Exit-Site Location Does Not Influence Peritoneal Catheter Infection Rate

1989 ◽  
Vol 9 (2) ◽  
pp. 127-129 ◽  
Author(s):  
Beth Piraino ◽  
Judith Bernardini ◽  
James R. Johnston ◽  
Michael I. Sorkin
Keyword(s):  
Risk Factors ◽  
Infection Rate ◽  
Important Determinant ◽  
Patient Comfort ◽  
Infection Rates ◽  
Site Location ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Catheter Infection ◽  
Catheter Infections

Peritoneal catheter infections are a cause of peritonitis, catheter loss, and permanent transfer of continuous ambulatory peritoneal dialysis (CAPO) patients to hemodialysis. Risk factors for catheter infections have not been delineated. We investigated the location of the peritoneal exit-site location as a risk factor for catheter infection and loss. There was no relationship between catheter infection rates and exit location. Catheters exiting on the beltline had a median infection rate of 0.5 episodesl year, as opposed to 1.2 episodes/year for catheters exiting above the beltline and 0.9 episodes/ year for catheters exiting below the beltline (ns). The percentage of catheters that became infected and required removal was the same for catheters exiting above, below, or on the beltline. Although we recommend avoiding the beltline for patient comfort, exit-site location is not an important determinant of infection rates or catheter outcome.

P1350A COMPARISON OF CENTRAL VENOUS CATHETER INFECTIONS FOR HEMODIALYSIS AND HEMATOLOGY PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ahmet Murt ◽  
Mevlut Tamer Dincer ◽  
Abdulkadir Ercaliskan ◽  
Cebrail Karaca ◽  
Tugrul Elverdi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bloodstream Infections ◽  
Hemodialysis Patients ◽  
Infection Risk ◽  
Infection Rates ◽  
Exit Site ◽  
Central Venous ◽  
Gram Positive ◽  
Delayed Complications ◽  
Catheter Infections

Abstract Background and Aims In addition to nephrologists who use central venous catheters (CVCs) as venous access for hemodialysis, it is also a routine practice for hematologists to benefit from them for their medical applications. There may be immediate or delayed complications of CVC placement and infections are accepted as delayed complications. We aimed to compare CVC-related infections in hematology and hemodialysis patients groups both of whose CVCs were placed by interventional nephrologists. Group specific infectious agents as well as infection risk factors were analyzed in order to develop guides and practices to decrease infection rates for the future. Method The number of patients who were placed a CVC in bone marrow transplantation (BMT) unit was 69 (37 males, 32 females) in the year of 2019. These patients were 47,5 ± 14,3 years old. Their CVC infection numbers and rates as well as infection agents were analyzed. This group was compared with hemodialysis patients that have non-cuffed hemodialysis catheters and who were age and sex matched with the BMT group. Infection rates for 1000 catheter days were calculated separately for both groups. Catheter infections were defined as hemoculture positivity of samples obtained from catheter lumens and/or identification of any microorganism in the catheter tip. Cases were followed up from insertion day of the catheters until when infection was identified or until the day of catheter removal. Results Catheters remained in a central vein for a median of 25 days in hemodialysis group [range: 10-51 days] while these duration was 16 days [range:8-29 days] for BMT group. The number of cases in whom a catheter related infection was identified was 17 for BMT (24%) and nine (13%) for hemodialysis group. Infection rate was 23 for 1000 catheter days in BMT group while it was 11 for 1000 catheter days in hemodialysis patients. BMT patients have a wider range of infection agents; 78% of them being gram positives and 19% of them being gram negatives. It was noteworthy that all of the catheter related infections in hemdialysis patients were related to gram positive bacteria. Rate of infections due to extended spectrum beta lactamase (ESBL) secreting E.coli or Klebsiella was 24% and infection risk of ESBL secreting agents was directly proportional to the time spent with the catheter. Infection findings in the catheter exit site (e.g. erythema, crusts or effusions) was found as statistically significant risk factors for bloodstream infections in BMT patients while these factors were not statistically significant for hemodialysis patients. Conclusion Gram positive infections make up the majority of CVC-related infections both for hematology and hemodialysis patients. Infection risks due to resistant species is proportional to the time spent with catheters. Catheter exit site findings should be cautionary for probable bloodstream infections especially for immunosuppressed patients.

