Disposable disinfection cap for preventing catheter-related blood stream infections: a Meta-analysis / 中国实用护理杂志

Objective:To evaluate the efficacy of disposable disinfection cap in preventing catheter-related blood stream infections (CRBSIs).Methods:Literature on the prevention of CRBSIs by disposable disinfection caps were retrieved from CNKI, Wanfang Database, VIP database, Chinese Biomedical Literature Database, PubMed, Cochrane Library, Embase and Web of Science databases. The retrieval period was from the database construction to June 30, 2022. After literature screening, data extraction and quality evaluation were independently carried out by 2 researchers, RevMan5.4 software was used for analysis.Results:A total of 12 articles were included, including 9 832 patients. Meta-analysis results showed that compared with conventional manual disinfection, disposable disinfection cap could reduce the incidence of CRBSIs, and the difference was statistically significant ( RR = 0.58, 95% CI 0.43-0.79, P<0.01). Disposable disinfection cap could reduce the incidence of CRBSIs in adults, but there was no significant difference in the incidence of CRBSIs in children ( P>0.05). It could reduce the incidence of CRBSIs in patients with indwelling vascular catheters in ICU ( RR = 0.58, 95% CI 0.38-0.89, P<0.05), but there was no statistical difference in the incidence of CRBSIs in patients without indwelling vascular catheters in ICU ( P>0.05). In addition, the compliance of the use of disinfection caps by nursing staff was improved by 80% - 90% and the treatment cost was saved by about 282 - 464 dollars. Conclusions:Disposable disinfection caps can reduce the occurrence of CRBSIs, improve the disinfection compliance of nursing staff, and save the hospitalization cost of patients. It is suggested to be popularized in clinical practice.

Evaluation the Pattern of BSI in Cancer Patients and Their Sensitivity and Resistance toward Antibiotic

Background: Bloodstream infections (BSIs) account for large-scale morbidity and mortality among cancer patients requiring a rational antibiotic policy. In Bangladesh, there is a paucity of data regarding incidence and pattern of BSI in such patients. Objective:To evaluate the pattern of BSI in cancer patients and their sensitivity and resistance toward antibiotic.Material & Methods:The present study was a retrospective analysis of BSI patterns among various cancer patients treated at Department of Oncology, Enam Medical College Hospital, Saver, Bangladesh during the period from January to June 2021. Blood culture results and their sensitivity patterns of these cancer patients along with the demographic characteristics were collected from the records and maintained in the structured pro forma. Before starting empirical antibiotics, 10 ml of blood was collected into Bract/ALERT culture media.Results:A total of 82 patients/episodes had confirmed BSI. Gram-negative bacteria accounted for 43 (52.4%) cases, followed by Gram positive 38 (46.4%) cases and 1 case of candida species. The most common organisms isolated were Klebsiella pneumonia and Staphylococcus aureus consisting of 17 cases each. The Gram-negative bacterial isolates (n = 43) were sensitive to cefoperazone plus sulbactam, piperacillin plus tazobactam, carbapenem, and colitis in 18 (41.9%), 19 (44.2%), 29 (67.4%), and 40 (93%) episodes, respectively. The sensitivity of Gram-positive bacteria (n = 38) to vancomycin, linezolid, and teicoplanin was seen in 37 (97.3%), 37 (97.3%), and 35 (92.1%) episodes, respectively. Multidrug-resistant bacteria accounted for 17 (39.5%) cases of Gram-negative isolates and 9 (53%) of which were K. pneumonia. Extended spectrum beta-lactamase activity was seen in 11 of 26 episodes of Enterobacteriaceae. Four of 17 S. aureus and 3 of 11 coagulase-negative Staphylococci were methicillin resistant, and 1 of 2 cases of Enterococcus was vancomycin resistant.Conclusions:Gram-negative bacteria are the predominant cause of BSI in cancer patients and development of a high degree of resistance to commonly used antibiotics is challenging.

