Bloodstream Infections in Pediatric Oncology Outpatients: A New Healthcare Systems Challenge

2002 ◽  
Vol 23 (5) ◽  
pp. 239-243 ◽  
Author(s):  
Theresa L. Smith ◽  
Gregg T. Pullen ◽  
Vonda Crouse ◽  
Jon Rosenberg ◽  
William R. Jarvis
Keyword(s):  
Bloodstream Infections ◽  
Venous Catheter ◽  
Case Patient ◽  
Gram Negative ◽  
Children's Hospital ◽  
Pediatric Hematology ◽  
Patient Demographics ◽  
Children’S Hospital ◽  
And Control ◽  
Control Study

Objective:To investigate a perceived increase in central venous catheter (CVC)–associated bloodstream infections (BSIs) among pediatric hematology–oncology outpatients.Design:A case–control study.Setting:A pediatric hematology–oncology outpatient clinic at Fresno Children's Hospital.Patients:Pediatric hematology–oncology clinic outpatients with CVCs at Fresno Children's Hospital between November 1994 and October 1997.Methods:A case-patient was defined as any hematology–oncology outpatient with a CVC-associated BSI at Fresno Children's Hospital from November 1996 to October 1997 (study period) without a localizable infection. To identify case-patients, we reviewed Fresno Children's Hospital records for all hematology–oncology clinic patients, those with CVCs and those with CVCs and BSIs. Control-patients were randomly selected hematology–oncology outpatients with a CVC but no BSI during the study period. Case-patient and control-patient demographics, diagnoses, caretakers, catheter types, catheter care, and water exposure were compared.Results:Twenty-five case-patients had 42 CVC-associated BSIs during the study period. No significant increase in CVC-associated BSI rates occurred among pediatric hematology–oncology patients. However, there was a statistically significant increase in nonendogenous, gram-negative (eg, Pseudomonas species) BSIs during summer months (May–October) compared with the rest of the year. Case-patients and control-patients differed only in catheter type; case-patients were more likely than control-patients to have a transcutaneous CVC. Summertime recreational water exposures were similar and high in the two groups.Conclusions:Hematology–oncology clinic patients with transcutaneous CVCs are at greater risk for CVC-associated BSI, particularly during the summer. Caretakers should be instructed on proper care of CVCs, particularly protection of CVCs during bathing and recreational summer water activities, to reduce the risk of nonendogenous, gram-negative BSIs.

scholarly journals 1375. Characterization of Recurrent Central Line-associated Bloodstream Infections at Texas Children’s Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S697-S698
Author(s):  
Catherine Foster ◽  
Lucila Marquez ◽  
Tjin Koy ◽  
Judith Campbell
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Mucosal Barrier ◽  
Fiscal Year ◽  
Severe Neutropenia ◽  
Candida Spp ◽  
Unique Challenge ◽  
Gram Negative ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract Background Recurrent central line-associated bloodstream infections (CLABSI) in children present a unique challenge to infection prevention efforts but guidelines for management are lacking. Methods We reviewed CLABSI data at Texas Children’s Hospital (TCH) from fiscal years (FY) 2017-2019. A chart review to characterize clinical features, risk factors, and outcomes of patients with recurrent CLABSIs in FY2019 was performed. Descriptive statistics and Fisher’s exact test were used. Results Recurrent CLABSIs increased from FY 2017-2019 [20% (26/126) to 33% (44/131)] (P=0.03). In FY2019, 15 patients accounted for 44 CLABSIs (Figure 1). Underlying conditions included aplastic anemia (4), hemophagocytic lymphohistiocytosis (3), malignancy (4), genetic disease (2), congenital heart disease (1) and biliary atresia (1). Two-thirds of the CLABSIs occurred in the setting of severe neutropenia (ANC < 100 cells/mm3) though only 16 (36%) were classified as mucosal barrier injury. The median time between line insertion and date of infection was 41 days (range 1-105). Line type included central venous catheters (25, 57%), peripherally inserted central catheters (17, 39%) and implantable ports (2, 5%). Most lines (80%) had double lumens. The most common organisms included: Gram-negative bacilli (15), coagulase negative staphylococci (14), viridans group streptococci (6) Candida spp. (5), Enterococcus faecalis (3) and Staphylococcus aureus (3). Four CLABSIs were polymicrobial. Patients with >2 CLABSIs were more likely to have subsequent infections with the same organism as compared to patients with only 2 CLABSIs (P=0.01). Lines were removed promptly (19, 43%), had delayed removal (removal >72 hours from infection date) (10, 23%) or remained in place (15, 34%). Lines were removed for all episodes of fungemia (5/44) and for most Gram-negative infections (10/12). Six of 7 Escherichia coli CLABSIs were breakthrough fluoroquinolone-resistant infections in patients on levofloxacin. Single Episode and Recurrent CLABSIs at Texas Children’s Hospital for Fiscal Year 2019 Conclusion Recurrent CLABSI accounted for a third of CLABSIs in FY2019. Line mismanagement was not a key contributor to recurrent CLABSI. Breakthrough CLABSIs in patients on levofloxacin prophylaxis need further investigation. For patients with CLABSIs due to Staphylococci decolonization may be considered. Disclosures All Authors: No reported disclosures

