Clinical and economic evaluation of the impact of rapid microbiological diagnostic testing.

UNLABELLED: The clinical value of information provided by the Microbiology Laboratory may be reduced by the time it takes to generate results for healthcare providers. The aim of this study was to measure the clinical and economic impact associated with rapid reporting of microbiological results. METHODS: 574 hospitalized patients with a bacterial clinical infection confirmed by culture were evaluated. 284 hospitalized patients were included in the historical control group (results available the day following the analysis) and 290 in the intervention group (results available the same day of the analysis). The Vitek(®) 2 system (bioMérieux) was used for identification and antimicrobial susceptibility testing in both groups. RESULTS: Faster reporting of microbiological results enabled the clinician to optimize the antibiotic treatment sooner (P < 0.001). This reduction in turnaround time (17.6 h) was associated with improved clinical outcome, a significant reduction in the length of hospitalization and the number of microbiological and biochemical tests performed. Intubation requirements were significantly lower in the intervention group. Mortality rates did not differ significantly between the two groups. Costs incurred for patients in the intervention group were significantly lower than those in the control group, including costs for Microbiology Laboratory testing, antibiotic costs, length of hospitalization and other patient care costs. CONCLUSIONS: Rapid microbiological information was associated with quality improvement seen in earlier changes in antibiotic use, an improved clinical outcome and financial benefits.

Effectiveness of teicoplanin versus vancomycin lock therapy in the treatment of port-related coagulase-negative staphylococci bacteraemia: a prospective case-series analysis.

The aim of this study was to analyse the effectiveness of teicoplanin versus vancomycin lock therapy in the treatment of coagulase-negative staphylococci (CoNS) venous access port-related bloodstream infection (BSI). The study included 44 consecutive patients during a 36-month prospective case-series study. The primary endpoint was failure to cure. Treatment was successful in 39 patients. At the end of the study, the cumulative port survival rate was 100% in the teicoplanin lock group compared with 77% in the vancomycin lock group (P=0.06). In the Cox regression analysis, fever beyond 48 h of treatment was a significant predictor of treatment failure (P=0.02). Use of vancomycin or teicoplanin locks had an effectiveness of 88.6% in the treatment of CoNS port-related BSI. Teicoplanin locks reduced the failure rate from 18.5% to 0% compared with vancomycin locks. The presence of fever after beginning antimicrobial lock therapy was associated with treatment failure.

Intra-catheter leukocyte culture to monitor hemodialysis catheter colonization. A prospective study to prevent catheter-related bloodstream infections.

The most serious problem related to the use of tunneled catheters in hemodialysis is bacteremia. The aim of this study was to detect hemodialysis catheter colonization and, establish a preemptive therapy based on a catheter antibiotic lock in order to prevent development of catheter-related bloodstream infections. During a 24-month period, all patients with tunneled catheters in our hemodialysis unit were evaluated by extracting a through-catheter leukocyte culture every 15 days.There were 28 episodes of catheter colonization occurring in 13 patients (2.2 colonization episodes per 1000 catheter patient-days). At the time of colonization, catheters had been in place for a mean of 562 days (range: 16 to 1475 days). Coagulase negative staphylococci (CNS) were the most common microorganisms to be isolated. A preemptive therapy consisting in teicoplanin locks (10 mg/mL) for 21 days was able to eradicate catheter colonization in 89% of the cases when CNS were isolated. However, relapse of colonization occurred in 61.2% of these cases. The mean duration of catheter use was 239 days (range: 9 to 483 days) after treatment of a colonization episode. The incidence of catheter-related bloodstream infection in our population was 0.78 episodes per 1000 catheter patient-days (IC 95%: 0.374-1.434). This study shows the utility of intra-catheter leukocyte culture for early detection of hemodialysis catheter colonization. Moreover, it establishes that the eradication of biofilm-related CNS is possible without the removal of the catheter, thus enabling a longer catheter lifespan.

Atazanavir / Atazanavir

No disponible

Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine.

