Outcome of Escherichia coli and/or Klebsiella Bloodstream Infection in Children With Central Venous Catheters

2011 ◽  
Vol 28 (11) ◽  
pp. 1308-1310 ◽  
Author(s):  
Jessica Buckley ◽  
Susan E. Coffin ◽  
Ebbing Lautenbach ◽  
Priya Prasad ◽  
Jaclyn Chu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Mechanical Ventilation ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Adjusted Odds Ratio ◽  
Significant Proportion ◽  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
Central Venous

We conducted a retrospective cohort study of children with catheter-associated bloodstream infections (BSIs) due to Escherichia coli and/or Klebsiella. Risk factors for poor outcome (ie, death or recurrence of infection) were receipt of mechanical ventilation (adjusted odds ratio [aOR], 4.6 [95% confidence interval {CI}, 1.39-16.30]) and receipt of total parenteral nutrition (aOR, 3.5 [95% CI, 1.1-10.8]). A significant proportion of children with catheter-associated BSI were treated successfully without catheter removal.

scholarly journals A Crossover Intervention Trial Evaluating the Efficacy of a Chlorhexidine-Impregnated Sponge in Reducing Catheter-Related Bloodstream Infections among Patients Undergoing Hemodialysis

2010 ◽  
Vol 31 (11) ◽  
pp. 1118-1123 ◽  
Author(s):  
Bernard C. Camins ◽  
Amy M. Richmond ◽  
Kathrin L. Dyer ◽  
Heather N. Zimmerman ◽  
Daniel W. Coyne ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Intervention Group ◽  
Bloodstream Infections ◽  
Central Venous Catheters ◽  
Control Group ◽  
Published Data ◽  
Stepwise Logistic Regression ◽  
Intervention Trial ◽  
Central Venous

Background.Catheter-related bloodstream infections (CRBSIs) account for the majority of hemodialysis-related infections. There are no published data on the efficacy of the chlorhexidine-impregnated foam dressing at reducing the rate of CRBSI among patients undergoing hemodialysis.Design.A prospective, nonblinded, crossover intervention trial to determine the efficacy of a chlorhexidine-impregnated foam dressing to reduce the rate of CRBSI among patients undergoing hemodialysis.Setting.Two outpatient dialysis centers.Patients.A total of 121 patients who underwent dialysis through tunneled central venous catheters received the intervention during the trial.Methods.The primary outcome of interest was the incidence of CRBSI. A nested cohort study of all patients who received the chlorhexidine-impregnated foam dressing was also conducted. Backward stepwise logistic regression analysis was used to determine independent risk factors for development of CRBSI.Results.Thirty-seven CRBSIs occurred in the intervention group, for an incidence of 6.3 CRBSIs per 1,000 dialysis sessions, and 30 CRBSIs occurred in the control group, an incidence of 5.2 CRBSIs per 1,000 dialysis sessions (risk ratio, 1.22 [95% confidence interval {CI}, 0.75-1.97]; P = .46). The chlorhexidine-impregnated foam dressing was well tolerated, with only 2 patients (<2%) experiencing dermatitis that led to its discontinuation. The only independent risk factor for development of CRBSI was dialysis treatment at one dialysis center (adjusted odds ratio, 4.4 [95% CI, 1.77-13.65]; P = .002). Age of at least 60 years (adjusted odds ratio, 0.28 [95% CI, 0.09-0.82]; P = .02) was associated with lower risk of CRBSI.Conclusions.The use of a chlorhexidine-impregnated foam dressing did not decrease the incidence of CRBSI among patients with tunneled central venous catheters who were undergoing hemodialysis.

scholarly journals Risk Factors for Umbilical Cord Prolapse at the Time of Artificial Rupture of Membranes

2018 ◽  
Vol 08 (02) ◽  
pp. e89-e94 ◽  
Author(s):  
Tetsuya Kawakita ◽  
Chun-Chih Huang ◽  
Helain Landy
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Adjusted Odds Ratio ◽  
Cervical Dilation ◽  
Cord Prolapse ◽  
Umbilical Cord Prolapse ◽  
Singleton Pregnancies

