scholarly journals Hypoalbuminemia and Central Venous Catheter as Risk Factors for Multidrug-resistant Healthcare-associated Pneumonia in an Intensive Care Setting

2020 ◽  
pp. 23-33
Author(s):  
Ignatius Leon Guang Woei ◽  
Farida Islahudin ◽  
Norazlah Bahari ◽  
Tong Ji Sen
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Care Setting ◽  
Empirical Therapy ◽  
Venous Catheter ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Intensive Care Setting ◽  
Central Venous

The rapid emergence of antibiotic-resistant bacteria is a threat to global health particularly in the area of healthcare-associate pneumonia (HCAP) where there is high rate of mortality. In general, guidelines should serve as a framework that needs to be complemented by local antibiogram data due to multiple factors influencing the development of multidrug-resistant (MDR) HCAP. Failure to administer prompt and appropriate empirical therapy would often result in a high mortality rate. Based on these concerns, the aim of the study was to evaluate the appropriate empirical use of antibiotic and risk factors of MDR HCAP based on local pathogen resistant pattern. This was a retrospective analysis on HCAP in critical care of a tertiary-care hospital with data from January 2016 to December 2018. Patients diagnosed with HCAP: hospital-associated pneumonia (HAP) and ventilator-associated pneumonia (VAP), with positive bacterial cultures were included into the study. Of the 269 patients and isolates included, 160 (59.5%) had MDR strains. The top causative pathogens isolated were Acinetobacter baumannii (n=104, 38.7%), Pseudomonas aeruginosa (n=66, 24.5%), Klebsiella spp (n==55, 20.4%), and Staphylococcus aureus (n=16, 5.9%). The incidence of inappropriate empirical antibiotic was significantly higher in patients with MDR HCAP (n=135, 84.4%) compared to those with non-MDR HCAP (n=34, 31.2%) (p < 0.001). Mortality was significantly higher in patients receiving inappropriate empirical therapy (n = 118, 72.4%) compared to those receiving appropriate empirical antibiotic (n = 36, 54.5%) (P = 0.009). The independent risk factors for MDR HCAP identified in this study were hypoalbuminemia (odds ratio [OR] 3.43, 95% confidence interval [CI] 1.08 – 10.87, p = 0.036) and indwelling central venous catheter (OR 5.65, 95% CI 1.13 – 28.18, p = 0.035). This work serves as a basis for a center-specific guideline to improve antibiotic use among HCAP patients in intensive care setting.

Risk factor identification and predictive models for central line requirements for patients on vasopressors

2021 ◽  
pp. 0310057X2110242
Author(s):  
Adrian D Haimovich ◽  
Ruoyi Jiang ◽  
Richard A Taylor ◽  
Justin B Belsky
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Single Agent ◽  
Composite Endpoint ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous

Vasopressors are ubiquitous in intensive care units. While central venous catheters are the preferred route of infusion, recent evidence suggests peripheral administration may be safe for short, single-agent courses. Here, we identify risk factors and develop a predictive model for patient central venous catheter requirement using the Medical Information Mart for Intensive Care, a single-centre dataset of patients admitted to an intensive care unit between 2008 and 2019. Using prior literature, a composite endpoint of prolonged single-agent courses (>24 hours) or multi-agent courses of any duration was used to identify likely central venous catheter requirement. From a cohort of 69,619 intensive care unit stays, there were 17,053 vasopressor courses involving one or more vasopressors that met study inclusion criteria. In total, 3807 (22.3%) vasopressor courses involved a single vasopressor for less than six hours, 7952 (46.6%) courses for less than 24 hours and 5757 (33.8%) involved multiple vasopressors of any duration. Of these, 3047 (80.0%) less than six-hour and 6423 (80.8%) less than 24-hour single vasopressor courses used a central venous catheter. Logistic regression models identified associations between the composite endpoint and intubation (odds ratio (OR) 2.36, 95% confidence intervals (CI) 2.16 to 2.58), cardiac diagnosis (OR 0.72, CI 0.65 to 0.80), renal impairment (OR 1.61, CI 1.50 to 1.74), older age (OR 1.002, Cl 1.000 to 1.005) and vital signs in the hour before initiation (heart rate, OR 1.006, CI 1.003 to 1.009; oxygen saturation, OR 0.996, CI 0.993 to 0.999). A logistic regression model predicting the composite endpoint had an area under the receiver operating characteristic curve (standard deviation) of 0.747 (0.013) and an accuracy of 0.691 (0.012). This retrospective study reveals a high prevalence of short vasopressor courses in intensive care unit settings, a majority of which were administered using central venous catheters. We identify several important risk factors that may help guide clinicians deciding between peripheral and central venous catheter administration, and present a predictive model that may inform future prospective trials.

scholarly journals Risk Factors of Central Venous Catheter Leakage in Neonatal Intensive Care Unit

Perinatology ◽  
2019 ◽  
Vol 30 (2) ◽  
pp. 60 ◽  
Author(s):  
Young Duck Kim ◽  
Na Mi Lee ◽  
Su Yeong Kim ◽  
Dae Yong Yi ◽  
Sin Weon Yun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Venous Catheter ◽  
Central Venous

scholarly journals Current Status and Risk Factors of Complications Associated with Central Venous Catheterization in Pediatric Intensive Care Unit

