A Case of Chryseobacterium hominis Isolated from Human Blood Drawn Through Peripherally Inserted Central Catheter

Chryseobacterium hominis is non-fermenting Gram-negative rod that was first identified as a novel species in 2007. Here, we report the first clinical case of C. hominis bacteremia, which was confirmed by MALDI-TOF MS and 16S rRNA gene sequencing. A 16-year-old boy diagnosed with acute lymphoblastic leukemia was hospitalized for three months. Two sets of blood culture test through a peripherally inserted central catheter (PICC), which was inserted a month ago, was performed when his white blood cell count declined and he had a high fever. Colonies of medium sizes that looked round, mucoid, sticky, and grayish on blood and chocolate agar plates were observed. Identification of bacteria using the VITEK MALDI-TOF MS system (BioMérieux, France) was not successful and the VITEK 2 system (BioMérieux, USA) indicated Sphingomonas paucimobilis, with a questionable level of confidence (92%). However, Microflex LT Biotyper (Bruker Daltonics, Germany) showed C. homins (log score: 1.81) and sequence of 16S rRNA showed a 100% identity with C. hominis. Piperacillin-tazobactam was administered since the isolate was susceptible to piperacillin-tazobactam but C. hominis showed growth in the next four follow-up culture of blood drawn through PICC. The fever subsided only after PICC was changed. The clinical prognosis and antimicrobial susceptibility test of C. hominis should be further studied.

Safety Assessment of Peripherally Inserted Central Venous Catheter: A Retrospective Single-center Study to Compare Cancer and Non-cancer Patients

<p>Objectives: Peripherally inserted central venous catheter (PICC) is widely used, because the incidence of complications and bloodstream infection in patients receiving PICC was lower than that in patients receiving central venous catheter. We compared PICC between cancer patients and non-cancer patients. Methods: This retrospective single-center study included 157 patients receiving PICC from May 2012 to September 2015. Patients were separated into cancer and non-cancer groups. Results: Cancer patients were 88 and non-cancer patients were 69. The most common causes of PICC were intravenous hyperalimentation (Cancer vs. non-cancer: 45 vs. 51) and difficult peripheral venous access (40 vs. 12) (p=0.0022). The duration of catheterization was 15 (6-39) vs. 21 (12-40) days (p<0.0001). The causes of catheter removal were death (50 vs. 14), remission (9 vs. 26), redness on insertion site or infection suspicion (10 vs. 11), and Some kind of catheter trouble (8 vs. 4) (p=0.0002). Complications occurred in 8 vs. 9 patients (p=0.429), and infection occurred in 0.9 vs. 2.0/1000 catheter days (p=0.041). Discussion: End-stage cancer patients have a weakened immune system. In this study, the incidences of PICC-related infection and other complications were not different between cancer and non-cancer patients, suggesting PICC was a safer method.</p>

Pathogen profile of central venous catheter-related blood stream infections in neurosurgical intensive care unit patients / 中国感染与化疗杂志

