A simple educational intervention to decrease incidence of central line-associated bloodstream infection (CLABSI) in intensive care units with low baseline incidence of CLABSI.

After an educational intervention in 3 intensive care units, 34 central line-associated bloodstream infections occurred in 11,582 central venous catheter [CVC]-days, compared with 45 episodes in 10,661 CVC-days before intervention (4.22 vs 2.94 episodes per 1,000 CVC-days [30.9% reduction]; P = .03, Wilcoxon rank sum test; P = .11, Poisson regression analysis).

How many lumens should be cultured in the conservative diagnosis of catheter-related bloodstream infections?

BACKGROUND: Recent practice guidelines for the diagnosis of catheter-related bloodstream infection (CRBSI) describe as an "unresolved issue" the number of lumens from which blood culture specimens should be drawn to make a conservative diagnosis of CRBSI. Our objective was to determine how many CRBSI episodes would be missed if not all catheter lumens were sampled. METHODS: We performed a retrospective study (1 January 2003-31 May 2009) in patients with microbiologically proven CRBSI in which all available catheter lumens (those that did not contain clots) were used to draw blood culture samples. We calculated the number of episodes that would have been missed in double- and triple-lumen catheters if the culture of samples obtained from 1 lumens had been eliminated. RESULTS: We studied 171 episodes of proven CRBSI in 154 patients. Overall, if 1 lumen-associated culture had been eliminated for both double-lumen and triple-lumen catheters, we would have missed 27.2% and 15.8% of episodes of CRBSI, respectively. If we had eliminated 2 cultures for triple-lumen catheters, 37.3% of episodes would have been missed. CONCLUSIONS: Samples for blood culture should be obtained through all catheter lumens to establish a diagnosis of CRBSI.

Is Candida colonization of central vascular catheters in non-candidemic, non-neutropenic patients an indication for antifungals?

PURPOSE: To assess the influence of antifungal therapy on the outcome of non-candidemic adult patients with central vascular catheter (CVC) tips colonized by Candida species. METHODS: A retrospective analysis of the outcome of patients with Candida colonization of their CVC tip and no concurrent candidemia was made over a 4-year period. Patients who either died or developed candidemia-invasive candidiasis (poor outcome) were compared with those who improved. RESULTS: We finally included 58 patients for analysis. Almost all (91.4%) had to be admitted to the ICU during their hospital stay. Independent predictors for outcome were a McCabe and Jackson score corresponding to ultimately fatal underlying disease [odds ratio (OR) 11.98; 95% confidence interval (CI), 1.37-104.97; P = 0.02], and maximum severity corresponding to severe sepsis, septic shock or multiorgan failure (OR: 6.16, CI 95%: 1.00-37.93; P = 0.05). We were unable to demonstrate that antifungal therapy was an independent variable influencing outcome (OR 0.82; 95% CI, 0.27-2.47; P = 0.73). CONCLUSIONS: Our data suggest that, in non-neutropenic critically ill patients with no concomitant candidemia and with CVC tips colonized by Candida, antifungal therapy does not seem to have a significant influence on clinical outcome.