We have carried out a study on the behaviour pattern of implanted allografts initially stored in perfect conditions (aseptically processed, culture-negative and stored at -80 degrees C) but which presented positive cultures at the implantation stage. There is no information available on how to deal with this type of situation, so our aim was to set guidelines on the course of action which would be required in such a case. This was a retrospective study of 112 patients who underwent a spinal arthrodesis and in whom a total of 189 allograft pieces were used. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV (via PCR techniques) were negative. The allografts were stored by freezing them at -80 degrees C. A sample of the allograft was taken for culture in the operating theatre just before its implantation in all cases. The results of the cultures were obtained 3-5 days after the operation. There were 22 allografts with positive culture results (12%) after implantation. These allografts were implanted in 16 patients (14%). Cultures were positive for staphylococci coagulase negative (ECN) in 10 grafts (46%), Pseudomonas stutzeri in two grafts (9%), Corynebacterium jeikeium in two grafts (9%), staphylococci coagulase positive in two grafts (9%) and for each of the following organisms in one case each (4%): Corynebacterium spp., Actinomyces odontolyticus, Streptococcus mitis, Peptostreptococcus spp., Rhodococcus equi and Bacillus spp. No clinical infection was seen in any of these patients. Positive cultures could be caused by non-detected contamination at harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment different from our antibiotic protocol is required in the case of positive culture results of a graft piece after implantation.

Estudio de la infección asociada a catéter intravascular durante el año 1998 en la Clínica Universitaria de Navarra / Intravascular catheter related infections during the year 1998 in the University Clinic of Navarra

Objetivos: Estudio de la infección y bacteriemia asociada a catéter intravascular (CIV) desde enero de 1998 a enero de 1999 en nuestro hospital, y de la posibilidad del empleo de una metodología diagnóstica conservadora, que no implique la retirada del CIV, de la infección asociada a catéter (IAC).Material y métodos: Se estudiaron un total de 540 puntas de CIV combinando la técnica semicuantitativa de Maki con una modificación de la técnica cuantitativa descrita por Cleri. Se clasificaron los catéteres en dos grupos, según cumpliesen criterios de infección asociada a catéter o no, y se correlacionaron con la presencia o ausencia de bacteriemia asociada. Resultados: Sólo un 24.5 por ciento de los pacientes a los que se les retiró un CIV por sospecha de infección cumplían criterios de IAC. El 44.7 por ciento de los pacientes que cumplían criterios de IAC tuvieron una bacteriemia asociada a catéter (BAC), mientras que sólo el 1.7 por ciento de los pacientes sin criterios de IAC tuvieron una bacteriemia, sin poderse filiar el origen de la misma en el CIV. Los microorganismos más frecuentemente aislados fueron los estafilococos coagulasa negativos (63 por ciento) seguidos de corinebacterias (7.7 por ciento) y Staphylococcus aureus (6.1 por ciento).Discusión y conclusiones: El 74.5 por ciento de los CIV retirados por sospecha de infección asociada en nuestro hospital hubiesen podido mantenerse, ya que éstos no cumplían criterios de IAC. Este grupo de pacientes se hubiese podido beneficiar de un diagnóstico conservador (AU)

[Infection associated with intravascular catheter in 1998 at the University Clinic of Navarra]. / Estudio de la infección asociada a catéter intravascular durante el año 1998 en la Clínica Universitaria de Navarra.

PURPOSE: To study the intravascular catheter related infections (CRI) since January of 1998 to January of 1999 in our hospital. METHODS: We studied 540 catheter tips using a modified combination of the cuantitative method of Cleri and the semicuantitative method of Maki. The catheters were classified into two groups according to the presence or absence of criteria for CRI. RESULTS: 74.5% of the retired catheters because of infection suspice did not satisfied criteria for CRI. 44.7% of the patients with criteria suffered a catheter-related bacteriemia while just 1.7% of the patients without criteria suffered a bacteriemia. The most common isolated microorganisms were coagulase-negative Staphylococci, Corynebacterium species and S. aureus. DISCUSSION AND CONCLUSIONS: At least, 74.5% of the patients with a suspice of catheter related infection could undergo a non invasive diagnosis procedure that would have showed that the catheter was not infected.