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Risk Factors for Central Line–Associated Bloodstream Infection in Pediatric Intensive Care Units

wallyr — Fri, 27 Aug 2010 23:27:30 +0000

Wylie MC et al. – The authors sought to identify risk factors for central line–associated bloodstream infection (CLABSI) to describe children who might benefit from adjunctive interventions. Duration of central access, receipt of parenteral nutrition, and receipt of blood transfusion were confirmed as risk factors for CLABSI among children in the ICU. Newly identified risk factors include presence of gastrostomy tube, nonoperative cardiovascular disease, and ICU placement of central venous catheter. Children with these risk factors may be candidates for adjunctive interventions for CLABSI prevention.
Objective.We sought to identify risk factors for central line–associated bloodstream infection (CLABSI) to describe children who might benefit from adjunctive interventions.

Design.Case‐control study of children admitted to the medical‐surgical intensive care unit (ICU) or cardiac ICU from January 1, 2004, through December 31, 2007.
Setting.Children’s Hospital Boston is a freestanding, 396‐bed quaternary care pediatric hospital with a 29‐bed medical‐surgical ICU and a 24‐bed cardiac ICU.
Patients.Case patients were patients with CLABSI who were identified by means of prospective surveillance. Control subjects were patients with a central venous catheter who were matched by ICU admission date.
Methods.Multivariate conditional logistic regression models were used to identify independent risk factors for CLABSI and to derive and to validate a prediction rule.
Results.Two hundred three case patients were matched with 406 control subjects. Independent predictors of CLABSI included duration of ICU central access (odds ratio [OR] for 15 or more days, 18.41 [95% confidence interval {CI}, 4.10–82.56]; ), central venous catheter placement in the ICU (OR for 2 or more ICU‐placed catheters, 8.63 [95% CI, 2.63–28.38]; ), nonoperative cardiovascular disease (OR, 7.44 [95% CI, 2.13–25.98]; ), presence of gastrostomy tube (OR, 3.48 [95% CI, 1.55–7.79]; ), receipt of parenteral nutrition (OR, 3.12 [95% CI, 1.55–6.32]; ), and receipt of blood transfusion (OR, 2.55 [95% CI, 1.21–5.36]; ). By use of risk factors known before central venous catheter placement, our model predicted CLABSI with a positive predictive value of 54% and a negative predictive value of 79%.

Conclusions.Duration of central access, receipt of parenteral nutrition, and receipt of blood transfusion were confirmed as risk factors for CLABSI among children in the ICU. Newly identified risk factors include presence of gastrostomy tube, nonoperative cardiovascular disease, and ICU placement of central venous catheter. Children with these risk factors may be candidates for adjunctive interventions for CLABSI prevention
Infect Control Hosp Epidemiol 2010;31 electronically published August 23, 2010.

Nursing home-associated infections in Department of Veterans Affairs community living centers

wallyr — Tue, 17 Aug 2010 17:37:38 +0000

Tsan L et al. – Little is known about factors contributing to nursing home–associated infections (NHAIs). Indwelling device use, but not bed location or treatment code, was found to be associated with increased rate of NHAIs.

Background
Little is known about factors contributing to nursing home-associated infections (NHAIs). We conducted a survey of residents in 133 Department of Veterans Affairs community living centers to determine the roles of indwelling device use, bed locations, and treatment codes on NHAIs.

Methods
A Web-based point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections was conducted on November 14, 2007.
Results
Among 10,939 residents, 575 had at least one NHAI, for a point prevalence rate of 5.3%. Urinary tract infection, skin infection, asymptomatic bacteriuria, and pneumonia were the most prevalent NHAIs. A total of 2687 residents had one or more indwelling devices; 290 of these also had an NHAI, for a prevalence of 10.8%. In contrast, the prevalence of NHAIs in residents without indwelling devices was 3.5% (P < .0001). Indwelling urinary catheters, percutaneous gastrostomy tubes, peripherally inserted central catheters, and suprapubic urinary catheters were the most commonly used devices. There were 4027 residents in designated units and 6912 residents in dispersed units. The rate of device use was 21.4% in the designated units and 26.4% in the dispersed units (P < .0001). The prevalence of NHAIs was 4.5% in the designated units and 5.7% in the dispersed units (P < .001). Rates of NHAIs and device use varied greatly among the various treatment codes; however, there was a positive correlation between the rates of NHAIs and device use. Stepwise logistic regression analysis of data from long-stay and short-stay skilled nursing care residents revealed that only the presence of an indwelling device, not length of stay or bed location, affected the rate of NHAIs.
Conclusion
Indwelling device use, but not bed location or treatment code, was found to be associated with increased rate of NHAIs.
American Journal of Infection Control
Volume 38, Issue 6, Pages 461-466 (August 2010)

