Local antibiotic lock for the treatment of infections related to central catheters in parenteral nutrition in children

BACKGROUND: Central venous catheter-related (CVC) infections represent the most common complication of parenteral nutrition. These infections are usually treated by means of long-term systemic antibiotic treatment. The objective of this study was to determine the efficacy of combining a local antibiotic lock with a short systemic double antibiotic to treat CVC-related staphylococci infections. METHODS: Any child with coagulase-negative staphylococci or Staphylococcus aureus septicemia, confirmed by a positive blood culture, was included in the study. A double antibiotic systemic treatment composed of amikacin and teicoplanin was started and continued for 5 days. The antibiotic treatment was combined from the first day (D0) with a local teicoplanin lock, which was left for 12 hours a day in the catheter for 15 days. Parenteral nutrition was continued on a nocturnal cyclic mode during antibiotic treatment. The efficacy of the treatment was evaluated by clinical (body temperature), biologic [C-reactive protein levels (CRP)], and bacteriologic (blood culture) measures. RESULTS: Twenty CVC-related infection episodes in 13 patients were analyzed for the study. In the initial biologic test, CRP varied from 2 to 130 mg/L (mean 43 mg/L). After 3 days of treatment, CRP varied from 2 to 61 mg/L (mean 12 mg/L). The median time until normalization of temperature and CRP levels after the beginning of antibiotic treatment was 3.2 days (range 1 to 14 days) and 6.2 days (range 2 to 19 days), respectively. All blood cultures were negative for infection 48 hours after stopping the treatment. Only 1 therapeutic failure was observed during the treatment. The patient had persistent signs of clinical septicemia that required removal of the CVC. Two catheter-related infection recurrences were observed in the month after termination of the local antibiotic lock, which also required removal of the CVC. The central venous catheter was maintained in the other cases. CONCLUSIONS: Teicoplanin antibiotic locks, combined with a short conventional systemic antibiotic treatment and continuation of cyclic parenteral nutrition, seem effective and well-tolerated treatments for CVC infections.     

Pretreatment with the protegrin IB-367 affects Gram-positive biofilm and enhances the therapeutic efficacy of linezolid in animal models of central venous catheter infection

BACKGROUND: Biofilms play an important role in the pathogenesis of several chronic infections and nosocomial infections related to indwelling medical devices. METHODS: To assess the efficacy of IB-367 and linezolid (LZD) in the treatment of central venous catheter (CVC) infections using the antibiotic-lock technique, in vitro and in vivo studies were performed. The in vitro antibiotic susceptibility assay for Staphylococcus aureus and Enterococcus faecalis biofilms developed on 96-well polystyrene tissue culture plates was performed to determine the activity of the compounds. Efficacy studies were performed in rat models of Gram-positive CVC infection. Silastic catheters were implanted into the superior cava of adult male Wistar rats. Twenty-four hours after implantation, the catheters were pretreated by filling with IB-367. Thirty minutes later, rats were challenged via the CVC with 1.0 x 10(6) CFU (colony forming units) of S aureus strain diffuse Smith and clinical isolate of slime-producing E faecalis. Administration of LZD into the CVC at a concentration equal to the minimum bacteriocidal concentration observed using adherent cells or at a much higher concentration (1024 microg/mL) began 24 hours later. RESULTS: Both for S aureus and E faecalis, the killing activities of LZD against adherent bacteria were at least 4-fold to 8-fold lower than that against freely growing cells. For both strains, in IB-367-pretreated wells, LZD strongly increases its activity. The in vivo studies showed that when CVCs were pretreated with IB-367, Gram-positive biofilm bacterial load was further decreased to 10(1) CFU/mL and bacteremia was not detected. CONCLUSIONS: IB-367 has potential as an adjunctive agent to LZD in the treatment of Gram-positive biofilm infections such as CVC infections.     

Nonuniform risk of bloodstream infection with increasing central venous catheter-days.