Bacteriological Profile, Antibiogram and Phenotypic Resistance Flagging of Blood Culture Isolates by Automated Methods in a Tertiary Care Hospital

Introduction: Microorganism present in blood whethercontinuously or intermittently are threat to every organ in thebody. The surveillance of etiological agents in these infectionsis essential for their prevention and treatment. Awarenessof the baseline microbial resistance specific to a hospitalprevents irrational use of antibiotics in that hospital. Thushelps progress a step forward in the prevention of spread ofantibiotic resistance.Material and methods: A retrospective study was conductedin the department of Microbiology. During the study period,blood samples collected from all age group OPD, IPD andICU patients suspected of bacteremia and septicemia wereanalyzed. All Gram-negative bacilli, Gram-positive cocci andYeast were investigated while anaerobic bacteria and cultureswith mixed growth were excluded.Results: During the study period of Jan 2017-Dec2017, 1885blood cultures were analyzed. 305 (16.1%) were found tobe positive, out of which 236 were from ICU, 58 were fromIPD and 11 from OPD. Among Gram positive cocci, CoNSis commonest followed by Staphylococcus aureus whereas inGram negative bacilli, Klebsiella pneumoniae was commonestorganism followed by Pseudomonas aeruginosa. In our study,90% of Enterobacteraceae were ESBL producers. MRSA wereisolated in 50% and MRCoNS in 71%.Gram-positive isolate were least sensitive to penicillin(10%) while it was most sensitive to tigecycline in 100%followed by vancomycin in 95%. Gram negative isolates ofEnterobacteriaceae were least sensitive to Aztreonam (11%)and while it was most sensitive to Colistin in 87% of cases.Candida species were isolated in 54 (18%) of which NICUaccounted for majority of cases. Candida albicans was leastsensitive to Fluconazole (82%) and Non albicans candida toAmphotericin B (70%) while they were sensitive to all otherantifungals.Conclusion: The retrospective study conducted showed bothgram positive and gram negative bacteria were responsiblefor blood stream infections. Most of the strains were multidrug resistant. Rapid isolation and identification of pathogensby automated blood culture system and antibiogram withminimum inhibitory concentration (MIC) value provides earlyand appropriate treatment to the seriously ill patients leadingto reduce mortality and reduce duration of hospitals.Resistance flagging of the bacterial isolates guides us toperform barrier nursing and isolate the patient to preventspread of infection. The daily analysis of resistance flaggingand MIC values give important information for choosingselective antibiotics leading to good antibiotic stewardshipwhich in turn reduces patient morbidity and mortality.

Effectiveness of chlorhexidine/silver sulfadiazine catheters in the prevention of catheter-related bloodstream infections: A traditional meta analysis / 解放军医学杂志

[Abstract] Objective To evaluate the effectiveness of chlorhexidine/silver sulfadiazine catheters vs. conventional standard catheters in the prevention of catheter-related bloodstream infections with bundles. Methods We searched the Cochrane Library, Embase, Medline, CINAHL and Web of Science databases from construction to March 2019 for randomized controlled trials to compare the use of chlorhexidine/silver sulfadiazine catheters and conventional standard catheters. Cochrane bias risk assessment tool was used to evaluate the included research, and the effective data was extracted. The set risk ratio (RR) was calculated with 95% confidence interval (CI), and the rate of CRBSI per 1000 catheter-days and bacterial colonization rate were measured. The primary outcome was CRBSI thousand day rate and the secondary outcome was bacterial colonization rate. The meta analysis was performed by R3.4.1 software. Results Seventeen trials included 4892 patients who received chlorhexidine/sulfadiazine silver coated catheters and conventional standard catheters were included. Compared with conventional standard catheters, chlorhexidine/ silver sulfadiazine catheters were associated with a lower incidence of catheter colonization (RR=0.55, 95%CI: 0.45-0.68, P=0.02). In addition, the the difference of the rate of CRBSI per 1000 catheter-days was not significant (RR=0.70, 95%CI: 0.48-1.02, P=0.32). Conclusion Compared with conventional standard catheters, the use of chlorhexidine/silver sulfadiazine-catheters with bundles can further reduce the incidence of catheter colonization, but does not reduce the rate of CRBSI per 1000 catheter-days.