Endoluminal colonization as a risk factor for coagulase-negative staphylococcal catheter-related bloodstream infections in haemodialysis patients

wallyr — Tue, 17 Aug 2010 17:19:17 +0000

Rodríguez–Aranda A et al. – Approximately 25% of haemodialysis (HD) patients use catheters as vascular access. Catheter–related bloodstream infections (CRBSI) are a major risk in this population. The study determines whether endoluminal catheter colonization (ECC) predicts CRBSI. This study shows that ECC may predict the risk of developing CRSBI. Surveillance cultures could, therefore, be used to triage individual HD patients who might benefit from specific intervention measures.
Background. Approximately 25% of haemodialysis (HD) patients use catheters as vascular access. Catheter-related bloodstream infections (CRBSI) are a major risk in this population. The objective of our study was to determine whether endoluminal catheter colonization (ECC) predicts CRBSI.
Methods. We followed up a cohort of HD patients in our institution who underwent HD with tunnelled cuffed central venous catheters (TCC) between December 2006 and June 2008. Colonization of the inner catheter lumen was assessed every 15 days immediately before HD by culture of blood–heparin mixture and the time to positivity (TTP) was recorded by the BacT/Alert automated system. CRBSI was confirmed by differential TTP (> 2 h) between TCC and peripheral blood cultures.
Results. We studied 51 patients who required 64 TCC. The incidence of CRBSI was 1.65 episodes per 1000 catheter-days, with Staphylococcus epidermidis being the most common cause of infection (76.2%). ECC was more frequent in the CRSBI group than in the non-CRBSI group (100 vs 5.4%, P < 0.001). For S. epidermidis CRBSIs, the median time from ECC to CRBSI was 31.5 days (interquartile range, 27.0–79.0). The sensitivity, specificity and negative and positive predictive values of arterial lumen cultures for S. epidermidis CRBSIs were 100, 96.3, 92.3 and 100%, respectively, while for venous culture, these values were 92.3, 96.3, 92.3 and 96.3%, respectively. For predicting S. epidermidis CRBSI, endoluminal cultures with a TTP of 14 h had sensitivity and specificity of 52.1 and 97.7%, respectively.
Conclusions. This study shows that ECC may predict the risk of developing CRSBI. Surveillance cultures could, therefore, be used to triage individual HD patients who might benefit from specific intervention measures.
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfq481

Long-term persistence of MRSA in re-admitted patients

wallyr — Mon, 09 Aug 2010 23:29:22 +0000

Mattner F et al. – A detailed knowledge of the dynamics of the loss of MRSA infection could result in a reduction of the incidence of MRSA in the future. Multiple anatomical site carriage of MRSA appeared to predict a prolonged persistence in the cohort of patients re–admitted to a university hospital.
Full Text Article link: http://www.springerlink.com/content/dp24012122553179/fulltext.html
Infection
A Journal of Infectious Disease
© The Author(s) 2010
10.1007/s15010-010-0038-8

Is previous Clostridium difficile infection a problem after reversal of ileostomy

wallyr — Mon, 09 Aug 2010 23:09:55 +0000

Randall JK et al. – Ileostomy closure and small bowel resection, may carry a higher risk of CDI.

Abstract
Aim: Clostridium difficile infection (CDI) is a cause of morbidity and mortalityin hospitals . Various independent risk factors have beenidentified, including age and antibiotic exposure. This studyattempted to determine whether surgery and associated antibiotic use influence the development of CDI.

Method: A retrospective review of all patients with a diagnosis of Clostridium difficile infection diagnosed during admission to a colorectal unit was conducted over a 20 month period. Patient records were cross referenced with a microbiology database to identify previous episodes of infection and cases of recurrence.

Results: There were 38 CDI episodes in 29 patients, including 9 with recurrence. In 33 the use of antibiotics prior to the onset of CDI was documented but in 14 (37%) cases this was limited to perioperative prophylaxis. The incidence of CDI after various procedures was :ileostomy closure (4.2%), small bowel resection (XX%),right hemicolectomy (2.1%) and anterior resection (1%).
Conclusion: Ileostomy closure and small bowel resection, may carry a higher risk of CDI.

