1694. Predictors of Septic Shock in Adult Patients with Candidemia: A Single-Center Experience Over 13 Years

Abstract Background Although the incidence of candidemia has been increased recently, factors associated with septic shock in adult patients with candidemia have not been well defined. We performed a study to identify septic shock risk factors. Methods This retrospective study was conducted among adult patients ≥19 years of age with candidemia who were diagnosed from 2006 to 2018 at a single tertiary care medical center. Clinical data were collected. Patients were excluded if they were noted to have concomitant bacteremia or to have received antifungal treatment <5 days. Results After application of the exclusion criteria, 46 patients (25.1%) were classified as having septic shock presentation out of 183 patients. Between the septic shock and non-septic shock patients, there were no differences regarding comorbidities. Variables associated with septic shock in the univariate analysis were non-remission of candidemia [23/46 (67.6%) vs. 100/137 (83.3%) P = 0.044], central venous catheter [41/46 (89.1%) vs. 98/137 (67.9) P = 0.005], hemodialysis [12/46 (26.1%) vs. 15/137 (10.9%) P = 0.012], neutropenia [10/46 (21.7%) vs. 14/137 (10.2%) P = 0.045], and previous hospitalization to the intensive care unit (ICU) [24/46 (52.2%) vs. 47/137 (34.3%) P = 0.031]. The group of other Candida species consisting of [C. guilliermondii, C. haemulonii, C. famata, C. lusitaniae, and unknown] was more common in the septic shock patients (10.9%) than in the non-septic shock patients (1.5%), P = 0.004. The mortality of patients with septic shock was significantly higher than that of patients without septic shock [37/46 (80.4%) vs. 59/137 (43.1%) P < 0.001]. Multivariate analysis showed central venous catheter (odds ratio [OR] 4.00, 95% confidence interval [CI] 1.12 – 14.30, P = 0.033) and abnormal aspartate aminotransferase [AST] (OR 2.76, 95% CI 1.06 – 7.16, P = 0.024) were significantly associated with septic shock. Presence of other Candida species (OR 6.78, 95% CI 0.87 – 53.03, P = 0.068) showed borderline significance. Conclusion Our findings suggest that venous catheter and abnormal AST were significant factors associated with septic shock in adult patients with candidemia. Also, candidemia caused by other Candida species may need to be monitored closely for the development of septic shock presentation. Disclosures All authors: No reported disclosures.

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Patient- and Device-Specific Risk Factors for Peripherally Inserted Central Venous Catheter—Related Bloodstream Infections

Infection Control and Hospital Epidemiology ◽

10.1086/669083 ◽

2013 ◽

Vol 34 (2) ◽

pp. 184-189 ◽

Cited By ~ 24

Author(s):

Makhawadee Pongruangporn ◽

M. Cristina Ajenjo ◽

Anthony J. Russo ◽

Kathleen M. McMullen ◽

Catherine Robinson ◽

...

Keyword(s):

Risk Factors ◽

Central Venous Catheter ◽

Tertiary Care ◽

Bloodstream Infections ◽

Venous Catheter ◽

Adult Patients ◽

Chronic Obstructive ◽

Central Venous ◽

Obstructive Pulmonary Disease ◽

Specific Risk

Objective.To determine the patient- and device-specific risk factors for hospital-acquired peripherally inserted central venous catheter–related bloodstream infections (PICC BSIs) in adult patients.Design.Nested case-control study.Setting.Barnes-Jewish Hospital, a 1,252-bed tertiary care teaching hospital.Patients.Adult patients with PICCs placed from January 1, 2006, through July 31, 2008.Methods.PICC BSI cases were identified using the National Healthcare Safety Network definition. Uninfected control patients with PICCs in place were randomly selected at a 3: 1 ratio. Patient- and device-related variables were examined using multivariate analysis.Results.The overall PICC BSI rate was 3.13 per 1,000 catheter-days. Independent risk factors for PICC BSIs included congestive heart failure (odds ratio [OR], 2.0 [95% confidence interval (CI), 1.26–3.17];P= .003), intra-abdominal perforation (OR, 5.66 [95% CI, 1.76–18.19];P= .004),Clostidium difficileinfection (OR, 2.25 [95% CI, 1.17–4.33];P= .02), recent chemotherapy (OR, 3.36 [95% CI, 1.15–9.78];P= .03), presence of tracheostomy (OR, 5.88 [95% CI, 2.99–11.55];P< .001), and type of catheter (OR for double lumen, 1.89 [95% CI, 1.15–3.10];P= .01; OR for triple lumen, 2.87 [95% CI, 1.39–5.92];P= .004). Underlying chronic obstructive pulmonary disease (OR, 0.48 [95% CI, 0.29–0.78];P= .03) and admission to surgical (OR, 0.43 [95% CI, 0.24–0.79];P= .006) or oncology and orthopedic (OR, 0.35 [95% CI, 0.13–0.99];P= .05) services were less likely to be associated with having a PICC BSI.Conclusions.We identified several novel factors related to PICC BSIs. These factors may inform preventive measures.