Objective To explore the distribution and antibiotic resistance of the pathogens in the patients with central venous catheter-related blood stream infection in neurosurgical intensive care unit (NSICU).Methods A total of 452 patients with central venous catheter were identified in NSICU from January 2014 to January 2017.Medical records were reviewed retrospectively to examine the incidence of central venous catheter-related blood stream infections,and the pathogen distribution and antibiotic resistance profile.Results The incidence of central venous catheter-related blood stream infection was 4.6％ (21/452).The incidence of such infection was significantly higher for the catheter in femoral vein (10.5％) than in internal jugular vein (4.0％) and subclavian vein (2.6％) (x2=9.755,P=0.008).Twenty-six strains of pathogen were isolated from the 21 patients,including 13 (50.0％) grampositive bacteria,11 (42.3％) gram-negative bacteria and 2 (7.7％) fungal strains (Candida albicans and Candida parapsilosis each).The most common gram-positive bacteria were Staphylococcus epidermidis(5) and Staphylococcus aureus(3).The most common gram-negative bacteria were Klebsiella pneumoniae(4) and Serratia marcescens(3).The most frequently isolated pathogen of central venous catheter-related blood stream infections was S.epidermidis (19.2％) and K.pneumoniae (15.4％).The antimicrobial susceptibility testing showed that gram-positive bacteria were highly resistant to penicillin,erythromycin,oxacillin and clindamycin.Gram-negative bacteria were highly resistant to cefazolin and piperacillin.The two fungal strain were highly sensitive to fluconazole,voriconazole,itraconazole and amphotericin B.Conclusions The predominant pathogens of central venous catheter-related blood stream infections in NSICU patients are gram-positive bacteria.S.epidermidis and K.pneumoniae are the major pathogens with high level of antibiotic resistance.Aseptic procedures and rational antibiotic therapy according to antimicrobial susceptibility test should be emphasized to control the resistant strains.

Catheter-related blood stream infection of neonates and the strategy of prevention and treatment / 中国小儿急救医学

Catheter-related blood stream infection is the common nosocomial infection in NICU,which has high morbidity and mortality,then affects the prognosis of those hospitalized neonates.The incidence of neonatal catheter-related blood stream infection can be significantly decreased through the synthetical management and multiple-preventive intervention.

Prevention and control strategy of hospital-acquired infection in neurosurgical intensive critical unit / 天津医药

Hospital acquired infection (HAI) is one of the common complications of hospitalized patients and poses a serious threat to public health worldwide, which causes an exacerbation, prolonged hospitalization and increased medical costs. Because of higher illness severity and more invasive operations, patients in neurosurgical intensive critical unit (NICU) are more susceptible to HAI such as hospital acquired pneumonia (HAP) and surgical site infection (SSI), leading to theincrease of mortality. Therefore, the prevention and treatment of HAI is an important challenge during the treatment of diseases in NICU. In this paper, we summarized the common types, pathogenic characteristics, prevention measures and antimicrobial treatment of HAI in NICU, aiming to provide ideas and reference on HAI treatment for medical personnel in NICU.

Effect of target intervention on preventing catheter-related bloodstream infection / 中国基层医药

Objective To investigate the effectiveness of target intervention in preventing catheter -related bloodstream infection ( CRBSI ) .Methods The targeted monitoring was launched by changing venepuncture site , reinforcing instructions in aseptic insertion technique and hand hygiene supervision ,avoiding femoral access and remo-ving unnecessary catheters ,venous puncture implemented by high qualification anesthesiologist ,then the incidence of CRBSI before and after the project was compared .Results The incidence of CRBSI after the project decreased signif-icantly from 17.97%to 4.32%,the difference was statistically significant (χ2 =40.82,P<0.05).Chi-square test and logistic regression analysis showed that the incidence of infection was increased in patients with catheter for longer than 10 days (χ2 =4.33,P<0.05),the incidence of CRBSI was decreased in patients that central venous puncture implemented by high qualification anesthesiologist (χ2 =9.21,P<0.05),and patients received catheter indwelling into femoral vein had increased incidence of CRBS (χ2 =7.45,P<0.05).Conclusion Indwelling catheter time, unskilled operator ,catheter site are risk factors in patients with CRBSI .In response to these factors ,we should develop interventions to maximize establish a protective barrier , improve the quality of the medical operation , prevent the occurrence of CRBSI more efficiently .