OBJECTIVE: To determine whether the conventional rate for central venous catheter (CVC)-associated bloodstream infection (BSI) accurately reflects risk for patients exposed for a variety of in situ periods. PATIENTS AND METHODS: Intensive care unit patients (n = 1,375) were monitored for 7,467 CVC-days. They were monitored until catheter removal, until diagnosis of CVC-associated BSI, or for 24 hours after discharge. RESULTS: The BSI rate was 3.7 per 1,000 CVC-days. Ninety-three percent of these patients had CVCs in situ for 1-15 days. These patients were exposed to 59.7% of all CVC-days; the remaining 7% were exposed to 40.3% of all CVC-days. BSI rates stratified by exposure periods of 1-5 and 6-15 days were 2.1 and 4.5 per 1,000 CVC-days, respectively. The rates for 16-30 and 31-320 days were 10.2 and 2.1 per 1,000 CVC-days, respectively. The probability of BSI with a CVC in situ was 6 in 100 by day 15, 14 in 100 by day 25, 21 in 100 by day 30, and 53 in 100 by day 320. CONCLUSION: The conventional aggregated rate better reflects the risk for the majority of patients rather than for patients exposed to the majority of CVC-days. It does not reflect the true probability of risk for all exposures, especially beyond 30 days. CVCs in situ from 1 to 15 days had less risk of BSI than CVCs in situ more than 15 days, which may explain why scheduled CVC replacement at days 5 to 7 has not been found beneficial.     

Central venous catheter-related bacteremia due to gram-negative bacilli: significance of catheter removal in preventing relapse.

OBJECTIVE: To study the characteristics of catheter-related, gram-negative bacteremia (GNB) and the role of central venous catheter (CVC) removal. DESIGN: This retrospective study involved a search of the microbiological department records of CVC and blood cultures and patients' medical records. SETTING: University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas. PATIENTS: Patients with cancer who had catheter-related GNB, defined as (1) a positive catheter tip culture with at least 15 colony-forming units semiquantitatively, (2) isolation of the same organism from the tip and peripheral blood cultures, (3) no other source for bacteremia except the CVC, and (4) clinical manifestations of infection (fever or chills). RESULTS: Between January 1990 and December 1996, 72 cases of catheter-related GNB were available for review. Most of the patients (67; 93%) had their CVCs removed in response to the bacteremia. Few patients (5; 7%) retained their CVCs and were treated with appropriate antibiotics. When CVCs were removed, only 1 patient (1%) relapsed with the same organism, whereas all 5 patients with retained CVCs relapsed after having responded (P < .001). The most commonly isolated organisms were Enterobacter, Klebsiella, Stenotrophomonas, Pseudomonas, and Acinetobacter species. Catheter removal within 72 hours of the onset of the catheter-related GNB was the only independent protective factor against relapse of the infection (odds ratio, 0.13; 95% confidence interval, 0.02-0.75; P = .02). CONCLUSION: In patients with documented catheter-related GNB, CVCs should be removed within 48 to 72 hours to prevent relapse.     

Central venous catheter thrombosis associated with 70% ethanol locks in pediatric intestinal failure patients on home parenteral nutrition: a case series

Central venous catheter (CVC) ethanol locks may reduce catheter-related bloodstream infection (CRBSI). Four children with intestinal failure on home parenteral nutrition (HPN) were selected for 70% ethanol locks because of their high rate of CRBSI. The 70% ethanol locks were instilled at a volume equal to the estimated internal volume of the CVC. Two children (aged 4 and 11 years) received 70% ethanol locks as CRBSI prophylaxis; another 2 children (aged 10 and 11 years) received 70% ethanol locks as adjunctive treatment for CRBSI. All 4 children developed either visible thrombosis in the CVC or CVC occlusion. To the authors' knowledge, this is the first report of CVC thrombosis associated with ethanol lock therapy in the pediatric HPN population. Although none of the CVCs were removed due to occlusion, these events raise serious concerns about the use of high-concentration ethanol locks.     

Effects of Ethanol Lock Therapy on Central Line Infections and Mechanical Problems in Children With Intestinal Failure

