Use of teicoplanin for Hickman catheter associated staphylococcal infection in immunosuppressed patients

Antibiotic-resistant coagulase-negative staphylococci are a frequent cause of infection in indwelling central venous (Hickman) catheters. Teicoplanin has been evaluated in the treatment of 19 immunosuppressed patients with staphylococcal Hickman catheter infections, nine of whom were septicaemic. All infections were eradicated, with minimal side effects. In 16 cases, the catheter was retained until no longer required. Two recurrent infections were eradicated by a second course of teicoplanin. We conclude that teicoplanin is an effective and well-tolerated antibiotic in the treatment of Hickman catheter infections in immunosuppressed patients.     

Hickman catheter complications in marrow transplant recipients

The complications associated with the insertion and use of 95 single lumen and 312 double lumen Hickman right atrial catheters in 357 marrow transplant recipients were retrospectively analyzed. Three-hundred (84%) first inserted catheters were in place for a median of 93 days (range, 16-209) without complications and were removed electively. Thirty-nine (9.6%) of all catheters were removed for infections and 24 (5.9%) for mechanical complications. Ninety-five patients (26.6%) had 111 episodes of septicemia involving 128 separate organisms and 25 patients had 25 episodes of localized catheter infection with 26 separate organisms. The most frequently isolated organism was coagulase-negative staphylococcus. Twelve of 24 removals due to mechanical complications were caused by accidental pulling of the catheter by the patient.     

Tunneled right atrial catheter infection presenting as renal failure

We report two cases of progressive renal failure secondary to membranoproliferative glomerulonephritis associated with subclinical septicemia from a tunneled right atrial catheter used for home parenteral nutrition administration. Although the occurrence of line infection and septicemia is a common complication of central venous catheters, a review of the literature reveals only one case report of renal failure secondary to an infected implanted central venous device. Both patients presented with azotemia and had biopsy-proven membranoproliferative glomerulonephritis, accompanied by leukocytoclastic vasculitis. In both cases, removal of the right atrial catheter and prolonged antibiotic therapy was effective in resolving the ongoing infection and resulted in marked improvement in renal function. A high index of suspicion for catheter sepsis should be maintained in patients with tunneled right atrial catheters presenting with subacute renal failure.     

Outcomes of Hickman catheter salvage in febrile neutropenic cancer patients with Staphylococcus aureus bacteremia.

OBJECTIVE: To evaluate the outcome of attempted Hickman catheter salvage in neutropenic cancer patients with Staphylococcus aureus bacteremia who were not using antibiotic lock therapy. DESIGN: Retrospective cohort study. SETTING: A university-affiliated, tertiary-care hospital with 1,500 beds for adult patients. PATIENTS: All neutropenic cancer patients who had a Hickman catheter and S. aureus bacteremia (32 episodes in 29 patients) between January 1998 and March 2002. METHODS: Salvage attempts were defined as cases where the Hickman catheter was not removed until we obtained the results of follow-up blood cultures performed 48 to 72 hours after starting treatment with antistaphylococcal antibiotics. Salvage was considered to be successful if the Hickman catheter was still in place 3 months later without recurrent bacteremia or death. RESULTS: Catheter salvage was attempted in 24 (75%) of the 32 episodes. Of the salvage attempts, the success rate was 50% (12 of 24). Salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures, and in 65% (11 of 17) of those with negative follow-up blood cultures (P = .07). If the analysis is confined to cases with no external signs of catheter infection, salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures and in 80% (8 of 10) of those with negative follow-up blood cultures (P = .02). CONCLUSION: In neutropenic cancer patients with S. aureus bacteremia, attempted catheter salvage without antibiotic lock therapy was successful in 50% of the cases.     

Osteomyelitis of the clavicle secondary to infected Hickman catheter

A patient receiving home parenteral nutrition developed osteomyelitis of the clavicle associated with a Hickman catheter which had been functioning for 14 months. The infection was treated with bone curettage, parenteral antibiotics, and catheter removal. Although this has been a reported complication of subclavian vein catheters, this is the first reported case associated with a Hickman catheter.     

A method to prevent unintentional removal of a Hickman catheter

Many patients benefit from the use of tunneled Dacron-cuffed central venous catheters. Operative insertion with the aid of fluoroscopy is required for the proper placement of these devices. Perioperative unintentional removal of the catheter is a reported complication. The outward migration of the device occurs before adequate tissue ingrowth into the Dacron cuff has taken place. The frequency with which this unfavorable outcome occurs can be reduced by placement of a subcutaneous absorbable restraining suture distal to the Dacron cuff during the insertion procedure. The authors advocate the routine use of this adjunctive measure for the insertion of all Dacron-cuffed caval catheters.     