Survey on healthcare-associated infection in general intensive care units re-ported to China HAI Surveillance Network / 中国感染控制杂志

Objective To realize the incidence of healthcare-associated infection (HAI),the rate of invasive procedure and related infection rate,use of antimicrobial agents and distribution of pathogens in gereral intensive care units (GICUs) of hospitals in China.Methods HAI cross-sectional investigation data of GICUs reported to China HAI Surveillance Net-work were summarized and analyzed.Results Of 1 313 hospitals,621(47.30%)had GICUs;a total of 5 887 patients were surveyed,1 634 patients developed 1 962 times of infection,HAI prevalence rate and case rate was 27.76% and 33.33%respectively.The main infection sites were lower respiratory tract(70.39%),urinary tract (12.79%)and blood(2.86%). The application rate of urinary catheter,arteriovenous catheter and ventilator was 53.52%(n=3 151),37.05%(n=2 181) and 35.62%(n=2 097)respectively,and related prevalence of urinary tract infection,pneumonia and blood stream infection was 4.67%,20.41%,and 0.60%,respectively,which accounting for 58.57%,30.99%,and 23.21 % of urinary tract infection,pneumonia and blood stream infection respectively,the overall prevalence of above invasive procedure-re-lated infection accounted for 29.97%(588/1 962)of the overall HAI prevalence.A total of 1 795 isolated pathogens causing HAI were detected,the top three were Pseudomonas aeruginosa (20.78%),Acinetobacter baumannii(17.99%)and Klebsiella pneumoniae (11 .64%).The usage rate of antimicrobial agents was 71 .58%(n=4 214), rate of specimens delivered for detection was up to 75.27%(2 553/3 392).Conclusion Prevalence and antimicrobial use in patients in GICUs are all high,all kinds of invasive procedure are frequent,30% of HAI are related to inva-sive procedure;infection caused by non-fermentative bacteria is serious,pathogen detection is well performed.

Improve cleaning and disinfectant methods for subclavian vein catheteriza-tion dressing change / 中国感染控制杂志

Objective To evaluate the effect of improved cleaning and disinfection method for subclavian venipunc-ture dressing change to prevent catheter-associated infection. Methods 120 hospitalized patients with right subcla-vian venipuncture at an intensive care unit in January-June 2012 were divided into control group (n= 60)and experi-mental group(n= 60)according to venipuncture date. Control group adopted conventional dressing change :disin-fected skin at and around puncture point by 2% iodine tincture,then used 75% alcohol for deiodination;experimen-tal group adopted improved dressing change :Wiped skin at and around puncture point three times by normal saline, cleaned catheter,disinfected skin around puncture point (avoid puncture point)three times by 75% alcohol,disin-fected skin at and around puncture point three times by 0 .5% iodine tincture ,then disinfected catheter . Associated infection rate between two groups were compared . Results Focal infection rate and CRBI rate of experimental group were both lower than control group(5.00% vs 16.67% ;1.67% vs 13.33% ),the difference was statistically different (P< 0.05 ). Conclusion Effect of improved dressing method is better than the conventional dressing method,it can effectively prevent occurrence of focal infection and CRBI.

Application and effect of FOCUS-PDCA methodology on the control of catheter-related blood stream infection / 中国感染控制杂志

Objective To evaluate the effect of FOCUS-PDCA program(find,organize,clarify,understand,se-lect,plan,do,check,act )on the prevention and control of catheter-related blood stream infection (CRBSI)in an intensive care unit(ICU).Methods Process of central venous catheterization and nursing care were analyzed by u-sing FOCUS-PDCA program,and the causes for CRBSI were found out ;a continuous quality improvement (CQI) team was established to provide training for ICU nurses,and the process was improved and supervised,virtuous cir-cle was created.Results Incidence of CRBSI decreased from 8.29‰ before FOCUS-PDCA intervention(January-December,2010)to 3.20‰ after FOCUS-PDCA intervention(January 2011 -December 2012),the difference was significant (χ2 =14.6,P <0.001).Conclusion FOCUS-PDCA program is effective for controlling the incidence of CRBSI.

