Mycobacterium neoaurum Bloodstream Infection Associated with a Totally Implanted Subclavian Port in an Adult with Diabetes and History of Colon Cancer

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.

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Prevention of Infection in Adults Receiving Intravenous Antibiotic Treatment via Indwelling Central Venous Access Devices

Reviews on Recent Clinical Trials ◽

10.2174/1574887113666180817125036 ◽

2019 ◽

Vol 14 (1) ◽

pp. 47-49

Author(s):

Basant K. Puri ◽

Anne Derham ◽

Jean A. Monro

Keyword(s):

Bloodstream Infection ◽

Antibiotic Treatment ◽

Central Venous Access ◽

Case Series ◽

Bloodstream Infections ◽

Venous Access ◽

Host Cells ◽

Central Venous ◽

Intravenous Antibiotic ◽

Venous Access Devices

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.

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Is diabetes a risk factor for central venous access port-related bloodstream infection in oncological patients?

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-012-1728-1 ◽

2012 ◽

Vol 32 (1) ◽

pp. 133-138 ◽

Cited By ~ 5

Author(s):

A. Touré ◽

P. Vanhems ◽

C. Lombard-Bohas ◽

J.-C. Souquet ◽

M. Lauverjat ◽

...

Keyword(s):

Risk Factor ◽

Bloodstream Infection ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Access Port ◽

Oncological Patients ◽

Venous Access Port

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Increased Catheter-Related Bloodstream Infection Rates After the Introduction of a New Mechanical Valve Intravenous Access Port

Infection Control and Hospital Epidemiology ◽

10.1086/499166 ◽

2006 ◽

Vol 27 (1) ◽

pp. 67-70 ◽

Cited By ~ 97

Author(s):

Lisa L. Maragakis ◽

Karen L. Bradley ◽

Xiaoyan Song ◽

Claire Beers ◽

Marlene R. Miller ◽

...

Keyword(s):

Bloodstream Infection ◽

Bloodstream Infections ◽

Mechanical Valve ◽

Positive Pressure ◽

Infection Rates ◽

Intravenous Catheter ◽

Access Port ◽

Intravenous Access ◽

Mechanical Valves ◽

Catheter Related Bloodstream Infection

The technology of intravenous catheter access ports has evolved from open ports covered by removable caps to more-sophisticated, closed versions containing mechanical valves. We report a significant increase in catheter-related bloodstream infections after the introduction of a new needle-free positive-pressure mechanical valve intravenous access port at our institution.

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.327 ◽

2017 ◽

Vol 38 (4) ◽

pp. 444-448 ◽

Cited By ~ 4

Author(s):

Yin-Yin Chen ◽

Wan-Tsuei Huang ◽

Chia-Ping Chen ◽

Shu-Mei Sun ◽

Fu-Mei Kuo ◽

...

Keyword(s):

Bloodstream Infection ◽

Normal Saline ◽

Saline Solution ◽

Medical Center ◽

Bloodstream Infections ◽

Venous Access ◽

Ralstonia Pickettii ◽

Control And Prevention ◽

Saline Solutions ◽

Hospital Wards

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

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Complications of Implantable Venous Access Devices In Patients with Sickle Cell Disease

Blood ◽

10.1182/blood.v116.21.1649.1649 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1649-1649

Author(s):

Nirmish Shah ◽

Daniel Landi ◽

Radhika Shah ◽

Jennifer Rothman ◽

Courtney Thornburg

Keyword(s):

Sickle Cell Disease ◽

Bloodstream Infection ◽

Sickle Cell ◽

Pediatric Patients ◽

Conflicts Of Interest ◽

Bloodstream Infections ◽

Venous Access ◽

Categorical Variables ◽

Cell Disease ◽

Venous Access Devices

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.

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The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-309731 ◽

2016 ◽

Vol 101 (10) ◽

pp. 886-893 ◽

Cited By ~ 27

Author(s):

Kate A Hodgson ◽

Julie Huynh ◽

Laila F Ibrahim ◽

Bronwyn Sacks ◽

Daniel Golshevsky ◽

...

