , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/instrumentación , Cateterismo Venoso Central/enfermería , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/cirugía , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo
3.
BMC Infect Dis ; 20(1): 761, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33066740

RESUMEN

BACKGROUND: Device-associated health care-associated infections (DA-HAIs) in intensive care unit (ICU) patients constitute a major therapeutic issue complicating the regular hospitalisation process and having influence on patients' condition, length of hospitalisation, mortality and therapy cost. METHODS: The study involved all patients treated > 48 h at ICU of the Medical University Teaching Hospital (Poland) from 1.01.2015 to 31.12.2017. The study showed the surveillance and prevention of DA-HAIs on International Nosocomial Infection Control Consortium (INICC) Surveillance Online System (ISOS) 3 online platform according to methodology of the INICC multidimensional approach (IMA). RESULTS: During study period 252 HAIs were found in 1353 (549F/804M) patients and 14,700 patient-days of hospitalisation. The crude infections rate and incidence density of DA-HAIs was 18.69% and 17.49 ± 2.56 /1000 patient-days. Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI) and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 12.63 ± 1.49, 1.83 ± 0.65 and 6.5 ± 1.2, respectively. VAP(137) constituted 54.4% of HAIs, whereas CA-UTI(91) 36%, CLA-BSI(24) 9.6%.The most common pathogens in VAP and CA-UTI was multidrug-resistant (MDR) Acinetobacter baumannii (57 and 31%), and methicillin-resistant Staphylococcus epidermidis (MRSE) in CLA-BSI (45%). MDR Gram negative bacteria (GNB) 159 were responsible for 63.09% of HAIs. The length of hospitalisation of patients with a single DA-HAI at ICU was 21(14-33) days, while without infections it was 6.0 (3-11) days; p = 0.0001. The mortality rates in the hospital-acquired infection group and no infection group were 26.1% vs 26.9%; p = 0.838; OR 0.9633;95% CI (0.6733-1.3782). Extra cost of therapy caused by one ICU acquired HAI was US$ 11,475/Euro 10,035. Hand hygiene standards compliance rate was 64.7%, while VAP, CLA-BSI bundles compliance ranges were 96.2-76.8 and 29-100, respectively. CONCLUSIONS: DA-HAIs was diagnosed at nearly 1/5 of patients. They were more frequent than in European Centre Disease Control report (except for CLA-BSI), more frequent than the USA CDC report, yet less frequent than in limited-resource countries (except for CA-UTI). They prolonged the hospitalisation period at ICU and generated substantial additional costs of treatment with no influence on mortality. The Acinetobacter baumannii MDR infections were the most problematic therapeutic issue. DA-HAIs preventive methods compliance rate needs improvement.


Asunto(s)
Infecciones por Acinetobacter/epidemiología , Acinetobacter baumannii/genética , Infecciones Relacionadas con Catéteres/epidemiología , Hospitales Universitarios/economía , Control de Infecciones/métodos , Unidades de Cuidados Intensivos/economía , Staphylococcus aureus Resistente a Meticilina/genética , Neumonía Asociada al Ventilador/epidemiología , Infecciones Estafilocócicas/epidemiología , Infecciones Urinarias/epidemiología , Infecciones por Acinetobacter/economía , Infecciones por Acinetobacter/microbiología , Infecciones por Acinetobacter/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Relacionadas con Catéteres/economía , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/prevención & control , Farmacorresistencia Bacteriana Múltiple , Femenino , Higiene de las Manos/normas , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neumonía Asociada al Ventilador/economía , Neumonía Asociada al Ventilador/microbiología , Neumonía Asociada al Ventilador/prevención & control , Polonia/epidemiología , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Infecciones Estafilocócicas/economía , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/prevención & control , Infecciones Urinarias/economía , Infecciones Urinarias/microbiología , Infecciones Urinarias/prevención & control
4.
Medicine (Baltimore) ; 99(39): e22218, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-32991414