Objectives: Although use of 70% ethanol lock therapy (ELT) has been shown to decrease the rate of catheter‐related bloodstream infections (CRBSIs) in patients with intestinal failure and central venous catheters (CVCs), concerns have been raised about its association with higher rates of mechanical problems and CVC replacements (CVC‐Rs). We sought to compare the rates of CRBSI, mechanical problems, and CVC‐Rs in a cohort of pediatric patients with intestinal failure, with and without ELT (ELT⁺ and ELT^?, respectively). Methods: Data were collected in a retrospective chart review from February 2007 to May 2014. Mann‐Whitney and Wilcoxon signed‐rank tests were used to compare nonparametric and paired data, respectively. Results: Twenty‐nine children had 9033 catheter days (CDs). The ELT⁺ group (vs ELT^?) had lower rate of infection and significantly fewer CVC‐Rs due to infection but significantly more mechanical events and related CVC‐Rs with significantly shorter mean CVC survival. In 13 children who had a pre‐ELT and post‐ELT period, ELT was associated with a decrease in the rate of CVC‐Rs due to infection (0.36 vs 4.74/1000 CDs, P = .046) and an increase in the rate of CVC‐Rs due to mechanical problems (5.05 vs 0/1000 CDs, P = .018). Conclusions: While ELT⁺ is associated with a lower rate of CRBSIs and related CVC‐Rs, it is also associated with higher rates of mechanical problems and related CVC‐Rs. In addition to investigating the ideal concentration, duration, and timing of ELT to preserve the integrity of the CVC, alternatives to exclusively ethanol‐based lock solutions should be developed.     

In situ endoluminal brushing: a safe technique for the diagnosis of catheter-related bloodstream infection

We assessed the safety of the endoluminal brush technique for the in situ diagnosis of central-venous-catheter (CVC)-related bloodstream infection (CRBSI). The endoluminal brush was used to investigate patients with suspected CRBSI by sampling the CVC lumen to within 3-5 cm of the catheter tip (the brush was kinked to mark the length required). Quantitative peripheral blood cultures were taken 1 min pre-brushing and 1 min and 1h post-brushing. In addition, a 1 mL sample of through-catheter blood was aspirated immediately pre- and post-brushing, and aliquots were directly plated on to blood agar to determine the load of CVC-associated bacteria. After CVC removal, catheter tips were sent for culture using the Maki roll and modified Cleri flush techniques. Of 139 suspected cases, 61 (45%) had confirmed episodes of CRBSI. No patients experienced fever or rigors, or had evidence of embolic phenomena after CVC endoluminal brushing. There was no difference overall in pre-brushing and 1-min post-brushing peripheral blood bacterial counts (P < 0.702). Peripheral and CVC blood bacterial counts were significantly reduced 1h post-brushing (P < 0.03 and P < 0.001, respectively), possibly due to removal of endoluminal biomass. The endoluminal brush technique can be safely used to diagnose CRBSI without the need for CVC removal, provided that the brush is not allowed to protrude beyond the tip of the catheter.     

患儿导管相关性放射根瘤菌血流感染实验室诊断方法探讨

目的探讨患儿导管相关性放射根瘤菌血流感染的诊断方法和感染因素。方法收集某院2012年2月—2014年2月1 014例使用各类中心静脉导管的患儿资料,检测放射根瘤菌感染患儿导管半定量培养,导管与静脉血菌落数比,以及静脉血与导管培养时间差;分析放射根瘤菌感染危险因素。结果 1 014例使用各类中心静脉导管的患儿,导管和静脉血标本分别培养出放射根瘤菌32例和28例,27例患儿导管血和静脉血均为阳性。导管半定量培养菌落数≥15 CFU者27例,15 CFU者5例;导管与静脉血菌落数比≥5∶1者22例,5∶1者6例;静脉血与导管培养时间差≥2 h者26例,2 h者2例。危险因素分析结果显示,患儿年龄、导管留置时间各组比较差异有统计学意义(均P0.05)。结论导管半定量培养、导管与静脉血菌落数比值及静脉与导管血培养时间差均是判断导管相关性放射根瘤菌血流感染的重要诊断依据;患儿年龄2岁、导管留置时间5 d是导管相关性放射根瘤菌血流感染的危险因素。     

