Prevention of Central Venous Catheter–Related Infections and Thrombotic Events in Immunocompromised Children by the Use of Vancomycin/Ciprofloxacin/Heparin Flush Solution: A Randomized, Multicenter, Double-Blind Trial

PURPOSE: To determine whether an antibiotic flush solution containing vancomycin, heparin, and ciprofloxacin (VHC) can prevent the majority of line infections.PATIENTS AND METHODS: A prospective double-blind study was performed comparing VHC to vancomycin and heparin (VH) to heparin alone in 126 pediatric oncology patients.RESULTS: The 153 assessable lines resulted in 36,944 line days studied. There were 58 blood stream infections (43 Gram-positive, 14 Gram-negative, and one fungal). Forty were defined as line infections (31 heparin, three VH, six VHC). The time to develop a line infection was significantly increased using either antibiotic flush (VH, P = .011; VHC, P = .036). The rate of total line infections (VH, P = .004; VHC, P = .005), Gram-positive line infections (VH, P = .028; VHC, P = .022), and Gram-negative line infections (VH, P = .006; VHC, P = .003) was significantly reduced by either VH or VHC. Sixty-two (41%) of the lines developed 119 occlusion episodes (heparin, 3.99 per 1,000 line days; VHC, 1.75 per 1,000 line days; P = .0005). Neither antibiotic could be detected after flushing, and no adverse events were detected, including increased incidence of vancomycin-resistant Enterococcus colonization or disease.CONCLUSION: The use of either VH or VHC flush solution significantly decreased the complications associated with the use of tunneled central venous lines in immunocompromised children and would save significant health care resources.

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Central Venous Catheter Tip Culture and Sensitivity Pattern from a Tertiary Care Hospital in Jammu Region, India

International Journal of Current Research and Academic Review ◽

10.20546/ijcrar.2019.704.011 ◽

2019 ◽

Vol 7 (4) ◽

pp. 101-106

Author(s):

P. Sharma Perika ◽

S. Sudan N. Rajput ◽

S. Gupta Y. Bhandari ◽

R. Tomar

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Blood Stream ◽

Care Hospital ◽

Central Venous ◽

Gram Positive ◽

Blood Stream Infections ◽

Gram Negative ◽

Catheter Tip ◽

Gram Positive Cocci

The use of Central Venous Catheters (CVC) in critically ill patients often leads to Catheter Related Blood Stream Infections (CRBSI). Blood stream infections which are associated with catheter is associated with high morbidity and mortality. Aim of the study is to find the type of organisms isolated from Central venous catheter tip and to determine their antimicrobial susceptibility pattern. A total of 100 samples were received in our laboratory over a period of one year. Samples were processed; organisms were isolated and subjected to antimicrobial sensitivity according to standard laboratory procedures. AST interpretation was done according to latest CLSI Guidelines. Of the 100 samples received in our laboratory, 11(11%) showed no growth or insignificant growth. 64% of the total samples were Gram Negative Bacilli and 23% were Gram Positive Cocci, 2% were Candida albicans. Escherichia coli and Staphylococcus aureus were the most common organisms isolated among gram negative bacilli and gram positive cocci respectively. Sensitive drugs in case of gram positive cocci were vancomycin and linezolid and in case of gram negative bacilli were Colistin and polymyxin B.

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Bacteriological profile and their antimicrobial susceptibility pattern in central venous catheter tip culture

Journal of Pathology of Nepal ◽

10.3126/jpn.v7i1.16670 ◽

2017 ◽

Vol 7 (1) ◽

pp. 1059-1061

Author(s):

J Sapkota ◽

B Mishra ◽

B Jha ◽

M Sharma

Keyword(s):

