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.

Study on risk factor of central venous catheter infection in ICU: 1 160 patients report / 中华危重病急救医学

Objective To analyze the etiology and risk factors of central venous catheter (CVCs) infections, and to explore the prophylaxis and treatment for catheter-related infections. Methods A retrospective study was conducted. The patients with CVCs admitted to intensive care unit (ICU) of Qianfoshan Hospital Affiliated to Shandong University from January 2000 to December 2016 were enrolled. The gender, age, catheter data and microorganism culture results of all patients were collected. The infection rate and the incidences of CVCs infection per 1 000 catheter days were calculated. The risk factors of CVCs infection were analyzed by Logistic regression. Results 1 160 patients were enrolled in 17 years [male 915, female 245, age 7-98 years, mean (71.8±17.5) years]. The incidences of CVCs infection per 1 000 catheter days were descended every 3 years (cases/1 000 days: 21.87, 24.50, 19.95, 12.64, 16.34, 12.40, χ2=38.851, P = 0.000). Of the 1 160 patients, 375 were positive for catheter culture, and 397 strains were cultured, among which 173 strains (43.58%) were Gram negative (G-), 130 strains (32.74%) of Gram positive (G+), and 94 strains of fungi (23.68%). Non-fermenting bacteria (Pseudomonas aeruginosa 11.59%, Acinetobacter baumannii 8.82%) was predominant in the G- bacteria, followed by Enterobacteria (Klebsiella pneumoniae 8.06%, Escherichia coli 2.02%); Staphylococcus spp. (Staphylococcus epidermidis 11.84%, Staphylococcus aureus 5.29%) was the main species of G+bacteria; the main fungi were Candida tropicalis (9.07%) and Candida albicans (5.79%). The catheter infection rate of internal jugular vein, femoral vein and subclavian vein were 36.07% (22/61), 35.52% (119/335), 30.63% (234/764) respectively (χ2=2.275, P = 0.099), the incidence of catheter infection of three vein insertion sites per 1 000 catheter days were 18.00, 17.71, 17.08 cases/1 000 days respectively (χ2= 0.034, P = 0.714). The mean placement time of infected CVCs in situ was longer than that of non-infected CVCs (days: 20.80±11.68 vs. 17.64±10.77, t = 4.417, P = 0.000).The positive rate was lowest during 1-7 days of indwelling time (19.87%, 30/151). The infection rate was increased with long indwelling time. The positive rate was 44.44% (68/153) as indwelling time was over 30 days. The infection rate was significantly positively related to indwelling time (χ2= 22.849, P = 0.000). Multiple Logistic regression analysis showed that the infection risk of femoral vein catheter was increased [odds ratio (OR) = 1.362, 95% confidence interval (95%CI) = 1.030-1.801, P = 0.030] as compared with that of subclavian vein catheter; the infection risk was increased with long indwelling time (OR = 1.306, 95%CI = 1.177-1.480, P = 0.000). Conclusions G- are the major pathogens of CVCs infection. Femoral vein catheter and long indwelling time are the risk factors of CVCs infection.

Evaluation of application effect of permanent deep venous catheter in hemodialysis and nursing / 中国实用护理杂志

ObjectiveTo investigate the nursing scheme to prevent infection,thromboembolism,accidental shedding during application of permanent deep venous catheter in hemodialysis. Methods28 patients undergoing maintenance hemodialysis from January 2007 to February 2009 were randomly divided into the observation group and the control group with 14 patients in each group.The control group took conventional care only,the observation group was given pertinent nursing intervention.After treatment the number of patients with infection and thromboembolism were compared in both groups. ResultsAll patients were successfully placed catheters.Number of patients with infection,thromboembolism and accidental shedding in the observation group were less than those in the control group.But there was no significant difference in average indwelling time of catheters between two groups. ConclusionsApplication of permanent deep venous catheter in hemodialysis shows good effect,it can decrease the incidence of complication and should be widely applied.

Preventing peripheral central venous catheter-related bloodstream infections through process management / 中华临床营养杂志

Objective To explore the role of process management in preventing peripheral central venous catheter (PICC)-related bloodstream infections (CRBSI). Methods A standard process management policy was established for the uniform management of PICC in our hospital. The incidences of CRBSI before and after the implementation of this policy were compared. Results The incidences of CRBSI was 6.0‰ (48/79 793 ) every 1000 catheter-days before process management and 2.9‰ (29/99643) after process management (P =0.000).Conclusion Standard process management can effectively prevent and control CRBSI caused by PICC.

Parenteral nutrition related central venous catheter infection in elder patients with malignant tumors / 上海交通大学学报（医学版）

Objective To investigate the prevalence of parenteral nutrition related central venous catheter infection in elder patients with malignant tumors,and explore the risk factors. Methods The clinical data of 366 patients with malignant tumors who were managed with parenteral nutrition after operation were retrospectively analysed.The data of age,gender, body weight,diagnosis of primary disease,surgical approach,past history,volume of blood and albumin transfusion and time of fever(body temperature ≥38℃) were collected.Parenteral nutrition related parameters such as time of parenteral nutrition,total calorie,non-protein cMorie,amount of fat,protein and glucose,calorie to nitrogen ratio and carbohydrate to fat ratio were also recorded. Results The mean age of 366 patients was (71.8±6.9)years,mean time of parenteralnutrition was (10.6±6.3)d,and total time of catheterization was 3 336 days.The prevalence of parenteral nutrition related central venous catheter infection was 2.5%(9/366).Logistic regression analysis demonstrated that the relative risks of plasma albumin level before parenteral nutrition and time of high fever to catheter infection were 1.257 and 2.518,respectively(P<0.01 for both). Conclusion Plasma albumin level before parenteral nutrition and time of fever were two risk factors for parenteral nutrition related catheter infection in elder patients with malignant tumors.

Keep watching versus immediately remove central venous catheter in unexplained fever patients / 中国医师进修杂志

Objective To evaluate, the safety of keeping watching central venous catheter and whether it decreased unnecessary catheter removal in unexplained fever patients. Methods Eighty-two unexplained fever patients with suspected catheter-related infection whose clinical conditions were relatively stable were retrospectively analyzed and divided into keep watching group (31 patients) and immediate removal group (51 patients). ICU mortality, sequential organ failure assessment (SOFA) score, temperature, the rate of catheter-related infection, and the rate of central venous catheter removal were compared. Results There was no significant difference in ICU mortality, SOFA score, temperature and the rate of catheter-related infection between two groups (P > 0.05). Eleven of 31 (35.5%) were removed central venous catheter at last, versus all patients (100.0%) in the immediate removal group (P < 0.05). Conclusion Keep watching central venous catheter will decrease a substantial unnecessary catheter removal without increased morbidity in unexplained fever patients with suspected catheter-related infection if their clinical conditions are relatively stable.