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.

Multivariate study on central line-associated bloodstream infection in patients undergoing hematopoietic stem cell transplantation / 中国感染控制杂志

Objective To investigate the incidence of central line-associated bloodstream infection (CLABSI) in patients with hematopoietic stem cell transplantation (HSCT), explore risk factors for the occurrence of CLABSI.Methods Basic information of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) who underwent HSCT in a hematology department from November 1, 2016 to October 31, 2017 was collected, incidences of original CLABSI (OCLABSI) and modified CLABSI (MCLABSI) were calculated, related risk factors were analyzed by multivariate Cox regression.Results A total of 218 patients with AML and MDS who underwent HSCT were enrolled, 19 of whom had OCLABSI and 10 had MCLABSI.Twenty-one strains of pathogens were isolated from 19 patients with OCLABSI, including 9 gram-positive bacteria, 11 gram-negative bacteria, 1 fungus;9 strains were multidrug-resistant organisms.The main risk factors for OCLABSI included the female (HR=0.088;95％CI:0.017-0.440;P=0.003), age (HR=1.560;95％CI:1.066-2.530;P=0.034), bone marrow cell transplantation only (HR=4.408;95％CI:1.860-22.593;P=0.043), ATG/CSA/MMF/MTXG for preventing graft-versus-host disease (GVHD) (HR=0.101;95％CI:0.015-0.686;P=0.019), and MTX for preventing GVHD (HR=0.097;95％CI:0.011-0.816;P=0.032).Conclusion Definition of MCLABSI can provide more accurate monitoring on deep central venous catheter-related bloodstream infection.Incidence of CLABSI in HSCT patients can be reduced by early detection of high-risk population according to high-risk factors, strict adherence to the prevention and control measures of bloodstream infection, and implementation of immune recombination after enhanced transplantation.

Research of effect about two disinfectors on prevention for central line-associated blood stream infection in hemodialysis / 中国医学装备

Objective: To explore the clinical effect of two disinfectors on prevention for central line-associated blood stream infection (CLABSI) in hemodialysis. Methods: 168 patients received blood purification through central venous indwelling catheter were divided into control group (82 cases) and observation group (86 cases) as random table. The patients of control group were disinfected by using iodophor disinfectant on central venous catheter and skin around puncture, while the patients of observation group were disinfected by using medical chlorhexidine gluconate (2% chlorhexidine gluconate, 70% isopropanol and 28%injection) on the same positions. In different stages, before and after central venous indwelling catheter and 24 hours after central venous indwelling catheter, the colony count and incidence of CLABSI of patients between two groups were compared. Results: There was no significant difference between the two groups for colony count around puncture before central venous indwelling catheter (t=-1.478, P>0.05). The colony count of observation group was lower than that of control group after 24 hours of disinfection. According to the diagnosis standards of CLABSI, the incidence of CLABSI in observation group was significant lower than that in control group (x2=6.048, P<0.05). Conclusion: The disinfector of chlorhexidine gluconate can decrease the incidence of CLABSI in hemodialysis and its bacteriostatic time is longer than that of iodophor disinfectant. Therefore, this method is worthy for promotion in clinical practice.

Central line-associated bloodstream infections in the intensive care unit: importance of the care bundle / 대한마취과학회지

BACKGROUND: The importance and efficacy of a care bundle for preventing central line-associated bloodstream infections (CLABSIs) and infectious complications related to placing a central venous catheter (CVC) in patients in the intensive care unit (ICU). METHODS: A care bundle was implemented from July 2013 to June 2014 in a medical ICU and surgical ICU. Data were divided into three periods: the prior period (July 2012–June 2013), the intervention period (July 2013–June 2014; first and second periods), and the post-intervention period (July 2014–December 2014; third period). A care bundle consisting of optimal hand hygiene, skin antisepsis with chlorhexidine (2%) allowing the skin to dry, maximal barrier precautions for inserting a catheter (sterile gloves, gown, mask, and drapes), choice of optimal insertion site, prompt catheter removal, and daily evaluation of the need for the CVC was introduced. RESULTS: The catheterization duration was longer and femoral access was more frequently observed in patients with CLABSIs. CLABSI rates decreased with use of the care bundle. The CLABSI rate in the medical ICU was 6.20/1,000 catheter days during the prior period, 3.88/1,000 catheter days during the intervention period, and 1.05/1,000 catheter days during the third period. The CLABSI rate in the surgical ICU was 8.27/1,000, 4.60/1,000, and 3.73/1,000 catheter days during these three periods, respectively. CONCLUSIONS: The choice of an optimal catheter insertion site, use of all barrier precautions, and removal of catheters when they are no longer needed are essential to decrease the CLABSI rate.

A Quality Improvement Program to Reduce Central Line Associated Blood Stream Infections in Neonates.

Introduction: Late onset sepsis is a common problem among neonatal intensive care unit (NICU) population with central venous catheter (CVC) being the primary source of infection in the majority of the cases. Central line associated bloodstream infections (CLABSIs) have been significantly reduced by care bundles implanted in NICUs. This study is conducted to detect the overall CLABSI rate, by comparing the rate per 1000 line days in the pre-intervention to that in the post-intervention periods, to prove that change could be attributed to the quality improvement bundles. Methods: This was a retrospective observational study. It included all patients with central line inserted at NICU of MGH from January 2012 to February 2014 and compared these patients with historical cohort from 22 months of 2010 and 2011. Specific interventions were designed for the central line related practices. Specific interventions according to CDC recommendations emphasize best practices in all areas of central line care: reduction of line entries, aseptic entries into the line, and aseptic procedures when changing line components. Results: Overall, CLABSI rates, in our NICU, declined significantly by 57.3% from 15 CLABSI per 1000 central line days in the pre-intervention period to 6.4 CLABSI in 1000 central line days in the post-intervention period (P<0.05). Significant reductions in CLABSI rates were noted for neonates with birth weight less than <1000g and neonates between 1001 g and 1500 g during the postintervention period, compared with the CLABSI rates for neonates from pre-intervention period. Conclusion: We found that our efforts didn’t result in a decrease in the use of CVC among neonates. Hence, central line utilization rate was not associated, in our study, with CLABSI risk. Our quality improvement effort was successful in significantly reduced CLABSI rates. The majority of our success can be linked to educational efforts based on pertinent and timely data and literature.