P8.02 Central Catheter as the Potential Source for Candida Parapsilosis Bloodstream Infection

Catheter-related bloodstream infection (CRBSI) is an important healthcare-associated infection caused by various nosocomial pathogens. Candida parapsilosis has emerged as a crucial causative agent for the CRBSI in the last two decades. Many factors have been associated with the development of CRBSI including, demography, pre-maturity, comorbidities (diabetes mellitus, hypertension, heart diseases, neuropathy, respiratory diseases, renal dysfunction, hematological and solid organ malignancies, and intestinal dysfunction), intensive care unit (ICU) admission, mechanical ventilation (MV), total parenteral nutrition (TPN), prior antibiotic and/or antifungal therapy, neutropenia, prior surgery, immunosuppressant, and type, site, number, and duration of catheters. This study aims to determine C. parapsilosis CRBSI risk factors. A retrospective study has been performed in an 853-bedded tertiary-care hospital in north-eastern Malaysia. All inpatients with C. parapsilosis positive blood cultures from January 2006 to December 2018 were included, and their medical records were reviewed using a standardized checklist. Out of 208 candidemia episodes, 177 had at least one catheter during admission, and 31 cases had not been catheterized and were excluded. Among the 177 cases, 30 CRBSI cases were compared to 147 non-CRBSI cases [81 bloodstream infections (BSIs), 66 catheter colonizers]. The significance of different risk factors was calculated using multivariate analysis. Multivariate analysis of potential risk factors shows that ICU admission was significantly associated with non-CRBSI as compared to CRBSI [OR, 0.242; 95% CI (0.080–0.734); p = 0.012], and TPN was significantly positively associated with CRBSI than non-CRBSI [OR, 3.079; 95%CI (1.125–8.429); p = 0.029], while other risk factors were not associated significantly. Patients admitted in ICU were less likely to develop C. parapsilosis CRBSI while patients receiving TPN were more likely to have C. parapsilosis CRBSI when compared to the non-CRBSI group.

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Concurrent bloodstream infection with Lodderomyces elongisporus and Candida parapsilosis

Medical Mycology Case Reports ◽

10.1016/j.mmcr.2020.03.007 ◽

2020 ◽

Vol 28 ◽

pp. 23-25

Author(s):

Bryant Koh ◽

Catriona Halliday ◽

Raymond Chan

Keyword(s):

Bloodstream Infection ◽

Candida Parapsilosis

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Centrally inserted tunnelled peripherally inserted central catheter: Off-label use for venous access in oncology patients

The Journal of Vascular Access ◽

10.1177/1129729820909028 ◽

2020 ◽

Vol 21 (5) ◽

pp. 773-777 ◽

Cited By ~ 1

Author(s):

Dayananda Lingegowda ◽

Anisha Gehani ◽

Saugata Sen ◽

Sumit Mukhopadhyay ◽

Priya Ghosh

Keyword(s):

Bloodstream Infection ◽

Local Anaesthesia ◽

Venous Access ◽

Exit Point ◽

Safe Procedure ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Oncology Patients ◽

Peripheral Venous Access ◽

Catheter Related Bloodstream Infection

Purpose: Vascular access in oncology patients can often be challenging, especially after a few cycles of chemotherapy through peripheral lines which can cause veins to become attenuated. We evaluated the feasibility of centrally placed non-cuffed tunnelled peripherally inserted central catheter in the chest as an alternative to conventional peripherally inserted central catheter. Method: Patients referred for peripherally inserted central catheter found to have inadequate peripheral venous access in their arms due to prior chemotherapy, and therefore they were offered placement of the non-cuffed tunnelled peripherally inserted central catheter in the chest. Adult patients were subjected to the procedure under local anaesthesia, while paediatric patients underwent this procedure under general anaesthesia. Ultrasound guidance was used for venous access, and fluoroscopy was used for tip positioning. Using internal jugular vein access, BARD Groshong-valved 4F peripherally inserted central catheter was placed with its tip in the cavo-atrial junction. Proximal end of the catheter was brought out through the subcutaneous tunnel, so that the exit point of the peripherally inserted central catheter lies over the upper chest. Extra length of the catheter was trimmed, and extensions were attached. The device was stabilized with adhesive and sutures. Results: Out of 19 patients, 18 patients were male (4–72 years). Technical success was achieved in 100% cases. No catheter-related bloodstream infection was noted within 30 days of peripherally inserted central catheter. Overall, during 1966 catheter days, no catheter-related bloodstream infection was observed. The purpose of peripherally inserted central catheter was achieved in 15 patients (78.9%) either in the form of completion of chemotherapy (8/15) or maintained peripherally inserted central catheter line till death (7/15). Partial or complete pullout was observed in four patients (20.1%), which required cuffed tunnelled catheter or implantable port. External fracture was noted in one patient, which was successfully corrected using repair kit. No exit site infection, bleeding, catheter occlusion, catheter dysfunction, venous thrombosis, venous stenosis or catheter embolizations were noted in our series. Conclusion: Centrally placed tunnelled peripherally inserted central catheter is a promising alternative method, when conventional arm peripherally inserted central catheter placement is not feasible. It is an easy and safe procedure that can be performed under local anaesthesia.

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