Design and application of quality improvement checklist of catheter-related blood stream infection in the intensive care units / 中国实用护理杂志

Objective To design quality improvement checklist of catheter-related blood stream infection (CRBSI),in order to improve the nursing quality of ICU and ensure nursing safety.Methods A new ICU quality improvement checklist of CRBSI was designed and applied for the quality control of the patients with central venous catheter from April to June 2012.The using rate of central venous catheter and incidence of CRBSI were observed.Results After application of the checklists,the using rate of central venous catheter was decreased and the incidence of CRBSI was decreased.Conclusions The checklist may help improve the prevention and control of CRBSI in ICU.

Preventive effect of CVC cluster intervention strategies on catheter-related blood stream infection / 现代临床护理

Objective To study the preventive effect of cluster intervention strategies for central venous catheter(CVC)on catheter-related bloodstream infection? Methods One hundred and eighty six patients with CVC during Jan? to Oct? 2011 before application of cluster intervention strategies were assigned in the control group and another 193 with CVC during Jan? to Oct? 2012 after using cluster intervention strategies in the cluster group? The two groups were compared in terms of the incidence and time of CRBSI as well as the catheteration? Results After using the cluster intervention strategies,the incidence of CRBSI was decreased from 8?31‰to 1?67‰ (P < 0?001)? The time of CRBSI was prolonged from(7?47±2?44)to(13?75±1?92)d(P < 0?05)? The catheteration in subclavian vein was significantly increased from 39?78% to 71?50%(P < 0?05)and the catheteration was significantly deceased from 45?70% to 18?65%(P < 0?05)? Conclusion The CVC cluster intervention strategies may effectively reduce the incidence of CRBSI?

Retrospective analysis of risk factors of colonization of central venous catheters / 中华临床营养杂志

Objective To investigate the risk factors of central venous catheters (CVC) colonization.Methods A retrospective study was performed on adult patients with CVCs placement in Renji Hospital,Shanghai Jiaotong University from January 2006 to March 2010.Clinical data,catheter-related information (including duration of catheter placement,position and purpose of catheterization,and whether or not out-of-ward catheterization),catheter culture results,and prevalence of catheter-related blood stream infection (CRBSI)was collected.Results A total of 651 patients aged 18 to 97 years (median:63 years) were enrolled in the study,in whom 762 CVC were placed.The median duration of catheter placement was 1 1 days (2 to 122 days)and the total duration of CVC placement was 10 725 days.The prevalence of catheter colonization was 16％(122/762),and 134 germs were cultured.Gram-positive cocci was the most common colonized bactera (52.2％,70/122),followed by gram-negative bacilli (33.6％,45/122) and fungi (14.2％,19/122).Overall 13 CRBSI were confirmed and the rate of CRBSI was 1.21/1000 catheter-days.Logistic regression analysis demonstrated that the risk factors for CVC colonization included mechanical ventilation [odds ratio (OR) =1.783,95％ confidence interval (Cl) =1.108 ～2.870],serum albumin concentration less than 25 g/L before catheterization (OR =1.783,95％ Cl =1.357 ～ 6.757),prolonged duration of catheter placement (OR =1.105,95％ Cl =1.009 ～ 1.111),and out-of-ward catheterization (OR =2.837,95％ Cl =1.010 ～7.969).Conclusion Patients with prolonged duration of catheter placement and out-of-ward catheterization are inclined to CVC colonization.

Prevención de la infección asociada a catéteres: utilidad y costo-eficacia de los catéteres con antisépticos en pediatría / Prevention of catheter-related infection: usefulness and cost-effectiveness of antiseptic catheters in children