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Predominance of Candida Glabrata among Non-albicans Candida Species in a 16-Year Study of Candidemia at a Tertiary Care Center in Lebanon

Pathogens ◽

10.3390/pathogens10010082 ◽

2021 ◽

Vol 10 (1) ◽

pp. 82

Author(s):

Aline El Zakhem ◽

Rachid Istambouli ◽

Maria Alkozah ◽

Amal Gharamti ◽

Mohamad Ali Tfaily ◽

...

Keyword(s):

Central Venous Catheter ◽

High Mortality ◽

Candida Species ◽

Care Center ◽

Antifungal Susceptibility ◽

Tertiary Care ◽

Venous Catheter ◽

Arab Countries ◽

Tertiary Care Center ◽

Central Venous

Background: Candidemia is associated with a high mortality rate, and its incidence is increasing worldwide with a rise in non-albicans candidemia (NAC). Epidemiologic data from Arab countries are scarce and there are no data from Lebanon; Methods: This is a single-center retrospective chart review of patients with candidemia in a tertiary care center in Lebanon from 2004 to 2019. We extracted data on patient characteristics, isolated Candida species antifungal susceptibility, management and outcomes; Results: We included 170 cases of candidemia. NAC was more common than albicans candidemia (64.7% vs. 35.3%). C. glabrata was the most common non-albicans species (37 isolates) followed by C. tropicalis (14). Recent use of antifungals was a risk factor for NAC (OR = 2.8, p = 0.01), while the presence of a central venous catheter was protective (OR = 0.41, p = 0.02). Fluconazole resistance was 12.5% in C. albicans and 21.5% in non-albicans spp. Mortality at 30 days was 55.5%, with no difference between NAC and albicans candidemia. It was higher in older and critically ill patients but lower in patients whose central venous catheter was removed after detecting fungemia; Conclusions: Candidemia is associated with high mortality in Lebanon, with a predominance of NAC and high prevalence of C. glabrata.

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Central venous catheter-related blood stream infection rate in critical care units in a tertiary care, teaching hospital in Mumbai

Indian Journal of Medical Microbiology ◽

10.4103/0255-0857.81796 ◽

2011 ◽

Vol 29 (2) ◽

pp. 169 ◽

Cited By ~ 7

Author(s):

C Chande ◽

S Chavan ◽

P Veer ◽

V Wabale ◽

K Vishwakarma ◽

...

Keyword(s):

Critical Care ◽

Central Venous Catheter ◽

Infection Rate ◽

Teaching Hospital ◽

Blood Stream Infection ◽

Tertiary Care ◽

Venous Catheter ◽

Blood Stream ◽

Central Venous ◽

Critical Care Units

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Utilization Patterns and Outcomes Associated With Central Venous Catheter in Septic Shock

Critical Care Medicine ◽

10.1097/ccm.0b013e31827caa89 ◽

2013 ◽

Vol 41 (6) ◽

pp. 1450-1457 ◽

Cited By ~ 59

Author(s):

Allan J. Walkey ◽

Renda Soylemez Wiener ◽

Peter K. Lindenauer

Keyword(s):

Septic Shock ◽

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous ◽

Utilization Patterns

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Temporary Central Venous Catheter Utilization Patterns in a Large Tertiary Care Center Tracking the “Idle Central Venous Catheter”

Infection Control and Hospital Epidemiology ◽

10.1086/663645 ◽

2012 ◽

Vol 33 (1) ◽

pp. 50-57 ◽

Cited By ~ 44

Author(s):

Sheri Chernetsky Tejedor ◽

David Tong ◽

Jason Stein ◽

Christina Payne ◽

Daniel Dressler ◽

...

Keyword(s):

Central Venous Catheter ◽

Observational Study ◽

Dwell Time ◽

Antimicrobial Agents ◽

Tertiary Care ◽

Care Facility ◽

Venous Catheter ◽

Retrospective Observational Study ◽

Central Venous ◽

Tertiary Care Facility

Objectives.Although central venous catheter (CVC) dwell time is a major risk factor for catheter-related bloodstream infections (CR-BSIs), few studies reveal how often CVCs are retained when not needed (“idle”). We describe use patterns for temporary CVCs, including peripherally inserted central catheters (PICCs), on non-ICU wards.Design.A retrospective observational study.Setting.A 579-bed acute care, academic tertiary care facility.Methods.A retrospective observational study of a random sample of patients on hospital wards who have a temporary, nonimplanted CVC, with a focus on on daily ward CVC justification. A uniform definition of idle CVC-days was used.Results.We analyzed 89 patients with 146 CVCs (56% of which were PICCs); of 1,433 ward CVC-days, 361 (25.2%) were idle. At least 1 idle day was observed for 63% of patients. Patients had a mean of 4.1 idle days and a mean of 3.4 days with both a CVC and a peripheral intravenous catheter (PIV). After adjusting for ward length of stay, mean CVC dwell time was 14.4 days for patients with PICCs versus 9.0 days for patients with non-PICC temporary CVCs (other CVCs; P< .001). Patients with a PICC had 5.4 days in which they also had a PIV, compared with 10 days in other CVC patients (P< .001). Patients with PICCs had more days in which the only justification for the CVC was intravenous administration of antimicrobial agents (8.5 vs 1.6 days; P = .0013).Conclusions.Significant proportions of ward CVC-days were unjustified. Reducing “idle CVC-days” and facilitating the appropriate use of PIVs may reduce CVC-days and CR-BSI risk.Infect Control Hosp Epidemiol 2012;33(1):50-57

