scholarly journals An Outbreak of Ralstonia pickettii Bloodstream Infection Associated with an Intrinsically Contaminated Normal Saline Solution

2017 ◽  
Vol 38 (4) ◽  
pp. 444-448 ◽  
Author(s):  
Yin-Yin Chen ◽  
Wan-Tsuei Huang ◽  
Chia-Ping Chen ◽  
Shu-Mei Sun ◽  
Fu-Mei Kuo ◽  
...  

OBJECTIVERalstonia pickettii has caused contamination of pharmaceutical solutions in many countries, resulting in healthcare infections or outbreak events. We determined the source of the outbreak of R. pickettii bloodstream infection (BSI).METHODSThis study was conducted in a 3,000-bed tertiary referral medical center in Taiwan with >8,500 admissions during May 2015. Patients had been treated in the injection room or chemotherapy room at outpatient departments, emergency department, or hospital wards. All patients who were culture positive for R. pickettii from May 3 to June 11, 2015, were eligible for the study. The aim of the survey was to conduct clinical epidemiological and microbiological investigations to identify possible sources of infection.RESULTSWe collected 57 R. pickettii–positive specimens from 30 case patients. We performed 24 blood cultures; 14 of these revealed >2 specimens and 6 used fluid withdrawn from Port-a-Cath implantable venous access devices. All patients received an injection of 20 mL 0.9% normal saline via catheter flushing. In addition, 2 unopened ampules of normal saline solution (20 mL) were confirmed positive for R. pickettii. The Taiwan Centers for Disease Control and Prevention performed sampling and testing of the same manufactured batch and identified the same strain of R. pickettii. Pulsed-field gel electrophoresis tests revealed that all clinical isolates had similarity of >90%, validating the outbreak of the same clone of R. pickettii.CONCLUSIONSR. pickettii can grow in saline solutions and cause bloodstream infections. Hospital monitoring mechanisms are extremely important measures in identifying and ending such outbreaks.Infect Control Hosp Epidemiol 2017;38:444–448

2019 ◽  
Vol 14 (1) ◽  
pp. 47-49
Author(s):  
Basant K. Puri ◽  
Anne Derham ◽  
Jean A. Monro

Background: The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days. Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs. Method: A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine. Results: There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected. Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae.


2003 ◽  
Vol 24 (12) ◽  
pp. 942-945 ◽  
Author(s):  
Michael Climo ◽  
Dan Diekema ◽  
David K. Warren ◽  
Loreen A. Herwaldt ◽  
Trish M. Perl ◽  
...  

AbstractObjective:To determine the prevalence of central venous catheter (CVC) use among patients both within and outside the ICU setting.Design:A 1-day prevalence survey of CVC use among adult inpatients at six medical centers participating in the Prevention Epicenter Program of the CDC. Using a standardized form, observers at each Epicenter performed a hospital-wide survey, collecting data on CVC use.Setting:Inpatient wards and ICUs of six large urban teaching hospitals.Results:At the six medical centers, 2,459 patients were surveyed; 29% had CVCs. Among the hospitals, from 43% to 80% (mean, 59.3%) of ICU patients and from 7% to 39% (mean, 23.7%) of non-ICU patients had CVCs. Despite the lower rate of CVC use on non-ICU wards, the actual number of CVCs outside the ICUs exceeded that of the ICUs. Most catheters were inserted in the subclavian (55%) or jugular (22%) site, with femoral (6%) and peripheral (15%) sites less commonly used. The jugular (33.0% vs 16.6%; P < .001) and femoral (13.8% vs 2.7%; P < .001) sites were more frequently used in ICU patients, whereas peripherally inserted (19.9% vs 5.9%; P < .001) and subclavian (60.7% vs 47.3%; P < .001) catheters were more commonly used in non-ICU patients.Conclusions:Current surveillance and infection control efforts to reduce morbidity and mortality associated with bloodstream infections concentrate on the high-risk ICU patients with CVCs. Our survey demonstrated that two-thirds of identified CVCs were not in ICU patients and suggests that more efforts should be directed to patients with CVCs who are outside the ICU.