RESUMEN

BACKGROUND: Chlorhexidine and silver sulfadiazine coated central venous catheters (CSS-CVC) may cause loss of antimicrobial efficacy due to friction between the CVC surface and sheer stress caused by the blood flow. Therefore, the aim of this study was to investigate the antibacterial efficacy of CSS-CVC at various flow rates using a bloodstream model. METHODS: Each CVC was subjected to various flow rates (0.5, 1, 2, and 4 L/min) and wear-out times (0, 24, 48, 72, 96, and 120 hours), and the optical density (OD) 600 after a Staphylococcus aureus incubation test was used to determine the antibacterial effect of CSS-CVC. RESULTS: In the 0.5 L/min group, there was no significant change in the OD600 value up to 120 hours compared with the baseline OD600 value for CSS-CVC (P > .467). However, the OD600 values of CSS-CVC in the 1 L/min (P < .001) and 2 L/min (P < .001) groups were significantly reduced up to 72 hours, while that in the 4 L/min (p < 0.001) group decreased rapidly up to 48 hours. CONCLUSION: This study suggests that there is a doubt whether sufficient antibacterial function can be maintained with prolonged duration of catheter placement.


Asunto(s)
Antiinfecciosos Locales/farmacología , Velocidad del Flujo Sanguíneo , Cateterismo Venoso Central/instrumentación , Clorhexidina/farmacología , Sulfadiazina de Plata/farmacología , Antibacterianos/farmacología , Antiinfecciosos Locales/administración & dosificación , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres Venosos Centrales/normas , Clorhexidina/administración & dosificación , Humanos , Modelos Biológicos , Proyectos Piloto , Sulfadiazina de Plata/administración & dosificación
5.
Pediatrics ; 146(4)2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32883806

RESUMEN

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are a leading cause of health care-associated infection. Catheter insertion bundles (IBs) and maintenance bundles (MBs) have been developed to prevent CAUTIs but have not been extensively validated for use in pediatric populations. We report the CAUTI prevention efforts of a large network of children's hospitals. METHODS: Children's hospitals joined the Children's Hospitals' Solutions for Patient Safety engagement network from 2011 to 2017, using an open start time engagement approach, and elected to participate in CAUTI prevention efforts, with 26 submitting data initially and 128 at the end. CAUTI prevention recommendations were first released in May 2012, and IBs and MBs were released in May 2014. Hospitals reported on CAUTIs, patient-days, and urinary catheter-line days and tracked reliability to each bundle. For the network, run charts or control charts were used to plot CAUTI rates, urinary catheter use, and reliability to each bundle component. RESULTS: After the introduction of the pediatric CAUTI IBs and MBs, CAUTI rates across the network decreased 61.6%, from 2.55 to 0.98 infections per 1000 catheter-line days. Centerline shifts occurred both before and after the 2015 Centers for Disease Control and Prevention CAUTI definition change. Urinary catheter use rates did not decline during the intervention period. Network reliability to the IBs and MBs increased to 95.4% and 86.9%, respectively. CONCLUSIONS: IBs and MBs aimed at preventing CAUTIs were introduced across a large network of children's hospitals. Across the network, the rate of urinary tract infections among hospitalized children with indwelling urinary catheters decreased 61.6%.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Catéteres de Permanencia/efectos adversos , Infección Hospitalaria/prevención & control , Paquetes de Atención al Paciente , Cateterismo Urinario/efectos adversos , Infecciones Urinarias/prevención & control , Infecciones Relacionadas con Catéteres/epidemiología , Niño , Infección Hospitalaria/epidemiología , Hospitales Pediátricos , Humanos , Seguridad del Paciente , Mejoramiento de la Calidad/organización & administración , Reproducibilidad de los Resultados , Estados Unidos/epidemiología , Infecciones Urinarias/epidemiología
6.
Braz J Infect Dis ; 24(5): 373-379, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32949494