scholarly journals Impact of a Rapid Blood Culture Diagnostic Test in a Children's Hospital Depends on Gram-Positive versus Gram-Negative Organism and Day versus Night Shift

2019 ◽  
Vol 58 (4) ◽  
Author(s):  
Lillian J. Juttukonda ◽  
Sophie Katz ◽  
Jessica Gillon ◽  
Jonathon Schmitz ◽  
Ritu Banerjee
Keyword(s):  
Blood Culture ◽  
Night Shift ◽  
Bloodstream Infections ◽  
Negative Resistance ◽  
Gram Positive ◽  
Antibiotic Selection ◽  
Gram Negative ◽  
Content Type ◽  
Children's Hospital ◽  
Children’S Hospital

ABSTRACT Rapid diagnostic tests (RDTs) for bloodstream infections (BSIs) decrease the time to organism identification and resistance detection. RDTs are associated with early deescalation of therapy for Gram-positive BSIs. However, it is less clear how RDTs influence antibiotic management for Gram-negative BSIs and whether RDT results are acted on during off-hours. We performed a single-center, retrospective review of children with BSI and Verigene (VG) testing at a children’s hospital. Of the 301 positive cultures included in the study (196 Gram-positive, 44 Gram-negative, 32 polymicrobial, and 29 non-VG targets), the VG result had potential to impact antibiotic selection in 171 cases; among these, antibiotic changes occurred in 119 (70%) cases. For Gram-negative cultures, the Verigene result correlated with unnecessary antibiotic escalation and exposure to broader-spectrum antibiotics than needed. In contrast, for Gram-positive cultures, the VG results correlated with appropriate antibiotic selection. VG results permitted early deescalation for methicillin-susceptible Staphylococcus aureus (MSSA) (19/24 [79%]) and avoidance of antibiotics for skin contaminants (30/85 [35%]). Antibiotic changes occurred more quickly during the day than at night (4.6 versus 11.7 h, respectively; P < 0.05), and antibiotic escalations occurred more quickly than did deescalations (4.1 versus 10.1 h, P < 0.01). In a pediatric institution with a low prevalence of Gram-negative resistance, the VG RDT facilitated antibiotic optimization for Gram-positive BSIs but led to unnecessary escalation of antibiotics for Gram-negative BSIs. The time to action was slower for RDT results reported at night than during the day. Laboratories should consider these factors when implementing blood culture RDTs.