Central Venous Catheter ◽

Bacterial Colonization ◽

Antibiotic Sensitivity ◽

Venous Catheter ◽

Blood Stream ◽

Central Venous ◽

Candida Spp ◽

Gram Positive ◽

Gram Negative ◽

Sensitivity Pattern

Background: Bacterial colonization of central venous catheter (CVC) carries risk of developing catheter-related blood stream infections (CRBSI). The purpose of this study is to find out the frequency of colonization of CVC by different bacterial pathogens and their antibiotic sensitivity pattern.Materials and Methods: A total of 53 CVC tip were received in one-year duration for culture and antibiotic sensitivity pattern. The isolated organisms were identified by standard microbiological procedure and subjected to antimicrobial sensitivity.Results: out of 53 CVC tip sent for culture and sensitivity, 21 (39.6%) showed significant growth. Out of 21 culture positive 52.3% were gram negative bacilli, 33.3% were gram positive cocci, 4.8% were Candida spp. Acenitobacter baumannii and Staphylococcus aureus were frequent pathogens isolated. Gram negative bacteria were less sensitive to antibiotics whereas gram positive bacteria were sensitive to Vancomycin.Conclusion: Though various organisms were isolated as colonizer of CVC, Acenitobacter baumannii is the most common colonizer. Antibiotic resistance has already emerged and represents a major problem.

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The efficacy of a non-leaching antibacterial central venous catheter - a prospective, randomized, double-blind study

Biomedical Papers ◽

10.5507/bp.2019.022 ◽

2020 ◽

Vol 164 (2) ◽

pp. 154-160

Author(s):

Ivo Krikava ◽

Martin Kolar ◽

Barbora Garajova ◽

Tomas Balik ◽

Alena Sevcikova ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Blind Study ◽

Double Blind Study ◽

Central Venous ◽

Double Blind

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Incidence of central venous and Foley’s catheter related bacteraemia, organisms responsible and antibiotic sensitivity pattern: in cardio-thoracic intensive theraputic unit following elective surgery, in a tertiary care hospital of Kolkata, India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20202036 ◽

2020 ◽

Vol 7 (6) ◽

pp. 893

Author(s):

Swarnendu Datta ◽

Ushnish Chakrabarty ◽

Priyanka Chakrabarty ◽

Plaban Mukherjee

Keyword(s):

Blood Stream Infection ◽

Antibiotic Sensitivity ◽

Blood Stream ◽

Care Hospital ◽

Central Venous ◽

Gram Positive ◽

Gram Negative ◽

Sensitivity Pattern ◽

Culture Sensitivity ◽

Foley’S Catheter

Background: Mortality from bacteraemia related to indwelling Central Venous Pressure (CVP) lines could be as high as 12 - 25% and that due to indwelling urinary catheters about 5%, in critically ill patients. Hence, initiation of early and aggressive antibiotic therapy, often even before the culture- sensitivity reports are available is necessary. Objectives of the study was to find out the incidence of bacteraemia related to indwelling CVP catheters &/or Foley’s catheters in post operative patients in Cardio-thoracic Intensive Theraputic Unit (ITU) and to understand the antibiotic sensitivity patterns against the organisms causing such bacteraemiaMethods: 48 hours after their insertion, CVP catheter tips, Foley’s catheter tips and Peripheral blood samples were collected for cultures in 50 patients who underwent elective cardiothoracic surgery, over a period of one year and results were interpreted.Results: Incidence of bacteraemia associated with indwelling CVP catheters was 8% and was caused by both - Gram positive (Staphylococcus aureus, Enterococcus faecium) and Gram negative (Acinetobacter baumanii, Pseudomonas aeruginosa) organisms. Foley’s catheter was not related to such blood stream infection. Vancomycin and Linezolid were effective against the Gram positive organisms; while Piperacillin- Tazobactam, Meropenem, Polymyxin B and Colistin were effective against the Gram negative organisms.Conclusions: Indwelling CVP catheters were associated with blood stream infection in 4 post operative patients in our ITU. An idea about the organisms responsible, as well as their antibiogram may help in early initiation of antibiotics empirically before culture-sensitivity reports are available.

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A Phase 3, Randomized, Double-Blind Study Comparing Tedizolid Phosphate and Linezolid for Treatment of Ventilated Gram-Positive Hospital-Acquired or Ventilator-Associated Bacterial Pneumonia

Clinical Infectious Diseases ◽

10.1093/cid/ciab032 ◽

2021 ◽

Author(s):

Richard G Wunderink ◽

Antoine Roquilly ◽

Martin Croce ◽

Daniel Rodriguez Gonzalez ◽

Satoshi Fujimi ◽

...