scholarly journals Implementation of an infection prevention bundle is associated with reduced surgical site infections in cranial neurosurgery

2019 ◽  
Vol 47 (2) ◽  
pp. E3 ◽  
Author(s):  
Samuel L. Rubeli ◽  
Donato D’Alonzo ◽  
Beate Mueller ◽  
Nicole Bartlomé ◽  
Hans Fankhauser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infection Rate ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Postoperative Bleeding ◽  
Care Hospital ◽  
Infection Rates ◽  
Senior Faculty ◽  
Cutibacterium Acnes ◽  
The Impact

OBJECTIVEThe objective of this study was to quantify surgical site infection (SSI) rates after cranial neurosurgery in a tertiary care hospital, identify risk factors for SSI, and evaluate the impact of standardized surveillance and an infection prevention bundle (IPB).METHODSThe authors compared SSI rates during 7 months before and after the intervention. The IPB included standardized patient preparation, perioperative antibiotic/antiseptic use, barrier precautions, coaching of surgeons, and the implementation of a specialized technical operation assistant team.RESULTSThree hundred twenty-two unselected consecutive patients were evaluated before the IPB, and 296 were evaluated after implementation. Infection rates after 1 year decreased from 7.8% (25/322) to 3.7% (11/296, p = 0.03) with similar mortality rates (14.7% vs 13.8%, p = 0.8). The isolated bacteria included Staphylococcus aureus (42%), Cutibacterium acnes (22%), and coagulase-negative staphylococci (14%). Organ/space infections dominated with 67%, and mostly consisted of subdural empyema and meningitis/ventriculitis. Among the 36 SSIs, 13 (36%) occurred during hospitalization, and 29 (81%) within the first 3 months of follow-up. In multivariable analysis including established risk factors described in the literature, non-CNS neoplasia (odds ratio [OR] 3.82, 95% confidence interval [CI] 1.39–10.53), postoperative bleeding (OR 4.09, 1.44–11.62), operations performed by or under supervision of a senior faculty surgeon (OR 0.38, 0.17–0.84), and operations performed after the implementation of standardized surveillance and an IPB (OR 0.38, 0.17–0.85) significantly influenced the infection rate.CONCLUSIONSThe introduction of an IPB combined with routine surveillance and personal feedback was associated with a 53% reduced infection rate. The lower infection rates of senior faculty and the strong association between postoperative bleeding and infection underline the importance of both surgical experience as well as thorough supervision and coaching of younger surgeons.

scholarly journals An observational study of incidence of surgical site infections in gastrointestinal surgeries

2021 ◽  
Vol 8 (12) ◽  
pp. 3595
Author(s):  
Jenishkumar Vijaykumar Modi ◽  
Darshit Kalaria
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Surgical Site Infection Rate ◽  
Long Time ◽  
Surgery Department

Background: This study analysed the incidence of surgical site infections in gastrointestinal surgeries and its risk factors. so this study helped us in reducing surgical site infection by avoiding or minimizing that risk factors.Methods: The present study was conducted at general surgery department, SMIMER, Surat. An observational study of 400 cases that have undergone abdominal surgery in SMIMER hospital and were followed up from the day of operation to 30 days after discharge was done.Results: The overall infection rate for a total of the 400 cases was 17.25%. The incidence rate in this study was well within the infection rates of 2.8% to 17% seen in other studies. Different studies from India at different places have shown the SSI (surgical site infection) rate to vary from 6.09% to 38.7%.Conclusions: Our study reveals that though SSIs have been widely studied since a long time, they still remain as one of the most important causes of morbidity and mortality in surgically treated patients.