2004 ◽  
Vol 25 (10) ◽  
pp. 878-882 ◽  
Author(s):  
Yesim Cetinkaya Sardan ◽  
Pinar Zarakolu ◽  
Belgin Altun ◽  
Aycan Yildirim ◽  
Gonul Yildirim ◽  
...  

AbstractBackground:On February 19, 2003, four patients (patients 1-4) in the neurology ward underwent cranial magnetic resonance angiography (MRA) and developed fever within 1 hour afterward. Klebsiella oxytoca was isolated from blood cultures of patients 1 through 3.Objective:To identify the source of this cluster of nosocomial K. oxytoca bloodstream infections.Design:Outbreak investigation.Setting:A 1,000-bed university hospital.Methods:The infection control team reviewed patient charts and interviewed nursing staff about the preparation and administration of parenteral fluids. The procedure of cranial MRA was observed. Arbitrarily primed polymerase chain reaction (AP-PCR) was performed to show the clonal relationship among these three strains.Results:AP-PCR revealed that three K. oxytoca isolates had the same molecular profile. Cranial MRA was found to be the only common source among these patients. During MRA, before injection of the contrast medium, normal saline solution was infused to check the functioning of the intravenous catheter. Use of the solution for multiple patients was routine, but the access diaphragm of the bottle was not cleansed. The bottle of normal saline solution used on February 19 had already been discarded and the culture sample taken from the solution on the day of observation was sterile.Conclusions:We speculate that normal saline solution became contaminated during manipulation and that successive uses might have been responsible for this cluster. Poor aseptic techniques employed during successive uses appear to be the most likely route of contamination. Use of parenteral solutions for multiple patients was discontinued..


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1649-1649
Author(s):  
Nirmish Shah ◽  
Daniel Landi ◽  
Radhika Shah ◽  
Jennifer Rothman ◽  
Courtney Thornburg

Abstract Abstract 1649 INTRODUCTION: Implantable venous access devices (VADs) are used in sickle cell disease (SCD) for patients with poor venous access to facilitate chronic blood transfusions and management of acute complications. Children and adults with chronic illnesses have high rates of VAD-related complications including bloodstream infection and thrombosis. Patients with SCD may be at higher risk given the presence of functional asplenia and evidence of a hypercoaguable state. The objective of this study was to define the frequency of VAD related bloodstream infections and thrombosis in adults and children with SCD. PATIENTS AND METHODS: We performed a single institution retrospective review of VAD placement in patients with SCD. Subjects were identified through the sickle cell clinic database and the Hospital Information System. Subjects were included if they had SCD, VAD placement between December 1, 1998 to December 1, 2009 and had completed at least 12 months of follow-up. VAD-related bloodstream infection was defined by positive blood culture and VAD-related thrombosis (deep vein thrombosis, superior vena cava syndrome, and pulmonary embolism without lower extremity thrombosis) was defined by imaging. Comparisons were made between pediatric and adult sickle cell patients using Student's t-test for continuous variables and Fisher's exact test was used to compare categorical variables; p<0.05 was considered significant. RESULTS: Of the greater than 800 sickle cell patients followed at our Comprehensive Sickle Cell Center, 32 subjects were eligible for inclusion (median age 20 years, range 1–59). There were 81 VAD placed (median 2.6 VAD per patient, range 1–7) with a total of 49268 catheter days (median 608, range 323–3999). The mean catheter lifespan in adults (1798 days ± 266) was significantly higher than pediatric patients (971 ± 328, p=0.039). There were a total of 66 VAD-related bloodstream infections (1.34 infections per 1000 catheter days) occurring in 17 of 32 (53%) subjects. Although not statistically significant, children had fewer VAD-related bloodstream infections (3 of 10; 30%) compared to adults (14 of 22; 64%, p=0.08). There were 24 catheter-related thromboses (0.49 thromboses per 1000 catheter days) occurring in 10 of 32 (41%) of subjects. Children also had fewer VAD-related thrombosis (1 of 10; 10%) compared to adults (9 of 22; 40%, p=0.08). The overall rates of infection and thrombosis per 1000 catheter days were not significantly different between adult and pediatric patients. CONCLUSION: In summary, we report a long lifespan and low rate of infection in the subjects who had VADs during the study period. Most concerning was a high proportion of adults with catheter-related thrombosis, which adds the burden of anticoagulation to patient management and put patients at risk for post-thrombotic syndrome. Potential lifespan of VADs, risk of bloodstream infection and thrombosis as well as its long-term consequences should be discussed with patients and families considering VAD placement. Disclosures: No relevant conflicts of interest to declare.


