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

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

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

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

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

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

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

TNFbeta+250 polymorphism and hyperdynamic state in cardiac surgery with extracorporeal circulation.

We have investigated genetic and clinical factors associated with hyperdynamic state (HS) after heart surgery with extracorporeal circulation (ECC). We performed a prospective cohort study of consecutive patients who underwent elective heart surgery with ECC. HS was defined as hyperthermia (>38 degrees C), cardiac index (CI) >3.5 l/min/m(2) and systemic vascular resistance index (SVRI) <1600 dynes x s/cm(5) x m(2). The study included demographic variables, gene polymorphisms A/G of tumor necrosis factor-beta (TNFbeta+250), G/A-1082 of interleukin-10 (IL-10), polymorphism of interleukin-1 receptor antagonist (IL-1ra), comorbidity, type of surgery, serum levels of interleukin-6 (IL-6), and postoperative course. We used Pearson chi(2) or Fisher exact test, and Student t-test for univariate analysis, with forward stepwise logistic regression for multivariate adjustment. Eighty patients were studied, of whom 22 (27.5%) developed HS. The presence of allele G of TNFbeta+250 polymorphism was associated with an increased incidence of HS (68% vs. 37%; P=0.011). In the multivariate analysis, a longer duration of ECC, and the presence of the G allele, were associated with the development of HS. The G allele of TNFbeta+250 polymorphism, and prolonged extracorporeal circuit times, may favor the development of a hyperdynamic state after heart surgery with ECC.

Prolonged intubation rates after coronary artery bypass surgery and ICU risk stratification score.

OBJECTIVE: To determine prolonged intubation rates among patients undergoing coronary artery bypass graft (CABG) surgery, and to evaluate the ability of the Intensive Care Unit Risk Stratification Score (ICURSS) model to predict these events. DESIGN: Prospective observational study. SETTING: A 24-bed ICU in a tertiary referral university hospital. PATIENTS: Five hundred sixty-nine patients undergoing CABG surgery. INTERVENTIONS: Variables of the ICURSS model were recorded at ICU admission. Extubation was performed according to a standard protocol. Patients remaining intubated within 8 h after ICU admission were designated as having early extubation failure (EEF). The next evaluations at 16, 24, 48, 72, and 96 h designated patients as having a prolonged intubation period (PIP) and prolonged mechanical ventilation (PMV) for 24, 48, 72, and 96 h. The ability of the ICURSS model to predict extubation failure at different cutoff values was measured using the Hosmer-Lemeshow goodness-of-fit test and the area under the receiver operating characteristic curve. MEASUREMENTS AND RESULTS: Prolonged intubation rates were as follows: EEF, 40.2%; PIP, 17.2%; PMV for 24 h, 10.4%; PMV for 48 h, 7.6%; PMV for 72 h, 6.5%; and PMV for 96 h, 6.0%. At every cutoff, the ICURSS showed poor discrimination to predict the failure to be extubated. Calibration was also poor, although some ability to predict both EEF and PMV at > or = 48 h was shown. CONCLUSIONS: Prolonged intubation rates after undergoing CABG surgery in our setting were comparable with those of other reports from institutions where fast-track cardiac anesthesia is currently in practice. In our cohort, the ICURSS was not useful for the prediction of length of intubation.

Evolución clínica del condiloma con y sin tratamiento mujeres de 15-49 años, Hospital Bertha Calderón Roque enero-dicembre 1997-1999

El grupo etáreo mayormente afectado en este estudio fueron mujeres entre los 27-32 años con un 26 porciento continuándoles el grupo de 33 a 38 años con un 25 porciento. La ocupación más representativa fueron las amas de casa con un 70 porciento y un 78 porciento en los grupos tratados y no tratados respecativamente. La mayoría de las mujeres fueron de procedencia urbana con un 72 porciento y 69 porciento en los grupos de tratadas y no tratadas;, la escolaridad que predominó fue la primaria con un 46 porciento y un 32 porciento respectivamente; la mediana de los antecedentes ginecobstétricos en las mujeres con condiloma fueron gesta 4, paridad 3, cesárea 0 y aborto 0; las caracteríticas clínicas que predominaron fue la leucorrea con 67.9 porciento en las tratadas y de un 80.7 porciento de las no tratadas; el método de diagnóstico más frecuente utilizado fue le papanicolaou con un 49 porciento en las tratadas y 82 porciento en las no tratadas; dentro de las patologías asociadas al condiloma no se encontró ninguna patología relevante 33.8 porciento pero también hay que hacer notar que la vaginitis ocupa un segundo lugar de importancia como patología asociada a esta entidad con un 22 porciento; el esquema terapéutico más utilizado fue la crioterapia con un 54.6 porciento y ácido tricloroacetico en un 45.3 porciento; en un 77 porciento de las pacientes con tratamiento y un 44 porciento de las pacientes sin tratammiento no se presentaron complicaciones; las pacientes respectivamente al egresar de consulta externa