RESUMEN

BACKGROUND: Infection control interventions can be erroneously interpreted if outcomes are assessed in short periods. Also, statistical methods usually applied to compare outcomes before and after interventions are not appropriate for analyzing time series. AIMS: To analyze the impact of a bundle directed at reducing the incidence of ventilator-associated pneumonia (VAP) and other device-associated infections in two medical-surgical intensive care units (ICU) in Brazil. METHODS: Our study had a quasi-experimental design. Interrupted time series analyses (ITS) was performed assessing monthly rates of overall healthcare-associated infections (HCAI), VAP, laboratory-confirmed central line associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI), from January 2007 through June 2019. Moreover, multivariate ITS was adjusted for seasonality in Poisson regression models. An intervention based on a bundle for VAP prevention was introduced in August 2010. FINDINGS: The intervention was followed by sustained reduction in overall HCAI, VAP and CLABSI in both ICU. Continuous post-intervention trends towards reduction were detected for overall HCAI and VAP. CONCLUSION: Interventions aimed at preventing one specific site of infection may have sustained impact on other HCAI, which can be documented using time series analyses.


Asunto(s)
Infecciones Relacionadas con Catéteres , Infección Hospitalaria , Neumonía Asociada al Ventilador , Brasil/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Cuidados Críticos , Infección Hospitalaria/prevención & control , Humanos , Control de Infecciones , Unidades de Cuidados Intensivos , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada al Ventilador/prevención & control
7.
Ann. intensive care ; 118: 1-26, Sept. 07, 2020.
Artículo en Inglés | BIGG - guías GRADE | ID: biblio-1128263

RESUMEN

The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emer­ gency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Inten­ sivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheterrelated infections' prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed defnitions, and therapeutic strategies.


Asunto(s)
Humanos , Adulto , Control de Infecciones/métodos , Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones Relacionadas con Catéteres/transmisión , Clorhexidina/uso terapéutico , Medicina Basada en la Evidencia , Unidades de Cuidados Intensivos/normas
8.
Medicine (Baltimore) ; 99(31): e20912, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32756081

RESUMEN

INTRODUCTION: Adverse events (AE) in care are recognized as a leading cause of mortality and injury in patients. Improving patients' safety is difficult to achieve. Therefore, innovative research strategies are needed to identify errors in subgroups of patients and related severity of outcomes as well as reliably measured efficiency of reproducible strategies to improve safety. This trial aims to evaluate the impact of a combined multiprofessional education program on the rate of AE in neonatal intensive care units (NICUs). METHODS AND ANALYSIS: This is a stepped-wedge cluster randomised controlled trial with 3 clusters each containing 4 units. The study time period will be 20 months. The education program will be implemented within each cluster following a random sequence with a control period, a 4-month transition period and a post-educational intervention period. Eligibility criteria: for clusters: 6 NICUs from Ile-de-France and 6 NICUs from different regions in France; for patients: in-hospital during the study period (November 23, 2015 and November 2, 2017 [inclusion start dates varying by unit]) in one of the 12 NICUs; corrected gestational age ≤42 weeks upon admission; hospitalization period >2 days; and parents informed and not opposed to the use of their newborn's data. A routine occurrence reporting of medical errors and their consequence will take place during the entire study period. The intervention will combine an education to implement a standardized root cause analysis method, creation of bundles (insertion, daily goals, maintenance bundles) to prevent catheter-associated blood-stream infection and a poster to prevent extravasation injuries. OUTCOME: We hypothesize a reduction from 60 (control) to 50 (intervention) AE/1000 patient-days. The primary outcome will be the rate of AE/1000 patient-days in the NICU. TRIAL REGISTRATION NUMBER: NCT02598609, trial registered November 6, 2015. https://clinicaltrials.gov/ct2/show/NCT02598609. ETHICS AND DISSEMINATION: Study approved by the regional ethic committee CPP Ile-de-France III (no 2014-A01751-46). The results will be published in peer-reviewed journals.


Asunto(s)
Unidades de Cuidado Intensivo Neonatal , Errores Médicos/prevención & control , Neonatología/educación , Infecciones Relacionadas con Catéteres/prevención & control , Educación Médica Continua/métodos , Extravasación de Materiales Terapéuticos y Diagnósticos/prevención & control , Humanos , Recién Nacido , Seguridad del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto
9.
PLoS One ; 15(7): e0235593, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32634171

