Infectious complications associated with parenteral nutrition in intensive care unit and non-intensive care unit patients

ABSTRACT Introduction: Malnutrition is associated with an increased risk of complications in hospitalized patients, and parenteral nutrition (PN) is used when oral or enteral feeding is not possible. This study aimed at analyzing associations between PN characteristics and infectious complications in hospitalized patients. Material and methods: This was a retrospective cohort study conducted in a tertiarycare university hospital. Data from consecutive adult patients submitted to PN (January 2016 to December 2017; ICU and ward) were reviewed by means of an electronic database. Patient's clinical characteristics, PN prescription and catheter insertion procedure data were extracted and analyzed. The main outcome was the development of central line-associated bloodstream infection (CLABSI). The secondary outcomes were other infectious complications and mortality, as well as factors associated with CLABSI. Results: We analyzed 165 patients and 247 catheters used for parenteral nutrition infusion. The CLABSI rate was 6.47 per 1000 catheter-days. In the univariable analysis, CLABSI was associated with longer hospitalization time, longer PN time, longer catheter time, catheter insertion performed by a surgeon or a surgical resident, and procedures performed outside the ICU. In an extended time-dependent Cox regression, no variable was associated with a higher risk of CLABSI, and additional PN days did not increase the rate of CLABSI. The overall mortality rate was 24.8%. Only the patients' comorbidity index was associated with death in the multivariable analysis. Discussion: In our study, patients who needed PN had an overall CLABSI rate of 6.47 per 1000 catheter-days. These outcomes were not associated with PN and catheter characteristics studied after adjustment for catheter time. The overall mortality rate was 24.8% and it was not associated with PN in multivariable analyses, only with Charlson comorbidity index.

Candida auris infection in the central catheter of a patient without sepsis symptoms / Infección por Candida auris en el catéter central de un paciente sin síntomas de sepsis

Abstract Background: Candida auris is an emerging yeast frequently reported as resistant to multiple antifungal drugs commonly used to treat Candida infections. This specie can colonize the patient's skin and has great ability for producing outbreaks in hospitals. C. auris is phylogenetically related to other Candida species, can be misidentified using conventional biochemical or commercial methods and requires specific technology for its identification. Case report: We report the first isolate of C. auris in Cali, Colombia, from a central venous catheter in a 37-year-old patient with rheumatoid arthritis and endocarditis who did not have symptoms of sepsis. The yeast was initially misidentified as C. haemulonii using the Phoenix system and subsequently identified as C. auris by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). The broth microdilution method was used to determine the minimum inhibitory concentration; the isolate was susceptible to fluconazole, itraconazole, voriconazole and amphotericin B. Conclusions: This report contributes to knowledge of the epidemiology of C. auris infections in individuals with underlying disease and describes an isolate with a behavior different from what is usually reported.

Resumen Antecedentes: Candida auris es una levadura emergente, informada con frecuencia como resistente a diversos antifúngicos usados comúnmente para tratar infecciones por Candida. Esta especie puede colonizar la piel y tiene gran capacidad de producir brotes en ambientes hospitalarios. Está filogenéticamente relacionada con otras especies de Candida, es mal identificada por los métodos bioquímicos o comerciales, y requiere tecnología específica para su identificación. Reporte de caso: Se informa el primer aislamiento de C. auris en Cali, Colombia en un paciente de 37 años con artritis reumatoide y endocarditis, sin síntomas de sepsis, a partir de la punta de catéter venoso central. La levadura inicialmente se identificó como C. haemulonii por el sistema Phoenix® y posteriormente como C. auris por espectrometría de masas desorción/ionización láser asistida por una matriz con detección de masas por tiempo de vuelo (MALDI-TOF MS). Se determinó la concentración inhibitoria mínima por el método de microdilución en caldo que mostró un aislamiento sensible a fluconazol, itraconazol, voriconazol y anfotericina B. Conclusión: Este informe contribuye al conocimiento de la epidemiología de las infecciones por C. auris en individuos con enfermedad subyacente y describe un aislamiento con un comportamiento diferente a lo indicado en otros estudios.

