RESUMO
AIM: Tunnelled haemodialysis (HD) catheters can be used instantly, but there are several anatomical variables that could impact it survival. This study aimed to examine the impact of different novel anatomic variables, with catheter replacement. METHODS: In a single-centre a prospective cohort in chronic kidney disease G5 patients were conducted. The primary outcome was to determine the factors associated with catheter replacement during the first 6-month of follow-up. All procedures were performed without fluoroscopy. Three anatomic regions for catheter tip position were established: considered as superior vena cava (SVC), cavo-atrial junction (CAJ) and mid-to deep atrium (MDA). Many other anatomical variables were measured. Catheter-related bloodstream infection was also included. RESULTS: Between January 2019 and January 2020 a total of 75 patients with tunnelled catheter insertion were analysed. Catheter replacement at 6-month occur in 10 (13.3%) patients. By multivariate analysis, the incorrect catheter tip position (SVC) (OR 1.23, 95% CI 1.07-1.42, p <.004), the presence of extrasystoles during the procedure (OR 0.88, 95% CI 0.78-0.98, p = .03), incorrect catheter tug (OR 1.31, 95% CI 1.10-1.55, p = .003), incorrect catheter top position (kinking; OR 1.40, 95% CI 1.04-1.88, p = .02) and catheter-related bloodstream infection (OR 2.60, 95% CI 2.09-3.25, p <.001) were the only variables associated with catheter replacement at 6-month follow-up. CONCLUSION: The risk of catheter replacement at 6-month follow-up could be attenuated by avoiding incorrect catheter tug and top position, and by placing the vascular catheter tip in the CAJ and MDA.
Assuntos
Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Diálise Renal , Adulto , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/terapia , Cateterismo Venoso Central/efeitos adversos , Remoção de Dispositivo , Falha de Equipamento , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available. METHODS: Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. RESULTS: We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter-associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter-associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter-associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: Escherichia coli (22.9%), Klebsiella spp (10.7%), Pseudomonas aeruginosa (5.3%), Enterobacter spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were Staphylococcus aureus (11.4%). CONCLUSIONS: Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter-associated bloodstream infections.
Assuntos
Infecções Bacterianas/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Periférico/efeitos adversos , Infecção Hospitalar/epidemiologia , Dispositivos de Acesso Vascular/efeitos adversos , Ásia/epidemiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Infecções Bacterianas/terapia , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/mortalidade , Infecções Relacionadas a Cateter/terapia , Cateterismo Periférico/mortalidade , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/terapia , Mortalidade Hospitalar , Humanos , Incidência , Controle de Infecções , Tempo de Internação , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
Intensive care unit-acquired bloodstream infections (ICU-BSI) are frequent and are associated with high morbidity and mortality rates. We conducted this study to describe the epidemiology and the prognosis of ICU-BSI in our ICU and to search for factors associated with mortality at 28 days. For this, we retrospectively studied ICU-BSI in the ICU of the Cayenne General Hospital, from January 2013 to June 2019. Intensive care unit-acquired bloodstream infections were diagnosed in 9.5% of admissions (10.3 ICU-BSI/1,000 days). The median delay to the first ICU-BSI was 9 days. The ICU-BSI was primitive in 44% of cases and secondary to ventilator-acquired pneumonia in 25% of cases. The main isolated microorganisms were Enterobacteriaceae in 67.7% of patients. They were extended-spectrum beta-lactamase (ESBL) producers in 27.6% of cases. Initial antibiotic therapy was appropriate in 65.1% of cases. Factors independently associated with ESBL-producing Enterobacteriaceae (ESBL-PE) as the causative microorganism of ICU-BSI were ESBL-PE carriage before ICU-BSI (odds ratio [OR]: 7.273; 95% CI: 2.876-18.392; P < 0.000) and prior exposure to fluoroquinolones (OR: 4.327; 95% CI: 1.120-16.728; P = 0.034). The sensitivity of ESBL-PE carriage to predict ESBL-PE as the causative microorganism of ICU-BSI was 64.9% and specificity was 81.2%. Mortality at 28 days was 20.6% in the general population. Factors independently associated with mortality at day 28 from the occurrence of ICU-BSI were traumatic category of admission (OR: 0.346; 95% CI: 0.134-0.894; P = 0.028) and septic shock on the day of ICU-BSI (OR: 3.317; 95% CI: 1.561-7.050; P = 0.002). Mortality rate was independent of the causative organism.
Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bacteriemia/terapia , Candidemia/epidemiologia , Candidemia/mortalidade , Candidemia/terapia , Portador Sadio/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/mortalidade , Infecções Relacionadas a Cateter/terapia , Cateterismo Venoso Central/estatística & dados numéricos , Cateterismo Periférico/estatística & dados numéricos , Coma/epidemiologia , Comorbidade , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/terapia , Infecções por Enterobacteriaceae/epidemiologia , Feminino , Guiana Francesa/epidemiologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/terapia , Prognóstico , Terapia de Substituição Renal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Choque/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/terapia , Ferimentos e Lesões/epidemiologiaRESUMO
Las micobacterias de crecimiento rápido son una rara causa de endocarditis bacteriana. Durante las últimas décadas han aumentado las infecciones debido a este tipo de micobacterias, en especial las postraumáticas y las posquirúrgicas. Estas infecciones pueden ser localizadas o diseminadas, y también pueden producir brotes nosocomiales debido a la contaminación del equipamiento médico. Por lo general, las tinciones para bacterias ácido-alcohol resistentes no se emplean de rutina en el procesamiento de hemocultivos positivos. Sin embargo, el microbiólogo debe estar atento al ver un bacilo gram positivo, ya que podría tratarse de una micobacteria de crecimiento rápido. Describimos un caso de endocarditis por de Mycobacterium mageritense en una paciente con parche pericárdico autógeno y un catéter para medir la presión en la aurícula izquierda. La bacteria fue identificada por espectrometría de masas (MALDI-TOF MS), score 2,3, y luego confirmada por secuenciación y análisis del gen ARNr 16s con las bases de datos del NCBI y EzTaxon, con una concordancia del 99,8 y el 100%, respectivamente.
Rapidly growing non-tuberculosis mycobacteria are a rare cause of bacterial endocarditis. During the last decades, there has been an increase in infections due to rapidly growing mycobacteria, mainly after trauma and post-surgical procedures, both localized and disseminated, as well as nosocomial outbreaks due to contamination of medical equipment. Routine acid-fast staining for blood culture bottles is not always performed; however, the microbiologist should be aware of potential RGM infections especially when gram positive bacilli are observed. We describe a case of endocarditis caused by Mycobacterium mageritense in a patient with an autologous pericardial patch and a pressure catheter in the left auricle. The bacterial species was identified as Mycobacterium mageritense by mass spectrometry (MALDI-TOF MS), score 2.3, and confirmed by 16S rRNA analysis with 99.8 and 100% agreement, respectively.
Assuntos
Humanos , Feminino , Adulto , Endocardite Bacteriana/microbiologia , Infecções Relacionadas a Cateter/diagnóstico , Mycobacterium/isolamento & purificação , Espectrometria de Massas/métodos , RNA Ribossômico 16S/análise , Infecções Relacionadas a Cateter/terapia , Hemocultura/métodosRESUMO
Fungal peritonitis is a major complication of peritoneal dialysis associated with high mortality. Most survivors have a high rate of abandonment of peritoneal dialysis. We report a case of fungal peritonitis due to an unusual agent. An 83 year-old woman, with a history of type 2 diabetes mellitus and multiple episodes of bacterial peritonitis associated to technical flaws in the implementation of automated peritoneal dialysis, was admitted due to abdominal pain and cloudy peritoneal fluid. Rhodotorula mucilaginosa was identified in the peritoneal fluid by MALDI-TOF. She was treated with catheter removal and oral posaconazole for 14 days showing clinical resolution and non-recurrence.