Objetivo: Evaluar la costo-eficacia de catéteres venosos centrales con antisépticos comparados con catéteres convencionales en la prevención de episodios infecciosos asociados. Diseño: Análisis de costo-eficacia; ensayo clínico, experimental, aleatorizado, controlado, abierto. Población y métodos: Pacientes con catéteres venosos centrales, menores de 1 año o 10 kg, posquirúrgicos cardiovasculares. Se compararon las características de los pacientes y la permanencia, costos y complicaciones de los catéteres venosos centrales. Intervención: Catéter venoso central Arrow®, doble lumen, > 48 h de duración; grupo de intervención: catéteres con antiséptico contra grupo control: catéteres convencionales. Resultados: Se estudiaron 172 catéteres pertenecientes a 149 pacientes. La tasa cruda de episodios infecciosos asociados fue del 27% en los catéteres con antisépticos y 31% en los catéteres convencionales (p= 0,6), con incidencia acumulada similar de bacteriemia asociada a catéter: 2,8 contra 3,3 por 1000 días-catéter. No se encontraron diferencias entre los grupos, excepto en el menor peso: mediana 4,0 kg (r 2-17) contra 4,7 kg (r 2-9) p= 0,0002 y edad mediana 2 m (r 1-48) contra 5 m (r 1-24) p= 0,0019 en la población de catéteres venosos centrales con antisépticos. Estas diferencias se consideraron clínicamente irrelevantes. El costo promedio por paciente internado en el grupo con catéter convencional fue $ 3.417 (359-9.453) y en el grupo catéter con antisépticos fue de $ 4.962 (239-24.532), p= 0,10. Conclusiones: El uso de catéteres venosos centrales con antisépticos comparado con el de catéteres convencionales no redujo los episodios infecciosos asociados, con una tendencia de mayor costo en el grupo de catéteres con antisépticos. Estos resultados no respaldan el uso de estos catéteres en nuestro medio.

Objective: To evaluate the cost-effectiveness of the antiseptic-impregnated catheter compared with conventional catheters in preventing catheter-related blood stream infections (CR-BSI). Design: Cost-effectiveness analysis; clinical trial, experimental, randomized, controlled, prospective, open label. Patients and methods: A 172 patient cohort, under 1-year-old or less than 10 kg, postoperative cardiovascular children with central venous catheters (CVC) admitted to Cardiac Intensive Care Unit (UCI35) at Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan", since September 2005 to December 2007. Demographic and CVC data were retrieved to compare: age, gender, weight, diagnosis, surgery, CVC days, costs and complications. Intervention. CVC Arrow, double-lumen, > 48 h of duration; intervention group: antiseptic-impregnated CVC vs. control group: CVC without antiseptics (conventional). Results. The incidence of CR-IE (CR-Infected Events: colonization, local infection and/or CRBSI; combined end point) was 27% for antiseptic-impregnated CVC vs. 31% for conventional catheters (p= 0.6) with similar accumulated incidence of CR- BSI: 2.8 vs. 3.3 per 1000 days catheter. We found no differences between groups, except in weight: median 4.0 kg (r 2-17) vs. 4.7 kg (r 2-9) p= 0.0002 and age, median 2 months (r 1-48) vs. 5 months (r 1- 24) p= 0.0019 in antiseptic-impregnated CVC group. These differences, though statistically significant were clinically non relevant. Median cost per patient during intensive care stay in the conventional CVC group was $3.417 (359-9.453) and in the antiseptic-impregnated-CVC group was $4.962 (239-24.532), p= 0.10. Conclusions: The use of antiseptic-impregnated CVC compared with conventional CVC did not decrease CR-BSI in this population. The cost per patients was higher in the antiseptic impregnated CVC group. These results do not support the routine use of this type of CVC in our population.

The First Case of Catheter-related Bloodstream Infection Caused by Nocardia farcinica

Nocardia farcinica is an emerging pathogen in immunocompromised hosts. Even though several species of Nocardia have been reported as causative pathogens of catheter-related blood stream infections (CRBSI), CRBSI caused by N. farcinica has not been reported. A 70-yr-old man with a tunneled central venous catheter (CVC) for home parenteral nutrition was admitted with fever for two days. Norcardia species was isolated from the blood through CVC and peripheral bloods and identified to N. farcinica by 16S rRNA and rpoB gene sequence analyses. This report emphasizes the rapid and correct identification of causative agents in infectious diseases in the selection of antimicrobial agents and the consideration of catheter removal.