2018 ◽  
Vol 19 (4) ◽  
pp. 358-365 ◽  
Author(s):  
İlker Devrim ◽  
Yeliz Oruç ◽  
Bengü Demirağ ◽  
Ahu Kara ◽  
Mine Düzgöl ◽  
...  

Objective: The clinical impact of central line bundle programs for central line–associated bloodstream infections has been well demonstrated in intensive care units. However, the experience of central line bundle programs in totally implantable venous access devices (ports) in pediatric-hematology patients was limited. Methods: A retrospective study was designed to compare and evaluate the clinical impact of implementing a central line bundle for a 2-year 5-month period, including 10 months of prebundle period, 11 months of central line bundle (that includes needleless split-septum devices), and finally 8 months of central line bundle period in which single-use prefilled flushing devices were added to the previous central line bundle. Results: During the prebundle period, the rate of 14.5 central line–associated bloodstream infections per 1000 CL-days had decreased to 5.49 CLABSIs per 1000 CL-days in the first bundle period. The incidence rate ratio with these two groups was 0.379, indicating a relative risk reduction of 62% ( p = 0.005). By the addition of single-use prefilled flushing devices to the first bundle program, the central line–associated bloodstream infection rate decreased to 2.63 per 1000 CL-days. Port removal rate due to central line–associated bloodstream infections was 0.46 per 1000 catheter days in the bundle period, which was significantly lower than in the prebundle period in which port removal rate was 4.5 per 1000 catheter days ( p < 0.001). Conclusion: Central line bundle programs were found to be effective in decreasing central line–associated bloodstream infection rates, improving patients’ quality of life by preventing ports removal due in pediatric cancer patients.


2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Jack E. Moseley Jr. ◽  
Sharanjeet K. Thind

Background. Mycobacterium neoaurum is a rapidly growing nontuberculosis mycobacterium (NTM) that was first isolated from soil in 1972 and is ubiquitous in soil, water, and dust. The first reported case of human infection by M. neoaurum was published in 1988, presenting as a Hickman catheter-related bacteremia in a patient with ovarian cancer. M. neoaurum has since been recognized as a source of predominantly opportunistic bloodstream infections in immunocompromised hosts. We report the case of an adult diabetic male with M. neoaurum bloodstream infection secondary to an infected venous-access port that had been implanted nearly six years prior for temporary chemotherapy. Case Presentation. A 66-year-old male with schizophrenia, type 2 diabetes mellitus, and a history of excision and chemotherapy to treat adenocarcinoma of the colon 6 years prior, presented with fever and behavioral changes. He was found to have a M. neoaurum bloodstream infection secondary to his implanted subclavian port. Multiple preoperative blood cultures, as well as the removed catheter tip culture, were positive for M. neoaurum. The patient’s condition improved to near premorbid levels after port removal and 6 weeks of targeted antimicrobial therapy. Discussion and Conclusions. Bloodstream infections due to rapidly growing NTM, such as M. neoaurum, have been infrequently reported; however, improved isolation and identification techniques based on genomic testing are resulting in a more in-depth recognition of these widely scattered environmental microbes in human infections. Nonetheless, lengthy identification and susceptibility processes remain a diagnostic and treatment barrier. Patients such as ours who have a history of malignancy and an indwelling foreign body have most often been reported as acquiring M. neoaurum bacteremia. Fortunately, device removal and appropriate antimicrobial therapy guided by susceptibility data is often enough to manage these atypical mycobacterial infections.