Central venous catheter sepsis: prognosis and treatment

The purpose of this study was to evaluate the prognosis of patients with central venous catheter (CVC) sepsis, with particular reference to two therapeutic procedures, 1) CVC exchange over a guide wire and 2) removal of the catheter An evaluation was made of the clinical records of 22 cancer patients receiving total parenteral nutrition because of severe malnutrition and of 27 CVC-related septic episodes defined as growth of the same microorganism on the CVC and in peripheral blood. Bacteriological findings included Candidae n = 17, S albus n = 4, E Cloacae n = 4, Enterococcus n = 1 and P aeruginosa n = 1. In 22 cases the CVC was exchanged and in five cases it was removed on the clinical suspicion of CVC-related sepsis. Nineteen of the 22 patients had their blood culture rendered negative with CVC exchange and in three of the other five patients it was resolved bacteriologically after removal of the CVC. There was no clear effect of the CVC sepsis on the final outcome of the patients' illness. In fact, seven patients eventually died because of reasons apparently unrelated to the CVC sepsis-which had bacteriologically and clinically resolved-and seven patients recovered and were discharged in good condition despite the initial failure of CVC manipulation. The conclusion reached was that death should not occur as a result of CVC sepsis, provided this is properly identified and adequately treated. Since CVC change allows earlier recognition of the complication and effective treatment, it may be considered the therapy of choice in the management of suspected CVC sepsis.     

Central venous catheter-related infections in children on long-term home parenteral nutrition: incidence and risk factors

BACKGROUND AND AIMS: This study aimed to assess the incidence and etiology of central venous catheter (CVC) infections in children on home parenteral nutrition (HPN). METHODS: 207 CVC-years were studied retrospectively in 47 children on HPN, aged 8.1+/-5.0 years. RESULTS: 125 CVC were used (means: 2.6 CVC/patient and 21 months utilization/CVC). Half of the hospitalizations (162) were due to proven CVC-related infections. The mean infection incidence was 2. 1/1000 HPN days. The total population divided in two groups below and above this value: group one including 24 children, incidence < or = 2.1 per 1000 days (mean: 0.83) and group two including 23 children, incidence >2.1 per 1000 days (mean: 4.3). No differences were found between the two groups in terms of underlying disease, presence of ostomies, age at the time of HPN onset, or micro-organisms responsible. The only differences (p<0.05) were the mean duration of HPN (longer in group one) and the delay between HPN onset and the first infection (longer in group one). CONCLUSIONS: This study does not highlight any risk factors for CVC infection. However, early CVC infections after HPN onset appear to predict a bad prognosis.     

Central venous catheter replacement with the aid of wire introducer in patients receiving total parenteral nutrition: short report

During a 1-year period, 24 of 71 patients receiving total parenteral nutrition, underwent replacement of their central venous catheter (CVC) for presumed CVC sepsis or catheter malposition with the use of a wire inducer, according to the Seldinger technique. Catheters were defined as sterile when cultures of both the catheter tip and the peripheral blood were negative, contaminated when culture of the tip was positive whereas the peripheral blood culture(s) was either sterile or positive with different bacteria than those obtained from the tip culture, and septic when cultures from the catheter tip and peripheral blood grew identical microorganisms. Among 19 catheters with suspected sepsis, six were sterile, ten contaminated and three septic. Guidewire catheter replacement was easily and safely performed, and succeeded in sterilizing all contaminated catheters but only one of three septic catheters.     

The Hospital Infection Standardised Surveillance (HISS) programme: analysis of a two-year pilot

In 1998 the New South Wales (NSW) Health Department funded the development and implementation of the State's first standardized methodology for the surveillance of healthcare-associated infection for public hospitals. Fifteen pilot hospitals targeted inpatient groups considered to represent their core patient groups to act as sentinel measurements of patient safety. The aggregated rates of surgical site infection for coronary artery bypass graft (CABG) (chest & leg) surgery was 1.7% (95%CI: 1.1-2.5), CABG (chest only) 2.1% (95%CI: 1.0-3.7), vascular 7.1% (95%CI: 4.6-10.3), hip prosthesis 1.3% (95%CI: 0.5-2.7), knee prosthesis 6.1% (95%CI: 2.8-11.2) and colorectal 12.5% (95%CI: 9.5-16.1). The development of a bloodstream infection (BSI) associated with a central venous catheter (CVC) was not significantly (P=0.6) different when examined by duration of exposure with 3.7 BSI per 1000 line-days for CVC in situ six or more days compared with 4.0 BSI per 1000 line-days for CVC in situ for five or less days. A significantly (P<0.0001) greater proportion of patients whose CVC was in situ six or more days (6.8 per 100 patients, 95%CI: 4.2-10.2) developed a BSI compared with the proportion of patients whose CVC was in situ for five or fewer days (0.6 per 100 patients, 95%CI: 0.3-1.3). Significantly (P<0.0001) different rates of patients acquiring a new methicillin-resistant Staphylococcus aureus infection were found when hospital type was examined with rates ranging from 0.2 to 5.0 per 10000 occupied acute-care bed-days. The pilot highlighted that the collection of data for aggregation of some procedures and intravascular catheters may take many years before a reliable benchmark can be identified and many hospitals may not achieve reliable local rates annually. For surveillance to provide timely measures of patient safety we should consider surveillance methods for many small to medium sized hospitals that includes active surveillance only for infections with concurrent passive surveillance of the relevant denominators.     