RESUMEN

BACKGROUND: To decrease contamination of needleless catheter hubs, caps or port protectors impregnated with isopropanol (IPA) have been developed and shown to be superior to other disinfection methods. The safety of the caps has been questioned, as they can be associated with alcohol leakage across the hub membrane. OBJECTIVES: We evaluated the use of IPA caps and the scrub-the-hub method from the safety standpoint of possible alcohol leakage across the hub membrane. METHODS: Circuits imitating an intravenous line were constructed. Circuits with an IPA cap were flushed with sodium chloride after the hub had been exposed to the cap for 1 hour, 24 hours, and 7 days. At the end of each period the fluid was collected and amounts of IPA in it were measured, using gas chromatography. Scrub circuits without IPA caps were also tested and ethanol from these was measured using the same method. RESULTS: In this in vitro study, IPA was detected in all samples from cap circuits, and ethanol was detected from all scrub circuits. Leakage increased over time in IPA circuits. After 24 hours and 7 days of exposure, the first injection resulted in higher amounts of IPA; thereafter, the levels decreased. The amounts of ethanol measured from the scrub circuits were low. CONCLUSIONS: IPA caps can cause leakage of alcohol across the hub membrane. Leakage increased over time, and a 30 sec drying time was not sufficient to solve the problem. Scrub-the-hub seems safe to use with regard to alcohol leakage.


Asunto(s)
2-Propanol/análisis , Diseño de Equipo , Infecciones Relacionadas con Catéteres/prevención & control , Cromatografía de Gases/métodos , Humanos , Cuidado del Lactante , Recién Nacido
10.
Med Clin North Am ; 104(4): 663-679, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32505259

RESUMEN

Hospital-acquired infections increase cost, morbidity, and mortality for patients across the United States and the world. Principal among these infections are central line-associated bloodstream infection, catheter-associated urinary tract infection, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus colonization and infections. This article provides succinct summaries of the background, epidemiology, diagnosis, and treatment of these conditions. In addition, novel prevention strategies, including those related to recent national interventions, are reviewed.


Asunto(s)
Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones por Clostridium/epidemiología , Infecciones Estafilocócicas/epidemiología , Infecciones Urinarias/epidemiología , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Bacteriemia/terapia , Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones Relacionadas con Catéteres/terapia , Catéteres de Permanencia/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/prevención & control , Infecciones por Clostridium/terapia , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Humanos , Incidencia , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/prevención & control , Infecciones Estafilocócicas/terapia , Estados Unidos/epidemiología , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/prevención & control , Infecciones Urinarias/terapia
11.
J Cancer Res Ther ; 16(2): 350-355, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32474523

RESUMEN

The coronavirus disease 2019 (COVID-19) has become a global pandemic since its outbreak in December 2019, which posed a threat to the safety and well-being of people on a global scale. Cancer patients are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and their critical morbidity and case fatality rates are high. The ablation expert committee of the Chinese Society of Clinical Oncology compiled corresponding expert recommendations. These recommendations summarize the preventive measures and management of tumor ablation treatment in medical institutions, including outpatient clinics, oncology wards, ablation operation room, and postablation follow-ups in accordance with the guidelines and protocols imposed by the National Health Commission of the People's Republic of China and the experience in management and prevention according to various hospitals. This consensus aims to reduce and prevent the spread of SARS-CoV-2 and its cross-infection between cancer patients in hospitals and provide regulatory advice and guidelines for medical personnel.


Asunto(s)
Betacoronavirus , Ablación por Catéter/efectos adversos , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones por Coronavirus/prevención & control , Brotes de Enfermedades , Neoplasias/cirugía , Pandemias/prevención & control , Neumonía Viral/prevención & control , Guías de Práctica Clínica como Asunto/normas , Infecciones Relacionadas con Catéteres/virología , China/epidemiología , Congresos como Asunto , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Humanos , Neoplasias/patología , Neoplasias/virología , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/virología
12.
PLoS One ; 15(6): e0234966, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32569313