Bacteriological Profile and Antibiogram of Gram Negative Bacteria Isolated from Blood Culture

Introduction: Blood stream infections are one of the important cause of morbidity and mortality all over the world. Bacteraemia ranges from self-limiting infections to life-threatening septicaemia that requires rapid and aggressive antimicrobial treatment. The mortality rate ranges from 20% to 50% in cases of bacteraemia infections. Aim and Objective: The present study was undertaken to know the profile of gram negative organism causing  bacteraemia with their Antibiogram from suspected cases. Material and Method: During a one-year period, 400 blood samples were taken from bacteraemia suspected patients. Blood culture was done by using BacT/Alert 3D system.  Further identification of organism was done by different biochemical test. Antimicrobial sensitivity pattern was determined by Kirby Bauer Disc Diffusion method according to CLSI guidelines. Result: Out of 400 samples, the total number of culture positive cases were found to be 131 giving culture positive rate of 32.75%. Gram positive organism were more than gram negative organism, constituting about 75 (57.69%) of total isolates. 56(42.74%) Gram negative organism were isolated in this study. Most frequent pathogen identified among gram negative bacteria were Klebseilla 24(42.8%), followed by E. coli 18(32.14%), Acinetobacter 10(17.85%), Pseudomonas 2(3.57%) and Salmonella 2(3.57%) respectively. Isolated gram negative organism was highly sensitive to Polymyxin B 51(91.07%). After Polymyxin B isolated gram negative bacteria show high sensitivity for Levofloxacin(60.71%), Cefixime (57.78%), Gentamicin, Meropenem, Piperacillin/tazobactum (50%), Cefepime (44.64%) with least sensitivity for Ampicillin/Sulbactum (14.28%). Conclusion: The present study provides information about gram negative pathogens responsible for blood    stream infection along with their sensitivity towards commonly used antimicrobial. Antibiotic sensitivity pattern of isolates provides useful guidelines to clinicians in initiating empiric therapy and help in management of blood stream infections.

Tunnelled Peripherally Inserted Central Catherer- How We Do Them

In the current study, we report a new technique to place a tunnelled peripherally inserted central catheter (PICC) at the upper arm of patient under real-time ultrasound-guided venipuncture using disposal equipment provided within a standard PICC set. The tunnelling of the PICC required an extra time of 5 minutes but was well tolerated by all patients involved in the study. The tunnelled PICC was applied on 50 patients and the infection rate as well its catheter dwell time were compared to another 50 patients with conventional PICC. The rate of patients who developed infection decreased from 34% for conventional PICC to 16% in tunnelled PICC patients. The central line-associated blood stream infections rate was also decreased from 4.4 per 1000 catheter-days for conventional PICC to 1.3 per 1000 catheter-days for tunnelled PICC. The mean time to infection development for tunnelled PICC (24 days) was longer than those observed with conventional PICC (19 days). Tunnelled PICC has also increased the mean catheter dwell time from 27 days (for conventional PICC) to 47 days. Tunnelling a PICC has the potential to reduce the infection rate while increase the catheter dwell time.

Gram-negative infection as an unusual cause of endocarditis in a hemodialysis patient

Gram-negative endocarditis is rare and it has high mortality if there is a delay in diagnosis and treatment. Gram-negative organisms should be considered in the differential diagnosis of IE in hemodialysis patients. Central lineassociated bloodstream infections (CLABSIs) can be prevented by following sterile measures during catheter insertion and proper management of catheter site.

Device-associated infections at a level-1 trauma centre of a developing Nation: Impact of automated surveillance, training and feedbacks.