Endocarditis infecciosa por Mycobacterium mageritense asociada a dispositivo cardíaco electrónico / Electronic cardiovascular device-associated to infective endocarditis caused by Mycobacterium mageritense

Las micobacterias de crecimiento rápido son una rara causa de endocarditis bacteriana. Durante las últimas décadas han aumentado las infecciones debido a este tipo de micobacterias, en especial las postraumáticas y las posquirúrgicas. Estas infecciones pueden ser localizadas o diseminadas, y también pueden producir brotes nosocomiales debido a la contaminación del equipamiento médico. Por lo general, las tinciones para bacterias ácido-alcohol resistentes no se emplean de rutina en el procesamiento de hemocultivos positivos. Sin embargo, el microbiólogo debe estar atento al ver un bacilo gram positivo, ya que podría tratarse de una micobacteria de crecimiento rápido. Describimos un caso de endocarditis por de Mycobacterium mageritense en una paciente con parche pericárdico autógeno y un catéter para medir la presión en la aurícula izquierda. La bacteria fue identificada por espectrometría de masas (MALDI-TOF MS), score 2,3, y luego confirmada por secuenciación y análisis del gen ARNr 16s con las bases de datos del NCBI y EzTaxon, con una concordancia del 99,8 y el 100%, respectivamente.

Rapidly growing non-tuberculosis mycobacteria are a rare cause of bacterial endocarditis. During the last decades, there has been an increase in infections due to rapidly growing mycobacteria, mainly after trauma and post-surgical procedures, both localized and disseminated, as well as nosocomial outbreaks due to contamination of medical equipment. Routine acid-fast staining for blood culture bottles is not always performed; however, the microbiologist should be aware of potential RGM infections especially when gram positive bacilli are observed. We describe a case of endocarditis caused by Mycobacterium mageritense in a patient with an autologous pericardial patch and a pressure catheter in the left auricle. The bacterial species was identified as Mycobacterium mageritense by mass spectrometry (MALDI-TOF MS), score 2.3, and confirmed by 16S rRNA analysis with 99.8 and 100% agreement, respectively.

Infecciones asociadas a catéteres venosos centrales: Actualización y recomendaciones intersociedades / Central venous catheter related infections. Inter-Societies update and recommendations

Representantes de la Sociedad Argentina de Infectología (SADI) y la Sociedad Argentina de Terapia Intensiva (SATI) se reunieron para trabajar en la elaboración de recomendaciones concretas de diagnóstico, tratamiento y prevención de las infecciones asociadas a catéteres venosos centrales (IAC). La metodología utilizada fue el análisis de la bibliografía publicada en los últimos 10 años complementada con la opinión de expertos y datos locales. En este documento se pretende ofrecer herramientas básicas de optimización de diagnóstico sobre la base de criterios clínicos y microbiológicos, orientar acerca de los esquemas antibióticos empíricos y dirigidos, la posología y la administración de antibióticos en pacientes críticos, y promover las medidas efectivas para reducir el riesgo de IAC. Asimismo, se ofrece un algoritmo de diagnóstico y tratamiento para uso en la actividad asistencial y consideraciones sobre la dosificación de antibióticos. Este trabajo conjunto de infectólogos e intensivistas pone en evidencia la preocupación por el manejo de las IAC y la importancia de velar por la mejora en las prácticas cotidianas. A través de esta recomendación se establecen pautas locales para optimizar el diagnóstico, el tratamiento y la prevención de las IAC con el objeto de disminuir la morbimortalidad, los días de internación, los costos y la resistencia antimicrobiana.

Representatives of the Argentine Society of Infectious Diseases (SADI) and the Argentine Society of Intensive Therapy (SATI) joined together to issue specific recommendations for the diagnosis, treatment, and prevention of intravascular catheter related infections (CRI). The methodology used was the analysis of the literature published in the last 10 years, complemented with the opinion of experts and local data. This document aims to promote effective measures to reduce the risk of CRI and to offer basic tools for diagnosis optimization based on clinical and microbiological criteria, orientation on empirical and targeted antibiotic schemes, posology, and administration of antibiotics in critical patients. It also offers a diagnostic and treatment algorithm for use in the care activity, as well as considerations on the dosage of antibiotics. The joint work of both societies highlights the concern for the management of CRI and the importance of ensuring improvement in daily practices. Through this recommendation, local guidelines are established to optimize the diagnosis, treatment and prevention of CRI in order to reduce morbidity and mortality, days of hospitalization, costs, and antimicrobial resistance.

