scholarly journals Catheter-Associated Bloodstream Infections in General Medical Patients Outside the Intensive Care Unit: A Surveillance Study

2007 ◽  
Vol 28 (8) ◽  
pp. 905-909 ◽  
Author(s):  
Jonas Marschall ◽  
Carole Leone ◽  
Marilyn Jones ◽  
Deborah Nihill ◽  
Victoria J. Fraser ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
The United States ◽  
Medical Patients ◽  
Coagulase Negative Staphylococci ◽  
Saint Louis ◽  
Medical Icus ◽  
Medical Wards

Objective.To determine the incidence of central venous catheter (CVC)-associated bloodstream infection (CA-BSI) among patients admitted to general medical wards outside the intensive care unit (ICU).Design.Prospective cohort study performed over a 13-month period, from April 1, 2002, through April 30, 2003.Setting.Four selected general medical wards at Barnes-Jewish Hospital, a 1,250-bed teaching hospital in Saint Louis, Missouri.Patients.All patients admitted to 4 general medical wards.Results.A total of 7,337 catheter-days were observed during 33,174 patient-days. The device utilization ratio (defined as the number of catheter-days divided by the number of patient-days) was 0.22 overall and was similar among the 4 wards (0.21, 0.25, 0.19, and 0.24). Forty-two episodes of CA-BSI were identified (rate, 5.7 infections per 1,000 catheter-days). Twenty-four (57%) of the 42 cases of CA-BSI were caused by gram-positive bacteria: 10 isolates (24%) were coagulase-negative staphylococci, 10 (24%) were Enterococcus species, and 3 (7%) were Staphylococcus aureus. Gram-negative bacteria caused 7 infections (17%). Five CA-BSIs (12%) were caused by Candida albicans, and 5 infections (12%) had a polymicrobial etiology. Thirty-five patients (83%) with CA-BSI had nontunneled CVCs in place.Conclusions.Non-ICU medical wards in the study hospital had device utilization rates that were considerably lower than those of medical ICUs, but CA-BSI rates were similar to CA-BSI rates in medical ICUs in the United States. Studies of catheter utilization and on CVC insertion and care should be performed on medical wards. CA-BSI prevention strategies that have been used in ICUs should be studied on medical wards.

scholarly journals Staphylococcus pettenkoferi Bacteremia in an American Intensive Care Unit

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Cameron Strong ◽  
Michael Cosiano ◽  
Melanie Cabezas ◽  
J. W. Barwatt ◽  
L. Gayani Tillekeratne
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Reports ◽  
Bloodstream Infections ◽  
Signs And Symptoms ◽  
The United States ◽  
Coagulase Negative Staphylococci ◽  
Prosthetic Devices ◽  
Increased Risk ◽  
Clinically Significant

Coagulase-negative staphylococci (CoNS) are considered the most common cause of nosocomial bloodstream infections; yet, these species are frequently designated as contaminants in the absence of systemic signs and symptoms of infection. Immunocompromised patients or those with prosthetic devices are at increased risk for clinically significant bacteremia. With the advent of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) in clinical practice, there has been improved specificity of CoNS isolate identification and further elucidation of underrecognized pathogenic species. Staphylococcus pettenkoferi was a novel CoNS species first identified in 2002 and thought to be misdiagnosed as other CoNS due to limitations in biochemical identification. There is increasing identification of S. pettenkoferi isolates; however, there are limited case reports of clinically significant S. pettenkoferi bacteremia and no reported cases within the United States. We present the first known case of S. pettenkoferi from an American intensive care unit.

Surveillance of Nosocomial Infections in a Neurologic Intensive Care Unit

2005 ◽  
Vol 26 (8) ◽  
pp. 726-731 ◽  
Author(s):  
Dirk Zolldann ◽  
Christoph Spitzer ◽  
Helga Häfner ◽  
Birgit Waitschies ◽  
Wolfgang Klein ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Incidence Density ◽  
Targeted Prevention ◽  
Intensive Care Patients ◽  
Medical Icus ◽  
Tract Infections ◽  
Neurologic Intensive Care Unit

AbstractObjective:To assess data on the epidemiology of nosocomial infection (N1) among neurologic intensive care patients.Design:Prospective periodic surveillance study.Setting:An 8-bed neurologic intensive care unit (ICU).Patients:All those admitted for more than 24 hours during five 3-month periods between January 1999 and March 2003.Methods:Standardized surveillance within the German infection surveillance system.Results:Three hundred thirty-eight patients with a total of 2,867 patient-days and a mean length of stay of 8.5 days were enrolled during the 15-month study period. A total of 71 NIs were identified among 52 patients. Urinary tract infections (UTIs) were the most frequent N1 (36.6%), followed by pneumonia (29.6%) and bloodstream infections (BSIs) (15.5%). The overall incidence and incidence density of NIs were 21.0 per 100 patients and 24.8 per 1,000 patient-days, respectively. Incidence densities were 9.8 UTIs per 1,000 urinary catheter-days (CI95, 6.4-14.4), 5.6 BSIs per 1,000 central venous catheter-days (CI95, 2.8-10.0), and 12.8 cases of pneumonia per 1,000 ventilation-days (CI95, 8.0-19.7). Device-associated UTI and pneumonia rates were in the upper range of national and international reference data for medical ICUs, despite the intensive infection control and prevention program in operation in the hospital.Conclusion:Neurologic intensive care patients have relatively high rates of device-associated nosocomial pneumonia and UTI. For a valid comparison of surveillance data and implementation of targeted prevention strategies, we would strongly recommend provision of national benchmarks for the neurologic ICU setting.