Keyword(s):

Clinical Response ◽

Bacterial Pneumonia ◽

Double Blind Study ◽

Phase 3 ◽

Gram Positive ◽

Double Blind ◽

Intention To Treat ◽

The Difference ◽

Hospital Acquired ◽

Noninferiority Margin

Abstract Background Hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) are associated with high mortality rates. We evaluated the efficacy and safety of tedizolid (administered as tedizolid phosphate) for treatment of gram-positive ventilated HABP/VABP. Methods In this randomized, noninferiority, double-blind, double-dummy, global phase 3 trial, patients were randomized 1:1 to receive intravenous tedizolid phosphate 200 mg once daily for 7 days or intravenous linezolid 600 mg every 12 hours for 10 days. Treatment was 14 days in patients with concurrent gram-positive bacteremia. The primary efficacy end points were day 28 all-cause mortality (ACM; noninferiority margin, 10%) and investigator-assessed clinical response at test of cure (TOC; noninferiority margin, 12.5%) in the intention-to-treat population. Results Overall, 726 patients were randomized (tedizolid, n = 366; linezolid, n = 360). Baseline characteristics, including incidence of methicillin-resistant Staphylococcus aureus (31.3% overall), were well balanced. Tedizolid was noninferior to linezolid for day 28 ACM rate: 28.1% and 26.4%, respectively (difference, –1.8%; 95% confidence interval [CI]: –8.2 to 4.7). Noninferiority of tedizolid was not demonstrated for investigator-assessed clinical cure at TOC (tedizolid, 56.3% vs linezolid, 63.9%; difference, –7.6%; 97.5% CI: –15.7 to 0.5). In post hoc analyses, no single factor accounted for the difference in clinical response between treatment groups. Drug-related adverse events occurred in 8.1% and 11.9% of patients who received tedizolid and linezolid, respectively. Conclusions Tedizolid was noninferior to linezolid for day 28 ACM in the treatment of gram-positive ventilated HABP/VABP. Noninferiority of tedizolid for investigator-assessed clinical response at TOC was not demonstrated. Both drugs were well tolerated. Clinical Trials Registration NCT02019420.

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The epidemiology of central venous catheter-related bloodstream infection in our renal units is changing

The Journal of Vascular Access ◽

10.1177/1129729821990222 ◽

2021 ◽

pp. 112972982199022

Author(s):

Salvatore Mandolfo ◽

Adriano Anesi ◽

Vanina Rognoni

Keyword(s):

Burkholderia Cepacia ◽

Present Report ◽

Statistical Significance ◽

Bloodstream Infections ◽

Venous Catheter ◽

Renal Unit ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Over Time

Recent reports have shown an increase in the rate of Gram-negative bacteremia in several settings, including catheter-related bloodstream infections (CRBSI). To analyze if the epidemiology of CRBSI is also changing in hemodialysis patients, we revisited the etiology of CRBSIs in our renal unit over 8 years. During the observed periods, 149 episodes of CRBSIs were reported and the CRBSI incidence rate, ranged between 0.67 and 0.82 episodes/1000 tCVC days. Of these 149 episodes, 84 (56.3%) were due to Gram-positive bacteria, 62 (41.6%) to Gram-negative bacteria, and 3 (2.1%) to polymicrobial flora, no episodes of fungi were found. There was a trend, but not statistically significative, increase over time in the number of Gram-negative CRBSIs among the total CRBSIs, rising from 37.8% in the first period to 41.2% in the second period and to 44.3% in the last period, with a parallel decrease in the percentage of Gram-positive CRBSIs (from 59.5% to 56.9% and subsequently to 54.1%). Between Gram-negative, we reported an intensification of CRBSI due to Enterobacterales, particularly Escherichia coli. Among the Gram-negative, we have isolated germs rarely reported in the literature, such as Burkholderia cepacia, Pantoea agglomerans, and Rhizobium radiobacter. Regarding Gram-positive bacteria, a triplicate incidence of Staphylococcus aureus was reported with MRSA accounting for 42% in the third period. Among the Gram-positive bacteria, we reported two episodes of Kocuria kristinae and two of Bacillus spp. Our data demonstrated that the epidemiology of CRBSI in the same center, will change over time and Gram-negative strains are an increasing cause of CRBSI. The limitation of the present report is that statistical significance has not been reached, probably due to the limited number of CRBSI. New bacteria, both Gram-negative and Gram-positive, are emerging. Collaboration with the Microbiology Department appears essential to an appropriate diagnosis.

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