scholarly journals SUN-057 Reducing Central Venous Catheter Burden in Haemodialysis Patients: The Impact of Changing Practice within an Australian Renal Unit

2019 ◽  
Vol 4 (7) ◽  
pp. S178
Author(s):  
B. TALBOT ◽  
R. Lin ◽  
P. Sagar ◽  
S. Sen ◽  
M. Jun ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Renal Unit ◽  
Central Venous ◽  
Changing Practice ◽  
The Impact

scholarly journals Linezolid lock prophylaxis of central venous catheter infection

2008 ◽  
Vol 57 (4) ◽  
pp. 534-535 ◽  
Author(s):  
Jérôme Patrick Fennell ◽  
Martin O'Donohoe ◽  
Martin Cormican ◽  
Maureen Lynch
Keyword(s):  
Central Venous Catheter ◽  
Hospital Admissions ◽  
Blood Stream Infection ◽  
Central Venous Access ◽  
Venous Catheter ◽  
Venous Access ◽  
Blood Stream ◽  
Central Venous ◽  
Central Venous Catheter Infection ◽  
The Impact

Central venous catheter (CVC)-related infections are a major problem for patients requiring long-term venous access and may result in frequent hospital admissions and difficulties in maintaining central venous access. CVC-related blood stream infections are associated with increased duration of inpatient stay and cost approximately \#8364;13 585 per patient [Blot, S. I., Depuydt, P., Annemans, L., Benoit, D., Hoste, E., De Waele, J. J., Decruyenaere, J., Vogelaers, D., Colardyn, F. & Vandewoude, K. H. (2005). Clin Infect Dis 41, 1591–1598]. Antimicrobial lock therapy may prevent CVC-related blood stream infection, preserve central venous access and reduce hospital admissions. In this paper, the impact of linezolid lock prophylaxis in a patient with short bowel syndrome is described.

High success rate in salvage of catheter-related bloodstream infections due to Staphylococcus aureus, on behalf of project group of Italian society of nephrology

2019 ◽  
Vol 21 (3) ◽  
pp. 336-341
Author(s):  
Salvatore Mandolfo ◽  
Adriano Anesi ◽  
Milena Maggio ◽  
Vanina Rognoni ◽  
Franco Galli ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Central Venous Catheter ◽  
Prognostic Index ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Catheter Removal ◽  
Renal Unit ◽  
Chronic Haemodialysis ◽  
Central Venous

Background: Catheter-related bloodstream infections caused by Staphylococcus aureus represent one of the most fearful infections in chronic haemodialysis patients with tunnelled central venous catheters. Current guidelines suggest prompt catheter removal in patients with positive blood cultures for S. aureus. This manoeuvre requires inserting a new catheter into the same vein or another one and is not without its risks. Methods: A protocol based on early, prompt diagnosis and treatment has been utilized in our renal unit since 2012 in an attempt to salvage infected tunnelled central venous catheters. We prospectively observed 247 tunnelled central venous catheters in 173 haemodialysis patients involving 167,511 catheter days. Results: We identified 113 catheter-related bloodstream infections (0.67 episodes per 1000 days/tunnelled central venous catheter). Forty were caused by S. aureus, including 19 by methicillin-resistant S. aureus (79% saved) and 21 by methicillin-sensitive S. aureus (90% saved), of which 34 (85%) were treated successfully. Eight recurrences occurred and six (75%) were successfully treated. A greater than 12 h time to blood culture positivity for S. aureus was a good prognostic index for successful therapy and tunnelled central venous catheter rescue. Conclusion: Our data lead us to believe that it is possible to successfully treat catheter-related bloodstream infection caused by S. aureus and to avoid removing the tunnelled central venous catheter in many more cases than what has been reported in the literature. On the third day, it is mandatory to decide whether to replace the tunnelled central venous catheter or to carry on with antibiotic therapy. Apyrexia and amelioration of laboratory parameters suggest continuing systemic and antibiotic lock therapy for no less than 4 weeks, otherwise, tunnelled central venous catheter removal is recommended.

scholarly journals 120. The Impact of Early Central Venous Catheter Removal in the Management of Enterococcus Central Line-Associated Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S90-S91
Author(s):  
Hesham Awadh ◽  
Melissa Khalil ◽  
Anne-Marie Chaftari ◽  
Johny Fares ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Mucosal Barrier ◽  
Causative Organism ◽  
Central Venous ◽  
Central Venous Catheter Removal ◽  
The Impact

