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Author |
Raad, I.; Chaftari, A.-M.; Zakhour, R.; Jordan, M.; Al Hamal, Z.; Jiang, Y.; Yousif, A.; Garoge, K.; Mulanovich, V.; Viola, G.M.; Kanj, S.; Pravinkumar, E.; Rosenblatt, J.; Hachem, R. |
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Title |
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 |
Type |
Journal Article |
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Year |
2016 |
Publication  |
Antimicrobial Agents and Chemotherapy |
Abbreviated Journal |
Antimicrob Agents Chemother |
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Volume |
60 |
Issue |
6 |
Pages |
3426-3432 |
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Keywords |
Adult; Aged; Anti-Bacterial Agents/*therapeutic use; Bacteremia/*drug therapy/prevention & control; Biofilms/drug effects; Catheter-Related Infections/*drug therapy/prevention & control; Catheterization, Central Venous/*adverse effects; Central Venous Catheters/adverse effects/*microbiology; Edetic Acid/*therapeutic use; Ethanol/*therapeutic use; Female; Humans; Male; Middle Aged; Minocycline/*therapeutic use; Neoplasms/therapy; Pilot Projects; Prospective Studies; Treatment Outcome; Young Adult |
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Abstract |
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 vitro and 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 catheter in 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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MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA |
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0066-4804 |
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PMID:27001822 |
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Call Number |
ref @ user @ |
Serial |
99254 |
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Author |
Raad, I.; Chaftari, A.-M.; Zakhour, R.; Jordan, M.; Al Hamal, Z.; Jiang, Y.; Yousif, A.; Garoge, K.; Mulanovich, V.; Viola, G.M.; Kanj, S.; Pravinkumar, E.; Rosenblatt, J.; Hachem, R. |
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Title |
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 |
Type |
Journal Article |
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Year |
2016 |
Publication |
Antimicrobial Agents and Chemotherapy |
Abbreviated Journal |
Antimicrob Agents Chemother |
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Volume |
60 |
Issue |
6 |
Pages |
3426-3432 |
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Keywords |
Adult; Aged; Anti-Bacterial Agents/*therapeutic use; Bacteremia/*drug therapy/prevention & control; Biofilms/drug effects; Catheter-Related Infections/*drug therapy/prevention & control; Catheterization, Central Venous/*adverse effects; Central Venous Catheters/adverse effects/*microbiology; Edetic Acid/*therapeutic use; Ethanol/*therapeutic use; Female; Humans; Male; Middle Aged; Minocycline/*therapeutic use; Neoplasms/therapy; Pilot Projects; Prospective Studies; Treatment Outcome; Young Adult |
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Abstract |
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 vitro and 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 catheter in 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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MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA |
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0066-4804 |
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Notes |
PMID:27001822 |
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Call Number |
ref @ user @ |
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100284 |
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Author |
Hodgson, K.A.; Huynh, J.; Ibrahim, L.F.; Sacks, B.; Golshevsky, D.; Layley, M.; Spagnolo, M.; Raymundo, C.-M.; Bryant, P.A. |
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Title |
The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy |
Type |
Observational Study |
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Year |
2016 |
Publication |
Archives of Disease in Childhood |
Abbreviated Journal |
Arch Dis Child |
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Volume |
101 |
Issue |
10 |
Pages |
886-893 |
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Keywords |
Adolescent; Ambulatory Care/statistics & numerical data; Anti-Infective Agents/*administration & dosage; Bacterial Infections/drug therapy; Candidiasis/drug therapy; Catheterization, Central Venous/adverse effects/statistics & numerical data; Catheterization, Peripheral/adverse effects/statistics & numerical data; Ceftriaxone/administration & dosage; Cellulitis/drug therapy; Child; Child, Preschool; Cystic Fibrosis/drug therapy; Female; Gentamicins/administration & dosage; Humans; Infant; Infant, Newborn; Infusions, Intravenous; Infusions, Parenteral; Length of Stay/statistics & numerical data; Male; Patient Readmission/statistics & numerical data; Prescription Drugs/administration & dosage; Prospective Studies; Referral and Consultation/statistics & numerical data; Treatment Outcome; Urinary Tract Infections/drug therapy; Young Adult; *Infectious Diseases; *antibiotics; *home; *outpatient; *parenteral |
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OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children. DESIGN: This was a 12-month prospective observational study. SETTING: The hospital-in-the-home programme of The Royal Children's Hospital Melbourne. PATIENTS: All patients receiving OPAT. INTERVENTIONS: Data were collected including demographics, diagnosis, type of venous access and antibiotic choice. MAIN OUTCOME MEASURES: Length of stay, adverse events, readmission rate and appropriateness of antibiotic use. RESULTS: 228 patients received OPAT in 251 episodes. The median age was 7.4 years (range 1 week to 21 years), with 22 patients (10%) under 1 year. The most frequent diagnoses were exacerbation of cystic fibrosis (17%), urinary tract infection (12%) and cellulitis (9%). Most patients were transferred from the ward, but 18% were transferred directly from the emergency department, the majority with skin and soft-tissue infection (66%). Venous access was most commonly peripherally inserted central catheter (29%) and peripheral cannula (29%). 309 parenteral antibiotics were prescribed, most frequently ceftriaxone (28%) and gentamicin (19%). The majority of antibiotics (72%) were prescribed appropriately. However, 6% were deemed an inappropriate choice for the indication and 26% had inappropriate dose or duration. The incidence of central line-associated bloodstream infections was 0.9%. The unplanned readmission rate was 4%, with low rates of OPAT-related adverse events. Three children (1%) had an inadequate clinical response. CONCLUSIONS: OPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made. |
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RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Clinical Paediatrics Group, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Department of Paediatrics, University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia |
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0003-9888 |
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Notes |
PMID:27166221 |
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Call Number |
ref @ user @ |
Serial |
98922 |
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Author |
Hodgson, K.A.; Huynh, J.; Ibrahim, L.F.; Sacks, B.; Golshevsky, D.; Layley, M.; Spagnolo, M.; Raymundo, C.-M.; Bryant, P.A. |
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Title |
The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy |
Type |
Observational Study |
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Year |
2016 |
Publication |
Archives of Disease in Childhood |
Abbreviated Journal |
Arch Dis Child |
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Volume |
101 |
Issue |
10 |
Pages |
886-893 |
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Keywords |
Adolescent; Ambulatory Care/statistics & numerical data; Anti-Infective Agents/*administration & dosage; Bacterial Infections/drug therapy; Candidiasis/drug therapy; Catheterization, Central Venous/adverse effects/statistics & numerical data; Catheterization, Peripheral/adverse effects/statistics & numerical data; Ceftriaxone/administration & dosage; Cellulitis/drug therapy; Child; Child, Preschool; Cystic Fibrosis/drug therapy; Female; Gentamicins/administration & dosage; Humans; Infant; Infant, Newborn; Infusions, Intravenous; Infusions, Parenteral; Length of Stay/statistics & numerical data; Male; Patient Readmission/statistics & numerical data; Prescription Drugs/administration & dosage; Prospective Studies; Referral and Consultation/statistics & numerical data; Treatment Outcome; Urinary Tract Infections/drug therapy; Young Adult; *Infectious Diseases; *antibiotics; *home; *outpatient; *parenteral |
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Abstract |
OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children. DESIGN: This was a 12-month prospective observational study. SETTING: The hospital-in-the-home programme of The Royal Children's Hospital Melbourne. PATIENTS: All patients receiving OPAT. INTERVENTIONS: Data were collected including demographics, diagnosis, type of venous access and antibiotic choice. MAIN OUTCOME MEASURES: Length of stay, adverse events, readmission rate and appropriateness of antibiotic use. RESULTS: 228 patients received OPAT in 251 episodes. The median age was 7.4 years (range 1 week to 21 years), with 22 patients (10%) under 1 year. The most frequent diagnoses were exacerbation of cystic fibrosis (17%), urinary tract infection (12%) and cellulitis (9%). Most patients were transferred from the ward, but 18% were transferred directly from the emergency department, the majority with skin and soft-tissue infection (66%). Venous access was most commonly peripherally inserted central catheter (29%) and peripheral cannula (29%). 309 parenteral antibiotics were prescribed, most frequently ceftriaxone (28%) and gentamicin (19%). The majority of antibiotics (72%) were prescribed appropriately. However, 6% were deemed an inappropriate choice for the indication and 26% had inappropriate dose or duration. The incidence of central line-associated bloodstream infections was 0.9%. The unplanned readmission rate was 4%, with low rates of OPAT-related adverse events. Three children (1%) had an inadequate clinical response. CONCLUSIONS: OPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made. |
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Address |
RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Clinical Paediatrics Group, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Department of Paediatrics, University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia |
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0003-9888 |
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Notes |
PMID:27166221 |
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Call Number |
ref @ user @ |
Serial |
99952 |
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Author |
Richardson, I.P.; Sturtevant, R.; Heung, M.; Solomon, M.J.; Younger, J.G.; VanEpps, J.S. |
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Title |
Hemodialysis Catheter Heat Transfer for Biofilm Prevention and Treatment |
Type |
Journal Article |
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Year |
2016 |
Publication |
ASAIO Journal (American Society for Artificial Internal Organs : 1992) |
Abbreviated Journal |
Asaio J |
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Volume |
62 |
Issue |
1 |
Pages |
92-99 |
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Keywords |
Anti-Bacterial Agents/therapeutic use; *Biofilms; Catheter-Related Infections/drug therapy/microbiology/*therapy; Catheterization, Central Venous; Catheters, Indwelling/microbiology; Hot Temperature; Humans; Hydrodynamics; *Hyperthermia, Induced; Klebsiella Infections/physiopathology/*therapy; Klebsiella pneumoniae; Models, Cardiovascular; Renal Dialysis; Staphylococcal Infections/physiopathology/*therapy; Staphylococcus aureus; Staphylococcus epidermidis; Vancomycin/therapeutic use |
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Abstract |
Central line-associated bloodstream infections (CLABSIs) are not easily treated, and many catheters (e.g., hemodialysis catheters) are not easily replaced. Biofilms (the source of infection) on catheter surfaces are notoriously difficult to eradicate. We have recently demonstrated that modest elevations of temperature lead to increased staphylococcal susceptibility to vancomycin and significantly soften the biofilm matrix. In this study, using a combination of microbiological, computational, and experimental studies, we demonstrate the efficacy, feasibility, and safety of using heat as an adjuvant treatment for infected hemodialysis catheters. Specifically, we show that treating with heat in the presence of antibiotics led to additive killing of Staphylococcus epidermidis with similar trends seen for Staphylococcus aureus and Klebsiella pneumoniae. The magnitude of temperature elevation required is relatively modest (45-50 degrees C) and similar to that used as an adjuvant to traditional cancer therapy. Using a custom-designed benchtop model of a hemodialysis catheter, positioned with tip in the human vena cava as well as computational fluid dynamic simulations, we demonstrate that these temperature elevations are likely achievable in situ with minimal increased in overall blood temperature. |
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From the *Department of Emergency Medicine, daggerDivision of Nephrology, Department of Internal Medicine, and double daggerDepartment of Chemical Engineering, University of Michigan, Ann Arbor, Michigan |
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1058-2916 |
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Notes |
PMID:26501916 |
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Call Number |
ref @ user @ |
Serial |
99282 |
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