scholarly journals Central venous catheter-related bloodstream infections in the intensive care unit

2011 ◽  
Vol 15 (4) ◽  
pp. 213-223 ◽  
Author(s):  
Virendra C. Patil ◽  
Harsha V. Patil ◽  
M. N. Ramteerthkar ◽  
R. D. Kulkarni
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous

Central venous catheter bloodstream infections in the neonatal intensive care unit

1998 ◽  
Vol 33 (9) ◽  
pp. 1383-1387 ◽  
Author(s):  
Mary E. Fallat ◽  
Robert N. Gallinaro ◽  
Beth H. Stover ◽  
Shirley Wilkerson ◽  
L. Jane Goldsmith
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous

scholarly journals Delay of Active Antimicrobial Therapy and Mortality among Patients with Bacteremia: Impact of Severe Neutropenia

2008 ◽  
Vol 52 (9) ◽  
pp. 3188-3194 ◽  
Author(s):  
Michael Y. Lin ◽  
Robert A. Weinstein ◽  
Bala Hota
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Antimicrobial Therapy ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
The United States ◽  
Severe Neutropenia ◽  
Urban Hospital ◽  
The Impact

ABSTRACT Increasing bacterial antimicrobial resistance has prompted physicians to choose broad-spectrum antimicrobials in order to reduce the likelihood of inactive empirical therapy. However, for bacteremic patients already receiving supportive care, it is unclear whether delay of active antimicrobial therapy significantly impacts patient outcomes. We performed a retrospective cohort study of patients with monomicrobial bloodstream infections at a large urban hospital in the United States from 2001 to 2006. We assessed the impact of delay of active antimicrobial therapy on mortality by using multivariable logistic regression modeling with and without propensity score methodology. We evaluated 1,523 episodes of monomicrobial bacterial bloodstream infections at our institution. Nine hundred eighty-three bacteremic episodes (64.5%) were treated with an active antimicrobial agent within 24 h of the index blood culture; the remaining 540 episodes (35.5%) were considered to have delay of active antimicrobial therapy. In adjusted analysis, among patients in the non-intensive-care-unit setting with an absolute neutrophil count (ANC) of <100 cells/μl, delay was associated with increased mortality (odds ratio [OR], 18.0; 95% confidence interval [CI], 2.84 to 114.5; P < 0.01); among intensive-care-unit patients with an ANC of <100 cells/μl, the effect of delay on mortality was nearly significant (OR, 5.56; 95% CI, 0.85 to 36.3; P = 0.07). However, for patients who were nonneutropenic (ANC, >500 cells/μl) or had ANCs of 100 to 500 cells/μl, delay was not associated with increased mortality. While the delay of active antimicrobial therapy was not significantly associated with higher mortality for most patients in this cohort, patients with severe neutropenia appeared to be vulnerable.

Use of a 1-Piece Chlorhexidine Gluconate Transparent Dressing on Critically Ill Patients

2012 ◽  
Vol 32 (4) ◽  
pp. 35-40 ◽  
Author(s):  
Barbara Pfaff ◽  
Teresa Heithaus ◽  
Madeline Emanuelsen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cost Savings ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Chlorhexidine Gluconate ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Healthcare Improvement ◽  
Low Rate

Background New transparent dressings with chlorhexidine gluconate in the dressing are available. Objectives To compare the effectiveness of a new 1-piece occlusive dressing that incorporates chlorhexidine gluconate with that of a dressing plus a chlorhexidine gluconate patch in maintaining the low rate of catheter-related bloodstream infections in the intensive care unit and to evaluate nurses’ satisfaction with and cost of the new dressing. Methods A quality improvement observational study was done in an adult medical-surgical intensive care unit. All patients with a central venous catheter had initial and/or subsequent dressing changes done with the new dressing. The central catheter bundle elements of the Institute for Healthcare Improvement were followed. Patients were monitored for catheter-related bloodstream infections, and the rate of infection was calculated. Results During the study period of 1881 device days, the infection rate was 0.051 per 1000 device days, compared with a rate of 0.052 in 2008. Nurses preferred the new dressing. Cost savings were $3807. Conclusion A low rate of catheter-related bloodstream infections can be maintained, nurses’ satisfaction achieved, and cost savings realized with the new dressing.

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