Colorectal Disease
Article first published online: 19 NOV 2009
DOI: 10.1111/j.1463-1318.2009.02139.x

Surgical site infections in a tertiary health care center: Prospective cohort study

wallyr — Wed, 04 Aug 2010 18:48:10 +0000

Suljagic V et al. – The aim of this study was to investigate the most important risk factors associated with the development of surgical site infections (SSIs). Therefore, greater attention has been given to adherence to recommendations for the prevention and control of SSIs as well as to antibiotic prophylaxis protocols
Abstract
Purpose
To investigate the incidence and risk factors associated with the development of surgical site infections (SSIs) using the National Nosocomial Infection Surveillance (NNIS).
Methods
A prospective cohort study was conducted at a tertiary health care center. Infection control personnel collected general and health care related data about patients. The NNIS risk index was calculated on the basis of data relating to the operation: wound contamination class, duration of surgery, and the American Society of Anesthesiologists (ASA) score.
Results
A total of 5109 surgical procedures were included in the study. The overall cumulative incidence rate was 6.3%. The incidence of SSIs was 2.3% (63.5% of operative procedures), 8.3% (29.7%), 34.6% (6.2%), and 43.3% (0.6%), in patients with 0, 1, 2, and 3 risk index, respectively. The length of hospital stay (OR: 1.0; 95% CI: 1.053–1.075), preoperative length of stay (odds ratio [OR]: 1.9; 95% confidence interval [CI]: 1.953–1.981), antibiotic prophylaxis (OR: 2.5; 95% CI: 1.421–4.628), drainage (OR: 1.7; 95% CI: 1.360–2.353), ASA score (OR: 1.5; 95% CI: 1.235–1.946), class of wound contamination (OR: 2.0; 95% CI: 1.745–2.003), and NNIS risk index (OR: 1.3; 95% CI: 1.063–1.7) were independently associated with an increased risk for SSIs. Staphylococcus aureus was the most frequently isolated microorganism, 64% of them being methicillin-resistant.
Conclusion
The aim of this study was to investigate the most important risk factors associated with the development of surgical site infections (SSIs). Therefore, greater attention has been given to adherence to recommendations for the prevention and control of SSIs as well as to antibiotic prophylaxis protocols.
Surgery Today
Publisher Springer Japan
ISSN 0941-1291 (Print) 1436-2813 (Online)
Issue Volume 40, Number 8 / August, 2010

Targeted Surveillance of Methicillin-Resistant Staphylococcus aureus and Its Potential Use To Guide Empiric Antibiotic Therapy

wallyr — Mon, 02 Aug 2010 20:59:51 +0000

Harris AD et al. – The present study aimed to determine the frequency of methicillin–resistant Staphylococcus aureus (MRSA)–positive clinical culture among hospitalized adults in different risk categories of a targeted MRSA active surveillance screening program and to assess the utility of screening in guiding empiric antibiotic therapy. The risk of MRSA infection was far higher in those who were deemed to be at high risk and who were surveillance culture positive. Targeted MRSA active surveillance may be beneficial in guiding empiric anti–MRSA therapy.
The present study aimed to determine the frequency of methicillin-resistant Staphylococcus aureus (MRSA)-positive clinical culture among hospitalized adults in different risk categories of a targeted MRSA active surveillance screening program and to assess the utility of screening in guiding empiric antibiotic therapy. We completed a prospective cohort study in which all adults admitted to non-intensive-care-unit locations who had no history of MRSA colonization or infection received targeted screening for MRSA colonization upon hospital admission. Anterior nares swab specimens were obtained from all high-risk patients, defined as those who self-reported admission to a health care facility within the previous 12 months or who had an active skin infection on admission. Data were analyzed for the subcohort of patients in whom an infection was suspected, determined by (i) receipt of antibiotics within 48 h of admission and/or (ii) the result of culture of a sample for clinical analysis (clinical culture) obtained within 48 h of admission. Overall, 29,978 patients were screened and 12,080 patients had suspected infections. A total of 46.4% were deemed to be at high risk on the basis of the definition presented above, and 11.1% of these were MRSA screening positive (colonized). Among the screening-positive patients, 23.8% had a sample positive for MRSA by clinical culture. Only 2.4% of patients deemed to be at high risk but found to be screening negative had a sample positive for MRSA by clinical culture, and 1.6% of patients deemed to be at low risk had a sample positive for MRSA by clinical culture. The risk of MRSA infection was far higher in those who were deemed to be at high risk and who were surveillance culture positive. Targeted MRSA active surveillance may be beneficial in guiding empiric anti-MRSA therapy.
Antimicrobial Agents and Chemotherapy, August 2010, p. 3143-3148, Vol. 54, No. 8

