Biofilm and catheter-related bloodstream infections

2021 ◽  
Vol 30 (8) ◽  
pp. S4-S9
Author(s):  
Randy Wolcott
Keyword(s):  
Bloodstream Infection ◽  
Acute Infection ◽  
Bloodstream Infections ◽  
Clinical Findings ◽  
Solid Surfaces ◽  
High Dose ◽  
Culture Methods ◽  
Procedure Guidelines ◽  
Clinical Culture ◽  
Intravascular Catheters

Careful attention to detail and adherence to procedure guidelines when inserting and managing intravascular catheters has decreased the incidence of catheter-related bloodstream infections (CRBSIs). In order to limit these, health professionals must understand the underlying microbiology. Biofilms can explain the clinical findings most often seen with CRBSIs, yet they are poorly understood within medicine. Bacteria growing on solid surfaces such as a catheter are predominantly in biofilm phenotype, with a group of genes active that allow the bacteria to be tolerant to antiseptics and antibiotics by producing a self-secreted protective matrix. It is unclear whether it is planktonic seeding or small fragments of biofilm breaking off into the bloodstream that eventually results in the acute infection. The literature identifies four routes for microbes to adhere to a catheter and start biofilm formation: catheter contact, catheter insertion, catheter management and non-catheter-related sources. Routine clinical culture methods are inadequate to fully identify microbes producing catheter biofilm and/or bloodstream infection, therefore DNA methods may be required to diagnose CRBSIs. Treatment is removal and reinsertion of the catheter in a different site when possible. However, antibiofilm strategies can be employed to try to salvage the catheter. The use of high-dose antiseptics or antibiotics for long durations inside the catheter and hub (antibiotic/antiseptic lock) can suppress biofilm enough to reduce the seeding of the blood below a level where the patient's immune system can prevent bloodstream infection.

Catheter-Associated Infections

2016 ◽  
Author(s):  
Swathi Eluri
Keyword(s):  
Bloodstream Infection ◽  
Bloodstream Infections ◽  
Risk Groups ◽  
Mechanical Complication ◽  
Risk Of Infection ◽  
Ultrasound Guided ◽  
Line Placement ◽  
Oncologic Patients ◽  
Skin Integrity ◽  
Intravascular Catheters

Catheter-associated infections, which often present as sepsis, include primary bloodstream infections that occur in the presence of intravascular catheters. They are not related to an infection at another site and are defined as a primary bloodstream infection with documented colonization of the device and microbiologically proven, device-related bloodstream infection. Multiple hospitals have started to implement standardized quality control interventions to minimize catheter-related bloodstream infections. Ultrasound-guided line placement results in a decrease in mechanical complication and the number of attempts, which in turn reduces the risk of infection. Preparing the skin with 0.5% chlorhexidine or alcohol containing chlorhexidine solutions has been shown to reduce line-related infections. Antimicrobial lock solutions should be used in patients with recurrent catheter-associated infections and high-risk groups, such as those on total parenteral nutrition, dialysis, or oncologic patients. The preservation of skin integrity surrounding the device decreases the risk of infection.

Case 32

2020 ◽  
pp. 217-224
Author(s):  
Maheshi Ramasamy
Keyword(s):  
Bloodstream Infection ◽  
Subsequent Development ◽  
Bloodstream Infections ◽  
Pathogenic Organism ◽  
Intravascular Catheters

Indwelling intravascular catheters are susceptible to colonization by bacteria and yeasts, with subsequent development of bloodstream infection. The management of these bloodstream infections is determined by the nature of the pathogenic organism and the type of line involved.

scholarly journals Moraxella nonliquefaciens bloodstream infection and sepsis in a pediatric cancer patient: case report and literature review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carlos L. Correa-Martínez ◽  
Kerstin K. Rauwolf ◽  
Franziska Schuler ◽  
Miriam Füller ◽  
Stefanie Kampmeier ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Bloodstream Infection ◽  
Antibiotic Treatment ◽  
Pediatric Cancer ◽  
Antimicrobial Prophylaxis ◽  
Fatal Outcome ◽  
Bloodstream Infections ◽  
High Dose ◽  
Upper Respiratory Tract ◽  
Pediatric Cancer Patient

