Sonication did not provide reliability to Maki technique for catheter related bloodstream infection diagnosis.

OBJECTIVE: The aim of our study was to analyze sonication and Maki techniques for diagnosis of catheter tip colonization and catheter-related bloodstream infection (CRBSI) on patients admitted to ICU. METHODS: Observational and prospective study in one Intensive Care Unit. Patients with some central venous catheter (CVC) at least for 7 days and catheter-related infection (CRI) suspicion (new episode of fever or sepsis) were included. We performed Maki technique followed by sonication of catheter tip. We compared area under the curve (AUC) of Maki, sonication, and techniques combination to diagnosis catheter tip colonization and CRBSI. RESULTS: We included 94 CVC from 87 CRI suspicion episodes. We found 14 cases of catheter tip colonization and 10 cases 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 any only by sonication technique. We found higher AUC in Maki technique 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 Maki technique and combination techniques for diagnosis of catheter tip colonization (p=0.32) and of CRBSI (p=0.32). CONCLUSIONS: Sonication did not provide reliability to Maki technique for diagnosis of catheter tip colonization and CRBSI.

[Quality control of nosocomial infection in PICU]. / Control de calidad en la infección nosocomial en la UCIP.

INTRODUCTION: Nosocomial infection represents a problem of public health given his high morbidity and mortality, and the cost that it causes to the sanitary system. OBJECTIVE: To analyze the nosocomial infection related to the principal invasive techniques realized in the paediatric intensive care unit of our hospital. MATERIAL AND METHODS: We prospectively analyzed the epidemiological information (days of hospitalization, days of placement of devices, intravascular and closed drainage system, and mechanical ventilation) and the incidence of nosocomial infections (bacteriemias, pneumonias, urinary tract infections) in the patients admitted during the years 2000-2004. RESULTS: There was analyzed a total of 302 patients finding an accumulated incidence of nosocomial infection of 9.76 %. The microorganisms isolated with major frequency were the gramnegative stain (46.60 %), followed by Candida sp. (33.30 %) and grampositive cocci (20.01 %). The predominant location of infection was the bacteriemia, with an incidence of 4.09 % (2.99 % of primary bacteraemia Vs 1.10 % of catheter related infection). The mean rate of incidence of bacteriemias associated to intravasculares devices (BADV) was 8.92 (NNISS 7.3 ) with mean rate of utilization of the device of 0.65 (> Pc90 of the NNISS). The pneumonia associated with mechanical ventilation (NAVM) presented a mean rate of incidence of 1.80 departing from a mean rate of utilization of 0.27 (< Pc25 of the NNISS). The urinary infection associated with the closed drainage system presented an average rate of effect of 2.63 , with a mean rate of utilization of the closed drainage system of 0.37 (Pc75). CONCLUSIONS: Nosocomial infection represents an important problem in PICU. These data allow us the knowledge of the incidence of nosocomial infection in our PICU and target the strategies for reducing morbidity and mortality.

Control de calidad en la infección nosocomial en la UCIP / Quality control of nosocomial infection in PICU

Introducción: La infección nosocomial representa un problema de salud dada su elevada morbimortalidad y el incremento de costes que ocasiona al sistema sanitario. Objetivo: Analizar la infección nosocomial relacionada con las principales técnicas invasivas realizadas en la unidad de cuidados intensivos pediátricos de nuestro hospital. Material y métodos: Recogida prospectiva de datos epidemiológicos (número de días de ingreso, de colocación de dispositivos, intravasculares y sondaje urinario cerrado y ventilación mecánica) y aparición de infecciones nosocomiales (bacteriemias, neumonías, infecciones de orina) en los pacientes ingresados durante los años 2000-2004. Resultados: Se analizaron un total de 302 pacientes y se encontró una incidencia acumulada de infección nosocomial del 9,76 %. Los microorganismos aislados con mayor frecuencia fueron los gramnegativos (46,60 %), seguidos de Candida sp. (33,30 %) y cocos grampositivos (20,01 %). Su localización predominante fue la bacteriemia, con una incidencia acumulada parcial del 4,09 %, predominando las primarias frente a las relacionadas a dispositivo intravascular (el 2,99 frente al 1,10 %). La tasa media de incidencia de bacteriemias asociadas con dispositivos intravasculares (BADV) fue del 8,92 ‰ (National Nosocomial Infectious Surveillance System [NNISS] 7,3 ‰) con una tasa media de utilización del dispositivo de 0,65 (> Pc90 del NNISS). La neumonía asociada a ventilación mecánica (NAVM) presentó una tasa media de incidencia del 1,80 ‰ partiendo de una tasa media de utilización del 0,27 (< Pc25 del NISS). La infección urinaria asociada con el sondaje urinario cerrado presentó una tasa media de incidencia del 2,63 ‰, con una tasa media de utilización del sondaje del 0,37 (Pc75). Conclusiones: La infección nosocomial representa un problema importante en las UCIP. Los datos obtenidos de este estudio nos permiten conocer la incidencia de la infección nosocomial en nuestra unidad de cuidados intensivos pediátricos (UCIP) y dirigir las estrategias de mejora para disminuir la mortalidad y morbilidad (AU)

Introduction: Nosocomial infection represents a problem of public health given his high morbidity and mortality, and the cost that it causes to the sanitary system. Objective: To analyze the nosocomial infection related to the principal invasive techniques realized in the paediatric intensive care unit of our hospital. Material and methods: We prospectively analyzed the epidemiological information (days of hospitalization, days of placement of devices, intravascular and closed drainage system, and mechanical ventilation) and the incidence of nosocomial infections (bacteriemias, pneumonias, urinary tract infections) in the patients admitted during the years 2000-2004. Results: There was analyzed a total of 302 patients finding an accumulated incidence of nosocomial infection of 9.76 %. The microorganisms isolated with major frequency were the gramnegative stain (46.60 %), followed by Candida sp. (33.30 %) and grampositive cocci (20.01 %). The predominant location of infection was the bacteriemia, with an incidence of 4.09 % (2.99 % of primary bacteraemia Vs 1.10 % of catheter related infection). The mean rate of incidence of bacteriemias associated to intravasculares devices (BADV) was 8.92 ‰ (NNISS 7.3 ‰) with mean rate of utilization of the device of 0.65 (> Pc90 of the NNISS). The pneumonia associated with mechanical ventilation (NAVM) presented a mean rate of incidence of 1.80 ‰ departing from a mean rate of utilization of 0.27 (< Pc25 of the NNISS). The urinary infection associated with the closed drainage system presented an average rate of effect of 2.63 ‰, with a mean rate of utilization of the closed drainage system of 0.37 (Pc75). Conclusions: Nosocomial infection represents an important problem in PICU. These data allow us the knowledge of the incidence of nosocomial infection in our PICU and target the strategies for reducing morbidity and mortality (AU)