Objective The aim of the study was to examine the association between cervical exam at the time of artificial rupture of membranes (AROM) and cord prolapse. Study Design We conducted a retrospective cohort study using the data from the Consortium on Safe Labor. We included women with cephalic presentation and singleton pregnancies at ≥ 23 weeks' gestation who underwent AROM during the course of labor. Multivariable logistic regression was used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (95% CI), controlling for prespecified covariates. Results Of 57,204 women who underwent AROM, cord prolapse occurred in 113 (0.2%). Compared with dilation 6 to 10 cm + station ≥ 0 at the time of AROM, <6 cm + any station and 6–10 cm + station ≤ −3 were associated with increased risks of cord prolapse (<6 cm + station ≤ −3 [aOR, 2.29; 95% CI, 1.02–5.40]; <6 cm + station −2.5 to −0.5 [aOR, 2.34; 95% CI, 1.23–4.97]; <6 cm + station ≥ 0 [aOR, 3.31; 95% CI, 1.39–8.09]; and 6–10 cm + station ≤ −3 [aOR, 5.47; 95% CI, 1.35–17.48]). Conclusion Cervical dilation < 6 cm with any station and 6 to 10 cm with station ≤ −3 were associated with a higher risk of cord prolapse.

scholarly journals Clinical profile of Candidiasis in neonates

2017 ◽  
Vol 4 (5) ◽  
pp. 1875
Author(s):  
Latha G. S. ◽  
Veeresh Babu D. V. ◽  
Thejraj H. K.
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Birth Asphyxia ◽  
Central Venous Catheters ◽  
Clinical Profile ◽  
Central Venous ◽  
Factors Associated

Background: Opportunistic infections are increasing in Neonatal Intensive Care Unit (NICU). Neonates often have compromised skin integrity, gastrointestinal tract disease, chronic malnutrition, central venous catheters, long term endotracheal intubation and other factors that lead to increased risk of acquiring such infections. Infections with fungi (candida) and with coagulase-negative staphylococci (CoNS) are especially prevalent. The need of study is to know the clinical profile of candidiasis in neonates in our setup and to determine associated risk factors of candidiasis.Methods: The present study was undertaken by Dept of paediatrics, SSIMS and RC Davangere among 296 neonates of which 96 babies admitted in NICU and 200 were in PNC ward to study clinical profile of candidiasis in neonates and risk factors associated with them. Parents of 296 babies were interviewed using preformed study proforma. Clinical examination was done and investigations included KOH examination of oral swab, Gram stain of the swab and blood culture of suspected sepsis babies. There are several factors associated with development of neonatal candidiosis. Of them, prematurity, LBW, perinatal birth asphyxia, long term antibiotics, central venous catheters, mechanical ventilation, septicemia, played a major role in development of candidosis.Results: In the present study, incidence of candidiasis in neonates revealed 13.8% of babies admitted in NICU. Male babies out numbered the female babies in incidence of candidiasis in neonates. Males formed 69% and females 31% of positive cases. Most of neonates admitted in NICU (96) were of low birth weight between 1.5kg to 2.5 kg. Out of which most of cases positive for candidiasis/candidemia were belonged to 1.0-1.5 kg. In present study, 13 babies were positive for candidiasis, of which 5 babies (38.3%) were of birth weight between 1-1.5kg. Birth asphyxia alone or with mechanical ventilation played an important risk factor in development of candidiasis in neonates. In present study, birth asphyxia and mechanical ventilation per se had played a significant role in development of candidiasis in neonates admitted in NICU.Conclusions: The present study revealed the clinical profile of candidiasis in neonates associated with various risk factors. Study shows that low birth weight, birth asphyxia and mechanical ventilation were significant risk factors for candidiasis in neonates. Blood cultures were positive in babies without mucosal lesions suggesting the importance of diagnosing fungal sepsis. 

Risk factors for central line–associated bloodstream infections in children with tunneled central venous catheters

2020 ◽  
Vol 48 (1) ◽  
pp. 33-39
Author(s):  
Paolo Paioni ◽  
Sereina Kuhn ◽  
Yvonne Strässle ◽  
Burkhardt Seifert ◽  
Christoph Berger
Keyword(s):  
Risk Factors ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous

Carbapenems Versus Piperacillin-Tazobactam for Bloodstream Infections of Nonurinary Source Caused by Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae

2015 ◽  
Vol 36 (8) ◽  
pp. 981-985 ◽  
Author(s):  
Hadas Ofer-Friedman ◽  
Coral Shefler ◽  
Sarit Sharma ◽  
Amit Tirosh ◽  
Ruthy Tal-Jasper ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Multivariate Analysis ◽  
Urinary Tract ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Bloodstream Infections ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Efficacy Analysis ◽  
Extended Spectrum