A new approach to the diagnosis of central venous catheter sepsis

One hundred forty-four cancer patients harboring a central venous catheter (CVC) were prospectively investigated to assess the relationship between hub culture, clinical assessment of sepsis before removal, and CVC sepsis. In 22 patients, the CVC was removed because of clinical assessment of catheter sepsis expressed by the staff prior to the removal. For each CVC removal, peripheral blood (qualitative method), hub, and CVC tip (quantitative method) cultures were performed. Clinical sepsis (disappearance of fever after CVC removal) was observed in 13 patients, microbiologic "sepsis" (identification of the same microorganisms on the CVC tip and in the peripheral blood) in seven patients, and clinical and/or microbiologic sepsis in 16 patients. Staphylococcus epidermidis was the microorganism most frequently identified. Hub culture was negative in 48% and positive for a low number and a high number of colonies in 35% and 17%, respectively. The predictive value of hub culture was 96% when testing negative and 8% and 37% (p = 3 x 10(-3)) when testing positive for a low and a high number of colonies, respectively. Predictive values of clinical assessment were 55% if positive and 97% if negative. Combining hub cultures and clinical assessment, the risk of sepsis varied from 2% with both evaluations negative to 89% in the case of positive clinical assessment associated with positive high-count hub. Inasmuch as the CVCs used have a disposable hub, it is possible to have an accurate diagnosis of CVC sepsis without removing the CVC.     

The synthesis of phenylalanine-derived C5-substituted rhodanines and their activity against selected methicillin-resistant Staphylococcus aureus (MRSA) strains

A series of rhodanine compounds containing various substituents at the N3- and C5-positions were synthesized and their in vitro activity against a panel of clinically relevant MRSA strains was determined. The anti-MRSA activity of compounds 21 (MIC=3.9 μg/mL, MBC=7.8 μg/mL) and 22 (MIC=1.95 μg/mL, MBC=7.8 μg/mL) was significantly greater than that of the lead compounds, 1-3 and reference antibiotics penicillin G (MIC=31.25 μg/mL) and ciprofloxacin (MIC=7.8 μg/mL) and comparable to that of vancomycin (MIC=0.97 μg/mL). Compounds 21 and 22 were found to be bactericidal at only 2-4-fold higher than their MIC concentrations. In addition, their MIC values remained unchanged in the presence or absence of 10% serum. Overall, the results suggest that compounds 21 and 22 may be of potential use in the treatment of MRSA infections.     

Biofilms in drinking water and their role as reservoir for pathogens

Most microorganisms on Earth live in various aggregates which are generally termed "biofilms". They are ubiquitous and represent the most successful form of life. They are the active agent in biofiltration and the carriers of the self-cleaning potential in soils, sediments and water. They are also common on surfaces in technical systems where they sometimes cause biofouling. In recent years it has become evident that biofilms in drinking water distribution networks can become transient or long-term habitats for hygienically relevant microorganisms. Important categories of these organisms include faecal indicator bacteria (e.g., Escherichia coli), obligate bacterial pathogens of faecal origin (e.g., Campylobacter spp.) opportunistic bacteria of environmental origin (e.g., Legionella spp., Pseudomonas aeruginosa), enteric viruses (e.g., adenoviruses, rotaviruses, noroviruses) and parasitic protozoa (e.g., Cryptosporidium parvum). These organisms can attach to preexisting biofilms, where they become integrated and survive for days to weeks or even longer, depending on the biology and ecology of the organism and the environmental conditions. There are indications that at least a part of the biofilm populations of pathogenic bacteria persists in a viable but non-culturable (VBNC) state and remains unnoticed by the methods appointed to their detection. Thus, biofilms in drinking water systems can serve as an environmental reservoir for pathogenic microorganisms and represent a potential source of water contamination, resulting in a potential health risk for humans if left unnoticed.     