Purpose: Device-associated infections constitute the majority of health care-associated infections (HAIs) in ICUs. Trauma patients are predisposed to acquire such infections due to various trauma-related factors. The prevalence of HAIs is underreported from developing nations due to a lack of systematic surveillance. This study reports the impact of an intensive surveillance on the rates and outcome of device-associated infections in trauma patients from a developing country and compares the rates with a previous pilot observation. Materials and Methods: The study was conducted at a level-1 trauma centre of India. Surveillance for ventilator-associated pneumonia (VAP), central line-associated blood stream infections (CLA-BSIs) and catheter-associated urinary tract infections (CA-UTIs) was done based on centre for disease control-National Healthcare Safety Network (CDC-NHSN) defi nitions. The impact of an intensive surveillance, education and awareness drive on the rates of infections over the study period, and compliance to preventive bundles and hand hygiene was assessed. Results: A total of 15,462 ventilator days, 12,207 central line days and 17,740 urinary catheter days were recorded in the study population. The overall rates of VAP, CLA-BSI and CA-UTI were respectively 17, 7.2 and 15.5/1000 device days. There was a signifi cant correlation between device days and the propensity to develop infections. Infections were the cause of death in 36.6% of fatal trauma cases. A signifi cantly higher rate of VAP, CLA-BSI and CA-UTIs was noted in fatal cases. The compliance to ventilator bundle, central line bundle, bladder bundle and hand hygiene were 74.5%, 86%, 79.3% and 64.6%, respectively. A high rate of multi-drug-resistance was observed in all pathogens. A gross reduction in the rates of all infections was observed over time during the study due to implementation of a stringent surveillance system, feedbacks and education. The compliance to hand hygiene and preventive bundles also increased over time. Conclusion: The automated surveillance was easy and useful for data entry and analysis. Surveillance had a signifi cant impact on reduction of HAIs and mortality in trauma patients.

Prevention of healthcare-associated infections: protecting patients, saving lives.

Healthcare-Associated Infections (HAIs) are those infections which the patients acquire during the course of receiving treatment and are not present or incubating at the time of admission. It also includes infections which appear after discharge and occupational infections among healthcare staff. These infections are mostly caused by viral, bacterial or fungal pathogens and the most common types of HAIs include: blood stream infections, pneumonias (e.g. ventilator-associated pneumonia), urinary tract infections and surgical site infections. According to World Health Organization, for every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries are getting at least one HAI. Many countries lack strong surveillance system on HAIs and it remains a serious problem, which no institution or country can claim to have solved, despite huge efforts.

Epidemiology of blood stream infections in pediatric patients at a tertiary care cancer centre.

BACKGROUND: Blood stream infections (BSI) are among the most common causes of preventable deaths in children with cancer in a developing country. Knowledge of its etiology as well as antibiotic sensitivity is essential not only for planning antimicrobial policy, but also the larger infection prevention and control measures. AIMS: To describe the etiology and sensitivity of BSI in the pediatric oncology unit at a tertiary cancer center. MATERIALS AND METHODS: All the samples representative of BSI sent from pediatric oncology unit during the period of January to December, 2013 were included in the study, and analyzed for microbiological spectrum with their antibiotic sensitivity. RESULTS: A total of 4198 samples were representative of BSI. The overall cultures positivity rate was 6.97% with higher positivity rate (10.28%) from central lines. Of the positive cultures, 208 (70.9%) were Gram‑negative bacilli (GNB), 71 (24.2%) were Gram‑positive organisms, and 14 (4.7%) were Candida species. Lactose fermenting Enterobacteriaceae i.e., Escherichia coli (28.4%), Klebsiella pneumoniae (22.1%), and Enterobacter (4.8%) accounted for 55.3% of all GNB. Pseudomonas accounted for 53 (25.5%) and Acinetobacter 19 (9.1%) of GNB. Among Gram‑positive isolates, staphylococci were the most frequent (47.8%), followed by Streptococcus pneumoniae 17 (23.9%), beta‑hemolytic streptococci 11 (15.5%), and enterococci 9 (12.68%). Of GNB, 45.7% were pan‑sensitive, 24% extended spectrum beta–lactamase (ESBL) producers, 27% were resistant to carbapenems, and 3.4% resistant to colistin. Pseudomonas was most sensitive, and Klebsiella was least sensitive of GNB. Of the staphylococcal isolates, 41.67% were methicillin-resistant Staphylococcus aureus (MRSA) and 10% of Coagulase Negative Stapylococci (CONS) were methicillin. CONCLUSION: A high degree of ESBL producers and carbapenem‑resistant Enterobacteriaceae is concerning; with emerging resistance to colistin, raising the fear of a return to the preantibiotic era. An urgent intervention including creating awareness and establishment of robust infection control and antibiotic stewardship program is the most important need of the hour.

Microbiology, infection control and infection related outcome in pediatric patients in an oncology center in Eastern India: Experience from Tata Medical Center, Kolkata.