RESUMEN

BACKGROUND/AIM: Prolonged maintenance of central venous catheters, including peripherally inserted central catheters (PICCs), is a major risk factor for central line-associated bloodstream infection (CLABSI). This study was conducted to evaluate the appropriate duration of PICC maintenance to prevent CLABSI. METHODS: A single-center retrospective study was conducted at an 824-bed tertiary hospital in Korea between January 2010 and December 2017. All hospitalized patients who underwent ultrasound-guided PICC insertion were enrolled. CLABSI was diagnosed according to the definitions of the National Health Safety Network. CLABSI caused by PICC was defined as PICC-associated bloodstream infection (PABSI). To identifying statistical correlations between catheter days and PABSI, the odds ratio for PABSI on the basis of the continuous value of catheter days was analyzed using restricted cubic spline splits with five knots. The optimal cut-off value for catheter days was identified by maximizing the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS: A total of 1,053 patients underwent ultrasound-guided PICC insertion during the study period. Among them, 36 were confirmed as having a PABSI (3.5%, 36/1014; 1.14 per 1000 catheter days). In the restricted cubic spline regression, catheter days showed a dose-dependent relationship with the risk of PABSI. The AUC of the ROC curve for developing a PABSI according to the duration of catheter maintenance was 0.715 (95% CI, 0.639-0.790); the calculated optimal cut-off value was 25 days. CONCLUSION: The incidence of PABSI was 1.14 per 1000 catheter days and the optimal cut-off value of catheter days to avoid a PABSI was 25 days.


Asunto(s)
Bacteriemia/epidemiología , Infecciones Relacionadas con Catéteres , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Anciano , Anciano de 80 o más Años , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Femenino , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Grampositivas/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Micosis/epidemiología , República de Corea , Estudios Retrospectivos , Factores de Riesgo , Centros de Atención Terciaria
13.
J Clin Neurosci ; 78: 135-138, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32536507

RESUMEN

Patients with acute traumatic cervical spinal cord injury (ATCSCI) have an increased risk of catheter-associated urinary tract infection (CAUTI). The effectiveness of silver alloy-coated silicone urinary catheters (SACC) in preventing CAUTI in ATCSCI is unknown and was the objective of this study. We performed a quality improvement initiative in an attempt to reduce CAUTI in patients undergoing spine surgery at a single quaternary center. Prior to July 2015, all patients received a latex indwelling catheter (LIC). All patients with ATCSCI with limited hand function (AIS A,B, or C) received a SACC. Incidence of CAUTI, microbiology, duration of infection, antibiotic susceptibility, and catheter-associated adverse events were recorded prospectively. We studied 3081 consecutive patients over the three years, of whom 302 (9.8%) had ATCSCI; 63% of ATCSCI patients were ASIA Impairment Scale (AIS) A or B. The overall rate of CAUTI was 19% (585/3081), and was 38% (116/302) in patients with ATCSCI. Of 178 ATCSCI patients with LIC, 100 (56%) developed a CAUTI compared with 28 of 124 (23%) patients with SACC (p < 0.05). Poly-microbial and gram-positive infection was more common in LIC than in SACC (p < 0.05). Median duration of infection was 9 days in SACC group and 12 days in LIC group (p = 0.08). Resistance to trimethoprim (p < 0.001) and ciprofloxacin (p < 0.05) were more common in LIC group. There was no difference in catheter-associated adverse events or length of stay between the groups. This quality improvement initiative illustrates the effectiveness of antiseptic silver alloy-coated silicone urinary catheters in patients with ATCSCI. In our population, the use of SACC reduces the incidence and the complexity of CAUTI.


Asunto(s)
Aleaciones/normas , Mejoramiento de la Calidad/normas , Siliconas/normas , Plata/normas , Traumatismos de la Médula Espinal/terapia , Catéteres Urinarios/normas , Adulto , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres de Permanencia/efectos adversos , Catéteres de Permanencia/normas , Catéteres de Permanencia/tendencias , Médula Cervical/lesiones , Diseño de Equipo/normas , Femenino , Humanos , Masculino , Estudios Prospectivos , Mejoramiento de la Calidad/tendencias , Traumatismos de la Médula Espinal/epidemiología , Resultado del Tratamiento , Catéteres Urinarios/efectos adversos , Catéteres Urinarios/tendencias , Infecciones Urinarias/epidemiología , Infecciones Urinarias/prevención & control
15.
Isr Med Assoc J ; 22(5): 299-302, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32378822

