Central venous catheter-related infections caused by Corynebacterium amycolatum and other multiresistant non-diphtherial corynebacteria in paediatric oncology patients

ABSTRACT Bloodstream and venous catheter-related corynebacterial infections in paediatric patients with haematological cancer were investigated from January 2003 to December 2014 at the Brazilian National Cancer Institute in Rio de Janeiro, Brazil. We observed that during cancer treatment, invasive corynebacterial infections occurred independent of certain factors, such as age and gender, underlying diseases and neutropenia. These infections were ssscaused by Corynebacterium amycolatum and other non-diphtherial corynebacteria. All cases presented a variable profile of susceptibility to antimicrobial agents, except to vancomycin. Targeted antibiotic therapy may contribute to catheters maintenance and support quality of treatment. Non-diphtherial corynebacteria must be recognized as agents associated with venous access infections. Our data highlight the need for the accurate identification of corynebacteria species, as well as antimicrobial susceptibility testing.

Probable fungemia por Rhodotorula mucilaginosa asociada a catéter venoso central en un paciente pediátrico: presentación de un caso / Probable fungemia by rhodotorula mucilaginosa associated to a central venous catheter in a pediatric pacient: a case report

Las levaduras del género Rhodotorula son patógenos oportunistas emergentes, especialmente en pacientes inmunocomprometidos. Se presenta el caso de un niño de 9 años con sarcoma de Ewing en tratamiento con quimioterapia que cursó con una probable fungemia por Rhodotorula mucilaginosa. Se identificaron varios factores de riesgo tales como la presencia de un catéter venoso central (CVC) y una neoplasia maligna sólida. El diagnóstico se realizó a través de un hemocultivo de una rama del CVC. Nuestra cepa fue identificada como R. Mucilaginosa por morfofisiología y pruebas bioquimicas. El éxito terapeutico se basó en el retiro del CVC y en el tratamiento con anfotericina B desoxicolato como primera alternativa.

Yeasts from Rhodotorula genus are opportunistic pathogen that emerge especially in immunocompromised patients. We report a case of a 9-years-old boy, he developed an Ewing’s sarcoma that was treated with chemotherapy an underwent with problable fungemia by Rhodotorula mucilaginosa. Several risk factors were identified such as presence of a central venous catheter (CVC) and a solid malignant neoplasm. The diagnosis was made by blood culture of a branch of the CVC. Our isolated was identified as R. mucilaginosa by morphofisiology and biochemical test. The therapy did success based on withdrawal of CVC and treatment with amphotericin B deoxycholate as the first alternative.

Microbiological testing of devices used in maintaining peripheral venous catheters / Testes microbiológicos de dispositivos utilizados na manutenção de cateteres venosos periféricos / Pruebas microbiológicas de dispositivos utilizados en el mantenimiento de catéteres venosos periféricos

ABSTRACT Objective: to evaluate the use of peripheral venous catheters based on microbiological analysis of devices (dressing and three-way stopcocks) and thus contribute to the prevention and infection control. Methods: this was a prospective study of microbiological analysis of 30 three-way stopcocks (external surfaces and lumens) and 30 dressing used in maintaining the peripheral venous catheters of hospitalized adult patients. Results: all external surfaces, 40% of lumens, and 86.7% of dressing presented bacterial growth. The main species isolated in the lumen were 50% coagulase-negative Staphylococcus, 14.3% Staphylococcus aureus, and 14.3% Pseudomonas aeruginosa. Fifty nine percent of multidrug-resistant bacteria were isolated of the three-way stopcocks, 42% of the lumens, and 44% of the dressing with a predominance of coagulase-negative Staphylococcus resistant to methicillin. Besides, 18% gram-negative bacteria with resistance to carbapenems were identified from multidrug-resistant bacteria on the external surfaces of the three-way stopcocks. Conclusion: it is important to emphasize the isolation of coagulase-negative Staphylococcus and gram-negative bacteria resistant to methicillin and carbapenems in samples of devices, respectively, which reinforces the importance of nursing care in the maintenance of the biologically safe environment as well as prevention and infection control practices.

RESUMO Objetivo: avaliar o uso de cateteres venosos periféricos com base em análises microbiológicas de dispositivos (curativos e torneiras de três vias - T3Vs) e assim contribuir para a prevenção e controle de infecção. Métodos: estudo prospectivo de análise microbiológica de 30 T3Vs (superfícies externas e lúmens) e 30 curativos utilizados na manutenção dos cateteres venosos periféricos de pacientes adultos hospitalizados. Resultados: todas as superfícies externas, 40% dos lúmens e 86,7% dos curativos apresentaram crescimento bacteriano. As principais espécies isoladas no lúmen foram 50% Staphylococcus coagulase-negativa, 14,3% Staphylococcus aureus e 14,3% Pseudomonas aeruginosa. Cinquenta e nove por cento das bactérias multirresistentes foram isoladas das T3Vs, 42% dos lúmens e 44% dos curativos com predominância de Staphylococcus coagulase-negativa resistente à meticilina. Além disso, 18% das bactérias gram-negativas com resistência aos carbapenêmicos foram identificadas a partir de bactérias multirresistentes nas superfícies externas das T3Vs. Conclusão: é importante enfatizar o isolamento de Staphylococcus coagulase-negativa resistente à meticilina e bactérias gram-negativas resistentes aos carbapenêmicos em amostras de dispositivos, o que reforça a importância do cuidado de enfermagem na manutenção do ambiente biologicamente seguro, assim como práticas de prevenção e controle de infecção.