Keyword(s):

Adverse Events ◽

Antimicrobial Therapy ◽

Readmission Rate ◽

Bloodstream Infections ◽

Antibiotic Use ◽

Venous Access ◽

Central Line ◽

Unplanned Readmission ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Inappropriate Choice

ObjectiveOutpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children.DesignThis was a 12-month prospective observational study.SettingThe hospital-in-the-home programme of The Royal Children's Hospital Melbourne.PatientsAll patients receiving OPAT.InterventionsData were collected including demographics, diagnosis, type of venous access and antibiotic choice.Main outcome measuresLength of stay, adverse events, readmission rate and appropriateness of antibiotic use.Results228 patients received OPAT in 251 episodes. The median age was 7.4 years (range 1 week to 21 years), with 22 patients (10%) under 1 year. The most frequent diagnoses were exacerbation of cystic fibrosis (17%), urinary tract infection (12%) and cellulitis (9%). Most patients were transferred from the ward, but 18% were transferred directly from the emergency department, the majority with skin and soft-tissue infection (66%). Venous access was most commonly peripherally inserted central catheter (29%) and peripheral cannula (29%). 309 parenteral antibiotics were prescribed, most frequently ceftriaxone (28%) and gentamicin (19%). The majority of antibiotics (72%) were prescribed appropriately. However, 6% were deemed an inappropriate choice for the indication and 26% had inappropriate dose or duration. The incidence of central line-associated bloodstream infections was 0.9%. The unplanned readmission rate was 4%, with low rates of OPAT-related adverse events. Three children (1%) had an inadequate clinical response.ConclusionsOPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made.

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Central line bundle for prevention of central line–associated bloodstream infection for totally implantable venous access devices (ports) in pediatric cancer patients

The Journal of Vascular Access ◽

10.1177/1129729818757955 ◽

2018 ◽

Vol 19 (4) ◽

pp. 358-365 ◽

Cited By ~ 9

Author(s):

İlker Devrim ◽

Yeliz Oruç ◽

Bengü Demirağ ◽

Ahu Kara ◽

Mine Düzgöl ◽

...

Keyword(s):

Line Bundle ◽

Bloodstream Infection ◽

Removal Rate ◽

Bloodstream Infections ◽

Venous Access ◽

Central Line ◽

Pediatric Cancer Patients ◽

Single Use ◽

Venous Access Devices ◽

Central Line Bundle

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.

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Corynebacterium CDC group G native and prosthetic valve endocarditis

Infectious Disease Reports ◽

10.4081/idr.2015.5881 ◽

2015 ◽

Vol 7 (3) ◽

Author(s):

Adil Sattar ◽

Siegfried Yu ◽

Janak Koirala

Keyword(s):

Mitral Valve ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Mitral Valve Regurgitation ◽

Venous Access ◽

High Grade Fever ◽

Access Port ◽

First Case ◽

Life Threatening ◽

History Of

We report the first case of native and recurrent prosthetic valve endocarditis with <em>Corynebacterium</em> CDC group G, a rarely reported cause of infective endocarditis (IE). Previously, there have been only two cases reported for prosthetic valve IE caused by these organisms. A 69-year-old female with a known history of mitral valve regurgitation presented with a 3-day history of high-grade fever, pleuritic chest pain and cough. Echocardiography confirmed findings of mitral valve thickening consistent with endocarditis, which subsequently progressed to become large and mobile vegetations. Both sets of blood cultures taken on admission were positive for <em>Corynebacterium</em> CDC group G. Despite removal of a long-term venous access port, the patient’s presumed source of line associated bacteremia, mitral valve replacement, and aggressive antibiotic therapy, the patient had recurrence of vegetations on the prosthetic valve. She underwent replacement of her prosthetic mitral valve in the subsequent 2 weeks, before she progressed to disseminated intravascular coagulation and expired. Although they are typically considered contaminants, corynebacteria, in the appropriate clinical setting, should be recognized, identified, and treated as potentially life-threatening infections, particularly in the case of line-associated bacteremias, and native and prosthetic valve endocarditis.

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