2018 ◽  
Vol 39 (07) ◽  
pp. 878-880 ◽  
Author(s):  
Sonali D. Advani ◽  
Rachael A. Lee ◽  
Martha Long ◽  
Mariann Schmitz ◽  
Bernard C. Camins

The 2015 changes in the catheter-associated urinary tract infection definition led to an increase in central line-associated bloodstream infections (CLABSIs) and catheter-related candidemia in some health systems due to the change in CLABSI attribution. However, our rates remained unchanged in 2015 and further declined in 2016 with the implementation of new vascular-access guidelines.Infect Control Hosp Epidemiol 2018;878–880


Author(s):  
Sruthy Madhusudanan ◽  
Ambili Renjith

Introduction: Periodontitis is initiated by plaque microbes and modified by systemic and environmental factors. Treatment of periodontitis primarily focuses on plaque control by mechanical and chemical means. Chlorhexidine (CHX) mouthwash is considered as the ‘gold standard’ chemical plaque control agent. But studies have demonstrated cytotoxic effects of CHX. However, there is limited evidence available regarding the cytotoxicity of other commonly used postoperative mouthwashes. Aim: To evaluate cytotoxicity of commonly used postoperative mouthwashes (CHX- 0.12% and 0.2%, 2% povidone iodine, 3% hydrogen peroxide and 0.9% normal saline solutions) using MTT assay on fibroblast cells and to identify the least cytotoxic agent. Materials and Methods: The study was an invitro study conducted at Department of Periodontics, PMS College of Dental Sciences and Research, Vattapara, Thiruvananthapuram in association with Biogenix research centre Poojapura in January 2018. The cytotoxic effects of CHX -0.12% and 0.2%, Povidone iodine 2%, 3% hydrogen peroxide and 0.9% normal saline solution on L929 fibroblast cells were observed using inverted phase contrast microscope and images were recorded for all the groups. Cytotoxic evaluation was done by MTT {3,(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide} assay. Optical Density (OD) was measured and percentage of cell viability for each mouthwash was calculated. Statistical Analysis was carried out using analysis of variance (ANOVA). Intergroup comparison was done using Post hoc analysis (Tukey HSD). The p-value <0.05 was considered to be statistically significant. SPSS software version 22.0 IBM, Chicago, IL. was used. Results: Cell viability percentages were highest for normal saline (87.11%) followed by 2% povidone iodine (73.71%), 0.12% and 0.2% CHX (24.9% and 24.56%) and the least for 3% hydrogen peroxide (23.82%). Post hoc analysis showed significant difference for all the reagents compared to control (p<0.001) except normal saline (p=0.658). The difference between povidone iodine and normal saline was not significant (p=0.433). Comparison of both concentrations of CHX (0.2% and 0.12%) and povidone iodine 2% w/v was significantly different with p<0.001, but not with hydrogen peroxide (3%) (p=0.899). The comparison between povidone iodine 2% and hydrogen peroxide (3%) was significantly different (p<0.001). Microscopic findings of CHX and hydrogen peroxide treated cells included cell shrinkage, condensed nuclei, membrane blebbing and apoptotic bodies. Changes in cellular morphology were not observed in cells treated with povidone iodine and normal saline solution. Conclusion: Both 0.12% and 0.2% CHX and 3% hydrogen peroxide were found to have significant cytotoxic effects when compared to other mouthwashes. The findings of this study preclude the use of 0.12% and 0.2% CHX and 3% hydrogen peroxide as postoperative mouth rinses due to their possible cytotoxic effects. A 2% povidone iodine and normal saline solution can be considered as excellent alternatives as they were found to be least cytotoxic on fibroblast cells.


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