Assuntos
Diálise Peritoneal/efeitos adversos , Peritonite/microbiologia , Rhodotorula/isolamento & purificação , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/terapia , Feminino , Humanos , Diálise Peritoneal/métodos , Peritonite/terapia , Fatores de Tempo , Triazóis/uso terapêuticoRESUMO
Fungal peritonitis is a major complication of peritoneal dialysis associated with high mortality. Most survivors have a high rate of abandonment of peritoneal dialysis. We report a case of fungal peritonitis due to an unusual agent. An 83 year-old woman, with a history of type 2 diabetes mellitus and multiple episodes of bacterial peritonitis associated to technical flaws in the implementation of automated peritoneal dialysis, was admitted due to abdominal pain and cloudy peritoneal fluid. Rhodotorula mucilaginosa was identified in the peritoneal fluid by MALDI-TOF. She was treated with catheter removal and oral posaconazole for 14 days showing clinical resolution and non-recurrence.
La peritonitis fúngica es una complicación mayor de la diálisis peritoneal, con una alta mortalidad asociada y la mayoría de los sobrevivientes presentan una alta tasa de abandono de diálisis peritoneal como terapia de reemplazo renal. Se presenta un caso de peritonitis fúngica por un agente infrecuente. Mujer de 83 años, diabética con múltiples episodios de peritonitis bacteriana asociada a fallas técnicas en la ejecución de diálisis peritoneal automatizada, ingresa por cuadro clínico de dolor abdominal y líquido peritoneal turbio. Se confirmó la presencia de Rhodotorula mucilaginosa en líquido peritoneal mediante MALDI-TOF. Fue tratada con retiro del catéter y posaconazol oral por 14 días, presentando una evolución favorable.
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Peritonite/microbiologia , Rhodotorula/isolamento & purificação , Diálise Peritoneal/efeitos adversos , Febre Familiar do Mediterrâneo/terapia , Fatores de Tempo , Triazóis/uso terapêutico , Diálise Peritoneal/métodos , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/terapia , Antifúngicos/uso terapêuticoRESUMO
Objective To estimate the excess costs of urinary tract infection associated with catheter use and clinical interventions that influence costs the most. Methods A study of cohorts paired by the time of occurrence of the nosocomial event was carried out. Those exposed were patients with urinary tract infection associated with catheters and those unexposed were patients without nosocomial infection, admitted with a similar diagnosis. In both cohorts the direct costs of hospital care were evaluated. Results Excess total cost of care for a urinary tract infection associated with catheter was 2 460 168 (Colombian pesos in 2009). The highest percentage (71.8 %) was attributed to the days of hospitalization in the general ward; daily valuations contributed 19.1%, followed by antibiotics (6%), blood cultures (5 %), arterial blood gases (2 %). The remaining cost categories contributed less than 1 % each. Discussion This study tried to get closer to the actual cost, using variables such as ultrasound, arterial blood gases and others unused in previous studies in addition to the common variables such as length of hospital stay, and consumption of antibiotics. To our knowledge this is the first study of micro costs of nosocomial infections that has been done in the country, using a cohort as a design. Conclusion It was found that urinary tract infection associated with catheter use had a direct excess of costs of 2 460 168 Colombian pesos (US$ 1 329 dollars in 2009) It was found that urinary tract infection associated with catheter had a direct excess of costs of 2 460 168 Colombian pesos (US$ 1 329 dollars in 2009).
Assuntos
Infecções Relacionadas a Cateter/economia , Infecção Hospitalar/economia , Cateteres Urinários/efeitos adversos , Infecções Urinárias/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Infecções Relacionadas a Cateter/terapia , Colômbia , Custos e Análise de Custo , Infecção Hospitalar/etiologia , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Urinárias/etiologiaRESUMO
Las infecciones intrahospitalarias determinan un aumento en la morbimortalidad de los pacientes. La infección asociada al uso de catéteres intravenosos es la más frecuente en las unidades de cuidado intensivos. Objetivo: determinar la incidencia y etiología de bacteriemia asociada al uso de catéteres venosos centrales en la Unidad de Cuidados Intensivos de Niños (UCIN) del Centro Hospitalario Pereira Rossell. Material y método: se realizó un estudio descriptivo observacional entre el 1 de diciembre de 2009 hasta el 1 de julio de 2010. Se incluyeron todos los pacientes hospitalizados en UCIN, que cumplieran con la definición de paciente de Unidad de Cuidado Intensivo del National Nosocomial Infections Surveillance (NNIS) y que portaran un catéter venoso central. La fuente de recolección de datos fueron las historias clínicas. Resultados: se incluyeron 94 niños con vías centrales, un total de 109 vías, 988 días de cateterización. Se identificaron cinco casos de bacteriemias asociadas al catéter, una densidad de incidencia de bacteriemia asociada al catéter de 5.06 casos por cada 1000 días de cateterización. Los gérmenes aislados fueron Staphylococcus coagulasa negativo, Staphylococcus aureus, Klebsiella oxytoca, Enterobacter cloacae y Candida albicans. En todos los casos el tiempo de positivización diferencial del hemocultivo obtenido del catéter venoso fue menor a 2 horas frente al obtenido por punción periférica. Conclusiones: el valor hallado de incidencia de infección asociada al uso de catéter fue elevado y es necesario implementar medidas destinadas a disminuirla...
