The use of minocycline-rifampin coated central venous catheters for exchange of catheters in the setting of staphylococcus aureus central line associated bloodstream infections

Background: Although central-line–associated bloodstream infections (CLABSI) in US hospitals have improved in the last decade, ~30,100 CLABSIs occur annually.1,2 Central venous catheters (CVC) carry a high risk of infections and should be limited to appropriate clinical indications.6,7 Montefiore Medical Center, a large, urban, academic medical center in the Bronx, serves a high-risk population with multiple comobidities.8–11 Despite this, the critical care medicine (CCM) team is often consulted to place a CVC when a peripheral intravenous line (PIV) cannot be obtained by nurses or primary providers. We evaluated the volume of CCM consultation requests for avoidable CVCs and related CLABSIs. Methods: Retrospective chart review was performed for patients with CCM consultation requests for CVC placement between July and October 2019. The indication for CVC, type of catheter inserted or recommended, and NHSN data were used to identify CLABSIs. CVCs were considered avoidable if a PIV was used for the stated indication and duration of therapy, with no anatomical contraindications to PIV in nonemergencies, according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).6Results: Of 229 total CCM consults, 4 (18%) requests were for CVC placement; 21 consultations (9%) were requested for avoidable CVCs. Of 40 CVC requests, 18 (45%) resulted in CVC placement by the CCM team, 4 (10%) were deferred for nonurgent PICC by interventional radiology, and 18 (45%) were deferred in favor of PIV or no IV. Indications for CVC insertion included emergent chemotherapy (n = 8, 44%) and dialysis (n = 3, 16%), vasopressors (n = 3, 16%), antibiotics (n = 2, 11%) and blood transfusion (n = 2, 11%). Of 18 CVCs, 9 (50%) were potentially avoidable: 2 short-term antibiotics and rest for nonemergent indications; 2 blood transfusions, 1 dialysis, 2 chemotherapy and 2 vasopressors. Between July and October 2019, 6 CLABSIs occurred in CVCs placed by the CCM team; in 3 of 6 CLABSI events (50%), the CVC was avoidable. Conclusions: More than half of consultation requests to the CCM team for CVCs are avoidable, and they disproportionately contribute to CLABSI events. Alternatives for intravenous access could potentially avoid 9% of CCM consultations and 50% of CLABSIs in CCM-inserted CVCs on medical-surgical wards.Funding: NoneDisclosures: None

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High success rate in salvage of catheter-related bloodstream infections due to Staphylococcus aureus, on behalf of project group of Italian society of nephrology

The Journal of Vascular Access ◽

10.1177/1129729819875323 ◽

2019 ◽

Vol 21 (3) ◽

pp. 336-341

Author(s):

Salvatore Mandolfo ◽

Adriano Anesi ◽

Milena Maggio ◽

Vanina Rognoni ◽

Franco Galli ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Central Venous Catheter ◽

Prognostic Index ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Venous Catheters ◽

Catheter Removal ◽

Renal Unit ◽

Chronic Haemodialysis ◽

Central Venous

Background: Catheter-related bloodstream infections caused by Staphylococcus aureus represent one of the most fearful infections in chronic haemodialysis patients with tunnelled central venous catheters. Current guidelines suggest prompt catheter removal in patients with positive blood cultures for S. aureus. This manoeuvre requires inserting a new catheter into the same vein or another one and is not without its risks. Methods: A protocol based on early, prompt diagnosis and treatment has been utilized in our renal unit since 2012 in an attempt to salvage infected tunnelled central venous catheters. We prospectively observed 247 tunnelled central venous catheters in 173 haemodialysis patients involving 167,511 catheter days. Results: We identified 113 catheter-related bloodstream infections (0.67 episodes per 1000 days/tunnelled central venous catheter). Forty were caused by S. aureus, including 19 by methicillin-resistant S. aureus (79% saved) and 21 by methicillin-sensitive S. aureus (90% saved), of which 34 (85%) were treated successfully. Eight recurrences occurred and six (75%) were successfully treated. A greater than 12 h time to blood culture positivity for S. aureus was a good prognostic index for successful therapy and tunnelled central venous catheter rescue. Conclusion: Our data lead us to believe that it is possible to successfully treat catheter-related bloodstream infection caused by S. aureus and to avoid removing the tunnelled central venous catheter in many more cases than what has been reported in the literature. On the third day, it is mandatory to decide whether to replace the tunnelled central venous catheter or to carry on with antibiotic therapy. Apyrexia and amelioration of laboratory parameters suggest continuing systemic and antibiotic lock therapy for no less than 4 weeks, otherwise, tunnelled central venous catheter removal is recommended.