RESUMEN

BACKGROUND: Although indwelling catheters are increasingly used in modern medicine, they can be a source of microbial contamination and hard-to-treat biofilms, which jeopardize patient lives. At times 70% ethanol is used as a catheter-lock solution due to its bactericidal properties. However, high concentrations of ethanol can result in adverse effects and in malfunction of the catheters. OBJECTIVES: To determine whether low concentrations of ethanol can prevent and treat biofilms of Pseudomonas aeruginosa. METHODS: Ethanol was tested at a concentration range of 0.625-80% against laboratory and clinical isolates of P. aeruginosa for various time periods (2-48 hours). The following parameters were evaluated following ethanol exposure: prevention of biofilm formation, reduction of biofilm metabolic activity, and inhibition of biofilm regrowth. RESULTS: Exposing P. aeruginosa to twofold ethanol gradients demonstrated a significant biofilm inhibition at concentrations as low as 2.5%. Treating pre-formed biofilms of P. aeruginosa with 20% ethanol for 4 hours caused a sharp decay in the metabolic activity of both the laboratory and clinical P. aeruginosa isolates. In addition, treating mature biofilms with 20% ethanol prevented the regrowth of bacteria encased within it. CONCLUSIONS: Low ethanol concentrations (2.5%) can prevent in vitro biofilm formation of P. aeruginosa. Treatment of previously formed biofilms can be achieved using 20% ethanol, thereby keeping the catheters intact and avoiding complications that can result from high ethanol concentrations.


Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Biopelículas/efectos de los fármacos , Etanol/administración & dosificación , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/fisiología , Antiinfecciosos Locales/farmacología , Infecciones Relacionadas con Catéteres/prevención & control , Etanol/farmacología , Humanos , Pruebas de Sensibilidad Microbiana , Infecciones por Pseudomonas/prevención & control
16.
Cochrane Database Syst Rev ; 4: CD010996, 2020 04 30.
Artículo en Inglés | MEDLINE | ID: mdl-32352563

RESUMEN

BACKGROUND: Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion; there is debate, however, regarding the need for heparin and evidence to suggest normal saline (0.9% sodium chloride) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. This is an update of the review published in 2015. OBJECTIVES: To assess the clinical effects (benefits and harms) of intermittent flushing of normal saline versus heparin to prevent occlusion in long-term central venous catheters in infants and children. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases; World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials register to 9 April 2019. We also undertook reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared the efficacy of intermittent flushing with normal saline versus heparin to prevent occlusion of long-term CVCs in infants and children aged up to 18 years of age. We excluded temporary CVCs and peripherally inserted central catheters (PICC). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial inclusion criteria, trial quality and extracted data. We assessed study quality with the Cochrane 'Risk of bias' tool. For dichotomous outcomes, we calculated the rate ratio (RR) and corresponding 95% confidence interval (CI). We pooled data using a random-effects model; and we used GRADE to assess the overall certainty of the evidence supporting the outcomes assessed in this review. MAIN RESULTS: We identified one new study for this update, bringing the total number of included studies to four (255 participants). The four trials directly compared the use of normal saline and heparin; the studies all used different protocols for the intervention and control arms, however, and all used different concentrations of heparin. Different frequencies of flushes were also reported between studies. In addition, not all studies reported on all outcomes. The certainty of the evidence ranged from moderate to very low because there was no blinding; heterogeneity and inconsistency between studies was high; and the CIs were wide. CVC occlusion was assessed in all four trials. We were able to pool the results of two trials for the outcomes of CVC occlusion and CVC-associated blood stream infection. The estimated RR for CVC occlusion per 1000 catheter days between the normal saline and heparin groups was 0.75 (95% CI 0.10 to 5.51; 2 studies, 229 participants; very low certainty evidence). The estimated RR for CVC-associated blood stream infection was 1.48 (95% CI 0.24 to 9.37; 2 studies, 231 participants; low-certainty evidence). The duration of catheter placement was reported to be similar for the two study arms in one study (203 participants; moderate-certainty evidence), and not reported in the remaining studies. AUTHORS' CONCLUSIONS: The review found that there was not enough evidence to determine the effects of intermittent flushing with normal saline versus heparin to prevent occlusion in long-term central venous catheters in infants and children. It remains unclear whether heparin is necessary to prevent occlusion, CVC-associated blood stream infection or effects duration of catheter placement. Lack of agreement between institutions around the world regarding the appropriate care and maintenance of these devices remains.