Staphylococcus Aureus Peritoneal Catheter-Related Infections: A Cause of Catheter Loss and Peritonitis

1988 ◽  
Vol 8 (3) ◽  
pp. 191-194 ◽  
Author(s):  
Stephen W. Zimmerman ◽  
Mark O'Brien ◽  
Frances A. Wiedenhoeft ◽  
Curtis A. Johnson
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Host Factors ◽  
High Recurrence Rate ◽  
Coagulase Negative Staphylococcus ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Patients At Risk ◽  
Catheter Infections ◽  
The Impact

To determine the impact of Staphylococcus aureus catheter-related infections in a peritoneal dialysis program we reviewed all S. aureus catheter-related infections in our program over a six-year period. Twenty -five percent (51/204) of patients at risk developed S. aureus catheter exit-site or tunnel infections. S. aureus accounted for 61% of all positive exit-site cultures; of 320 catheters implemented, 65 were infected with S. aureus. Fifty-one S. aureus-infected patients were retrospectively matched with 51 noninfected patients from our peritoneal dialysis program. Patients with S. aureus catheter-related infections had significantly greater catheter loss from catheter infection and peritonitis. There was significantly more S. aureus peritonitis but less coagulase negative staphylococcus peritonitis in patients with S. aureus catheter-related infections. Significantly more noninfected control patients remained peritonitis free. During this period, 83% of all S. aureus peritonitis was associated with S. aureus catheter infections, and 28 of 57 replacement catheters were reinfected with S. aureus. These findings suggest S. aureus is a major catheter-related pathogen leading to catheter loss and peritonitis. The high recurrence rate suggests that host factors may predispose to S. aureus catheter-related infections.

Reducing Catheter Infections through use of the CD-1000: A Retrospective Review of a Unique Catheter Specific Composite Dressing

2008 ◽  
Vol 9 (4) ◽  
pp. 236-240 ◽  
Author(s):  
S.D. Altman ◽  
J.J. Ross ◽  
J. Work
Keyword(s):  
High Risk ◽  
Infection Rate ◽  
Retrospective Review ◽  
Tap Water ◽  
Significant Risk ◽  
Causative Factor ◽  
Blood Stream ◽  
Exit Site ◽  
Catheter Infection ◽  
Vascular Catheters

Purpose Catheter-related blood stream infections pose a significant risk for patients living with vascular catheters. The cost to manage these infections is substantial. Although the etiology of these infections is multifactorial, tap water has been implicated as a significant causative factor. This retrospective review evaluates the effectiveness of a surgical dressing, the CD-1000, at protecting catheters and exit site wounds from fluid and debris when patients engage in high risk activities like showering. Methods All patients who received the CD-1000 from a single national medical supplier from September 2006 through to March 2007 were contacted to participate in this retrospective review; 209 patients, representing 34 states and 175 unique physicians, participated in this study. Effectiveness of the dressing along with prior and current history of catheter events was queried. Results The CD-1000 was 95% effective at keeping the catheter and exit site dry while patients engaged in high risk activities like showering. Prior to using the CD-1000, the 209 patients reported a historical catheter infection rate of 1.83 per 1000 catheter days. While using the CD-1000 the 209 patients reported a catheter infection rate of 0.47 per 1000 catheter days. Conclusion The CD-1000 catheter specific composite dressing adequately protects vascular catheters and exit sites when patients engage in high risk activities like showering. In this geographically diverse retrospective review, use of the CD-1000 was associated with a 75% reduction in catheter associated infections.

Exit-Site Care in Austrian Peritoneal Dialysis Centers — a Nationwide Survey

2009 ◽  
Vol 29 (3) ◽  
pp. 330-339 ◽  
Author(s):  
Gertrude Kopriva–Altfahrt ◽  
Paul König ◽  
Michael Mündle ◽  
Friedrich Prischl ◽  
Johannes M. Roob ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Infection Rate ◽  
Sodium Hypochlorite ◽  
Povidone Iodine ◽  
Nationwide Survey ◽  
Infection Rates ◽  
Exit Site ◽  
Exit Site Infection ◽  
Staff Members ◽  
Octenidine Dihydrochloride