Abstract Background Moraxella nonliquefaciens is a usually non-pathogenic biofilm-producing Gram-negative coccobacillus which may colonize the upper respiratory tract, rarely causing invasive disease. Although very rare, bloodstream infections caused by this organism have been described, showing often a fatal outcome. Here, we report the case of a pediatric cancer patient with bloodstream infection and sepsis due to M. nonliquefaciens showing full recovery after appropriate antibiotic treatment. Case presentation A three-year-old boy with stage IV neuroblastoma was admitted for high-dose chemotherapy with autologous stem cell rescue after standard neuroblastoma treatment. Despite receiving antimicrobial prophylaxis with trimethoprim/sulfamethoxazole, acyclovir and amphothericin B, the patient presented with fever of up to 39.5 °C and neutropenia. Besides a chemotherapy-related mucositis and an indwelling Broviac catheter (removed), no infection focus was identified on physical examination. Moraxella nonliquafaciens was identified in blood cultures. After antibiotic treatment and neutrophil recovery, the patient was fit for discharge. Conclusions The case described highlights the importance of an otherwise non-pathogenic microorganism, especially in immunosupressed cancer patients. It should be kept in mind that, although very infrequently, Moraxella nonliquefaciens may cause bloodstream infections that can be successfully treated with prompt focus identification and antibiotic therapy.

scholarly journals 2566. infection Dynamics of Pseudomonas aeruginosa Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S891-S891
Author(s):  
Kelly E R Bachta ◽  
Jonathan P Allen ◽  
Alan R Hauser
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Bloodstream Infection ◽  
Imaging System ◽  
Acute Infection ◽  
Bloodstream Infections ◽  
Fecal Excretion ◽  
Healthcare Environment ◽  
Infection Dynamics ◽  
The Impact

Abstract Background Pseudomonas aeruginosa (PA) is a critically important healthcare-associated pathogen responsible for a variety of infections including bloodstream infection (bacteremia), pneumonia, and urinary tract infection. PA bacteremia is a significant cause of morbidity and mortality, especially in immunocompromised patients; However, little is known about the in-host infection dynamics of PA bacteremia and the impact of individually infected patients on transmission in the healthcare environment. Methods We utilized animal modeling in conjunction with sequencing technology to dissect the infection dynamics of PA bloodstream infections. BALB/c mice were challenged intravenously with a human bacteremia isolate, PABL012. At various time points post infection, organs were harvested and the surviving PA enumerated. In parallel, PABL012 engineered to express the luciferase cassette was used to track PA in live mice over time using the IVIS imaging system. STAMP (sequence tag-based analysis of microbial populations) analysis was then applied to define the population dynamics of PA bloodstream infection. Results Bacterial enumeration and IVIS imaging revealed that systemically infected mice have a focus of bacterial expansion in their gallbladders (GB). Surprisingly, the same mice also shed PA in their gastrointestinal tract (GI), a phenomenon not previously appreciated following bloodstream infection. Finally, STAMP analysis revealed that (1) PA experiences a severe in vivo bottleneck when trafficking to the GB, (2) the population in the GB expands tremendously during infection and (3) this population is ultimately the source of excreted bacteria in the GI tract. Conclusion Our research, using murine models, provides the first evidence that the GB acts as a sanctuary site for PA replication following systemic infection and links replication with fecal excretion. Fecal excretion of PA from hospitalized patients is observed, but the direct link between acute infection, GI shedding, and transmission remains unclear. Our observations have significant implications on understanding how PA evades initial host clearance, the identity of protected expansion niches, and how PA might exit the human host in the healthcare environment facilitating a transmission event. Disclosures All authors: No reported disclosures.

scholarly journals 75. Utility of Fungal Blood Cultures in Portland, Oregon

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S154-S155
Author(s):  
Sujeet Govindan ◽  
Luke Strnad
Keyword(s):  
Blood Culture ◽  
Bloodstream Infection ◽  
Bloodstream Infections ◽  
Hematologic Malignancies ◽  
Blood Cultures ◽  
Biologic Agent ◽  
Systemic Steroid ◽  
High Dose ◽  
Inappropriate Use ◽  
History Of