Microbiology and clinical characteristics of viridans group streptococci in patients with cancer

ABSTRACT This study assessed the microbiology, clinical syndromes, and outcomes of oncologic patients with viridans group streptococci isolated from blood cultures between January 1st, 2013 and December 31st, 2016 in a referral hospital in Mexico using the Bruker MALDI Biotyper. Antimicrobial sensitivity was determined using BD Phoenix 100 according to CLSI M100 standards. Clinical information was obtained from medical records and descriptive analysis was performed.Forty-three patients were included, 22 females and 21 males, aged 42 ± 17 years. Twenty (46.5%) patients had hematological cancer and 23 (53.5%) a solid malignancy. The viridans group streptococci isolated were Streptococcus mitis, 20 (46.5%); Streptococcus anginosus, 14 (32.6%); Streptococcus sanguinis, 7 (16.3%); and Streptococcus salivarius, 2 (4.7%). The main risk factors were pyrimidine antagonist chemotherapy in 22 (51.2%) and neutropenia in 19 (44.2%) cases, respectively. Central line associated bloodstream infection was diagnosed in 18 (41.9%) cases. Septic shock occurred in 20.9% of patients, with an overall mortality of 18.6%. Only four S. mitis revealed penicillin-resistance.Our results are similar to those of other series, identifying these bacteria as emerging pathogens with significant morbidity and mortality in oncologic patients. The MALDI-TOF system increased the rate of viridans group streptococci isolation in this population.

Infecciones asociadas a diálisis peritoneal en el paciente pediátrico: diagnóstico y tratamiento / Peritoneal dialysis-related infections in pediatric patients: diagnosis and treatment review

Resumen Las infecciones asociadas a diálisis peritoneal (DP), corresponden a la principal complicación de los pacientes pediátricos en esta terapia de reemplazo renal, disminuyendo la sobrevida de la membrana peritoneal y empeorando el pronóstico del paciente. El reconocimiento precoz y un tratamiento oportuno de éstas son fundamentales para preservar esta modalidad dialítica. Se presenta una revisión actualizada de la literatura científica, con el fin de entregar recomendaciones reproducibles en los distintos centros pediátricos que realizan diálisis peritoneal crónica en niños.

Peritoneal dialysis-related infections are the main complication in pediatric patients undergoing this renal replacement therapy, associating a high rate of morbidity, generating also a decreasing survival of the peritoneal membrane and worsening the patient outcome. We describe the recommended diagnostic and therapeutic modalities to treat dialysis-related in children.

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.

Estudio clínico y microbiológico de la infección urinaria asociada a catéter, en los servicios de medicina interna de un hospital universitario venezolano / Clinical and microbiological study of catheter-associated urinary tract infections in internal medicine services of a Venezuelan university hospital

RESUMEN Objetivos Determinar las características clínicas y microbiológicas de las infecciones del tracto urinario asociadas a catéter (ITUAC) en pacientes hospitalizados en los servicios de Medicina Interna del Hospital Universitario de Los Andes (HULA), Mérida, Venezuela y establecer la distribución clonal de Enterobacteriaceae multirresistentes productoras de esta infección. Materiales y métodos Se estudiaron 73 pacientes adultos con cateterismo vesical, durante enero a julio de 2015. El procesamiento microbiológico de las muestras de orina se realizó por métodos convencionales y automatizados. Las β-lactamasas de espectro extendido (BLEE) y carbapenemasas fueron detectadas fenotípicamente. La tipificación clonal se determinó por la amplificación de secuencias repetitivas por PCR. Resultados El 53,4% de los pacientes eran varones, con una edad media de 50,6 años. El promedio de permanencia del catéter fue de 10,9 + 6,5 días/paciente. El 54,8% de los pacientes tuvo urocultivos positivos. Las levaduras fueron el principal agente etiológico (44,7%), seguido por las enterobacterias (29,8%). Las enterobacterias, Pseudomonas aeruginosa y Acinetobacter baumannii produjeron BLEE y carbapenemasas asociadas a otros marcadores de resistencia. Dos grupos clonales fueron identificados en cepas de E. coli y K. pneumoniae multirresistentes, los cuales circularon en la unidad de trauma shock de la emergencia de adulto. Conclusiones Los hallazgos de este estudio permiten evidenciar la necesidad de adoptar estrictos criterios que justifiquen el uso del catéter vesical y la duración del mismo, así como el implementar programas para prevenir y controlar la diseminación de clonas bacterianas multirresistentes en pacientes con ITUAC en los servicios de medicina interna del HULA.