Asunto(s)
Obstrucción del Catéter , Catéteres Venosos Centrales , Fibrinolíticos/administración & dosificación , Heparina/administración & dosificación , Cloruro de Sodio/administración & dosificación , Adolescente , Obstrucción del Catéter/estadística & datos numéricos , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres Venosos Centrales/efectos adversos , Catéteres Venosos Centrales/estadística & datos numéricos , Niño , Preescolar , Humanos , Lactante , Ensayos Clínicos Controlados Aleatorios como Asunto
17.
J Vasc Access ; 21(6): 923-930, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32339063

RESUMEN

BACKGROUND: Point-of-care ultrasound in end-stage renal disease is on the rise. Presently the decision to cannulate an arteriovenous fistula is based on its duration since surgery and physical exam. This study examines the effects of point-of-care ultrasound on decreasing the time to arteriovenous fistula cannulation, time spent with a central venous catheter, and the complications and infections that arise. METHODS: Prospective point-of-care ultrasound patients were recruited between January 2015 and January 2018, while retrospective data (non-point-of-care ultrasound) were collected via chart review from patients who had fistula creation between November 2011 and May 2014. Patients had point-of-care ultrasound within 3 weeks after arteriovenous fistula creation and were followed for 1 year. Arteriovenous fistula cannulation was initiated when the following parameters were met: diameter > 6 mm (with no depreciable narrowing of more than 20% throughout), depth < 6 mm, and length > 6 cm. Demographic data, as well as time to cannulation and central venous catheter removal, number of infections, complications, and interventions were compared between point-of-care ultrasound and non-point-of-care ultrasound groups using unpaired t-test, chi-square, and Fisher exact test statistical analysis. RESULTS: A total of 37 patients with new arteriovenous fistulas were followed by point-of-care ultrasound compared to 29 non-point-of-care ultrasound patients. Point-of-care ultrasound patients had earlier cannulations (35.5 vs 63.3 days, p < 0.05), shorter central venous catheter duration (68.2 vs 98.3 days, p < 0.05), and less infections (12 vs 19) without differences in complication compared to the non-point-of-care ultrasound. CONCLUSION: Point-of-care ultrasound facilitates early and safe arteriovenous fistula cannulation leading to a reduction in central venous catheter time and risk of infection. Point-of-care ultrasound may also aid in earlier identification of complications and difficult cannulations.


Asunto(s)
Atención Ambulatoria , Derivación Arteriovenosa Quirúrgica , Fallo Renal Crónico/terapia , Pruebas en el Punto de Atención , Diálisis Renal , Ultrasonografía , Grado de Desobstrucción Vascular , Adulto , Anciano , Derivación Arteriovenosa Quirúrgica/efectos adversos , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo , Cateterismo Venoso Central/instrumentación , Catéteres de Permanencia , Catéteres Venosos Centrales , Remoción de Dispositivos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
18.
BMC Health Serv Res ; 20(1): 336, 2020 Apr 21.
Artículo en Inglés | MEDLINE | ID: mdl-32316939

RESUMEN

BACKGROUND: Central line bundle programs were found to be effective in decreasing central line-associated bloodstream infection rates in pediatric cancer patients with ports. However, cost-effectiveness studies of central line bundle programs in pediatric cancer patients are limited, and most available data are from intensive care unit or adult studies. METHODS: In this cross-sectional study spanning 6 years, comprehensive assessment of total health care costs attributable to CLABSI's associated with ports between two periods. RESULTS: This cross-sectional study was carried out in the pediatric hematology-oncology ward of Dr. Behçet Uz Children's Hospital from 1 August November 2011 to 31 July 2017. The CLABSI rates decreased significantly from 8.31 CLABSIs to 3.04 per 1000 central line days (p < 0.001). In the pre-bundle period, total attributable costs spent for of patients with CLABSI were $130,661, and in the bundle period, total attributable costs spent for patients with CLABSI were $116,579. Within bundle implantation, 71 potential CLABSI were prevented, which saved an additional $208,977. CONCLUSION: Our study shows that central line bundles decreases not only the CLABSI rate but also decreases attributable costs due to CLABSI. Expenses spent for bundle elements, were covered by savings by preventing CLABSI with higher costs.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/instrumentación , Catéteres Venosos Centrales/microbiología , Infección Hospitalaria/prevención & control , Jeringas , Adulto , Niño , Análisis Costo-Beneficio , Estudios Transversales , Femenino , Costos de la Atención en Salud , Recursos en Salud , Hospitales Pediátricos , Humanos , Unidades de Cuidados Intensivos , Masculino , Neoplasias
19.
PLoS One ; 15(4): e0231110, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32255798