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Use of Maximal Sterile Barrier Precautions and/or Antimicrobial-Coated Catheters to Reduce the Risk of Central Venous Catheter-Related Bloodstream Infection

Infection Control and Hospital Epidemiology ◽

10.1086/590356 ◽

2008 ◽

Vol 29 (10) ◽

pp. 947-950 ◽

Cited By ~ 25

Author(s):

Duk-hee Lee ◽

Koo Young Jung ◽

Yoon-Hee Choi

Keyword(s):

Multivariate Analysis ◽

Mortality Rate ◽

Central Venous Catheter ◽

Confidence Interval ◽

Bloodstream Infection ◽

Odds Ratio ◽

Venous Catheter ◽

Central Venous ◽

Factors Associated ◽

Catheter Related Bloodstream Infection

Central venous catheter-related bloodstream infection is clinically important because of its high mortality rate. This prospective study shows by multivariate analysis that the use of maximal sterile barrier precautions (odds ratio, 5.205 [95% confidence interval, 0.015-1.136]; P= .023) and the use of antimicrobial-coated catheters (odds ratio, 5.269 [95% confidence interval, 0.073-0.814]; P = .022) are independent factors associated with a lowered risk of acquiring a central venous catheter-related bloodstream infection.

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Prevalence, causative microorganisms, and risk factors of central venous catheter-related infections in a tertiary care hospital

Abant Medical Journal ◽

10.5505/abantmedj.2016.80388 ◽

2016 ◽

Vol 5 (2) ◽

pp. 108-117

Author(s):

Ismail Necati Hakyemez ◽

Mustafa Taner Yıldırmak ◽

Gül Çetmeli ◽

Nur Efe Iris

Keyword(s):

Risk Factors ◽

Central Venous Catheter ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Venous Catheter ◽

Care Hospital ◽

Central Venous

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Staphylococcus Aureus Bacteremia Due to Central Venous Catheter Infection: A Clinical Comparison of Infections Caused by Methicillin-Resistant and Methicillin-Susceptible Strains

10.21203/rs.3.rs-127180/v1 ◽

2021 ◽

Author(s):

Kazuhiro Ishikawa ◽

Keichi Furukawa ◽

Eri Hoshino

Keyword(s):

Staphylococcus Aureus ◽

Septic Shock ◽

Mortality Rate ◽

Central Venous Catheter ◽

Antimicrobial Therapy ◽

Time Lag ◽

Venous Catheter ◽

Mortality Rates ◽

Background Characteristics ◽

Central Venous

Abstract Background: Staphylococcus aureus (S.aureus) bacteremia has a mortality rate ranging from 20-40%. Central venous catheter (CVC) infection is the leading cause of S.aureus bacteremia. We investigated the differences in background characteristics, complications, and prognosis between patients with methicillin resistant S.aureus (MRSA) and methicillin sensitive S.aureus (MSSA) bacteremia due to CVC infection.Methods: We retrospectively investigated patients who had positive peripheral blood cultures versus positive semi-quantitative cultures for MRSA or MSSA from the CVC tip. We compared the clinical background characteristics, complications, and 60-day mortality rates between both groups. We analyzed our data using Mann-Whitney U test, chi-square test, and Fisher’s exact test.Results: This study had 17 (47%) and 19 (53%) MRSA and MSSA bacteremia patients, respectively. The median ages for MRSA and MSSA patients were 72 ± 27 and 55 ± 33 years, respectively (P<0.01). Comparison between baseline disease occurrence (MRSA vs. MSSA) was 10(59%) patients vs. 3(16%) patients (P=0.01), while complications included septic shock were 8(48%) vs. 3(16%) (P=0.07), respectively. The duration of catheter placement, time lag from onset of fever to CVC removal, and time lag from onset of fever to starting antimicrobial therapy were similar in both groups. Sixty-day mortality rates were 35%(6/17) vs. 5.3%(1/19), (P=0.04), in MRSA vs. MSSA groups, respectively. Conclusions: MRSA carriers and older patients were at a higher risk of MRSA CVC infection compared to MSSA bacteremia patients. MRSA bacteremia patients showed relatively higher rate of septic shock, and had significantly higher 60-day mortality rate despite appropriate antimicrobial therapy.

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