2021 ◽  
Author(s):  
JingMei Li ◽  
JiaFei Zhang ◽  
Bo Feng ◽  
ChunHui Wang ◽  
MeiLing Wang
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Intravenous Infusion ◽  
Insertion Site ◽  
Pediatric Intensive Care ◽  
Venous Catheter ◽  
Central Venous ◽  
Puncture Site

Abstract Background: The objective of this study was to evaluate incidence and influencing factors of complications related to central venous catheters (CVCs) in the Pediatric intensive care unit (PICU) of Xi'an Children's Hospital.Methods: We analyzed the complications of all children that had CVCs and were hospitalized between June 2020 to February 2021. A total of 334 CVCs were inserted in 310 children.Results: We noted 102 (30.54%) CVCs-related complications. Complications related to CVCs insertion were infection of catheter (13.17%) and malposition of catheter (8.38%), occlusion of CVCs (2.99%), accidental removal (0.6%), puncture site exudate (4.79%), central venous thrombosis (0.6%). Infection mainly due to Staphylococcus epidermidis. 88 cases (24.55%) of CVCs were extubated due to complications. Analysis of the frequency of maintenance-related complications except for center vein thrombosis showed no differences between the jugular, femoral and subclavian vein access (P > 0.05). It was found that the duration of the catheterization use was critical for the occurrence of CVCs-related infections, puncture site exudate, occlusion (P < 0.05). Suture-off, bleeding of insertion site, and the maximum channels of intravenous infusion in patients were dominant risk factors of catheter-related complications. Conclusion: The risk factors of complications during catheter indwelling are suture-off, bleeding of insertion site and the maximum channels of intravenous infusion in patients. Therefore, strict aseptic operation in various operations, control of the infusion channel, effective fixation of the central venous catheter, reduce the malposition and pull of the catheter, and reduce the infiltration of blood at the puncture point, are particularly important to prevent the complications related to the central venous catheter.

scholarly journals Determination Of Prevalence Of Thrombosis And Predisposing Factors In Patients Followed Up With A Central Venous Catheter In Pediatric Intensive Care Unit

2020 ◽  
Vol 7 (09) ◽  
pp. 4934-4943
Author(s):  
Merve Korkmaz ◽  
Muhammed Şükrü Paksu ◽  
Muhammet Furkan Korkmaz ◽  
Kerim Arslan ◽  
Mustafa Özdemir
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Pediatric Intensive Care ◽  
Venous Catheter ◽  
Catheter Placement ◽  
Central Venous ◽  
Hereditary Risk

Objective: Objective of this study is determination of prevalence of thrombosis and predisposing factors in critically ill patients with central venous catheter (CVC) placement in Pediatric Intensive Care Unit. Material and method: Of 76 cases with CVC placement aged between 1 month to 18 years; venous structures at the extremity where the CVC was placed and their symmetrical equivalents were prospectively examined by using Doppler ultrasonography (DUSG) at days 0, 3, 7, 14 and 28. Results: Median age of the cases included in the study was 19 (2-201) months. Of the cases; 49 (64.5%) was male and 27 (35.5%) was female, with a male/female ratio of 1.81:1. 55 (72.3%) of the cases had an underlying disease. Most common accompanying diseases were neurological and neuromuscular diseases (35.5%), followed by inborn errors of metabolism (14.4%). More than one catheters were placed for 26 (34.2%) of the cases. A total of 107 catheters were placed. Median catheter dwelling time was 12 (2-46) days. Most commonly placed catheters were of Seldinger type (90%). As an early complication, arterial embolism was observed in one (0.9%) case and pneumothorax in one (0.9%) case. As a late complication during the period with a catheter placed, six (7.8%) cases developed catheter infections and 11 (14.4%) cases developed catheter-induced thrombosis. Four (36.3%) of the cases which developed thrombosis were symptomatic. In six (54.4%) of the cases, thrombosis was determined to occur within first three days. When the cases were evaluated in regard to risk factors for thrombosis other than CVC placement, a significant association of CPR application (p= 0.004) and multiple catheter placement (p< 0.001) with thrombosis was determined in uni- and multivariate analyses. 72.7% of the cases with thrombosis were examined for hereditary risk factors and no significant evidence was determined. Conclusion: Our study reveals that multiple catheter placement and CPR application significantly increases risk of thrombosis. Even in absence of any clinical finding, routine evaluation with DSUG within first seven days following catheter placement is useful. Our results suggest that screening for hereditary risk factors which may cause predisposition to thrombosis in all patients with thrombosis in presence of acquired risk factors is unnecessary.

Risk Factors for Central Venous Catheter-Related Infections in Surgical and Intensive Care Units

1994 ◽  
Vol 15 (4) ◽  
pp. 253-264 ◽  
Author(s):  
Maria Luisa Moro ◽  
Egidio Franco Viganò ◽  
Alessandro Cozzi Lepri ◽  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Intensive Care Units ◽  
Venous Catheter ◽  
Central Venous
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