RESUMEN

Infection is one of the most commonly described complications, and a major cause of morbidity and mortality in pediatric patients treated using central venous catheters (CVCs). Taurolidine lock solutions have been used to decrease catheter-related bloodstream infections (CRBSIs) in both adult and pediatric patients. The purpose of this study was to systematically search the literature and conduct a meta-analysis to determine the efficacy of taurolidine in reducing CRBSI in children. We conducted an electronic search of the PubMed, EMBASE, Cochrane Library, TRIP Database, CINAHL, and Google Scholar databases for articles published up to 1st November 2019. Eligible studies included randomized controlled trials (RCTs) comparing the effects of taurolidine with control for preventing CRBSI in pediatric patients. Four studies were included. Our results indicated a statistical significant reduction in the total number of CRBSI with taurolidine as compared to control (RR: 0.23; 95% CI:0.13, 0.40; I2 = 0%; P<0.00001). The pooled analysis also indicated a statistical significant reduction in the incidence of CRBSI (defined as the number of CRBSI events/1000 catheter days) in the taurolidine group (MD: -1.12; 95% CI:-1.54, -0.71; I2 = 1%; P<0.00001). The number of catheters removed due to infection or suspected infection was not significantly different between the two groups (RR: 0.68; 95% CI:0.22, 2.10; I2 = 56%; P = 0.50) (Fig 5). The quality of the included studies was not high. The use of taurolidine as a catheter locking solution may significantly reduce CRBSI in pediatric patients. However, the quality of current evidence is not high and further high-quality large scale RCTs are needed to corroborate our results.


Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Infecciones Relacionadas con Catéteres/prevención & control , Taurina/análogos & derivados , Tiadiazinas/administración & dosificación , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Catéteres Venosos Centrales/efectos adversos , Niño , Humanos , Incidencia , Ensayos Clínicos Controlados Aleatorios como Asunto , Taurina/administración & dosificación , Resultado del Tratamiento
20.
Int J Nurs Pract ; 26(3): e12834, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32166846

RESUMEN

AIM: To explore interventions and strategies to prevent catheter-associated urinary tract infections in hospitalized patients with a short-term indwelling urinary catheter. BACKGROUND: Interventions and strategies to prevent catheter-associated urinary tract infections are reported in the literature, but it is not clear which might be relevant when the indwelling urinary catheter is in place for a short period of time. METHODS: An integrative review was performed. A search was undertaken in databases using the following search terms: "urinary catheter, bladder catheter OR urethral catheter*"and "bundl* OR care OR manag* OR intervent*." Electronic databases were searched up until June 2019. Manual searching of reference lists of included studies was undertaken. Twelve studies reported in 15 articles were identified and analysed by two independent reviewers. RESULTS: Multifaceted interventions were informed by evidence-based protocols or guidelines. Implementation strategies included local adaption of guidelines or protocols, use of an opinion leader, audit and feedback, multidisciplinary team involvement, reminders and stop orders, and education and training. CONCLUSION: Multifaceted, evidence-based interventions to prevent catheter-associated urinary tract infections are effective in preventing infections in patients with short-term urinary catheters. However, there is little evidence to inform which combined strategies are more likely to be effective.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Catéteres de Permanencia/efectos adversos , Cateterismo Urinario/efectos adversos , Humanos , Infecciones Urinarias/prevención & control
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