Catheter-related bloodstream infections

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Abstract

Central-venous-catheter-related bloodstream infections (CRBSIs) are an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. Consequences depend on associated organisms, underlying pre-morbid conditions, timeliness, and appropriateness of the treatment/interventions received. We have summarized risk factors, pathogenesis, etiology, diagnosis, and management of CRBSI in this review.

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Anidulafungin versus fluconazole for invasive candidiasis.

Annette Reboli, Coleman Rotstein, Peter Pappas … (2007)

Anidulafungin, a new echinocandin, has potent activity against candida species. We compared anidulafungin with fluconazole in a randomized, double-blind, noninferiority trial of treatment for invasive candidiasis. Adults with invasive candidiasis were randomly assigned to receive either intravenous anidulafungin or intravenous fluconazole. All patients could receive oral fluconazole after 10 days of intravenous therapy. The primary efficacy analysis assessed the global response (clinical and microbiologic) at the end of intravenous therapy in patients who had a positive baseline culture. Efficacy was also assessed at other time points. Eighty-nine percent of the 245 patients in the primary analysis had candidemia only. Candida albicans was isolated in 62% of the 245 patients. In vitro fluconazole resistance was infrequent. Most of the patients (97%) did not have neutropenia. At the end of intravenous therapy, treatment was successful in 75.6% of patients treated with anidulafungin, as compared with 60.2% of those treated with fluconazole (difference, 15.4 percentage points; 95% confidence interval [CI], 3.9 to 27.0). The results were similar for other efficacy end points. The statistical analyses failed to show a "center effect"; when data from the site enrolling the largest number of patients were removed, success rates at the end of intravenous therapy were 73.2% in the anidulafungin group and 61.1% in the fluconazole group (difference, 12.1 percentage points; 95% CI, -1.1 to 25.3). The frequency and types of adverse events were similar in the two groups. The rate of death from all causes was 31% in the fluconazole group and 23% in the anidulafungin group (P=0.13). Anidulafungin was shown to be noninferior to fluconazole in the treatment of invasive candidiasis. (ClinicalTrials.gov number, NCT00056368 [ClinicalTrials.gov]). Copyright 2007 Massachusetts Medical Society.

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Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access.

William A Ghali, Cam Donaldson, Helen Lee … (2002)

Care of patients with end-stage renal disease (ESRD) is important and resource intense. To enable ESRD programs to develop strategies for more cost-efficient care, an accurate estimate of the cost of caring for patients with ESRD is needed. The objective of our study is to develop an updated and accurate itemized description of costs and resources required to treat patients with ESRD on dialysis therapy and contrast differences in resources required for various dialysis modalities. One hundred sixty-six patients who had been on dialysis therapy for longer than 6 months and agreed to enrollment were followed up prospectively for 1 year. Detailed information on baseline patient characteristics, including comorbidity, was collected. Costs considered included those related to outpatient dialysis care, inpatient care, outpatient nondialysis care, and physician claims. We also estimated separately the cost of maintaining the dialysis access. Overall annual cost of care for in-center, satellite, and home/self-care hemodialysis and peritoneal dialysis were US $51,252 (95% confidence interval [CI], 47,680 to 54,824), $42,057 (95% CI, 39,523 to 44,592), $29,961 (95% CI, 21,252 to 38,670), and $26,959 (95% CI, 23,500 to 30,416), respectively (P < 0.001). After adjustment for the effect of other important predictors of cost, such as comorbidity, these differences persisted. Among patients treated with hemodialysis, the cost of vascular access-related care was lower by more than fivefold for patients who began the study period with a functioning native arteriovenous fistula compared with those treated with a permanent catheter or synthetic graft (P < 0.001). To maximize the efficiency with which care is provided to patients with ESRD, dialysis programs should encourage the use of home/self-care hemodialysis and peritoneal dialysis. Copyright 2002 by the National Kidney Foundation, Inc.

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Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures.

Anne Rapin, P Legrand, S Larabi … (1987)

The results of a simplified quantitative broth dilution quantitative tip culture (QTC) of 331 central venous catheters were compared with clinical data prospectively recorded in critically III patients to diagnose bacteremic or nonbacteremic catheter-related sepsis (CRS) (36 catheters), as opposed to contamination (42 catheters) or simple colonization from a distant septic focus (seven catheters). Thirty-five of 36 catheters associated with CRS yielded 10(3) colony-forming units per milliliter (CFU/mL) or more, and 3.8 X 10(2) Candida organisms grew from one. In contrast, 5 X 10(2) CFU/mL or less grew from 37 of 42 contaminated catheters. A QTC of 10(3) CFU/mL or more was 97.5% sensitive and 88% specific for the diagnosis of CRS. The QTC appeared especially useful for the diagnosis of CRS secondary to blood-borne seeding of catheters, or associated with coagulase-negative staphylococci.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Crit Illn Inj Sci

Journal ID (iso-abbrev): Int J Crit Illn Inj Sci

Journal ID (publisher-id): IJCIIS

Title: International Journal of Critical Illness and Injury Science

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2229-5151

ISSN (Electronic): 2231-5004

Publication date (Print): Apr-Jun 2014

Volume: 4

Issue: 2

Pages: 162-167

Affiliations

[1]Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi, India

[1 ]Department of Anaesthesia, Institute of Medical Science, Banaras Hindu University, Varanasi, India

Author notes

Address for correspondence: Dr. Rupam Gahlot, Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, India. E-mail: rupam.gahlot@ 123456gmail.com

Article

Publisher ID: IJCIIS-4-162

DOI: 10.4103/2229-5151.134184

PMC ID: 4093967

PubMed ID: 25024944

SO-VID: 6b51383e-2ff1-43e9-bcf7-2a9f95d7c41b

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Catheter-related bloodstream infections

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Most cited references 28

Anidulafungin versus fluconazole for invasive candidiasis.

Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access.

Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures.

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