Abstract Background There has been a rise in Enterococcus species Central Line-Associated Bloodstream Infections (CLABSI) ranking as the third overall causative organism according to the Center for Disease Control and Prevention (CDC) report issued in 2014. Central Venous Catheter (CVC) management including the need and timing of CVC removal is not well defined for enterococcus bacteremia (EB) in the 2009 Infectious Diseases Society of America (IDSA) management guidelines given the paucity of studies addressing CVC management. Methods We conducted a retrospective chart review on 543 patients diagnosed with EB between 2010 and 2018. We excluded patients without an indwelling CVC and those with mucosal barrier injury (MBI). We further evaluated 90 patients with EB that met the CDC definition for CLABSI without MBI or the IDSA definition for catheter-related bloodstream infections (CRBSI) and 90 patients with an indwelling CVC in place with documented non-CLABSI with another source. Results Early CVC removal (within 3 days of EB) was significantly higher in the CLABSI without MBI/CRBSI group compared with the non-CLABSI (43% vs. 27%; P = 0.02). Microbiological eradication associated with early CVC removal within 3 days of EB was significantly higher in the CLABSI without MBI/CRBSI group compared with the non-CLABSI (78% vs. 48%; P = 0.016). Complications were lower in the CLABSI without MBI/CRBSI compared with the non-CLABSI group (0% vs. 18%; P = 0.017). Defervescence, mortality (all-cause and infection-related mortality) and relapse were similar in both groups. Within each group, the outcome was similar irrespective of CVC management (removal within 3 days vs. retention). Conclusion In cases of EB, early CVC removal within 3 days of bacteremia is associated with a favorable outcome in the CLABSI without MBI/CRBSI group compared with the non-CLABSI group. Disclosures All authors: No reported disclosures.

Impact of a Multidisciplinary Team Review of Potential Outpatient Parenteral Antimicrobial Therapy Prior to Discharge from an Academic Medical Center

2011 ◽  
Vol 45 (11) ◽  
pp. 1329-1337 ◽  
Author(s):  
Brett H Heintz ◽  
Jenana Halilovic ◽  
Cinda L Christensen
Keyword(s):  
Central Venous Catheter ◽  
Hospital Discharge ◽  
Antimicrobial Therapy ◽  
Multidisciplinary Team ◽  
Cost Savings ◽  
Venous Catheter ◽  
Central Venous ◽  
Central Venous Catheter Placement ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
The Impact

Background:: Outpatient parenteral antimicrobial therapy (OPAT) is frequently prescribed at hospital discharge, often without infectious diseases (ID) clinician oversight. We developed a multidisciplinary team, including an ID pharmacist, to review OPAT care plans at hospital discharge to improve safety, clinical efficacy, practicality, and appropriateness of the proposed antimicrobial regimen. Objective: To evaluate the impact of the OPAT team on regimen safety, efficacy, and complexity; calculate the economic benefits of the service by avoiding hospital discharge delay, central venous catheter placement, or need for OPAT; and evaluate the discharge environment among OPAT referrals. Methods: In an observational design, we analyzed the impact of an OPAT team from July 2009 through June 2010 at a large academic tertiary care hospital. All patients with plans for continued parenteral therapy after discharge referred to the OPAT team were included in the analysis. Patients were excluded if OPAT was cancelled prior to processing of the referral. Results: During the 1-year study period. 569 of 644 consecutive referrals to the OPAT team met inclusion criteria, resulting in 494 OPAT courses. Interventions by an ID pharmacist were made for safety (56%), regimen complexity (41%), and efficacy (29%). Lack of formal ID physician consultation resulted in more interventions for safety (64% vs 48%, p < 0.001) and efficacy (36% vs 21%, p < 0.001). Discharge delays were avoided for 35 referrals, resulting in 228 hospital days avoided and approximately $366,000 in hospital bed cost savings. Use of OPAT was avoided in 75 referrals (13.2%), preventing central venous catheter placement in 48 patients (8.4%), resulting in an additional $58,080 in cost savings. Conclusions: The OPAT team optimized safety, efficacy, and convenience of OPAT while providing substantial cost savings. Further studies are needed to confirm the program's cost-effectiveness.

scholarly journals The correlation between nursing workload and bloodstream infection from central venous catheter in ICU

2019 ◽  
Vol 2 (1) ◽  
pp. 63 ◽  
Author(s):  
Olga Michali ◽  
Georgios Argyriou ◽  
Georgia Xristopoulou ◽  
Theodore Kapadohos ◽  
Georgios Vasilopoulos ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Venous Catheter ◽  
Care Quality ◽  
Nursing Workload ◽  
Statistical Criterion ◽  
Central Venous ◽  
Significant Difference ◽  
The Impact