ABSTRACT Objectives To determine the clinical and microbiological characteristics of catheter-associated urinary tract infections (CA-UTI) in patients admitted to the Internal Medicine services of the Hospital Universitario de Los Andes (HULA), Mérida, Venezuela and to establish the clonal distribution of multi-resistant Enterobacteriaceae that produce this infection. Materials and Methods Seventy-three adult patients with bladder catheterization were studied between January and July 2015. The microbiological processing of the urine samples was performed using conventional and automatized methods. Extended- spectrum beta-lactamase (ESBL) and carbapenemase were detected phenotypically. Clonal classification was determined using repetitive element sequence-based PCR. Results A total of 53.4% of the patients were male, and the average age was 50.6 years. The average time the catheter remained in the patient was 10.9 ± 6.5 days and 54.8% of patients had positive urine cultures. Yeasts were the main etiological agent (44.7%), followed by enterobacteria (29.8%). Enterobacteria, Pseudomonas aeruginosa, and Acinetobacter baumannii produced ESBL and carbapenemase associated with other resistance markers. Two clonal groups were identified in multi-resistant Escherichia coli and Klebsiella pneumoniae strains that circulated in the shock trauma unit in the adult emergency department. Conclusions The findings in this study show the need to adopt strict criteria justifying the use of bladder catheterization and its duration, as well as the implementation of programs to prevent and control the spread of multi-resistant bacterial clones in patients with CA-UTI in the HULA Internal Medicine department.

Can procalcitonin be a diagnostic marker for catheter-related blood stream infection in children? / A procalcitonina pode ser um marcador de diagnóstico de infecções de corrente sanguínea relacionadas a cateter em crianças?

Abstract Objective The potential role of procalcitonin (PCT) in the diagnosis of catheter-related bloodstream infection (CRBSIs) is still unclear and requires further research. The diagnostic value of serum PCT for the diagnosis of CRBSI in children is evaluated here. Method This study was conducted between October 2013 and November 2014, and included patients with suspected CRBSI from 1 month to 18 years of age who were febrile, with no focus of infection, and had a central venous catheter. Levels of PCT and other serum markers were measured, and their utility as CRBSI markers was assessed. Additionally, the clinical performance of a new, automated, rapid, and quantitative assay for the detection of PCT was tested. Results Among the 49 patients, 24 were diagnosed with CRBSI. The PCT-Kryptor and PCT-RTA values were significantly higher in proven CRBSI compared to those in unproven CRBSI (p = 0.03 and p = 0.03, respectively). There were no differences in white blood cell count and C-reactive protein (CRP) levels between proven CRBSI and unproven CRBSI. Among the 24 patients with CRBSI, CRP was significantly higher among those with Gram-negative bacterial infection than in those with Gram-positive bacterial infections. PCT-Kryptor was also significantly higher among patients with Gram-negative bacterial infection than in those with Gram-positive bacterial infections (p = 0.01 and p = 0.02, respectively). Conclusions The authors suggest that PCT could be a helpful rapid diagnostic marker in children with suspected CRBSIs.

Resumo Objetivo O possível papel da procalcitonina (PCT) no diagnóstico de infecções de corrente sanguínea relacionadas a cateter (ICSRCs) ainda não está claro e precisa ser mais pesquisado. O valor diagnóstico da PCT sérica para o diagnóstico de ICSRC em crianças é avaliado neste estudo. Método Este estudo foi feito entre outubro de 2013 e novembro de 2014 e incluiu pacientes com suspeita de ICSRC de um mês a 18 anos que estavam febris, não tinham foco de infecção e tinham cateter venoso central. Foram medidos os níveis de PCT e de outros marcadores séricos, cuja utilidade como marcadores de ICSRC foi avaliada. Adicionalmente, foi testado o desempenho clínico de um novo ensaio quantitativo automatizado e rápido para a detecção de PCT. Resultados Dentre 49 pacientes, 24 foram diagnosticados com ICSRC. Os valores de PCT-Kryptor e PCT-RTA foram significativamente maiores em ICSRCs comprovadas do que em ICSRCs não comprovadas (p = 0,03 e p = 0,03, respectivamente). Não houve diferença na contagem de glóbulos brancos e nos níveis de proteína C reativa (PCR) entre ICSRCs comprovadas e ICSRCs não comprovadas. Dentre os 24 pacientes com ICSRC, a PCR era significativamente maior entre aqueles com infecção bacteriana gram-negativa do que naqueles com infecção bacteriana gram-positiva. O PCT-Kryptor também foi significativamente maior entre pacientes com infecção por bactérias gram-negativas do que naqueles com infecção por bactérias gram-positivas (p = 0,01 e p = 0,02, respectivamente). Conclusões Sugerimos que a PCT pode ser um marcador de diagnóstico rápido útil em crianças com suspeita de ICSRCs.