Assuntos
Humanos , Masculino , Bacteriemia/diagnóstico , Bacteriemia/etiologia , Bacteriemia/terapia , Infecção Hospitalar , Cateteres Venosos Centrais/efeitos adversos , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/terapia , Candida albicans , Enterobacter cloacae , Klebsiella oxytoca , Staphylococcus aureusRESUMO
Las infecciones intrahospitalarias determinan un aumento en la morbimortalidad de los pacientes. La infección asociada al uso de catéteres intravenosos es la más frecuente en las unidades de cuidado intensivos. Objetivo: determinar la incidencia y etiología de bacteriemia asociada al uso de catéteres venosos centrales en la Unidad de Cuidados Intensivos de Niños (UCIN) del Centro Hospitalario Pereira Rossell. Material y método: se realizó un estudio descriptivo observacional entre el 1 de diciembre de 2009 hasta el 1 de julio de 2010. Se incluyeron todos los pacientes hospitalizados en UCIN, que cumplieran con la definición de paciente de Unidad de Cuidado Intensivo del National Nosocomial Infections Surveillance (NNIS) y que portaran un catéter venoso central. La fuente de recolección de datos fueron las historias clínicas. Resultados: se incluyeron 94 niños con vías centrales, un total de 109 vías, 988 días de cateterización. Se identificaron cinco casos de bacteriemias asociadas al catéter, una densidad de incidencia de bacteriemia asociada al catéter de 5.06 casos por cada 1000 días de cateterización. Los gérmenes aislados fueron Staphylococcus coagulasa negativo, Staphylococcus aureus, Klebsiella oxytoca, Enterobacter cloacae y Candida albicans. En todos los casos el tiempo de positivización diferencial del hemocultivo obtenido del catéter venoso fue menor a 2 horas frente al obtenido por punción periférica. Conclusiones: el valor hallado de incidencia de infección asociada al uso de catéter fue elevado y es necesario implementar medidas destinadas a disminuirla.
Assuntos
Humanos , Masculino , Bacteriemia/diagnóstico , Bacteriemia/etiologia , Bacteriemia/terapia , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/terapia , Infecção Hospitalar , Cateteres Venosos Centrais/efeitos adversos , Staphylococcus aureus , Klebsiella oxytoca , Enterobacter cloacae , Candida albicansRESUMO
We evaluated clinical factors associated with early central venous catheter (CVC) removal in cancer patients with candidaemia who survived >3 days after the index blood culture. This was a retrospective cohort study from a previous candidaemia database conducted between January 2001 and June 2005. Eligible patients were those whose catheters were removed. Those who died in the first 72 h were excluded. Early CVC removal was defined as withdrawal in the first 72 h. We enrolled 164 patients with a 10.4% mortality rate. Multivariate analysis showed temporary non-tunnelled catheter type (odds ratio 5.06; 95% confidence interval 2.16-11.83) as the only variable associated with early removal. Among the 84 episodes judged not catheter-related, 52 CVCs were removed due to the need for further cancer treatment. No differences in mortality were seen among patients with early or late catheter removal. Stratified analysis showed a survival benefit (p = 0.04) of early removal among patients with a Karnofsky performance status score >60. The study shows a propensity to immediately remove short-term catheters and a tendency for early removal in patients undergoing active cancer treatment. There was no benefit of early catheter removal with regard to overall mortality. The favourable impact of early over late removal on survival among patients without significant illness merits further investigation.