Challenging the 48‐Hour Rule‐Out for Central Line–Associated Bloodstream Infections in the Pediatric Intestinal Failure Population

Introduction: While parenteral nutrition (PN) has revolutionized the management of patients with intestinal failure (IF), central line–associated bloodstream infections (CLABSIs) remain a leading cause of mortality and morbidity in this population. The objective of this study is to characterize the presentation of CLABSIs in pediatric IF and to determine the time to positivity of blood cultures. Methods: A retrospective cohort study of children with IF who presented to our institution for evaluation of a possible CLABSI from January 1, 2012, to December 31, 2012, was performed. Results: Sixty patients with IF were identified. There were 33 cases of CLABSI in 16 patients, with a rate of 1.5 infections per 1000 catheter days. There were no significant differences in age, growth parameters, or catheter days between patients with or without CLABSI. Fever was documented in 85% of patients with CLABSI. These patients demonstrated an increased percentage of neutrophils and higher C‐reactive protein levels compared with patients without CLABSI. The mean time to culture positivity was 13.2 hours, and 97% of cultures were positive within 24 hours. Conclusion: Our data suggest that most pediatric patients with IF who have CLABSI develop positive cultures within 24 hours, and the absence of fever and leukocytosis does not necessarily indicate the absence of infection. These findings may support clinical practice guidelines in favor of shorter hospital stay when CLABSI is suspected; however, a prospective analysis of CLABSI in this population is recommended to determine the safety and appropriate setting prior to any practice change.     

Muscle‐related differences in mechanomyography–force relationships are model‐dependent

Introduction: In this study we examined the mechanomyographic amplitude (MMG_RMS)–force relationships with log‐transform and polynomial regression models for the vastus lateralis (VL), rectus femoris (RF), and first dorsal interosseous (FDI) muscles. Methods: Twelve healthy (age 23 ± 3 years) men performed isometric ramp contractions of the leg extensors and index finger from 10% to 80% of their maximal voluntary contraction (MVC) with MMG sensors positioned on the VL, RF, and FDI. Log‐transform and polynomial regression models were fitted to the relationships. Results: There were differences for the a terms (intercepts) and b terms (slopes) from the log‐transform model between the FDI, VL, and RF; however, there were no consistent differences identified with the polynomial regression models. Conclusions: The log‐transform model quantified differences in the patterns of responses between the FDI and the leg extensors, but polynomial regression could not distinguish such differences. Muscle Nerve 49 : 202–208, 2014     

Stürze in deutschen Krankenhäusern und Pflegeheimen 2006–2013

Background

In Germany, a nationwide systematic collection of data regarding fall incidents within health-care facilities is lacking. The objective of the study was to provide valid and robust data on fall rates, the severity of the fall and its resulting injuries, fall risk assessment, and preventive measures offered by professional caregivers in German hospitals and nursing homes.

Materials and methods

Each spring from 2006 to 2013, cross-sectional studies were conducted in 124 hospitals (n?=?22,493 patients) and 332 nursing homes (25,384 residents) throughout Germany. Fully trained nurses obtained information on the recent history (<?14 days) of the fall and its consequences. Further, they assessed the individual fall risk by clinical judgment and recorded ongoing preventive measures.

Results

The total fall rate was 3.9?% (95?% CI 3.6–4.2) in the hospitals and 4.6?% (95?% CI 4.3–4.9) in the nursing homes. Of the fall victims, 6.4?% of the nursing home residents and 8.8?% of the hospital patients were badly injured (i.e., fracture). The fall risk was considered high for residents, with two thirds of all residents being affected, while it was lower for the patients, at one third. The following factors were associated with fall risk: limited mobility, cognitive impairment, recent history of falls for nursing home residents, and additionally urinary incontinence and higher age in hospital patients. The most common preventive measure was counseling of the individual in both settings.

Conclusion

Although most falls have no severe consequences, the study shows that every 20–25th individual has a falling event in hospitals and nursing homes within 14 days. Despite the slight variance, the trend of the rates remains largely stable. Because specific fall risks were determined, preventive measures can be applied in a more personalized manner and care can be improved. Finally, the study provides valid and durable figures for national and international comparisons.