Catheter-Related Bloodstream Infections and Catheter Colonization among Haemodialysis Patients: Prevalence, Risk Factors, and Outcomes

Introduction. Catheter-related bloodstream infection (CRBSI) and catheter colonization (CC) are two complications among haemodialysis (HD) patients that lead to increased morbidity and mortality. This study aims to evaluate the prevalence of CRBSI and CC among HD patients registered at Universiti Kebangsaan Malaysia Medical Centre and to identify the factors involved by focusing on the demographic profile of the patients as well as their clinical characteristics and outcomes. Method. This is a retrospective study of end-stage renal disease patients with suspected CRBSI during the period from 1 January 2016 to 31 December 2018. Data on patients who fulfilled the blood culture criteria for CRBSI and CC diagnosis were further analysed for clinical manifestations, comorbidities, history of dialysis, catheter characteristics, and microbiological culture results. The outcomes of CRBSI and CC were also assessed. Findings. In the 3-year period under study, there were 496 suspected CRBSI cases with a total of 175 events in 119 patients who fulfilled the inclusion criteria. During that time, the percentage of patients who experienced CRBSI and CC was 4.2% and 4.8%, respectively. The majority of the cohort consisted of male (59.4%), Malay ethnicity (75%), and patients on a tunnelled dialysis catheter (83%). Patients who were fistula naïve and had an internal jugular catheter were more common in the CRBSI group than in the CC group. The predominant microorganisms that were isolated were Gram-positive organisms. In terms of clinical presentation and outcome, no differences were found between the CRBSI and CC groups. Patients with Gram-negative bacteraemia, high initial c-reactive protein, and catheter salvation were likely to have poor outcomes. Recurrence of CRBSI occurred in 31% of the cohort. Neither catheter salvation nor antibiotic-lock therapy were associated with the recurrence of CRBSI. On the other hand, the femoral vein catheter site was associated with risk of recurrence. The overall mortality rate was 1.1%. Discussion. From the analysis, it was concluded that clinical assessment and positive culture are crucial in diagnosing CRBSI with or without peripheral culture. This study provides essential information for the local setting which will enable healthcare providers to implement measures for the better management of CRBSI.

Taurolidine lock in the treatment of colonization and infection of totally implanted venous access devices in cancer patients

Background: Taurolidine lock is known to be effective in preventing catheter-related infections in a variety of venous access devices, including long term venous access devices for chemotherapy. Though, literature about the use of taurolidine for treating catheter colonization or catheter-related blood stream infection is scarce. Method: We have retrospectively reviewed the safety and efficacy of 2% taurolidine lock for treatment of catheter-colonization and of catheter-related bloodstream infection in cancer patients with totally implanted venous access devices. Diagnosis of colonization or catheter-related infection was based on paired peripheral and central blood cultures, according to the method of Delayed Time to Positivity. Results: We recorded 24 cases of catheter-related infection and two cases of colonization. Taurolidine lock—associated with systemic antibiotic therapy—was successful in treating all cases of catheter-related infection, with disappearance of clinical symptoms, normalization of laboratory values, and eventually negative blood cultures. Taurolidine lock was also safe and effective in treating device colonization. No adverse effect was reported. Conclusion: In our retrospective analysis, 2% taurolidine lock was completely safe and highly effective in the treatment of both catheter-colonization and catheter-related bloodstream infection in cancer patients with totally implanted venous access devices.