CONTEXT: Infection is a major determinant in the outcome of patients with cancer. AIMS: The aim was to know the epidemiology and outcome of patients with cancer in a cancer care center in Eastern India. SETTINGS AND DESIGN: Retrospective study of pediatric patients in Tata Medical Center, Kolkata, India. Methods: Patients (n = 262) between the age group of 0 and 18 years were reviewed for infections and infection‑related outcome (January to December 2013). STATISTICAL ANALYSIS: Modified Wald method was used to determine confidence interval of proportions. RESULTS: Gram‑negative bacteria were found to be the most common cause of bloodstream infections (BSIs) (56.4%), followed by Gram‑positive cocci (34.5%), and Candida species (9.1%). Carbapenem‑resistance was noted among 24% of Gram‑negative bacilli (GNB), and extended‑spectrum beta‑lactamase among 64% of GNBs. A single case of Vibrio cholerae septicemia was also noted. No case of vancomycin‑resistant Enterococcus was observed, whereas only two cases of methicillin‑resistant Staphylococcus aureus bacteremia (1/3 of all Staphylococcus aureus bacteremia) were detected. Escherichia coli, followed by Klebsiella, Pseudomonas, and Acinetobacter were the predominant organisms detected in BSIs. Among Candida spp. BSIs no resistance to caspofungin, amphotericin B, Voriconazole was noted. Candida tropicalis was the most common isolate, and 1 isolate of Candida glabrata showed dose‑dependent sensitivity to fluconazole. Three out of 25 patients died of multi‑drug resistant Gram‑negative bacteria (12%) in 2013. Seventeen patients had radiological evidence of invasive fungal infections (no mortality was noted). CONCLUSIONS: Periodic review of infection‑related data, as well as infection control practices, is essential to optimize clinical outcome in patients with pediatric malignancies.

Diagnosis of ventilator-associated pneumonia: Comparison between ante-mortem and post-mortem cultures in trauma patients.

Purpose: To evaluate the diagnostic utility of ante‑mortem tracheal aspirates for diagnosis of ventilator‑associated pneumonia (VAP). Trauma victims represent an otherwise healthy population, who are on multiple invasive life‑support devices, which predispose them to severe infections like VAP. The diagnosis of VAP is challenging, due to the difficulty in obtaining a representative sample from lungs. We studied the diagnostic utility of tracheal aspirates by comparing its results with the post‑mortem lung cultures. Materials and Methods: A total of 106 fatal trauma patients were included in the study. Lung samples and cardiac blood were taken for culture at the time of autopsy. The results of ante‑mortem and post‑mortem cultures were compared. Results: Septicemia was the cause of death in 51 (48%) of the fatal cases and VAP was identified in 36 (34%) cases. A total of 96 (90.5%) cases had pathogens isolated from lung samples. In 62 (58%) cases, the same organism was isolated from ante‑mortem and post‑mortem respiratory samples. Conclusions: Culture results of a properly collected tracheal aspirate should be taken into consideration along with Centre for Disease Control and Prevention (CDC’s) diagnostic criteria to maximise the diagnosis of VAP.

Intravascular catheter related infections and antimicrobial susceptibility pattern of isolated bacteria in a tertiary care hospital of Bangladesh.

The aim of this study was to evaluate the rate of bacterial colonisation and catheter related blood stream infections (CRBSI) together with the antibiotic susceptibility patterns in a tertiary care hospital. CRBSI was detected with semi-quantitative and quantitative methods. The antimicrobial susceptible patterns of the isolated organisms were performed by Kirby Bauer disk diffusion method. The rate of catheter colonisation and CRBSI were 42.1% and 14% (16.1/1000 catheter days) respectively. The most common causative pathogens were Pseudomonas sp. (23.7%), Acinetobacter sp. (18.4%), Staphylococcus aureus (13.2%) and Enterobacteriaceae (10.5%). The rate of isolation of methicillin resistance S. aureus, imipenem resistant Pseudomonas sp. and extended spectrum β lactamase producing Enterobacteriaceae were 60%, 44.0% and 100%. The result of this study would be useful for control and treatment of CRBSI.

Blood stream infection by an emerging pathogen Oligella ureolytica in a cancer patient: Case report and review of literature.

