A Case of Successfully Treated Central Line-Associated Bloodstream Infection Due to Vancomycin-Resistant Leuconostoc Citreum in a Child With Biliary Atresia

Introduction: To determine the central-line associated bloodstream infection rate after implementation of central venous catheter-care practice bundles and guidelines and to compare it with the previous central-line associated bloodstream infection rate. Material and Methods: A prospective, longitudinal, observational descriptive study with an exploratory component was performed in a Pediatric Intensive Care Unit during five months. The universe was composed of every child admitted to Pediatric Intensive Care Unit who inserted a central venous catheter. A comparative study with historical controls was performed to evaluate the result of the intervention (group 1 versus group 2). Results: Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, non-tunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter. Discussion: After multidimensional strategy implementation there was no reported central-line associated bloodstream infection Conclusions: Efforts must be made to preserve the same degree of multidimensional prevention, in order to confirm the effective reduction of the central-line associated bloodstream infection rate and to allow its maintenance.

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The Effect of Adding Comorbidities to Current Centers for Disease Control and Prevention Central-Line–Associated Bloodstream Infection Risk-Adjustment Methodology

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.129 ◽

2017 ◽

Vol 38 (9) ◽

pp. 1019-1024 ◽

Cited By ~ 7

Author(s):

Sarah S. Jackson ◽

Surbhi Leekha ◽

Laurence S. Magder ◽

Lisa Pineles ◽

Deverick J. Anderson ◽

...

Keyword(s):

Disease Control ◽

Bloodstream Infection ◽

Risk Adjustment ◽

Central Line ◽

Case Mix ◽

Type Model ◽

Patient Case ◽

Icu Patients ◽

Control And Prevention ◽

Centers For Disease Control

BACKGROUNDRisk adjustment is needed to fairly compare central-line–associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes.METHODSUsing a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank.RESULTSOverall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51–0.59) for the ICU-type model and 0.64 (95% CI, 0.60–0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model.CONCLUSIONSOur risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals.Infect Control Hosp Epidemiol 2017;38:1019–1024

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Clinical and microbiological characteristics of vancomycin-resistant Enterococcus faecium bloodstream infection in Central Taiwan

Medicine ◽

10.1097/md.0000000000009000 ◽

2017 ◽

Vol 96 (49) ◽

pp. e9000 ◽

Cited By ~ 5

Author(s):

Chang-Hua Chen ◽

Li-Chen Lin ◽

Yu-Jun Chang ◽

Chih-Yen Chang

Keyword(s):

Bloodstream Infection ◽

Enterococcus Faecium ◽

Vancomycin Resistant Enterococcus ◽

Microbiological Characteristics ◽

Vancomycin Resistant ◽

Central Taiwan

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Neonatal Cholestasis: Updates on Diagnostics, Therapeutics, and Prevention

NeoReviews ◽

10.1542/neo.22-12-e819 ◽

2021 ◽

Vol 22 (12) ◽

pp. e819-e836

Author(s):

Amy G. Feldman ◽

Ronald J. Sokol

Keyword(s):

Liver Disease ◽

Biliary Atresia ◽

Young Infant ◽

Management Strategies ◽

Bloodstream Infections ◽

Cost Effective ◽

Central Line ◽

Primary Indication ◽

Effective Diagnosis ◽

Made In

Cholestatic jaundice is a common presenting feature of hepatobiliary and/or metabolic dysfunction in the newborn and young infant. Timely detection of cholestasis, followed by rapid step-wise evaluation to determine the etiology, is crucial to identify those causes that are amenable to medical or surgical intervention and to optimize outcomes for all infants. In the past 2 decades, genetic etiologies have been elucidated for many cholestatic diseases, and next-generation sequencing, whole-exome sequencing, and whole-genome sequencing now allow for relatively rapid and cost-effective diagnosis of conditions not previously identifiable via standard blood tests and/or liver biopsy. Advances have also been made in our understanding of risk factors for parenteral nutrition–associated cholestasis/liver disease. New lipid emulsion formulations, coupled with preventive measures to decrease central line–associated bloodstream infections, have resulted in lower rates of cholestasis and liver disease in infants and children receiving long-term parental nutrition. Unfortunately, little progress has been made in determining the exact cause of biliary atresia. The median age at the time of the hepatoportoenterostomy procedure is still greater than 60 days; consequently, biliary atresia remains the primary indication for pediatric liver transplantation. Several emerging therapies may reduce the bile acid load to the liver and improve outcomes in some neonatal cholestatic disorders. The goal of this article is to review the etiologies, diagnostic algorithms, and current and future management strategies for infants with cholestasis.

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