RESUMEN Objetivo: evaluar el uso de catéteres venosos periféricos basado en el análisis microbiológico de dispositivos (vendajes y llaves de tres vías) y así contribuir a la prevención y control de infecciones. Métodos: se trata de un estudio prospectivo de análisis microbiológico de 30 llaves de tres vías (superficies externas y lumen) y 30 apósitos utilizados en el mantenimiento de los catéteres venosos periféricos de pacientes adultos hospitalizados. Resultados: todas las superficies externas, el 40% de los lúmenes y el 86,7% de los vendajes presentaron crecimiento bacteriano. Las principales especies aisladas en el lumen fueron 50% Staphylococcus coagulasa-negativa, 14.3% Staphylococcus aureus, y 14.3% Pseudomonas aeruginosa. Cincuenta y nueve por ciento de las bacterias resistentes a múltiples fármacos fueron aisladas de las llaves de tres vías, el 42% de los lúmenes, y el 44% del apósito con un predominio de Staphylococcus coagulasa-negativa resistente a la meticilina. Además, se identificaron 18% de bacterias gram-negativas con resistencia a carbapenems entre las bacterias multirresistentes en las superficies externas de las llaves de tres vías. Conclusión: es importante enfatizar el aislamiento de Staphylococcus coagulasa-negativa y bacterias gram-negativas resistentes a la meticilina y carbapenem en muestras de dispositivos, respectivamente, lo que refuerza la importancia de la atención de enfermería en el mantenimiento del medio ambiente biológicamente seguro, así como la prevención y las prácticas de control de la infección. assa

Clinical Features of Right-Sided Infective Endocarditis Occurring in Non-Drug Users

Right-sided infective endocarditis (RIE) occurs predominantly in intravenous drug users in western countries, and it has a relatively good prognosis. Clinical features and prognosis of RIE occurring in non-drug users are not well known. We investigated the clinical findings of RIE in non-drug users. We retrospectively reviewed 345 cases diagnosed with IE. Cases with RIE or left-sided infective endocarditis (LIE) defined by the vegetation site were included and cases having no vegetation or both-side vegetation were excluded. Clinical findings and in-hospital outcome of RIE were compared to those of LIE. Among the 245 cases, 39 (16%) cases had RIE and 206 (84%) cases had LIE. RIE patients were younger (40+/-19 yr vs 50+/-18 yr, P=0.004), and had a higher incidence of congenital heart disease (CHD) (36% vs 13%, P<0.001) and central venous catheter (CVC) (21% vs 4%, P=0.001) compared to LIE patients. A large vegetation was more common in RIE (33% vs 9%, P<0.001). Staphylococcus aureus was the most common cause of RIE, while Streptococcus viridans were the most common cause of LIE. In-hospital mortality and cardiac surgery were not different between the two groups. CHD and use of CVC were common in non-drug users with RIE. The short-term clinical outcome of RIE is not different from that of LIE.

Fatores de risco e letalidade de infecção da corrente sanguínea laboratorialmente confirmada, causada por patógenos não contaminantes da pele em recém-nascidos / Risk factors and lethality of laboratory-confirmed bloodstream infection caused by non-skin contaminant pathogens in neonates

OBJECTIVE: To evaluate risk factors and lethality of late onset laboratory-confirmed bloodstream infection (ICSLC) in a Brazilian neonatal unit for progressive care (NUPC). Methods: This was a case-control study, performed from 2008 to 2012. Cases were defined as all newborns with late onset ICSLC, excluding patients with isolated common skin contaminants. Controls were newborns who showed no evidence of late onset ICSLC, matched by weight and time of permanence in the NUPC. Variables were obtained in the Hospital Infection Control Committee (HICC) database. Analysis was performed using the Statistical Package for the Social Sciences (SPSS). The chi-squared test was used, and statistical significance was defined as p < 0.05, followed by multivariate analysis. RESULTS: 50 patients with late onset ICSLC were matched with 100 patients without late onset ICSLC. In the group of patients with late onset ICSLC, a a significant higher proportion of patients who underwent surgical procedures (p = 0.001) and who used central venous catheter (CVC) (p = 0.012) and mechanical ventilation (p = 0.001) was identified. In multivariate analysis, previous surgery and the use of CVC remained significantly associated with infection (p = 0.006 and p = 0.047; OR: 4.47 and 8.99, respectively). Enterobacteriacea was identified in 14 cases, with three (21.4%) deaths, and Staphylococcus aureus was identified in 20 cases, with three (15%) deaths. CONCLUSIONS: Surgical procedures and CVC usage were significant risk factors for ICSLC. Therefore, prevention practices for safe surgery and CVC insertion and manipulation are essential to reduce these infections, in addition to training and continuing education to surgical and assistance teams.