Oligella ureolytica is an emerging bacteria rarely implicated as a human pathogen. It is infrequently recovered from clinical specimens probably because of inadequate processing of non-fermenting oxidase positive Gram negative bacilli. We present here a case of a 30 year old male suffering from right lung adenocarcinoma (moderately differentiated) with multiple abdominal lymph node metastasis with Syringohydromyelia whose blood culture yielded Oligella ureolytica in pure culture. Oligella ureolytica isolation in pure culture and the patient’s response to targeted treatment supported that Oligella ureolytica was the true causative agent of the blood stream infection. Early suspicion, diagnosis and treatment with potent antibiotics are needed to prevent further complications resulting from infection with this emerging pathogen.

Control study of serum procalcitonin quantitative detection and blood culture results / 中国基层医药

Objective To study the clinical application value of quantitative detection of procalcitonin (PCT) in blood stream infections(BSI).Methods 620 patients with BSI were selected,they received PCT testing and inspection of whole blood culture tests.The results were compared.Results The positive rates of PCT detection and blood cultures were 32.42％ (201/620) and 29.68％ (184/620).The sensitivity,specificity,negative predictive value and positive predictive value of PCT detection were 90.97％ (564/620),63.06％ (391/620),82.34％ (345/419) and 54.73 (110/201).The species identification was conducted in 110 patients with positive PCT detection and blood cultures,42 cases were Gram negative (G-) bacteria,31 cases were Gram-positive (G +) bacteria,8 cases were fungi,29 cases were mixed infection,the difference of these four pathogens PCT concentrations was not statistically significant (x2 =2.364,P ＞ 0.05).Conclusion Quantitative detection of serum PCT in BSI patients has important guiding significance to early diagnosis.

Central venous catheter-related blood stream infection rate in critical care units in a tertiary care, teaching hospital in Mumbai.

Blood stream infections related to central venous catheterization are one of the major device-associated infections reported. Patients admitted in critical care units requiring central venous catheterization and presenting with signs of septicemia during catheterization period were investigated for catheter-related blood stream infections (CRBSI). The CRBSI rate was 9.26 per 1000 catheter days in general with highest rate in neonatal intensive care unit (27.02/1000 days). Site of insertion of catheter and duration of catheterization did not show the influence on the CRBSI rate. Coagulase-negative Staphylococci were the predominant cause. Mortality of 33% was observed in patients with CRBSI. Since central venous catheters are increasingly being used in the critical care, regular surveillance for infection associated them are essential.

Blood stream infections in cancer patients: A single center experience of isolates and sensitivity pattern.

Background : Up to 10% of patients who develop a nosocomial blood stream infection (BSI) in the hospital have an underlying malignancy. The treatment of infections in patients with malignancy often relies on the use of established guidelines along with the consideration of the local microbiology and antibiotic sensitivity patterns of possible etiologic agents. AIMS: This study attempts to identify the likely etiologic agents and the antibiotic sensitivity profile of BSIs in cancer patients. Settings and Design: This was a retrospective study. Methods and Material: The study was conducted at a tertiary care center for cancer patients, in which samples representing blood stream infections sent from the Medical Oncology services of the hospital during the year of 2007 were analysed. The microbiological profile and antibiotic sensitivity pattern of these isolates was studied. Results: There were 484 isolates that represented BSIs. The most common bacterial isolates from patients with cancer were Pseudomonas spp. (30.37%), Staphylococcus aureus (12.6%) and Acinetobacter spp. (11.57%). Meropenem was the most effective antibiotic with 71.2% sensitivity to the bacterial isolates it was tested against. Oxacillin resistance was seen in 18% of S. aureus isolates. Conclusion: Gram-negative bacteria were more common as etiologic agents of BSIs in cancer patients. The poor activity of the primary empirical agents for infections in cancer namely ceftazidime and piperacillin-tazobactam is alarming.Strict regulation of vancomycin use should be considered in areas where there is a low prevalence of methicillin-resistant S. aureus (MRSA).