Abstract Background Fungal blood cultures (fungal isolators) should be used, if at all, primarily for identification of mold infections. At our institution we noted patients having fungal blood cultures drawn in many other situations, including when the primary team was concerned for candida bloodstream infection. We sought to describe the utility of this practice and of fungal blood cultures in general. Methods We retrospectively reviewed the results of fungal blood cultures for 2 years, from 3/1/2019-3/1/2021. We evaluated the number of episodes, culture results, whether there was a had prior bloodstream infection, and risk factors for fungal infection including renal replacement (RRT), ECMO, and immunosuppression (IS). Immunosuppression was defined as chronic systemic steroid use, recent receipt of high dose steroids within 2 weeks, history of organ transplantation, history of stem cell transplantation, hematologic malignancies, or receipt of a biologic agent. Results 187 fungal blood cultures were drawn in 143 patients - 80 cultures in 70 patients from 3/2019-3/2020 and 107 cultures in 73 patients from 3/2020-3/2021. Only 3 patients had positive fungal blood cultures:1 (Candida krusei) from 3/2019-3/2020 and 2 (Candida albicans and Cyrptococcus neoformans) from 3/2020-3/2021; in all 3 cases the organism also grew from standard blood culture isolators. From 3/2019-3/2020, 1/80 cultures were drawn from an individual on ECMO while 15/80 were drawn from individuals on RRT, and 32/80 were in a IS individuals. From 3/2020-3/2021, 45/107 cultures were drawn from an individual on ECMO, 24/107 were drawn in an individual on RRT, and 73/107 were drawn in a IS individuals. The majority of individuals in whom a fungal blood culture was drawn during 3/2020-3/2021 were individuals with COVID-19. Upon chart review most of the cultures were drawn due to concern for candidemia. Results of fungal blood cultures drawn from 3/2019-3/2021 at OHSU Conclusion Fungal blood cultures have an extremely low yield at our institution, with a 1.6% positivity rate over a 2 year period, and all of those cultures were detected by standard blood culture isolators. Most of these cultures were drawn in situations where this test has no utility. Furthermore, the test has limited utility to detect dimorphic and mold bloodstream infections. Restriction of this test may limit inappropriate use. Disclosures All Authors: No reported disclosures

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

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.

scholarly journals 1341. Blood Volume Collected for Blood Cultures in Infants with Suspected Neonatal Sepsis in the NICU

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S682-S682
Author(s):  
Maria S Rueda Altez ◽  
Lamia Soghier ◽  
Joseph M Campos ◽  
James Bost ◽  
Jiaxiang Gai ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Blood Volume ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Volume Calculation ◽  
Culture Negative ◽  
Time Of Collection ◽  
Rule Out

Abstract Background Blood cultures have high sensitivity to detect bacteremia in septic neonates when >=1 ml of blood is collected. Neonatologists often cite low confidence in microbiologic sampling as rationale for continuing antibiotics without a focus of infection despite negative blood cultures, resulting in prolonged antimicrobial therapy. We aim to describe the blood culture sample volumes in NICU patients, to identify factors associated with sample volumes < 1ml, and to compare the sample volumes of patients treated for culture-negative sepsis with those with bloodstream infections and those treated for a ≤72-hour sepsis rule-out Methods Data from this observational cohort study were collected retrospectively and prospectively from NICU patients with blood cultures obtained from September 2018 to February 2019. Clinical data were collected through chart review. All inoculated culture bottles were weighed for volume calculation. We determined the association of age, weight, sample source, and time of collection with volume < 1mL. Continuous variables were analyzed using Wilcoxon-Mann-Whitney, and categorical variables using chi-squared test. For aim 3, the volumes of the groups were compared using analysis of variance. Results A total of 310 blood cultures were identified, corresponding to 159 patients. Of these, 49 (16%) were positive. Among the negative blood cultures, 86% were collected in patients who subsequently received antibiotics (Figure 1). Median inoculated volume was 0.6 ml (IQR: 0.1-2.4). Weight and age at time of culture collection, source of sample, and time of collection were not significantly associated with the inoculation of < 1ml of blood. Median volume of blood was 0.6ml (0.3-0.6) for sepsis rule-out, 0.6ml (0.2-0.6) for bloodstream infection, and 0.6ml (0.6-1.4) for culture-negative sepsis. No difference was found among the three groups (p=0.54) Figure 1. Classification of blood cultures identified during study period Conclusion The blood volume collected for cultures in the NICU is lower than recommended. Clinical and environmental characteristics are not significantly associated with the inoculated volume. The volume of blood sampled does not differ in patients with culture-negative sepsis, bloodstream infection and sepsis rule-out, and should not be a justification for longer duration of antibiotic therapy Disclosures All Authors: No reported disclosures