Caracterización clínica, microbiológica y epidemiológica en neonatos con infecciones relacionadas con la atención sanitaria / Clinical, microbiological and epidemiological characterization of neonates with health care-related infections

INTRODUCCIÓN: las infecciones relacionadas con la atención sanitaria representan un problema importante en la etapa neonatal por el compromiso con la mortalidad. OBJETIVO: caracterizar clínica, microbiológica y epidemiológicamente a los neonatos con infecciones relacionadas con la atención sanitaria. MÉTODOS: estudio descriptivo, transversal, retrospectivo, realizado en el Hospital "Eusebio Hernández Pérez" (2007-2014), en 151 neonatos, con análisis de variables epidemiológicas, clínicas y microbiológicas. Se estimaron: tasa de infección, de mortalidad e índice de letalidad, y porcentaje de resistencia antimicrobiana. RESULTADOS: la tasa de infección fue de 3,76 × 100 egresados, la de mortalidad de 1,96 × 100 egresados, y el índice de letalidad de 6,9 × 100 pacientes infectados. Como factores intrínsecos predisponentes se citan la prematuridad (83,1 %) y el bajo peso al nacer (85,6 %); y como extrínsecos, el catéter percutáneo (86,1 %) y la infección sistémica en 50 % de los pacientes. Los microorganismos mayormente aislados fueron: Estafilococo coagulasa negativo (25,3 %), Klebsiella spp. (16,9 %), Candida spp. (13,3 %) y Enterococcus faecalis (10,9 %), que se distribuyen diferentes significativamente (p= 0,000). La resistencia del Estafilococo coagulasa negativo se manifestó en las penicilinas (78,6 %), la eritromicina (63,0 %) y el cefoxitín (35,7 %). CONCLUSIONES: los factores de riesgo conocidos predominantes son la prematuridad, el bajo peso al nacer y el cateterismo percutáneo. Las principales características clínicas y microbiológicas son: la infección sistémica, la identificación de Estafilococo coagulasa negativo resistente a penicilinas, eritromicina y cefoxitìn; y bacilos gramnegativos resistentes a las cefalosporinas y la gentamicina.

INTRODUCTION: health care-related infections represent an important problem in the neonatal phase because of its association with mortality. OBJECTIVE: to characterize neonates with health-care related infections from the clinical, microbiological and epidemiological viewpoints. METHODS: retrospective, cross-sectional and descriptive study of 151 newborns conducted in ¨Eusebio Hernández Pérez¨ hospital from 2007 to 2014, with the analysis of epidemiological, clinical and microbiological variables. The infection rate, the mortality rate and the fatality index, and the antimicrobial resistance percentages were all estimated. RESULTS: the infection rate was 3.76 x 100 discharges; the mortality rate was 1.96 x 100 discharges and the fatality index reached 6.9 x 100 infected patients. Predisposing intrinsic factors were prematurity (83.1 %) and low birthweight (85.6 %) and the extrinsic ones were percutaneous catheter (86.1 %) and systemic infection (50 %) of the patients. The most isolated microorganisms included negative staphylococcus coagulasa (25.3 %), Klebsiella spp. (16.9), Candida spp. (13.3 %) and Enterococcus faecalis (10.9 %), with a significantly different distribution. It was observed that negative Staphylococcus coagulasa was resistant to penicillin (78.6 %), erythromycin (63 %) and cefoxitin (35.7 %). CONCLUSIONS: the predominant risk factors are prematurity, low birth weight and percutaneous catheterism. The main clinical and microbiological characteristics include systemic infections, detection of penicillin, erythromycin and cefoxitin-resistant negative Staphylococcus coagulase and cephalosporin-and gentamycin-resistant Gram-negative bacilli.

Body surface infrared thermometry in patients with central venous cateter-related infections / Termometria infravermelha da superfície corporal em pacientes com infecção relacionada a cateter venoso central

Objective To evaluate if body surface temperature close to the central venous catheter insertion area is different when patients develop catheter-related bloodstream infections.Methods Observational cross-sectional study. Using a non-contact infrared thermometer, 3 consecutive measurements of body surface temperature were collected from 39 patients with central venous catheter on the following sites: nearby the catheter insertion area or totally implantable catheter reservoir, the equivalent contralateral region (without catheter), and forehead of the same subject.Results A total of 323 observations were collected. Respectively, both in male and female patients, disregarding the occurrence of infection, the mean temperature on the catheter area minus that on the contralateral region (mean ± standard deviation: -0.3±0.6°C versus-0.2±0.5ºC; p=0.36), and the mean temperature on the catheter area minus that on the forehead (mean ± standard deviation: -0.2±0.5°C versus-0.1±0.5ºC; p=0.3) resulted in negative values. Moreover, in infected patients, higher values were obtained on the catheter area (95%CI: 36.6-37.5ºC versus 36.3-36.5ºC; p<0.01) and by temperature subtractions: catheter area minus contralateral region (95%CI: -0.17 - +0.33ºC versus -0.33 - -0.20ºC; p=0.02) and catheter area minus forehead (95%CI: -0.02 - +0.55ºC versus-0.22 - -0.10ºC; p<0.01).Conclusion Using a non-contact infrared thermometer, patients with catheter-related bloodstream infections had higher temperature values both around catheter insertion area and in the subtraction of the temperatures on the contralateral and forehead regions from those on the catheter area.

