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Author Wolf, H.-H.; Leithauser, M.; Maschmeyer, G.; Salwender, H.; Klein, U.; Chaberny, I.; Weissinger, F.; Buchheidt, D.; Ruhnke, M.; Egerer, G.; Cornely, O.; Fatkenheuer, G.; Mousset, S.
Title Central venous catheter-related infections in hematology and oncology : guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) Type Journal Article
Year 2008 Publication Annals of Hematology Abbreviated Journal Ann Hematol
Volume 87 Issue 11 Pages 863-876
Keywords Anti-Bacterial Agents/therapeutic use; Antifungal Agents/therapeutic use; *Bacteremia/diagnosis/drug therapy/prevention & control; Catheterization, Central Venous/*adverse effects/*standards; *Cross Infection/diagnosis/drug therapy/prevention & control; Humans; Microbiological Techniques/standards
Abstract Catheter-related infections (CRI) cause considerable morbidity in hospitalized patients. The incidence does not seem to be higher in neutropenic patients than in nonneutropenic patients. Gram-positive bacteria (coagulase-negative staphylococci, Staphylococcus aureus) are the pathogens most frequently cultured, followed by Candida species. Positive blood cultures are the cornerstone in the diagnosis of CRIs, while local signs of infection are not necessarily present. Blood cultures should be taken from peripheral blood and from the venous catheter. A shorter time to positivity of catheter blood cultures as compared with peripheral blood cultures supports the diagnosis of a CRI. In many cases, a definite diagnosis requires catheter removal and microbiological analysis. The role plate method with semiquantitative cultures has been established as standard in most laboratories. Antimicrobial treatment of CRI should be directed by the in vitro susceptibility of the isolated pathogen. Primary removal of the catheter is mandatory in S. aureus and Candida infections, as well as in case of tunnel or pocket infections. Future studies will elucidate whether the rate of CRI in neutropenic patients may be reduced by catheters impregnated with antimicrobial agents.
Address Klinik fur Innere Medizin IV, Onkologie, Hamatologie und Hamostaseologie, Martin-Luther-Universitat Halle, Ernst-Grube-Str. 40, 06120 Halle, Germany. hans.wolf@medizin.uni-halle.de
Corporate Author Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0939-5555 ISBN Medium
Area Expedition Conference
Notes PMID:18629501 Approved no
Call Number ref @ user @ Serial (down) 100514
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Author Wirtschafter, D.D.; Padilla, G.; Suh, O.; Wan, K.; Trupp, D.; Fayard, E.E.S.
Title Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique Type Multicenter Study
Year 2011 Publication Journal of Perinatology : Official Journal of the California Perinatal Association Abbreviated Journal J Perinatol
Volume 31 Issue 8 Pages 514-518
Keywords Anti-Bacterial Agents/*therapeutic use; Bacteremia/*drug therapy; Catheterization, Central Venous/*adverse effects; Catheters, Indwelling/adverse effects; Cross Infection/*drug therapy/*epidemiology/prevention & control; Drug Utilization; Humans; Infant, Newborn; *Intensive Care Units, Neonatal; Practice Patterns, Physicians'/*statistics & numerical data; Quality Indicators, Health Care
Abstract OBJECTIVE: To assess antibiotic use as a complementary neonatal intensive care unit (NICU) infection measure to the central line-associated blood stream infection (CLABSI) rate. STUDY DESIGN: Patient days (PDs), line days, antibiotic (AB) use, CLABSI and other proven infections were analyzed in consecutive admissions to two NICUs over 3 and 6 months, respectively, from 1 January 2008 until discharge. An antibiotic course (AC) consisted of one or more uninterrupted antibiotic days (AD), classified as perinatal or neonatal, if started </=3 d or >/=4 d post birth and as rule-out sepsis or presumed infection (PI) if treated </=4 d or >/=5d, respectively. Events were expressed per 1000 PD and aggregated by conventional treatment categories and by clinical perception of infection certainty: possible, presumed or proven. RESULT: The cohort included 754 patients, 18,345 PD, 6637 line days, 718 AC and 4553 AD. Of total antibiotic use, neonatal use constituted 39.2% of ACs, and 29.0% of ADs, When analyzed per 1000 PD, antibiotic use to treat PIs vs CLABSIs, was either 14 fold (CI 6.6-30) higher for ACs (5.40 vs 0.38/1000 PD, P<0.0001) or 8.8 fold (CI 7.1-11) higher for ADs (48.3 vs 5.5/1000 PD, P<0.0001). CONCLUSION: CLABSI rates, present a lower limit of NICU-acquired infections, whereas antibiotic-use measures, about 10-fold higher, may estimate an upper limit of that burden. Antibiotic-use metrics should be evaluated further for their ability to broaden NICU infection assessment and to guide prevention and antibiotic stewardship efforts.