A recent, frequently quoted study has suggested that for bloodstream infections (BSIs) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL) Escherichia coli, treatment with β-lactam/β-lactamase inhibitors (BLBLIs) might be equivalent to treatment with carbapenems. However, the majority of BSIs originate from the urinary tract. A multicenter, multinational efficacy analysis was conducted from 2010 to 2012 to compare outcomes of patients with non-urinary ESBL BSIs who received a carbapenem (69 patients) vs those treated with piperacillin-tazobactam (10 patients). In multivariate analysis, therapy with piperacillin-tazobactam was associated with increased 90-day mortality (adjusted odds ratio, 7.9, P=.03). For ESBL BSIs of a non-urinary origin, carbapenems should be considered a superior treatment to BLBLIs.Infect Control Hosp Epidemiol 2015;36(8):981–985

scholarly journals Environmental Exposures and the Risk of Central Venous Catheter Complications and Readmissions in Home Infusion Therapy Patients

2016 ◽  
Vol 38 (1) ◽  
pp. 68-75 ◽  
Author(s):  
Sara C. Keller ◽  
Deborah Williams ◽  
Mitra Gavgani ◽  
David Hirsch ◽  
John Adamovich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Environmental Exposures ◽  
Infusion Therapy ◽  
Central Venous ◽  
Home Infusion Therapy ◽  
Home Infusion

BACKGROUNDPatients are frequently discharged with central venous catheters (CVCs) for home infusion therapy.OBJECTIVETo study a prospective cohort of patients receiving home infusion therapy to identify environmental and other risk factors for complications.DESIGNProspective cohort study between March and December 2015.SETTINGHome infusion therapy after discharge from academic medical centers.PARTICIPANTSOf 368 eligible patients discharged from 2 academic hospitals to home with peripherally inserted central catheters and tunneled CVCs, 222 consented. Patients remained in the study until 30 days after CVC removal.METHODSPatients underwent chart abstraction and monthly telephone surveys while the CVC was in place, focusing on complications and environmental exposures. Multivariable analyses estimated adjusted odds ratios and adjusted incident rate ratios between clinical, demographic, and environmental risk factors and 30-day readmissions or CVC complications.RESULTSOf 222 patients, total parenteral nutrition was associated with increased 30-day readmissions (adjusted odds ratio, 4.80 [95% CI, 1.51–15.21) and CVC complications (adjusted odds ratio, 2.41 [95% CI, 1.09–5.33]). Exposure to soil through gardening or yard work was associated with a decreased likelihood of readmissions (adjusted odds ratio, 0.09 [95% CI, 0.01–0.74]). Other environmental exposures were not associated with CVC complications.CONCLUSIONScomplications and readmissions were common and associated with the use of total parenteral nutrition. Common environmental exposures (well water, cooking with raw meat, or pets) did not increase the rate of CVC complications, whereas soil exposures were associated with decreased readmissions. Interventions to decrease home CVC complications should focus on total parenteral nutrition patients.Infect Control Hosp Epidemiol 2016;1–8

Risk factors for death or mechanical ventilation time after bidirectional cavopulmonary anastomosis in a developing country

2021 ◽  
pp. 1-5
Author(s):  
Marina C. Jonas ◽  
Fabio Carmona ◽  
Luiz F. Caneo ◽  
Aida L. R. Turquetto ◽  
Marcelo B. Jatene ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Cardiopulmonary Bypass ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Prolonged Mechanical Ventilation ◽  
Z Score ◽  
Age At Surgery ◽  
Glenn Procedure ◽  
Weight For Age

Abstract Background: Glenn procedure is performed for patients with cyanotic CHD and univentricular physiology and has a survival rate above 90%. Aim: To evaluate the risk factors associated with a poor outcome after Glenn procedure. Methods: The data for this retrospective analysis were collected from a regional Brazilian registry of congenital heart surgeries (ASSIST initiative) from 2014 to 2019. Data from 97 patients who underwent the Glenn procedure were considered. The primary outcomes were prolonged mechanical ventilation (>24 hours post-operatively) or in-hospital death, alone and combined. Results: The overall in-hospital mortality was 13.4% (n = 13). Prolonged mechanical ventilation occurred in 52% (n = 51) of the patients. Our analysis found that risk factors for death or prolonged post-operative mechanical ventilation were cardiopulmonary bypass duration and post-operative lactate, whereas weight-for-age z-score and age at surgery were risk factors for prolonged mechanical ventilation. Cardiopulmonary bypass duration increased (adjusted odds ratio: 1.02; 95 % CI: 1.01, 1.03) and age at surgery decreased (adjusted odds ratio: 0.96; 95 % CI: 0.93, 0.99) the odds of the combined outcome. Conclusions: Age at surgery, post-operative lactate, and low-weight-for-age z-score are associated with prolonged mechanical ventilation and death following the Glenn procedure.