The epidemiology of central venous catheter-related bloodstream infection in our renal units is changing

2021 ◽  
pp. 112972982199022
Author(s):  
Salvatore Mandolfo ◽  
Adriano Anesi ◽  
Vanina Rognoni
Keyword(s):  
Burkholderia Cepacia ◽  
Present Report ◽  
Statistical Significance ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Renal Unit ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Over Time

Recent reports have shown an increase in the rate of Gram-negative bacteremia in several settings, including catheter-related bloodstream infections (CRBSI). To analyze if the epidemiology of CRBSI is also changing in hemodialysis patients, we revisited the etiology of CRBSIs in our renal unit over 8 years. During the observed periods, 149 episodes of CRBSIs were reported and the CRBSI incidence rate, ranged between 0.67 and 0.82 episodes/1000 tCVC days. Of these 149 episodes, 84 (56.3%) were due to Gram-positive bacteria, 62 (41.6%) to Gram-negative bacteria, and 3 (2.1%) to polymicrobial flora, no episodes of fungi were found. There was a trend, but not statistically significative, increase over time in the number of Gram-negative CRBSIs among the total CRBSIs, rising from 37.8% in the first period to 41.2% in the second period and to 44.3% in the last period, with a parallel decrease in the percentage of Gram-positive CRBSIs (from 59.5% to 56.9% and subsequently to 54.1%). Between Gram-negative, we reported an intensification of CRBSI due to Enterobacterales, particularly Escherichia coli. Among the Gram-negative, we have isolated germs rarely reported in the literature, such as Burkholderia cepacia, Pantoea agglomerans, and Rhizobium radiobacter. Regarding Gram-positive bacteria, a triplicate incidence of Staphylococcus aureus was reported with MRSA accounting for 42% in the third period. Among the Gram-positive bacteria, we reported two episodes of Kocuria kristinae and two of Bacillus spp. Our data demonstrated that the epidemiology of CRBSI in the same center, will change over time and Gram-negative strains are an increasing cause of CRBSI. The limitation of the present report is that statistical significance has not been reached, probably due to the limited number of CRBSI. New bacteria, both Gram-negative and Gram-positive, are emerging. Collaboration with the Microbiology Department appears essential to an appropriate diagnosis.

scholarly journals Bloodstream infections in oncology patients at Red Cross War Memorial Children’s Hospital, Cape Town, from 2012 to 2014

2018 ◽  
Vol 77 ◽  
pp. 40-47 ◽  
Author(s):  
Tisungane Mvalo ◽  
Brian Eley ◽  
Colleen Bamford ◽  
Christopher Stanley ◽  
Maganizo Chagomerana ◽  
...  
Keyword(s):  
Cape Town ◽  
Bloodstream Infections ◽  
Red Cross ◽  
Oncology Patients ◽  
Children's Hospital ◽  
Children’S Hospital

Percutaneously Inserted Polyurethane Central Catheters in the NICU: One Unit’s Experience

1999 ◽  
Vol 18 (6) ◽  
pp. 37-46 ◽  
Author(s):  
Martha Evans ◽  
Donna Lentsch
Keyword(s):  
Success Rates ◽  
Children's Hospital ◽  
Patient Demographics ◽  
Line Placement ◽  
Children’S Hospital ◽  
Central Catheters

This article describes the authors’ experiences with using polyurethane percutaneously inserted central catheters from June 1993, when these catheters were introduced in the NICU at Children’s Hospital, Omaha, Nebraska, through September 1997. Indications for line placement and anatomy are reviewed. Patient demographics, success rates, and complications are analyzed. Line cares, including dressing changes, management of infusions, and troubleshooting, are also discussed.