Determinants of carriage of resistant Staphylococcus aureus among S. aureus carriers in the Indonesian population inside and outside hospitals

wallyr — Fri, 30 Jul 2010 20:03:54 +0000

Lestari ES et al. – Antibiotic policies including proper diagnosis, treatment and drug delivery process should be made by healthcare providers in Indonesia to help limit the emergence of antibiotic resistance.
ABSTRACT
Objectives To identify determinants of carriage of resistant Staphylococcus aureus in both hospitalized patients and individuals from the community in two urban centres in Indonesia.

Methods Staphylococcus aureus cultures and data on recent antibiotic use, demographic, socioeconomic, disease-related and healthcare-related variables were collected from 3995 community dwellers and hospitalized persons. Nasal S. aureus carriage was found in 362 persons (9.1%). Logistic regression analysis was performed to identify which variables were independently associated with carriage of resistant S. aureus.

Results The penicillins were the most frequently used antibiotics both in the community and in hospitalized patients. In the community, admission to a hospital was associated with carriage of S. aureus resistant to any of the tested antibiotics [odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.3–4.9] and any tetracycline resistance (OR 2.4, 95% CI 1.1–5.1). Having no symptoms was associated with less carriage of S. aureus with resistance to any of the tested antibiotics (OR 0.5, 95% CI 0.3–0.9) and any tetracycline resistance (OR 0.5, 95% CI 0.3–0.9). Crowding (OR 4.5, 95% CI 1.2–4.9) and low income (OR 8.9, 95% CI 1.8–43.9) were associated with multidrug resistance. In hospitalized patients, the use of penicillins was associated with resistance to any of the tested antibiotics (OR 3.9, 95% CI 1.4–11.6) and any tetracycline resistance (OR 3.7, 95% CI 1.1–12.0).

Conclusions Antibiotic policies including proper diagnosis, treatment and drug delivery process should be made by healthcare providers in Indonesia to help limit the emergence of antibiotic resistance.
Tropical Medicine & International Health
Published Online: 27 Jul 2010, © 2010 Blackwell Publishing Ltd

Role of a disintegrin and metalloprotease 10 in Staphylococcus aureus {alpha}-hemolysin-mediated cellular injury

wallyr — Fri, 30 Jul 2010 19:48:48 +0000

Wilke GA et al. – These data implicate ADAM10 as the probable high–affinity toxin receptor. Upon Hla binding, ADAM10 relocalizes to caveolin 1–enriched lipid rafts that serve as a platform for the clustering of signaling molecules. It is demonstrated that the Hla–ADAM10 complex initiates intracellular signaling events that culminate in the disruption of focal adhesions.

Staphylococcus aureus α-hemolysin (Hla), a potent cytotoxin, plays an important role in the pathogenesis of staphylococcal diseases, including those caused by methicillin-resistant epidemic strains. Hla is secreted as a water-soluble monomer that undergoes a series of conformational changes to generate a heptameric, β-barrel structure in host membranes. Structural maturation of Hla depends on its interaction with a previously unknown proteinaceous receptor in the context of the cell membrane. It is reported here that a disintegrin and metalloprotease 10 (ADAM10) interacts with Hla and is required to initiate the sequence of events whereby the toxin is transformed into a cytolytic pore. Hla binding to the eukaryotic cell requires ADAM10 expression. Further, ADAM10 is required for Hla-mediated cytotoxicity, most notably when the toxin is present at low concentrations. These data thus implicate ADAM10 as the probable high-affinity toxin receptor. Upon Hla binding, ADAM10 relocalizes to caveolin 1-enriched lipid rafts that serve as a platform for the clustering of signaling molecules. It is demonstrated that the Hla–ADAM10 complex initiates intracellular signaling events that culminate in the disruption of focal adhesions
Proceedings of the National Academy of Sciences of the United States of America, PNAS July 27, 2010 vol. 107 no. 30 13473-13478

SBN: Dr. White, DPM

jeffrubow — Thu, 29 Jul 2010 17:18:11 +0000

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