Disseminated Mycobacterium fortuitum Infection Associated with Venous Access Device.

Mycobacterium fortuitum is an important opportunistic pathogen among the rapidly growing Mycobacteria. Disseminated disease occurs as a consequence of bacteremia linked to vascular catheters, which carry high morbidity and mortality when they occur in immuno-compromised patients. Conventional culture methods often miss these organisms since they may grow more slowly (after 48 h) and are dismissed as skin contaminants because of their morphological resemblance to diphtheroids on grams staining. We report a case of 10 months old child with primitive neuroectodermal tumor who developed disseminated disease with M. fortuitum that was related to an indwelling intravascular device. The isolates were confirmed as M. fortuitum by polymerase chain reaction based DNA sequencing targeting heat shock protein 65 gene. The child was treated with, rifampicin, ethambutol and azithromycin. The patient improved remarkably and became afebrile 2 days after institution of therapy and removal of the catheter. The treatment was given for 3 months.

Dispositivo intravascular periferico curtomais seguro para infusaode quimioterapicos antineoplasticos vesicantes: o que a literatura diz / A safer short peripheral intravascular device for infusion of vesicant antineoplastic chemotherapy: what the literature says / Dispositivo intravascular periferico corto mas seguro para infusion de quimioterapicos antineoplasticos vesicantes: que dice la literatura

Trata-se de uma revisão sistemática da literatura sobre a indicação do dispositivo intravenoso periférico curto que ofereça maior segurança ao paciente em tratamento quimioterápico. O objetivo é a prevenção da ocorrência de extravasamento, principalmente, de drogas antineoplásticas vesicantes. O extravasamento poderá tornar-se mais um agravante ao paciente oncológico que, geralmente já se encontra rodeado por efeitos colaterais decorrentes do tratamento. Foi observado que não há consenso entre os autores quanto a indicação do dispositivo mais seguro para tal finalidade e conclui-se que vários fatores devem ser considerados para a escolha do mesmo.

This is a systematic literature review about the indication of the short peripheral intravenous device that offers greater safety to patients undergoing chemotherapy. The objective is the prevention of extravasation, especially of vesicant antineoplastic drugs. The extravasation may become more problematic in cancer patients which, usually, have already been through the treatment side effects. It was observed that there is no consensus among authors on which is the safer catheter for the purpose. In conclusion several factors should be taken into consideration when selecting the appropriate device.

Se trata de una revisión sistemática de la literatura sobre la indicación del dispositivo intravenoso periférico corto que ofrece más seguridad a los pacientes sometidos a quimioterapia. El objetivo es prevenir la extravasación, especialmente de los fármacos antineoplásicos vesicantes. La extravasación puede ser más problemática en los pacientes con cáncer que, por lo general, ya sufren los efectos secundarios del tratamiento. Se observó que no hay consenso entre los autores sobre la indicación del dispositivo más seguro para este propósito y la conclusión es que deben considerarse varios factores antes de elegirlo.

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.