Application of Early Warning Nursing System During COVID-19 Epidemic in Children’s Hospital

Nano LIFE ◽  
2021 ◽  
pp. 2140004
Author(s):  
Wenying Yao ◽  
Jinxia Yang ◽  
Xin Wang ◽  
Min Shen
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Warning System ◽  
Popular Science ◽  
The Novel ◽  
Children's Hospital ◽  
Hospital Nursing ◽  
Children’S Hospital ◽  
Novel Coronavirus ◽  
And Control

Aim: To develop a nursing early warning system in children’s hospital during the outbreak of the novel coronavirus pneumonia, and to accomplish the construction and application of this system, so as to provide decision-support of the prevention and control for COVID-19 in children’s medical institutions. Method: Children’s hospital nursing early warning system was divided into three modules: hospital nursing early warning platform includes internal and external early warning platform, nursing staff early warning program includes protection, human resources early warning plan and patient early warning program includes outpatient, emergency and ward early warning plan. The data of epidemic training, assessment, prevention and control screening from January to June 2020 were collected from the nursing early warning system to evaluate the application effect of the system. Results: A total of 18 procedures and specifications were formulated, nine hospital-level trainings and about 1000 department-level trainings were organized, two hospital-level assessments (pass rate 95.6% and 98.2%), and 78 nurses were reserved, and 10 popular science articles, five popular science videos were published during the application of the nursing early warning system. A total of 583,435 children and 139,308 caregivers were screened in outpatient, emergency and wards during pre-checks, 2385 suspected cases of novel coronavirus pneumonia were confirmed (0.41%) after the screening and 1 case (0.0002%) was finally confirmed. Conclusion: The nursing early warning system of children’s hospital can prevent and control the novel coronavirus pneumonia epidemic from each module, ensure early warning and triage of suspected infected patients, reduce the risk of cross-infection in hospital and improve the safety of the children’s hospital medical environment.

scholarly journals 2454. A Cluster of Gram-Negative Bloodstream Infections in Connecticut Hemodialysis Patients Associated with Contaminated Wall Boxes and Priming Buckets

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S848-S849
Author(s):  
Lauren Backman ◽  
Diane G Dumigan ◽  
Adora Harizaj ◽  
Marylee Oleksiw ◽  
Evelyn Carusillo ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Case Control Study ◽  
Urine Culture ◽  
Bloodstream Infections ◽  
Case Control ◽  
Gram Negative ◽  
Increased Risk ◽  
Spent Dialysate ◽  
Culture Positive ◽  
Control Study

Abstract Background Patients requiring maintenance hemodialysis (HD) are at increased risk of bloodstream infections. We investigated a cluster of infections due to unusual Gram-negative bacilli that affected patients undergoing HD at an outpatient unit with 19 stations (Clinic A). Methods A case was defined as a HD patient at Clinic A with >1 blood or urine culture positive for Delftia acidovorans, Enterobacter absuriae, or Burkholderia cepacia during the period February 1 – April 30, 2018. An investigation included review of patient records, facility policies, practice observation, environmental cultures, and a 1:4 case–control study. Controls were patients without bloodstream infection (BSI) during the outbreak period. Results The cluster included 3 patients. Patient 1 had BSI due to D. acidovorans (2/08), E. absuriae (3/15) and B. cepacia (3/17). Patient 2 had BSI due to D. acidovorans (3/17 and 3/27) and S. maltophilia (4/5). Patient 3 had a urine culture positive for D. acidovorans and S. maltophilia (4/2). The case–control study showed that cases had been dialyzed more often than controls on the third shift (P < 0.0001) and at station 2 (P < 0.0001), where subsequently a wall box spent dialysate drain connection swab culture yielded D. acidovorans. E. absuriae was recovered from wall boxes and spent dialysate drain connection at two stations and from used prime buckets from two stations; one wall box culture grew S. maltophilia. D. acidovorans and E. absuriae patient isolates were not available for genomic analysis. Observations revealed that waste water was leaking onto the floor from several wall boxes, and that priming buckets were often rinsed with tap water after being disinfected with 1:100 bleach solution and not allowed to dry before reuse. Multiple deficiencies in hand hygiene and station disinfection were observed. No deficiencies in water treatment practices were identified. Multiple water cultures obtained in August were negative for the observed pathogens. Conclusion A cluster of unusual Gram-negative infections in outpatient HD patients was most likely due to exposures to contaminated wall boxes or priming buckets; poor hand hygiene and station disinfection can contribute to transmission to patients. Disclosures All authors: No reported disclosures.

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