Objetivo Avaliar se a temperatura da superfície corporal nas proximidades da área de inserção do cateter venoso central é diferente quando os pacientes desenvolvem infecções da corrente sanguínea relacionadas ao cateter.Métodos Estudo transversal observacional. Usando um termômetro infravermelho sem contato, 3 medições consecutivas de temperatura da superfície corporal foram coletadas de 39 pacientes com cateter venoso central nos seguintes locais: nas proximidades da área de inserção do cateter ou do reservatório do cateter totalmente implantável, na região contralateral equivalente (sem cateter), e na fronte do mesmo paciente.Resultados Um total de 323 observações foram coletadas. Respectivamente nos pacientes do sexo masculino e feminino, desconsiderando a ocorrência de infecção, a temperatura média na área do cateter menos a da região contralateral (média ± desvio padrão: -0,3±0,6°C versus -0,2±0,5°C; p=0,36) e a da área do cateter menos a da fronte (média ± desvio padrão: -0,2±0,5°Cversus -0,1±0,5°C; p=0,3) resultaram em valores negativos. Além disso, em pacientes infectados, foram obtidos valores mais elevados na área do cateter (IC95%: 36,6-37,5ºC versus36,3-36,5ºC; p<0,01) e nas subtrações de temperaturas: área do cateter menos região contralateral (IC95%: -0,17 - +0,33°C versus-0,33 - -0,20°C; p=0,02) e a área do cateter menos fronte (IC95%:-0,02 - +0,55°C versus -0,22 - -0,10ºC; p<0,01).Conclusão Utilizando um termômetro infravermelho sem contato, os pacientes com infecções da corrente sanguínea associadas ao cateter apresentaram valores de temperatura mais elevados, tanto ao redor da área de inserção do cateter e na subtração das temperaturas das regiões contralateral e fronte, em relação àquelas da área do cateter.

Purple urine bag syndrome in a patient with a urethral balloon catheter and a history of ileal conduit urinary diversion

No abstract available.

Incidencia y etiología de la bacteriemia asociada al uso de catéteres venosos centrales en una unidad de cuidados intensivos pediátricos / Incidence and etiology of bacteremia associated with the use of central venous catheters in a pediatric intensive care unit

Las infecciones intrahospitalarias determinan un aumento en la morbimortalidad de los pacientes. La infección asociada al uso de catéteres intravenosos es la más frecuente en las unidades de cuidado intensivos. Objetivo: determinar la incidencia y etiología de bacteriemia asociada al uso de catéteres venosos centrales en la Unidad de Cuidados Intensivos de Niños (UCIN) del Centro Hospitalario Pereira Rossell. Material y método: se realizó un estudio descriptivo observacional entre el 1 de diciembre de 2009 hasta el 1 de julio de 2010. Se incluyeron todos los pacientes hospitalizados en UCIN, que cumplieran con la definición de paciente de Unidad de Cuidado Intensivo del National Nosocomial Infections Surveillance (NNIS) y que portaran un catéter venoso central. La fuente de recolección de datos fueron las historias clínicas. Resultados: se incluyeron 94 niños con vías centrales, un total de 109 vías, 988 días de cateterización. Se identificaron cinco casos de bacteriemias asociadas al catéter, una densidad de incidencia de bacteriemia asociada al catéter de 5.06 casos por cada 1000 días de cateterización. Los gérmenes aislados fueron Staphylococcus coagulasa negativo, Staphylococcus aureus, Klebsiella oxytoca, Enterobacter cloacae y Candida albicans. En todos los casos el tiempo de positivización diferencial del hemocultivo obtenido del catéter venoso fue menor a 2 horas frente al obtenido por punción periférica. Conclusiones: el valor hallado de incidencia de infección asociada al uso de catéter fue elevado y es necesario implementar medidas destinadas a disminuirla...