Cateter venoso profundo recoberto com antibiótico para reduzir infecção: estudo piloto / Antibiotic coated catheter to decrease infection: pilot study

JUSTIFICATIVA E OBJETIVOS: A bacteremia associada a cateter venoso central (CVC) aumenta a morbidade e mortalidade hospitalar em pacientes internados em unidade de terapia intensiva (UTI). Os cateteres recobertos com rifampicina e minociclina (RM) reduzem a freqüência de colonização e bacteremia. No entanto, resultados de estudos recentes questionaram o seu impacto clínico. O objetivo deste estudo foi comparar a incidência de colonização e bacteremia associada à CVC recobertos com RM e não recobertos numa coorte de pacientes admitidos em UTI. METODO: Estudo prospectivo, controlado em UTI mista clínico-cirúrgica. Os pacientes receberam um CVC recobertos com RM ou não recoberto. Após remoção do CVC, foi feita cultura de ponta do cateter e hemoculturas foram coletadas. Avaliou-se a freqüência de colonização e bacteremia. RESULTADOS: Cento e vinte CVC foram inseridos e 100 puderam ser avaliados, 49 no grupo não recobertos e 51 no grupo recoberto. As características clínicas foram similares nos 2 grupos. Dois casos de bacteremia associada ao cateter (BAC) (3,9 por cento) ocorreram em pacientes que receberam CVC recobertos com RM comparado a 5 (10,2 por cento) casos de BAC no grupo não recobertos (p = 0,26). Seis (11,8 por cento) cateteres recobertos foram colonizados, comparados a 14 (28,6 por cento) no grupo não recoberto (p = 0,036). A análise de Kaplan-Meier não demonstrou diferença no risco de colonização ou BAC entre os dois grupos estudados. A taxa de BAC foi de 4,7 por 1000 cateteres-dia no grupo com CVC recobertos e 11,4 por 1000 cateteres-dia no grupo que recebeu cateteres não recobertos (p = 0,45). CONCLUSÕES: Neste estudo piloto, demonstrou-se menor freqüência de colonização em cateteres recobertos com RM, quando comparados a cateteres não recobertos. A freqüência de BAC não foi diferente entre os dois grupos.

BACKGROUND AND OBJECTIVES: Nosocomial catheter related bloodstream infections (CR-BSI) increase morbidity and mortality in critically ill patients. Central venous catheters (CVC) coated with rifampin and minocycline (RM) decrease rates of colonization and CR-BSI. However, recent trials challenged the clinical impact of such catheters. We designed this trial to compare rates of colonization and CR-BSI in RM catheters and controls in a cohort of critically ill patients in Brazil. METHODS: Prospective, controlled trial conducted in one medico-surgical ICU. Patients were assigned to receive a control or RM CVC. After removal, tips were cultured in association with blood cultures. Rates of colonization and CR-BSI were recorded. RESULTS: Among 120 catheters inserted, 100 could be evaluated, 49 in the uncoated and 51 in the coated group. Clinical characteristics of patients were similar in the two groups. Two cases of CR-BSI (3.9 percent) occurred in patients who received RM catheters compared with 5 (10.2 percent) in the uncoated group (p = 0.26). Six RM catheters (11.8 percent) were colonized compared with 14 (28.6 percent) control catheters (p = 0.036). Kaplan-Meier analysis showed no significant differences in the risk of colonization or CR-BSI. Rates of CR-BSI were 4.7 per 1000 catheter-days in the RM coated group compared to 11.4 per 1000 catheter days in the uncoated group (p = 0.45). CONCLUSIONS: In this pilot study, we showed lower rates of colonization in RM coated when compared with uncoated catheters. Incidence and rates of CR-BSI were similar in the two groups.