Address David D Wirtschafter, MD, Inc., Valley Village, CA 91607, USA. david.wirtschafter@juno.com
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0743-8346 ISBN Medium
Area Expedition Conference
Notes PMID:21546938 Approved no
Call Number ref @ user @ Serial (down) 100513
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Author Wintenberger, C.; Epaulard, O.; Hincky-Vitrat, V.; Brion, J.P.; Recule, C.; Francois, P.; Stahl, J.P.; Pavese, P.
Title Outcome of central venous catheter-related bacteraemia according to compliance with guidelines: experience with 91 episodes Type Journal Article
Year 2012 Publication The Journal of Hospital Infection Abbreviated Journal J Hosp Infect
Volume 80 Issue 3 Pages 245-251
Keywords Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents/administration & dosage/*therapeutic use; Bacteremia/diagnosis/*drug therapy/etiology/mortality; Catheterization, Central Venous/*adverse effects; Child; Child, Preschool; Female; France/epidemiology; *Guideline Adherence; Hospitals, University; Humans; Male; Middle Aged; *Practice Guidelines as Topic; Treatment Outcome; Young Adult
Abstract BACKGROUND: Infection is a major complication associated with the use of central venous catheters. Guidelines for medical management of catheter-related bacteraemia have been published, but no study has assessed the appropriateness of physician practices. AIM: To assess medical practices in cases of central venous catheter-related bacteraemia (CRB) in a university hospital. METHODS: Cases were recorded over a period of 12 months and their management was evaluated. All cases of positive blood cultures based on central venous catheter sampling were analysed, and episodes of CRB were determined in this group of patients. Medical management and patient outcome were analysed independently by two physicians. FINDINGS: In all, 187 cases of positive blood culture were recorded and 91 cases of CRB were analysed. Systemic antimicrobial therapy was optimal in 56% of the episodes. In 51 episodes, catheter salvage was attempted, for 29 with an indication in agreement with the guidelines but without antibiotic-lock therapy in 20 episodes. The overall medical management was appropriate in 41.8% of the episodes. The overall cure rate was 72.5%. CRB-related death occurred in 5.5% of the episodes. Cure was associated with guideline compliance (P = 0.03) and with adaptation of systemic antimicrobial therapy (P < 0.01). Conservative treatment success was associated with compliance with the guidelines for the indication (P = 0.01). CONCLUSION: Medical management of CRB did not closely adhere to international guidelines. CRB outcome was associated with the appropriateness of this management, particularly when conservative treatment was attempted.
Address Infectious Diseases Department, Grenoble University Hospital, Grenoble, France. CWintenberger@chu-grenoble.fr
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0195-6701 ISBN Medium
Area Expedition Conference
Notes PMID:22230103 Approved no
Call Number ref @ user @ Serial (down) 100512
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Author Winokur, E.J.; Pai, D.; Rutledge, D.N.; Vogel, K.; Al-Majid, S.; Marshall, C.; Sheikewitz, P.