Catheter related sepsis during long-term parenteral nutrition in paediatric gastroenterology patients: a study of 185 consecutive central venous catheters

We report the results of a prospective study of catheter-related sepsis (CRS) in 154 gastroenterology paediatric patients treated for medical (n = 102) or surgical (n = 52) disorders. Over 2 years, 185 central venous catheters (CVC) were placed, including 155 Broviac and 30 Jonathan Shaw CVC. CVC remained in place 13,331 days (6,539 days of cyclic parenteral nutrition), with a mean catheter life of 72 days. Forty-eight episodes of CRS occurred, most of them due to coagulase-negative staphylococci (n = 29) and Staphylococcus aureus (n = 17). CRS rate was 0.26, with an overall incidence of 1 infection per 278 days of parenteral nutrition (PN). Factors significantly associated with CRS were: age 1-5 years (p < 0.01), a medical indication for treatment (p < 0.001) and summer months of PN (p < 0.01). Interestingly, CRS occurred predominantly (65%) within the first 2 months following CVC placement and the risk of infection correlated with local haemorrhage at the time of insertion (p < 0.01). Appropriate systemic therapy, without removing the catheter, permitted resolution of 90.9% (40 44 ) of all CRS and 100% (28 28 ) of CRS due to coagulase-negative staphylococci.     

成人家庭肠外营养患者PICC导管相关血流感染发病率的Meta分析

 目的 比较成人家庭肠外营养(HPN)患者经外周静脉穿刺置入中心静脉导管(PICC)与中心静脉导管(CVC)的导管相关血流感染(CRBSI)发病率,为HPN患者选择合适的静脉血管通路装置提供证据支持。方法 计算机检索Cochrane图书馆、JBI图书馆、Pubmed、Embase、Ovid、Web of Science、中国生物医学文献数据库、维普数据库、万方及中国知网建库至2019年3月关于HPN患者CRBSI发病率的研究,应用Stata 13.0进行Meta分析。结果 共纳入9篇队列研究文献,1 407例患者。Meta分析结果显示,使用PICC的HPN患者CRBSI发病率低于CVC (12.14% VS 37.18%,RR=0.42,95%CI:0.34~0.52)。有6篇文献报道CRBSI日发病率,结果显示PICC的CRBSI发病率低于CVC(12.97% VS 37.21%,RR=0.37,95%CI:0.23~0.60)。亚组分析结果显示,不同PICC置管方式组(超声引导、X线检查、未报道组)、报道CRBSI的诊断方法组、不同血管导管使用日数组(报道和未报道组)、报道感染菌群种类组PICC患者CRBSI发病率均低于CVC患者,差异均有统计学意义(均P<0.05)。结论 与CVC相比,成人HPN患者选择PICC进行治疗时CRBSI的发生风险较低。     

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.     

Surveillance and infection control in an intensive care unit.

OBJECTIVE: To evaluate the effect of an infection control program on the incidence of hospital-acquired infection (HAI) and associated mortality. DESIGN: Prospective study. SETTING: A 2000-bed, university-affiliated hospital in Italy. PATIENTS: All patients admitted to the general intensive care unit (ICU) for more than 48 hours between January 2000 and December 2001. METHODS: The infection control team (ICT) collected data on the following from all patients: demographics, origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated microorganisms, and antibiotic susceptibility. INTERVENTIONS: Regular ICT surveillance meetings were held with ICU personnel. Criteria for invasive procedures, particularly central venous catheters (CVCs), were modified. ICU care was restricted to a team of specialist physicians and nurses and ICU antimicrobial therapy policies were modified. RESULTS: Five hundred thirty-seven patients were included in the study (279 during 2000 and 258 in 2001). Between 2000 and 2001, CVC exposure (82.8% vs 71.3%; P < .05) and mechanical ventilation duration (11.2 vs 9.6 days) decreased. The HAI rate decreased from 28.7% in 2000 to 21.3% in 2001 (P < .05). The crude mortality rate decreased from 41.2% in 2000 to 32.9% in 2001 (P < .05). The most commonly isolated microorganisms were nonfermentative gram-negative organisms and staphylococci (particularly MRSA). Mortality was associated with infection (relative risk, 2.11; 95% confidence interval, 1.72-2.59; P < .05). CONCLUSION: Routine surveillance for HAI, coupled with new measures to prevent infections and a revised policy for antimicrobial therapy, was associated with a reduction in ICU HAls and mortality.