Usefulness of anti-infective lock solutions for catheter-related bloodstream infections.

Central venous catheters are commonly used for the administration of medications in both the inpatient and outpatient settings, but their use carries the risk of developing catheter-related bloodstream infections, increasing morbidity and mortality. Guidelines from the Infectious Diseases Society of America include use of antibiotic lock solutions as a therapeutic option for intraluminal infections when the device is difficult to remove, but these lock solutions are not indicated routinely for the prophylaxis of catheter-related bloodstream infections. Because catheter removal is not always possible in patients who require chronic catheterization or who have multiple catheters, antibiotic lock therapy can be utilized with the goal of sparing removal of the catheter while sterilizing the lumen. The use of an antibiotic lock solution is an appealing option for localized infections because it is easy to use, is associated with a low cost, and is usually without systemic side effects if the catheter remains closed. Patients with long-term or short-term catheters with no signs of exit-site or tunnel infection for whom salvage is the goal may benefit from this technique when treated with systemic antibiotics. Consider antibiotic lock therapy only in uncomplicated infections, typically nontunneled catheter or port infections with coagulase-negative staphylococci or gram-negative bacilli. Generally, a short-term regimen of 7 to 14 days is recommended. Several studies have supported antimicrobial lock therapy with vancomycin, gentamicin, cefazolin, or ethanol. Antibiotic locks have the potential to positively impact mortality and cost savings. A protocol at the Mount Sinai Medical Center is in development.

Statistically designed survey of polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, and co-planar polychlorinated biphenyls in U. S. meat and poultry, 2002-2003: results, trends, and implications.

To obtain information on dioxin levels in the human diet, the Food Safety and Inspection Service of the United States Department of Agriculture recently determined levels of dioxin-like compounds (dioxins/dibenzofurans/PCBs) in four major slaughter classes (steers and heifers, market hogs, young chickens, and young turkeys) that comprise over 90% of the meat and poultry production in the United States. The data were analyzed and compared to data from smaller surveys carried out from 1994 to 1996. These surveys were conducted by different laboratories nearly 10 years apart, so a direct comparison of the data was not straightforward. Three approaches were taken: (1) comparison with nondetects set to zero, (2) comparison with nondetects set to half the limit of detection, and (3) comparison applying the earlier surveys' limits of detection to the newer data. The data analyses indicated that dioxin levels appear to have declined in three of the four slaughter classes, with young chickens, market hogs, and young turkeys declining 20-80%, while any declines in cattle dioxin levels, if real, are less than those observed in the other slaughter classes. Further study is needed to examine factors that might explain the differences in dioxin levels and distribution profiles in the four slaughter classes. A small number of market hog and steers/ heifers samples had dioxin toxic equivalency levels (TEQs) greater than 2 pg/g lipid weight. Follow-up investigations for those samples indicated a common source for the market hog samples (a dioxin-contaminated mineral supplement), but no commonality was found for the steers/ heifers samples.