Title Blood culture accuracy: discards from central venous catheters in pediatric oncology patients in the emergency department Type Journal Article
Year 2014 Publication Journal of Emergency Nursing: JEN : Official Publication of the Emergency Department Nurses Association Abbreviated Journal J Emerg Nurs
Volume 40 Issue 4 Pages 323-329
Keywords California; *Central Venous Catheters; Child; Emergency Nursing/*methods; Emergency Service, Hospital; Humans; Neoplasms/*blood/complications; Pediatrics/methods; Phlebotomy/*methods; Reproducibility of Results; Sensitivity and Specificity; Sepsis/*blood/complications; Blood culture; Blood discards; Central venous catheter (CVC); Oncology; Research
Abstract INTRODUCTION: Lack of specific guidelines regarding collection of blood for culture from central venous catheters (CVCs) has led to inconsistencies in policies among hospitals. Currently, no specific professional or regulatory recommendations exist in relation to using, reinfusing, or discarding blood drawn from CVCs before drawing blood for a culture. Repeated wasting of blood may harm immunocompromised pediatric oncology patients. The purpose of this comparative study was to determine whether differences exist between blood cultures obtained from the first 5 mL of blood drawn from a CVC line when compared with the second 5 mL drawn. METHODS: During 2009-2011, 62 pediatric oncology patients with CVCs and orders for blood cultures to determine potential sepsis were enrolled during ED visits. Trained study nurses aseptically drew blood and injected the normally discarded first 5 mL and the second specimen (usual care) into separate culture bottles. Specimens were processed in the microbiology laboratory per hospital policy. RESULTS: Positive cultures were evaluated to assess agreement between specimen results and to determine that the identified pathogen was not a contaminant. Out of 186 blood culture pairs, 4.8% demonstrated positive results. In all positive-positive matches, the normal discard specimen contained the same organism as the usual care specimen. In 4 matches, the normally discarded specimen demonstrated notably earlier time to positivity (4 to 31 hours) compared with the usual care specimen, which resulted in earlier initiation of definitive antibiotics. DISCUSSION: These findings support the accuracy of the specimen that is normally discarded and suggest the need to reconsider its use for blood culture testing.
Address Fullerton and Orange, CA
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 0099-1767 ISBN Medium
Area Expedition Conference
Notes PMID:23816324 Approved no
Call Number ref @ user @ Serial (down) 100511
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Author Wilson, S.; Young, A.
Title Analysis of exit site care on IV antibiotic use in facilities using electrolytically produced sodium hypochlorite: a pilot retrospective study Type Journal Article
Year 2012 Publication Nephrology Nursing Journal : Journal of the American Nephrology Nurses' Association Abbreviated Journal Nephrol Nurs J
Volume 39 Issue 2 Pages 125-9; quiz 130
Keywords Administration, Topical; Anti-Bacterial Agents/administration & dosage/*therapeutic use; Disinfectants/*administration & dosage; Humans; Incidence; Infection/epidemiology; Infection Control/methods; Infusions, Intravenous; Pilot Projects; Prospective Studies; Sodium Hypochlorite/*administration & dosage
Abstract In a retrospective survey of 226 dialysis facilities, the present study compared the effectiveness of topical disinfection with electrolytically produced sodium hypochlorite (ESH) and povidone iodine in preventing central venous catheter-related infections by tracking intravenous (IV) antibiotic administration. In patients undergoing hemodialysis, 18.1% of patients in ESH facilities and 19.2% of patients in povidone iodine facilities were administered IV antibiotics one or more times during the six-month study (p = 0.09). These findings suggest that ESH and povidone iodine are comparable in effectiveness for exit site care in patients dialyzing with central venous catheters.
Address DaVita Clinical Research, Minneapolis, MN, USA. Steve.wilson@davita.com
Corporate Author Thesis
Publisher Place of Publication Editor
Language English Summary Language Original Title
Series Editor Series Title Abbreviated Series Title
Series Volume Series Issue Edition
ISSN 1526-744X ISBN Medium
Area Expedition Conference
Notes PMID:22690445 Approved no
Call Number ref @ user @ Serial (down) 100510
Permanent link to this record