Predictors and clinical outcomes of persistent methicillin-resistant Staphylococcus aureus bacteremia: a prospective observational study

BACKGROUND/AIMS: The high mortality attributable to persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in spite of glycopeptide treatment has heightened the need for early detection and intervention with alternative agents. The purpose of this study was to determine the clinical characteristics of and risk factors for persistent MRSA bacteremia. METHODS: All first episodes of significant MRSA bacteremia at a 710-bed academic medical center from November 2009 through August 2010 were recorded. Blood cultures were conducted at 3 days and every 2 to 3 days thereafter until clearance. Clinical characteristics and outcomes were compared between persistent MRSA bacteremia (> or = 7 days) and nonpersistent MRSA bacteremia (< or = 3 days). RESULTS: Of 79 patients with MRSA bacteremia during the study period, 31 (39.2%) had persistent MRSA bacteremia. The persistent MRSA bacteremia group had significantly higher 30-day mortality than the nonpersistent MRSA bacteremia group (58.1% vs. 16.7%, p < 0.001). Multivariate analysis indicated that metastatic infection at presentation (odds ratio [OR], 14.57; 95% confidence interval [CI], 3.52 to 60.34; p < 0.001) and delayed catheter removal in catheter-related infection (OR, 3.80; 95% CI, 1.04 to 13.88; p = 0.004) were independent predictors of persistent MRSA bacteremia. Patients with a time to blood culture positivity (TTP) of < 11.8 hours were at increased risk of persistent MRSA bacteremia (29.0% vs. 8.3%, p = 0.029). CONCLUSIONS: High mortality in patients with persistent MRSA bacteremia was noted. Early detection of metastatic infection and early removal of infected intravascular catheters should be considered to reduce the risk of persistent MRSA bacteremia. Further studies are needed to evaluate the role of TTP for predicting persistent MRSA bacteremia.

Diferença de tempo de positividade: método útil no diagnóstico de infecção de corrente sanguínea relacionada com cateter? / Differential time to positivity: a useful tool for the diagnosis of catheter-related infections?

INTRODUÇÃO: As infecções de corrente sanguínea relacionadas com cateter (ICSRCs) apresentam impacto significativo na morbidade e na mortalidade de pacientes internados, além de elevar custos hospitalares. A utilização de equipamentos automatizados no processamento de hemoculturas gerou uma alternativa para diagnóstico de ICSRC por meio da análise da diferença de tempo de positividade (DTP) entre hemoculturas pareadas (coletadas simultaneamente) de sangue periférico e sangue de cateter. Um diagnóstico acurado e rápido dessas infecções pode otimizar as condutas clínicas e terapêuticas, poupando a retirada precoce dos cateteres. OBJETIVOS: Avaliar na rotina a DTP como ferramenta auxiliar no diagnóstico de ICSRC e determinar os principais microrganismos isolados. MÉTODOS: Foram avaliadas retrospectivamente hemoculturas coletadas no complexo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP) de maio a agosto de 2008. Somente amostras que apresentaram DTP maior que 120 minutos foram consideradas possíveis ICSRCs pelo critério laboratorial. RESULTADOS: A seção processou 11.017 hemoculturas aeróbias durante o período de estudo; somente 5% foram coletadas de forma pareada. Destas, 148 (28%) foram positivas, sendo 9% com crescimento somente em sangue periférico, 41% somente em sangue de cateter e 50% em ambas as amostras com 88% de homologia de microrganismos identificados. A DTP apresentou valores acima de 120 minutos em 50% dos casos e os microrganismos mais isolados foram Staphylococcus aureus (22%), Candida spp. (18%), Klebsiella spp. (7%) e Enterobacter spp. (7%). CONCLUSÃO: A determinação da DTP como ferramenta auxiliar no diagnóstico de ICSRC é viável e fácil de ser executada em laboratórios de rotina com automação, porém o processo de coleta das amostras pareadas deve ser rigidamente padronizado.