Background Catheter-associated infections markedly contribute to treatment failure in peritoneal dialysis (PD) patients. There is much controversy surrounding prophylactic strategies to prevent these infections. Methods In this nationwide multicenter study we analyzed strategies to prevent catheter-associated infections as performed in Austrian PD centers in 2006. A questionnaire was sent to all 23 PD centers in Austria. Results Ten different catheter models were used in the 332 patients being treated in the 23 Austrian PD centers. Systemic antibiotics prior to catheter placement were given by 17 of the 23 PD centers (glycopeptides, n = 7; cephalosporins, n = 10). Nasal swabs were taken preoperatively by 17 PD centers; nasal Staphylococcus aureus carriers were treated prophylactically with mupirocin cream in 15 of these centers. Dressing change was routinely performed in 318 of 332 chronic PD patients (nonocclusive film dressing, n = 58; gauze dressing, n = 260). Disinfectants for chronic exit-site care included povidone iodine ( n = 155), sodium hypochlorite ( n = 31), povidone iodine + sodium hypochlorite together ( n = 102), and octenidine dihydrochloride/phenoxyethanol ( n = 17). Water+non-disinfectant soap or 0.9% sodium chloride was administered as a cleansing agent to the exit site by 27 patients. Routine S. aureus screening (nasal and/or exit-site swabs) in chronic PD patients was performed in 12 PD centers; carriers were treated with mupirocin cream in 11 of these centers. Dialysis staff members were screened for S. aureus in 8 PD centers and spouses were screened for S. aureus in 5 PD centers. The overall exit-site infection rate was 1 episode/43.9 patient-months, tunnel infection rate was 1 episode/88.9 patient-months, and peritonitis rate was 1 episode/51.0 patient-months. Patients of centers that have installed a prophylaxis protocol for treating S. aureus carriers had lower mean infection rates compared with those not using such a protocol. Conclusion Various individual prophylactic strategies are used to prevent catheter-associated infections in Austrian PD centers. Infection rates are within the range reported in the literature. There is still scope for improvement in some centers ( e.g., by establishing a prophylaxis protocol).

Effect of Preventing Staphylococcus Aureus Carriage on Rates of Peritoneal Catheter-Related Staphylococcal Infections. Literature Synthesis

2001 ◽  
Vol 21 (5) ◽  
pp. 471-479 ◽  
Author(s):  
Jennifer Ritzau ◽  
Richard M. Hoffman ◽  
Antonios H. Tzamaloukas
Keyword(s):  
Staphylococcus Aureus ◽  
Controlled Study ◽  
Site Infection ◽  
Exit Site ◽  
Peritoneal Catheter ◽  
Exit Site Infection ◽  
Literature Synthesis ◽  
Mupirocin Ointment ◽  
Catheter Infections ◽  
Historical Controls

Objective To determine whether specific preventive measures reduce the rate of peritoneal catheter-related infections and peritoneal catheter loss due to Staphylococcus aureus. Design Structured literature synthesis. Methods Relevant studies were identified by medline search, from personal files, and from the reference lists of retrieved articles. We analyzed English-language studies on treatment targeted at S. aureus, with at least 10 subjects and at least 3 months of follow-up, and data on staphylococcal peritoneal dialysis catheter infections. We excluded noncontrolled studies. Two investigators abstracted data using a structured form. Results W e evaluated six studies with concurrent controls and eight studies with historical controls. In one randomized, placebo-controlled, blinded study, periodic nasal mupirocin ointment reduced the rate of staphylococcal exit-site infection from 0.42 to 0.12 episodes/patient-year ( p = 0.006), but had no effect on the rates of staphylococcal tunnel infection, peritonitis, or catheter loss. In one randomized study without placebo control, periodic oral rifampin reduced the rate of staphylococcal exit-site infection from 0.65 to 0.22 epi/pt-yr ( p = 0.011), but had no effect on the rate of staphylococcal peritonitis. In another nonblinded, randomized, controlled study, the use of either rifampin or mupirocin was associated with low rates of staphylococcal catheter infections and catheter loss. In one study with historical controls, the rate of staphylococcal exit-site infection and peritonitis was lower after oral rifampin prophylaxis. In seven other studies comparing nasal or exit-site mupirocin to historical controls, the rate of staphylococcal exit-site infection decreased from 0.17 to 0.05 epi/pt-yr, the rate of staphylococcal peritonitis decreased from 0.18 to 0.06 epi/pt-yr, and the rate of catheter loss decreased from 0.09 to 0.05 epi/pt-yr during the mupirocin period. Conclusion The literature provides strong evidence that staphylococcal carriage prophylaxis using either oral rifampin or mupirocin ointment in the nares or exit site reduces significantly the rate of exit-site infection due to Staphylococcus aureus. Weaker evidence based on studies with historical controls suggests that rifampin or mupirocin prophylaxis also reduces the rate of staphylococcal peritonitis and peritoneal catheter loss. Studies with a stronger level of evidence are needed to verify this last point.