Effect of Nurse Staffing and Antimicrobial-Impregnated Central Venous Catheters on the Risk for Bloodstream Infections in Intensive Care Units

2003 ◽  
Vol 24 (12) ◽  
pp. 916-925 ◽  
Author(s):  
Juan Alonso-Echanove ◽  
Jonathan R. Edwards ◽  
Michael J. Richards ◽  
Patrick Brennan ◽  
Richard A. Venezia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lower Risk ◽  
Multivariable Analysis ◽  
Nurse Staffing ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Prevention Measures ◽  
Central Venous ◽  
Central Catheters

AbstractBackground:Defining risk factors for central venous catheter (CVC)-associated bloodstream infections (BSIs) is critical to establishing prevention measures, especially for factors such as nurse staffing and antimicrobial-impregnated CVCs.Methods:We prospectively monitored CVCs, nurse staffing, and patient-related variables for CVC-associated BSIs among adults admitted to eight ICUs during 2 years.Results:A total of 240 CVC-associated BSIs (2.8%) were identified among 4,535 patients, representing 8,593 CVCs. Antimicrobial-impregnated CVCs reduced the risk for CVC-associated BSI only among patients whose CVC was used to administer total parenteral nutrition (TPN, 2.6 CVC-associated BSIs per 1,000 CVC-days vs no TPN, 7.5 CVC-associated BSIs per 1,000 CVC-days;P= .006). Among patients not receiving TPN, there was an increase in the risk of CVC-associated BSI in patients cared for by “float” nurses for more than 60% of the duration of the CVC. In multivariable analysis, risk factors for CVC-associated BSIs were the use of TPN in non-antimicrobial-impregnated CVCs (P= .0001), patient cared for by a float nurse for more than 60% of CVC-days (P= .0019), no antibiotics administered to the patient within 48 hours of insertion (P= .0001), and patient unarousable for 70% or more of the duration of the CVC (P= .0001). Peripherally inserted central catheters (PICCs) were associated with a lower risk for CVC-associated BSI (P= .0001).Conclusions:Antimicrobial-impregnated CVCs reduced the risk of CVC-associated BSI by 66% in patients receiving TPN. Limiting the use of float nurses for ICU patients with CVCs and the use of PICCs may also reduce the risk of CVC-associated BSI.

scholarly journals Risky Business: Peripheral and Central Venous Catheters Both Pose Risks

2019 ◽  
pp. 28-39
Author(s):  
Lynette Hathaway ◽  
Mary Magee
Keyword(s):  
Risk Factors ◽  
Patient Safety ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Healthcare Facilities ◽  
Relationship Of

Venous access is an essential method of providing life-saving therapy. As part of intensive efforts to decrease the incidence of central line–associated bloodstream infections (CLABSIs), healthcare facilities may be increasing the use of short (noncentral) peripheral venous catheters (PVCs). To investigate this, the Patient Safety Authority (PSA) sought to explore the relationship of actual to predicted complications per central venous catheters (CVCs) and PVCs over a nine-year period. In addition, as PVCs are not without risk and CVCs pose risks aside from infection, we sought to identify the type and relationship of PVC to CVC complications and to quantify the timing and types of PVC and CVC complications and their associated risk factors. A query of the PSA’s statewide event reporting database, the Pennsylvania Patient Safety Reporting System (PA-PSRS), for venous catheter complication events and a query of the National Healthcare Safety Network (NHSN) database for both primary bloodstream infections (BSIs) and CLABSIs occurring at inpatient facilities from January 1, 2009, through December 31, 2017, yielded 115,937 events. A methodical sampling of PA-PSRS yielded 2,413 PVC and CVC events. These were analyzed for the timing of complications reported, the type of complication reported, and any identified risk factors. Overall reports of PVC complications increased, and the correlation between actual and predicted PVC events over the nine years studied is strong and statistically significant. The slight decrease in the number of reported CVC complications was not statistically significant. The authors used regression analysis to determine the best-fitting line through the predicted and actual observed events during the period of observation. These data are not intended to present a predictive model of future events. No correlation was found between the numbers of PVC and CVC complications. The greatest number of PVC complications, particularly infiltration, occurred during catheter maintenance. Excluding NHSN-reported CLABSIs, the greatest number of CVC complications, particularly pneumothorax, occurred during catheter insertion. Education and training are key to preventing intravascular device–associated complications. Healthcare facilities are encouraged to evaluate policy, procedures, and actual practices to eliminate complications and improve outcomes. In addition, quality improvement efforts aimed at decreasing CLABSIs should include measuring CVC complications and all PVC complications as a balancing metric.

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