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The Effect of Multiple Concurrent Central Venous Catheters on Central Line Associated Bloodstream Infections

American Journal of Infection Control ◽

10.1016/j.ajic.2013.03.113 ◽

2013 ◽

Vol 41 (6) ◽

pp. S54-S55

Author(s):

Cathleen Concannon ◽

Edwin van Wijngaarden ◽

Vanessa Stevens ◽

Kelly Thevenet-Morrison ◽

Ghinwa Dumyati

Keyword(s):

Bloodstream Infections ◽

Central Line ◽

Central Venous Catheters ◽

Central Venous

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Risk factors for central line–associated bloodstream infections in children with tunneled central venous catheters

American Journal of Infection Control ◽

10.1016/j.ajic.2019.06.027 ◽

2020 ◽

Vol 48 (1) ◽

pp. 33-39

Author(s):

Paolo Paioni ◽

Sereina Kuhn ◽

Yvonne Strässle ◽

Burkhardt Seifert ◽

Christoph Berger

Keyword(s):

Risk Factors ◽

Bloodstream Infections ◽

Central Line ◽

Central Venous Catheters ◽

Central Venous

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Impact of number of lumens in central-venous catheters on central-line bloodstream infection (CLABSI) and venous thromboembolism (VTE) risk in patients with acute leukemia

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.423 ◽

2021 ◽

pp. 1-3

Author(s):

Alina Varabyeva ◽

Christabel Pui-See Lo ◽

Adamo Brancaccio ◽

Anthony J. Perissinotti ◽

Twisha Patel ◽

...

Keyword(s):

Retrospective Study ◽

Venous Thromboembolism ◽

Acute Leukemia ◽

Bloodstream Infections ◽

Central Line ◽

Central Venous Catheters ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Central Venous ◽

Double Lumen

Abstract This retrospective study was conducted to determine whether the number of peripherally inserted central-catheter lumens affected the rate of central-line associated bloodstream infections (CLABSIs) in adult patients with acute leukemia. The results show that CLABSI rates were not significantly different between patients with triple-lumen or double-lumen PICCs (22.1% vs 23.4%; P = .827).

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Comparison of central-line–associated bloodstream infections between central venous catheters lined by combined chlorhexidine and silver sulfadiazine versus silver ionotrophes alone: A before–after–before retrospective study — CORRIGENDUM

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1381 ◽

2020 ◽

pp. 1-1

Author(s):

Youssef Z. Abouleish ◽

Edward C. Oldfield ◽

Paul E. Marik

Keyword(s):

Retrospective Study ◽

Bloodstream Infections ◽

Central Line ◽

Central Venous Catheters ◽

Silver Sulfadiazine ◽

Central Venous

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Successful Salvage of Central Venous Catheters in Patients with Catheter-Related or Central Line-Associated Bloodstream Infections by Using a Catheter Lock Solution Consisting of Minocycline, EDTA, and 25% Ethanol

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02565-15 ◽

2016 ◽

Vol 60 (6) ◽

pp. 3426-3432 ◽

Cited By ~ 24

Author(s):

Issam Raad ◽

Anne-Marie Chaftari ◽

Ramia Zakhour ◽

Mary Jordan ◽

Zanaib Al Hamal ◽

...

Keyword(s):

Animal Studies ◽

Bloodstream Infections ◽

Central Line ◽

Infectious Complications ◽

Central Venous Catheters ◽

Control Group ◽

Central Venous ◽

Systemic Antibiotic Therapy ◽

Lock Solution

In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites.In vitroand animal studies showed that a minocycline-EDTA-ethanol (M-EDTA-EtOH) lock solution may eradicate microbial organisms in biofilms, hence enabling the treatment of central line-associated bloodstream infections (CLABSI) while retaining the catheterin situ. Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted. Each catheter lumen was locked with an M-EDTA-EtOH solution for 2 h administered once daily, for a total of 7 doses. Patients who received locks had clinical characteristics that were comparable to those of the control group. The times to fever resolution and microbiological eradication were similar in the two groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy than that of the control patients (median, 11 days versus 16 days, respectively;P< 0.0001), and they were able to retain their CVCs for a median of 74 days after the onset of bacteremia. The M-EDTA-EtOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to that of the CVC removal/reinsertion group, who received a longer duration of systemic antimicrobial therapy. (This study has been registered at ClinicalTrials.gov under registration no. NCT01539343.)

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Comparison of central-line–associated bloodstream infections between central venous catheters lined by combined chlorhexidine and silver sulfadiazine versus silver ionotrophes alone: A before–after–before retrospective study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.423 ◽

2020 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Youssef Z. Abouleish ◽

Edward C. Oldfield ◽

Paul E. Marik

Keyword(s):

Retrospective Study ◽

Bloodstream Infections ◽

Central Line ◽

Central Venous Catheters ◽

Primary Objective ◽

Silver Sulfadiazine ◽

Central Venous

Abstract A before–after–before direct comparison between catheters lined with chlorhexidine and silver sulfadiazine (CHSS) versus silver ionotrophes (SI) with a primary objective of comparison of rate of central-line–associated infection (CLABSI) in three 10-month windows. The CHSS catheters were associated with a lower rate of CLABSI.

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