Catheter Infections in Insulin-Dependent Diabetics on Continuous Ambulatory Peritoneal Dialysis

1991 ◽  
Vol 11 (4) ◽  
pp. 347-350 ◽  
Author(s):  
Jean Holley ◽  
Judith Bernardini ◽  
Beth Piraino
Keyword(s):  
Significant Risk ◽  
Significant Risk Factor ◽  
Insulin Dependent Diabetes Mellitus ◽  
Dependent Diabetes Mellitus ◽  
Diabetic Patients ◽  
Infection Rates ◽  
Catheter Infection ◽  
Increased Risk ◽  
Insulin Dependent ◽  
Catheter Infections

We compared a group of 60 insulin-dependent diabetics maintained on CAPO with 60 nondiabetic matched controls to determine if the diabetic patients were at increased risk for catheter-related infections. Although catheter infection rates were 17% higher in the diabetics (1.4/year versus 1.2/year in nondiabetics), time to first catheter infection was not different between the groups (p=0.6). Rates of peritonitis, peritonitis associated with catheter infection, multiple catheter infection, and catheter removal were also similar among the diabetics and controls. S. aureus caused 52% (42/81) of the catheter infections in the diabetics and 60% (35/58) in the controls. More catheter infections in the nondiabetics versus the diabetics lacked drainage or resulted in sterile cultures (17/75 versus 7/88 respectively, p≤0.01), but the significance of this finding is uncertain. In conclusion, we did not find insulin-dependent diabetes mellitus to be a statistically significant risk factor for catheter-related infections.

scholarly journals Peritoneal catheter infections : data from the French language peritoneal dialysis registry (RDPLF), risk factors

2019 ◽  
Vol 2 (3) ◽  
pp. 135-141
Author(s):  
Isabelle Vernier ◽  
Emmanuel Fabre ◽  
Max Dratwa ◽  
Christian Verger
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Nasal Carriage ◽  
Catheter Insertion ◽  
French Language ◽  
Clinical Practices ◽  
Peritoneal Catheter ◽  
Wide Variability ◽  
Catheter Infections

Peritoneal catheter infections : data from the French language peritoneal dialysis registry (RDPLF), risk factors The French Language Peritoneal Dialysis Registry (RDPLF) record since 1997 all data dealing with peritoneal catheter insertion and follow up. The aim of this study is to analyze catheter infections on 10801 catheters in 144 centres from January 1, 1997 and December 31, 2018. Infections are more common in the first month and 50% occur before the tenth month. The risk of infection increases in case of wall hematoma, initial fluid leakage, and obesity. It decreases with the use of prophylactic antibiotics at the time of catheter insertion, with experienced operator, if the first dressing is delayed for 7 days, and with mupirocin as exit-site prophylaxis. During last two decades the percentage of Staphylococcus aureus infections has decreased, whereas the proportion of Pseudomonas, Corynebacterium and other Gram + cocci increased. The incidence of catheter infections is low compared to literature data: it decreased to 0.16 episodes per year for the 2013-2017 period. Adherence to ISPD guidelines: preoperative antibioprophylaxis is the most followed guideline (70.7% of catheter implantations in 2018). Local antibioprophylaxis concerns only 15.6% of catheters, and remains concentrated in a few centres ; mupirocin is the most frequently used agent. Screening for nasal carriage of S. aureus is performed in only 42% of cases. The catheter section of the RDPLF has allowed the follow-up of clinical practices incidence of infections and ecology for 21 years, both at the national and center level Our study confirms a wide variability in clinical practices, compared to ISPD guidelines.

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