INTRODUCTION: Not only do catheter related bloodstream infections (CRBSIs) have considerable impact on morbidity and mortality in hospitalized patients, but they also raise hospital costs. The use of automated equipment in blood culture processing has allowed an alternative diagnosis of CRBSI by analyzing the differential time to positivity (DTP) of paired blood cultures (collected simultaneously) of peripheral blood and catheter blood. A rapid and accurate diagnosis of these infections may optimize clinical and therapeutic management, which prevents early catheter removal. OBJECTIVES: To assess DTP as an auxiliary tool for the diagnosis of CRBSI as well as to determine the main isolated microorganisms. METHODS: We evaluated blood cultures that had previously been collected in the complex Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP) from May to August 2008. According to the laboratory criteria, only DTP higher than 120 minutes was regarded as possible CRBSI. RESULTS: During the investigation period 11,017 aerobic blood cultures were processed, from which only 5% were paired samples. One hundred forty-eight (28%) samples were positive, from which 9% showed growth in peripheral blood, 41% only in catheter blood and 50% in both blood samples with 88% homology of identified microorganisms. DTP higher than 120 minutes occurred in 50% of the cases. The most common isolated microorganisms were: Staphylococcus aureus (22%), Candida spp. (18%), Klebsiella spp (7%). and Enterobacter spp (7%). CONCLUSION: The determination of the DTP as an auxiliary tool for the diagnosis of CRBSI is feasible and easily performed in clinical laboratories with automation, although the process of paired sample collection must be rigidly standardized.

The first case of Staphylococcus aureus ST398 causing bacteremia in an immunocompromised patient in Greece.

We describe a case of catheter-related bloodstream infection, in a patient with colon cancer, caused by a methicillin-sensitive Staphylococcus aureus strain, nontypeable by pulsed field gel electrophoresis of SmaI macrorestriction fragment analysis, belonging to ST398. The patient recovered after daptomycin therapy. This is the first report that documents the emergence of ST398 in Greece.

Infecções relacionadas a cateteres torácicos / Thoracic catheter-related infections

OBJETIVO: Determinar o status de colonização de uma amostra de pacientes que recebeu cateteres torácicos (CTs) e correlacionar esse status a possíveis fatores prognósticos. MÉTODOS: Estudo retrospectivo com 48 pacientes (17 mulheres e 31 homens) que receberam CTs no Departamento de Cirurgia Torácica do Hospital Universitário Adnan Menderes, localizado na cidade de Aydin, Turquia, entre dezembro de 2008 e março de 2009. Amostras de sangue para cultura foram coletadas da porção distal dos CTs e de cada um dos 48 pacientes. Procuramos por correlações entre culturas positivas e possíveis fatores prognósticos de infecção. RESULTADOS: Resultados positivos de cultura em amostras de CT ocorreram somente 3 pacientes, em sangue em 2, e nas duas amostras em outros 2. A idade avançada correlacionou-se com culturas positivas das amostras de CT e sangue (r = 0,512 e r = 0,312, respectivamente; p < 0,05), assim como o uso prolongado do CT e com culturas positivas das mesmas amostras (r = 0,347 e r = 0,372, respectivamente; p < 0,05). Houve uma correlação significativa entre o status cirúrgico dos pacientes (aqueles submetidos a cirurgias) e culturas positivas somente das amostras de CT (p < 0,05), mas a presença de malignidade inoperável correlacionou-se com o crescimento bacteriano em ambos os tipos de amostras (p < 0,05 para ambos). CONCLUSÕES: Os fatores de risco acima citados aumentam o risco de infecções. No caso de pacientes com CTs e que apresentam tais fatores de risco, é imperativo que se utilize uma profilaxia com antibióticos de amplo espectro.

OBJECTIVE: To determine the incidence of local and systemic infection in a sample of patients catheterized with thoracic catheters (TCs) and to identify the prognostic factors for catheter-related infection. METHODS: A retrospective study involving 48 patients (17 females and 31 males) catheterized with TCs between December of 2008 and March of 2009 in the Thoracic Surgery Department of the Adnan Menderes University Hospital, located in Aydin, Turkey. Blood samples for culture were collected from the distal end of each TC and from each of the 48 patients. We looked for correlations between positive culture and possible prognostic factors for catheter-related infection. RESULTS: Culture results were positive in TC samples only for 3 patients, in blood samples only for 2, and in both types of samples for another 2. Advanced age correlated significantly with positive culture in TC samples and in blood samples (r = 0.512 and r = 0.312, respectively; p < 0.05 for both), as did prolonged catheterization (r = 0.347 and r = 0.372, respectively; p < 0.05). There was a significant correlation between having undergone surgery and positive culture in TC samples only (p < 0.05). However, having an inoperable malignancy correlated with bacterial growth in blood and in TC samples alike (p < 0.05 for both). CONCLUSIONS: Risk factors, such as advanced age, prolonged catheterization, comorbidities, and inoperable malignancy, increase the risk of catheter-related infection. It is imperative that prophylaxis with broad-spectrum antibiotics be administered to patients who present with these risk factors and might be catheterized with a TC.