Introduction: Bloodstream infection associated with the presence of central venous catheters is the second most common hospital infection in the Intensive Care Unit (ICU). The nursing stuff is an essential part of the human resources of the ICU which contributes substantially to provide holistic and effective care to critically ill patients. The level of the nursing workload and its possible influence on the clinical course and outcome of critically ill ICU patients has been systematically studied in recent years. Mainly, was studied the connection with the care quality indicators such as mortality and infections Aim: The purpose of this study was to estimate the nursing workload in the ICU and to investigate the impact of bloodstream infection from Central Venous Catheter (CLABSI). Methods: The study sample consisted of 39 patients who were hospitalized in a multidisciplinary ICU in a 3 month period. For the detection of bloodstream infections we used the surveillance definition of CDC/NHSN for in vitro confirmed bloodstream infection (CLABSI). Measurement of nursing workload was via the NAS scale and the calculation was performed for each patient once existed or entering the ICU from baseline and constantly on a daily basis. A comparison of the quantitative variables was done with the statistical criterion Pearson’s x 2 , to compare the bisectors qualitative variables selected quantitative variables was used the t-test analysis and MannWhitney test. Results: Of the total sample, 74,4% (n = 29) were male, with a mean age 59 ± 21 years. The duration of ICU stay was 24 ± 23 days and mortality was 41%. The duration of hospitalization was 28 ± 24 days and the corresponding mortality of 46.2%. All correlations presented no statistically significant difference than the first day’s NAS in which appears the biggest difference between the values (p=0,046) but the NAS of the patients who did not develop bacteremia be more increased over those experienced. Conclusions: The nursing workload in our study did not prove as a risk factor for the occurrence of bloodstream infection in the ICU.

P1318EPIDEMIOLOGY OF BLOODSTREAM INFECTIONS IN A SCOTTISH HAEMODIALYSIS POPULATION WITH FOCUS ON VASCULAR ACCESS METHOD

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Kirsty Crowe ◽  
Beth White ◽  
Nitish Khanna ◽  
Peter Thomson
Keyword(s):  
Central Venous Catheter ◽  
Vascular Access ◽  
Venous Catheter ◽  
Central Venous ◽  
Coagulase Negative Staphylococci ◽  
Access Methods ◽  
Gram Negative ◽  
Co Morbidity ◽  
Gram Negative Organisms ◽  
The Impact

Abstract Background and Aims Haemodialysis (HD) vascular access infections account for approximately 28% of infection-associated hospitalisations in patients with end-stage renal disease1. Traditionally there has been focus on Staphylococcus aureus (S. aureus) infections, however there is increasing recognition of the burden of Gram-negative bloodstream infection (BSI) in the HD population2,3. Epidemiological analysis has enabled surveillance of the impact of antimicrobial protocols on BSI rate and outcome2. Scottish Registry data reflects that access methods are changing alongside the HD population phenotype, with increasing use of arterio-venous graft (AVG) and central venous catheters for incident and prevalent HD access3. In this study, the rate of BSI in a contemporary Scottish HD cohort is reported by microbial species and vascular access type: arterio-venous fistula (AVF), AVG, tunnelled central venous catheter (TCVC) or non-tunnelled central venous catheter (NTCVC). Method The Strathclyde Electronic Renal Patient Record (SERPR) database for the West of Scotland was utilised to obtain retrospective observational data all adult patients attending inpatient and outpatient renal services across seven dialysis units between 1st January 2017 and 31st December 2017. All BSIs were analysed as separate episodes if more than 14 days apart, regardless of the suspected source of infection, and expressed as events per 1000 HD days. The number of days each patient was exposed to each vascular access subtype was calculated utilising the prospectively recorded HD access observations. Prevalent HD vascular access type was noted for each BSI. Results There were 786 patients who underwent HD with 217 503 total HD days over the study period. A total of 147 separate BSIs occurred, involving 115 patients. A total of 168 organisms were encountered in these BSIs. There were 49 BSIs during 126, 674 HD days using AVF access, 14 BSIs during 25, 511 AVG HD days, 81 BSIs during 64, 353 TCVC HD days and 3 BSIs during 965 NTCVC HD days. Table 1 outlines the BSI rates by vascular access and organisms identified Staphylococci-related BSI comprised the majority of events (51.7%), with S. aureus implicated in 47% of these BSIs. Coagulase-negative staphylococci were the most commonly identified organisms in the AVF, TCVC and NTCVC groups, with S. aureus the leading organism in the AVG group. Gram-negative organisms accounted for the next largest proportion of BSIs (27%) and were more prevalent in the TCVC and NTCVC groups. Conclusion AVF access subtype was associated with the lowest BSI rate, and NTCVC the highest which is in keeping with previous studies and one of the drivers for AVF as the preferred HD access type internationally. Staphylococci continue to represent a large proportion of BSIs in this cohort, however other organisms are prevalent. BSIs caused by Gram-negative organisms and Candida species were represented more heavily in the TCVC and NTCVC population, perhaps representing co-morbidity of these groups.

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