Tunneling the long-term central venous and right atrial catheter: a simple cost-effective approach

Multiple techniques for tunneling right atrial catheters have been described. This is an atraumatic technique which involves using the introducer and sheath needed for venous access.     

左心房容积追踪技术评价肺动脉高压患者右心房功能

目的 探讨左心房容积追踪技术(LAVT)评价肺动脉高压患者右心房功能.方法 选择肺动脉高压患者41例作为肺动脉高压组,同时选择与肺动脉高压组患者年龄和性别相匹配的健康体检者37例作为对照组.应用LAVT获取右心房最大容积(RAVmax)、右心房收缩期前容积(RAVpre)及右心房最小容积(RAVmax)、收缩期右心房充盈速率峰值(dv/dtS)、舒张早期右心房排空速率峰值(dv/dtE)及舒张晚期右心房排空速率峰值(dv/dtA),计算右心房被动排空容积(RAVp)、右心房被动排空分数(RAVpEF)、右心房主动排空容积(RAVa)、右心房主动排空分数(RAVaEF)、右心房总排空容积(RAVt)、右心房总排空分数(RAVtEF),所有右心房容积指标均经体表面积校正得到右心房容积指数(RAVI).结果 肺动脉高压组RAVImax、RAVImax、RAVIpre、RAVIt、RAVIa、dv/dtS、dv/dtA显著高于对照组[(78.39±49.35) ml/m2比(24.80±11.91) ml/m2、(62.59±46.56) ml/m2比(17.46±8.40) ml/m2、(70.12±48.03) ml/m2比(20.02±9.46) ml/m2、(18.77±11.47) ml/m2比(9.35±6.74) ml/m2、(8.53±9.81) ml/m2比(3.25±3.00) ml/m2、(145.85±80.56) ml/s比(86.44±48.46) ml/s、(155.63±126.47) ml/s比(67.74±33.27) ml/s],RAVIp显著低于对照组[(6.09±5.16) ml/m2比(10.23±11.12) ml/m2],差异均有统计学意义(P＜0.05),两组RAVItEF、RAVIpEF、RAVIaEF、dv/dtE比较差异无统计学意义(P＞0.05).结论 肺动脉高压患者右心房助力泵功能、存储器功能增强,管道功能减低,LAVT可无创性评价肺动脉高压患者右心房功能.     

导管射频消融术治疗心房颤动127例临床分析

【摘要】目的探讨导管射频消融术治疗心房颤动的有效性、安全性及术后复发的相关因素。方法回顾性分析127例心房颤动患者的临床资料,在三维标测系统指导下行环肺静脉消融,观察患者手术远期成功率及有无不良反应,并分析心房颤动术后复发的相关因素。结果127例患者术后12个月进行随访,共94例患者保持窦性心律,33例患者复发,单次消融成功率为74．02％（94／127）。复发患者中11例接受再次消融并成功,两次消融成功率82．68％（105／127）,其中持续性心房颤动成功率为56．52％（13／23）,阵发性心房颤动成功率为88．46％（92／104）。单因素分析显示：心房颤动类型、左房内径、病程、早期复发、体质量指数与心房颤动导管射频消融术后复发相关。多因素Logistic回归分析显示心房颤动类型和左房内径是预测其术后复发的独立危险因素（P〈0．05）。结论导管射频消融术治疗心房颤动具有较好的临床疗效,心房颤动类型、左房内径是心房颤动导管射频消融术后复发的临床预测指标。     

2 511例住院患者医院感染现患率调查与分析

目的了解某院住院患者医院感染现状,为制定目标监测方案及完善预防控制措施提供依据。方法采用床旁调查与病历调查相结合的方法进行医院感染现患率调查。根据《医院感染诊断标准（试行）》对医院感染病例进行诊断。结果实查住院患者2 511例,发生医院感染198例,219例次,医院感染现患率为7.89%,例次现患率为8.72%。医院感染现患率最高的科室为重症监护室（45.00%,9/20）。医院感染部位以下呼吸道（46.58%,102/219）居首位。共检出病原菌269株,其中细菌226株（84.01%）,以革兰阴性菌为主;真菌43株（15.99%）。调查日抗菌药物使用率为31.38%（788/2 511）,治疗用药病原学送检率为54.69%（373/682）。结论通过此次调查,了解了该院医院感染的真实情况,为目标监测的开展和干预措施的完善提供了可靠依据。     

Antibacterial honey (Medihoney?) for wound care of immunocompromised pediatric oncology patients

The physiologic process of wound healing is impaired and prolonged in paediatic patients receiving chemotherapy. Due to profound immunosuppression, wound infection can easily spread and act as the source of sepsis. Referring to in vitro studies, which confirmed the antibacterial potency of special honey preparations against typical isolates of nosocomially acquired wound infections (including MRSA and VRE) and considering the encouraging reports from other groups, Medihoney™ has now been used in wound care at the Department of Pediatric Oncology, Children''s Hospital, University of Bonn for three years. Supplemented with exemplary clinical data from pediatric oncology patients, this presentation reviews the scientific background and our promising experience with Medihoney™ in wound care issues at our institution.     