OBJETIVO: Avaliar os fatores de risco e a letalidade da infecção da corrente sanguínea laboratorialmente confirmada (ICSLC) de início tardio em uma Unidade Neonatal de Cuidados Progressivos (UNCP) brasileira. MÉTODOS: Trata-se de um estudo caso-controle realizado de 2008 a 2012. Os casos foram definidos como todos os recém-nascidos com ICSLC de início tardio, excluindo pacientes isolados com contaminantes da pele comuns. Os controles foram recém-nascidos que não mostraram qualquer evidência de ICSLC de início tardio, sendo separados por peso e tempo de permanência na UNCP. As variáveis foram obtidas na base de dados da Comissão de Controle de Infecção Hospitalar (CCIH). A análise foi realizada utilizando o Pacote Estatístico para Ciências Sociais. O teste χ² foi utilizado e a relevância estatística foi definida como p < 0,05, seguida pela análise multivariada. RESULTADOS: No estudo, 50 pacientes com ICSLC de início tardio foram combinados com 100 pacientes sem ICSLC de início tardio. No grupo de pacientes com ICSLC de início tardio, identificamos uma proporção significativamente maior de pacientes que foram submetidos a procedimentos cirúrgicos (p = 0,001) e que usaram cateter venoso central (CVC) (p = 0,012) e ventilação mecânica (p = 0,001). Na análise multivariada, cirurgia prévia e uso de CVC permaneceram significativamente associados à infecção (p = 0,006 e p = 0,047; OU: 4,47 e 8,99, respectivamente). A Enterobacteriacea foi identificada em 14 casos, com três (21,4%) óbitos, e Staphylococcus aureus foi identificado em 20 casos, com três (15%) óbitos. CONCLUSÕES: Procedimentos cirúrgicos e uso de CVC constituíram fatores de risco significativos para ICSLC. Portanto, práticas de prevenção para cirurgia segura, inserção e manipulação de CVC são essenciais para reduzir essas infecções, além de treinamento e educação contínua às equipes cirúrgicas e de assistência.

Microrganismos isolados de pacientes em hemodiálise por cateter venoso central e evolução clínica relacionada / Microorganisms isolated from patients on hemodialysis by central venous catheter and related clinical evolution

OBJETIVO: Identificar os microrganismos isolados da pele pericateter, ponta do cateter e corrente sanguínea de pacientes em hemodiálise por cateter venoso central, verificar o perfil de sensibilidade destes microrganismos aos antimicrobianos e avaliar a evolução clínica e a mortalidade relacionada a estes microrganismos. MÉTODOS: Estudo transversal. As cepas isoladas de pacientes em hemodiálise por cateter venoso central que em estudo prévio apresentaram infecção na pele pericateter, ponta do cateter e corrente sanguínea foram analisadas quanto ao perfil microbiológico e letalidade relacionada. RESULTADOS: Foram isolados 128 microrganismos em corrente sanguínea nos 94 pacientes estudados. Ocorreram 35 casos de septicemia e 27 de endocardite. A letalidade nos casos de endocardite por Staphylococcus aureus resistente à meticilina foi 100%. CONCLUSÃO: Infecção em corrente sanguínea e endocardite por Staphylococcus aureus resistente à meticilina são preditivas de alta mortalidade e letalidade.

OBJECTIVE: To identify the microorganisms isolated on the pericatheter skin, catheter tip and blood stream of patients on hemodialysis by central venous catheter, to verify the profile of sensitivity of these microorganisms to antimicrobials and to assess the clinical evolution and mortality related to these microorganisms. METHODS: A cross sectional study. The strains were isolated from the patients on hemodialysis by central venous catheter that, in a previous study, presented pericatheter skin, catheter tip and blood stream infection and were analyzed for microbiological profile and lethality related. RESULTS: 128 microorganisms were isolated in the bloodstream in the 94 patients studied. There were 35 cases of septicemia and 27 of endocarditis. The mortality in cases of endocarditis due to methicillin-resistant Staphylococcus aureus was 100%. CONCLUSION: Infection in the bloodstream and endocarditis caused by methicillin-resistant Staphylococcus aureus was predictive of mortality and lethality.