scholarly journals Clinical Outcomes and Risk Factors for Tunneled Hemodialysis Catheter-Related Bloodstream Infections

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Kylie Martin ◽  
Yves S Poy Lorenzo ◽  
Po Yee Mia Leung ◽  
Sheri Chung ◽  
Emmet O’flaherty ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bloodstream Infection ◽  
Jugular Vein ◽  
Insertion Site ◽  
Bloodstream Infections ◽  
Left Internal Jugular Vein ◽  
Hemodialysis Catheter ◽  
Increased Risk ◽  
Catheter Related Bloodstream Infection ◽  
Reduced Risk

Abstract Diabetes and left internal jugular vein insertion site were significantly associated with increased risk of a catheter-related bloodstream infection from a tunneled hemodialysis catheter. Ex-smoker status was significantly associated with reduced risk.

scholarly journals A SNP in the Cache 1 Signaling Domain of Diguanylate Cyclase STM1987 Leads to Increased In Vivo Fitness of Invasive Salmonella Strains

2021 ◽  
Vol 89 (4) ◽  
Author(s):  
Akosiererem S. Sokaribo ◽  
Lindsay R. Balezantis ◽  
Keith D. MacKenzie ◽  
Yejun Wang ◽  
Melissa B. Palmer ◽  
...  
Keyword(s):  
Acute Infection ◽  
Bloodstream Infections ◽  
Sub Saharan Africa ◽  
Human Macrophage ◽  
Diguanylate Cyclase ◽  
Nucleotide Polymorphisms ◽  
Cellulose Production ◽  
Content Type ◽  
Signaling Domain

ABSTRACT Nontyphoidal Salmonella (NTS) strains are associated with gastroenteritis worldwide but are also the leading cause of bacterial bloodstream infections in sub-Saharan Africa. The invasive NTS (iNTS) strains that cause bloodstream infections differ from standard gastroenteritis-causing strains by >700 single-nucleotide polymorphisms (SNPs). These SNPs are known to alter metabolic pathways and biofilm formation and to contribute to serum resistance and are thought to signify iNTS strains becoming human adapted, similar to typhoid fever-causing Salmonella strains. Identifying SNPs that contribute to invasion or increased virulence has been more elusive. In this study, we identified a SNP in the cache 1 signaling domain of diguanylate cyclase STM1987 in the invasive Salmonella enterica serovar Typhimurium type strain D23580. This SNP was conserved in 118 other iNTS strains analyzed and was comparatively absent in global S. Typhimurium isolates associated with gastroenteritis. STM1987 catalyzes the formation of bis-(3′,5′)-cyclic dimeric GMP (c-di-GMP) and is proposed to stimulate production of cellulose independent of the master biofilm regulator CsgD. We show that the amino acid change in STM1987 leads to a 10-fold drop in cellulose production and increased fitness in a mouse model of acute infection. Reduced cellulose production due to the SNP led to enhanced survival in both murine and human macrophage cell lines. In contrast, loss of CsgD-dependent cellulose production did not lead to any measurable change in in vivo fitness. We hypothesize that the SNP in stm1987 represents a pathoadaptive mutation for iNTS strains.

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