Infective endocarditis as a complication of a permanent indwelling right atrial catheter in a patient with severe aplastic anaemia

Endocarditis is a recognized complication of both temporary and permanent indwelling right atrial catheters. Endocardial damage by the catheter may result in non-bacterial thrombotic endocarditis. Sterile vegetations composed of platelets and fibrin may become infected, either by direct spread of bacteria along the catheter, or following an episode of bacteraemia. Bacteria in infected vegetations may be protected from phagocytosis by a 'roof' of fibrin. Echocardiography is a valuable non-invasive method of diagnosis and may be used to monitor the resolution of vegetations and valve function. The right atrial catheter produces reflections which must be distinguished from cardiac abnormalities. We report a case of infective endocarditis in a patient with severe aplastic anaemia and a permanent indwelling right atrial catheter which was managed conservatively.     

Candida parapsilosis bloodstream infection in pediatric oncology patients: results of an epidemiologic investigation.

OBJECTIVE: To investigate an outbreak of Candida parapsilosis bloodstream infections (BSIs) involving three patients admitted to a pediatric oncology unit between April and June 2002. METHODS: After the third case was documented, cultures were performed of the hands of all medical and paramedical staff members in the pediatric oncology unit and of environmental surfaces in the rooms occupied by the three patients. Electrophoretic karyotyping with pulsed-field gel electrophoresis and arbitrarily primed polymerase chain reaction were used to assess the genetic relatedness among C. parapsilosis isolates. RESULTS: The three cases of C. parapsilosis BSI were diagnosed based on blood cultures performed during a 38-day period. Evidence of prior C parapsilosis colonization of the gastrointestinal tract was present in only the first case. Each patient had an indwelling central venous catheter (CVC), which was promptly removed, and semiquantitative catheter tip cultures also revealed C. parapsilosis. None of the 30 environmental cultures performed was positive for C. parapsilosis, but the fungus was isolated from the hands of 6 of the 20 nurses tested. Both molecular typing methods revealed identical DNA fingerprinting patterns for all 13 patient isolates (7 from blood, 3 from CVC tips, and 3 from the gastrointestinal tract) and for 5 of the 6 recovered from the nurses' hands. CONCLUSIONS: These findings suggest the possibility of cross-infection with a single C. parapsilosis strain that was transmitted (probably during CVC dressing changes) by nurses whose hands were colonized with it. The role of previous gastrointestinal colonization in the first case cannot be excluded.     

导管射频消融治疗阵发性心房颤动两种术式疗效对比

目的 比较节段性肺静脉电隔离术(SPⅥ)和环肺静脉前庭电隔离术(CPVA)对阵发性心房颤动射频消融治疗的临床疗效.方法 选取68例行导管射频消融治疗的阵发性心房颤动患者,根据所采用的术式分为SPVI组(30例)和CPVA组(38例),比较两组手术时间、X线暴露时间及复发率.结果 CPVA组手术时间为(171.0±25.8)min,SPVI组为(168.2±21.7)min,两组比较差异无统计学意义(P=0.579).CPVA组X线暴露时间为(38.5±8.4)min,SPVI组为(45.8±16.1)min,两组比较差异有统计学意义(P=0.019).所有病例平均随访(17.1±7.8)个月,CPVA组复发率为5.3%,SPVI组为23.3%,两组比较差异有统计学意义(P=0.029).两组均未发生严重并发症.结论 导管射频消融治疗阵发性心房颤动,CPVA比SPVI具有更少的X线暴露时间和更低的复发率,且不增加手术时间和手术风险.     

Atrial mapping by basket catheter in patients with atrial fibrillation submitted to linear ablation

Recently non-pharmacological therapies for atrial fibrillation (AF) have been developed. The electrophysiological mechanisms of AF is thought to be the development of multiple reentrant wavelets circulating around anatomic barriers and variable regions of functional conduction block responsible of the perpetuation of the arrhythmia. Also the role of the triggering foci has been highlighted. To cure AF by means of non pharmacological therapy we may eliminate and/or modify the substrate. To better understand the mechanism underlying the AF and to choose the best ablation strategy is of fundamental importance to map the right and the left atrium during AF. Our experience shows that in chronic idiopathic AF disorganized atrial activity is observed at all atrial regions while in paroxysmal idiopathic AF the left septum and the right atrial posterior areas are highly disorganized while the lateral region shows more organized atrial electrical activity. Multipolar basket catheters are extremely useful in mapping right and left atrium in order to guide the best ablation strategy.