Rate and time to develop first central line-associated bloodstream infections when comparing open and closed infusion containers in a Brazilian Hospital

The objective of the study was to determine the effect of switching from an open (glass or semi-rigid plastic) infusion container to a closed, fully collapsible plastic infusion container (Viaflex®) on rate and time to onset of central lineassociated bloodstream infections (CLABSI). An open-label, prospective cohort, active healthcare-associated infection surveillance, sequential study was conducted in three intensive care units in Brazil. The CLABSI rate using open infusion containers was compared to the rate using a closed infusion container. Probability of acquiring CLABSI was assessed over time and compared between open and closed infusion container periods; three-day intervals were examined. A total of 1125 adult ICU patients were enrolled. CLABSI rate was significantly higher during the open compared with the closed infusion container period (6.5 versus 3.2 CLABSI/1000 CL days; RR=0.49, 95 percentCI=0.26- 0.95, p=0.031). During the closed infusion container period, the probability of acquiring a CLABSI remained relatively constant along the time of central line use (0.8 percent Days 2-4 to 0.7 percent Days 11-13) but increased in the open infusion container period (1.5 percent Days 2-4 to 2.3 percent Days 11-13). Combined across all time intervals, the chance of a patient acquiring a CLABSI was significantly lower (55 percent) in the closed infusion container period (Cox proportional hazard ratio 0.45, p= 0.019). CLABSIs can be reduced with the use of full barrier precautions, education, and performance feedback. Our results show that switching from an open to a closed infusion container may further reduce CLABSI rate as well as delay the onset of CLABSIs. Closed infusion containers significantly reduced CLABSI rate and the probability of acquiring CLABSI.

Bacterial Profile of Blood Stream Infections and Antibiotic Resistance Pattern of Isolates.

Blood samples from 2542 clinically diagnosed cases of septicemia were processed. Out of these 946 (76.55%) were from Pediatric Department and rest from other Departments. Growth was obtained in 509(20.02%) cases . Candida spp were isolated from 23 (4.57 ) cases Out of 486 bacterial isolates 52.67 % were gram positive bacteria whereas 47.33% were gram negative bacilli . Staph aureus 133 (27.37%)was the predominant organisms followed by CONS 98 (20.1%). Amongst gram negative organisms Enterobacter 69 (14.19 %) was the most predominant followed by Esch coli 45 (9.27 %) Pseudomonas 37 (7.62 %) and Acinetobacter spp 34 (6.69 %). Amongst gram positive organisms maximum resistance was seen with ampicillin (74.61%) and erythromycin (69.67 %). Most of the gram negative bacilli were MDR (71%). Maximum resistance was observed with ampicillin (86.1% ) cephalexin (68.07%) and piperacillin (57.71%). Most successful drugs were amikacin,gentamicin and cefotaxime. 34.35% of the isolates were ESBL producers.

Acessos vasculares e infecção relacionada à cateter / Vascular access and catheter associated blood-stream infections

JUSTIFICATIVA E OBJETIVOS: A infecção da corrente sangüínea relacionada à cateter ocorre quando o germe presente no local de inserção atinge a corrente sangüínea, resultando em bacteremia, que quando não contida, provoca infecção com grave comprometimento clínico, podendo resultar em septicemia. Essa infecção a partir do cateter deve ser suspeitada quando não existe um foco infeccioso primário aparente e quando as hemoculturas (do sangue e da ponta do cateter), colhidas após 48h de internação, resultarem no crescimento do mesmo agente infeccioso. O objetivo deste estudo foi revisar as principais recomendações para prevenção, diagnóstico e tratamento das infecções da corrente sangüínea relacionadas à cateteres. CONTEÚDO: Serão apresentadas as atuais recomendações para a prevenção, o diagnóstico e o tratamento das infecções da corrente sangüínea relacionada a cateteres. CONCLUSÕES: Consiste em problema freqüente em centro de terapia intensiva (CTI), contribuindo com a morbimortalidade hospitalar. A elaboração de protocolos para a prevenção e o controle dessas infecções, deve fazer parte da rotina dos CTI.

BACKGROUND AND OBJECTIVES: The catheter related infections occurs when the bacteria of the skin around the catheter reach the blood stream. The catheter related infection is suspected when there is no other evident site of infection and the cultures of the material collected from the catheter and the patientÆs blood show the same agent. CONTENTS: The recommendations of prevention, diagnose and treatment of catheter related infections are presented in this article. CONCLUSIONS: The catheter related infection is a relevant problem in intensive care units (ICU), contributing to a raise in hospital mortality. The elaboration of protocols to prevent and control these infections must be a routine in Intensive Care Unit.