Efficacy of Antimicrobial-Impregnated Catheters for Prevention of Bloodstream Infections in Pediatric Patients: A Meta-Analysis

Background: Multiple Randomized controlled trials (RCTs) have evaluated the efficacy of antimicrobial-impregnated catheters to prevent catheter-related bloodstream infections (CRBSI). However, the RCTs showed contradictory results, the studies were limited in sample size and methodology quality. Thus, we conducted a meta-analysis to overcome these RCT limitations.Methods: We designed a meta-analysis of RCTs comparing antimicrobial-impregnated and conventional catheters for the prevention of CRBSI. We conducted a detailed search of various databases for RCTs published before November 2019. We calculated mean differences (MDs) and pooled odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model.Results: We included five RCTs with a total of 2,294 patients. The incidence of CRBSI between the two groups was 0.50 (95% CI, 0.19–1.27), with evidence of heterogeneity (I2 = 55%). The difference was not statistically significant (p = 0.15). On subgroup analysis based on the age of the sample, there was no difference in the rate of CRBSI in the neonatal population [0.42 (95% CI, 0.08–2.27 I2 = 61% p = 0.31] as well as pediatric population [0.45 (95% CI, 0.12–1.67 I2 = 39% p = 0.23]. The summary OR on the incidence of catheter colonization between antimicrobial-impregnated and conventional catheters was 0.64 (95% CI, 0.17–2.35), with no evidence of heterogeneity (I2 = 0%) and a non-significant difference (p = 0.50).Conclusions: To conclude, analysis of a limited number of heterogeneous studies mostly with a small sample indicates that the CRBSI and catheter colonization rates are similar between conventional and antimicrobial-impregnated catheters in the pediatric and neonatal population. There is an urgent need for large-scale RCTs focusing on different antimicrobial-impregnated catheters in these patients to further enhance current evidence.

Comparison of chlorhexidine impregnated dressing and standard dressing for the prevention of central-line associated blood stream infection and colonization in Critically Ill Pediatric Patients: A Randomized Controlled Trial

Objective: The purpose of this study is to compare chlorhexidine gluconate (CHG)-impregnated dressing and standard dressing with respect to their effects on the frequency of central-line associated bloodstream infection (CLABSI), catheter related bloodstream infection (CRBSI), primary bloodstream infection (BSI) and catheter colonization in critically ill pediatric patients with short-term central venous catheter.Methods: Prospective, single-center randomized controlled trial performed in pediatric intensive care unit (PICU) of a tertiary referral hospital. The patients were randomized with respect to the type of catheter fixation they had received, either with CHG-impregnated dressing or standard dressing.Results: A total of 307 patients (151 CHG-impregnated dressing, 156 standard dressing), with 307 catheters amounting to a collective total of 4993 catheter days, were included in the study. Use of CHG impregnated dressing did not significantly decrease the incidence of CLABSI (6.36 per 1000 catheter days vs. 7.59 per 1000 catheter days; HR: 0.93, P = 0.76), CRBSI (3.82 per 1000 catheter days vs. 4.18 per 1000 catheter days; HR: 0.98, P = 0.98), primary BSI (2.54 per 1000 catheter days vs. 3.42 catheter days; HR: 0.39, P = 0.67). CHG-impregnated dressing significantly decreased the incidence of catheter colonization (3.82 per 1000 catheter days vs. 7.59 per 1000 catheter days; HR: 0.40, P = 0.04). Longer catheter time-in-place and use of blood product transfusion were found to be independently associated with CLABSI.Conclusions: The use of CHG-impregnated dressing does not significantly decrease CLABSI incidence in critically ill pediatric patients compared to standard dressing, but it is effective in reducing catheter colonization.

Antibiofilm activity of flavonoids on staphylococcal biofilms through targeting BAP amyloids

The opportunistic pathogen Staphylococcus aureus is responsible for causing infections related to indwelling medical devices, where this pathogen is able to attach and form biofilms. The intrinsic properties given by the self-produced extracellular biofilm matrix confer high resistance to antibiotics, triggering infections difficult to treat. Therefore, novel antibiofilm strategies targeting matrix components are urgently needed. The Biofilm Associated Protein, Bap, expressed by staphylococcal species adopts functional amyloid-like structures as scaffolds of the biofilm matrix. In this work we have focused on identifying agents targeting Bap-related amyloid-like aggregates as a strategy to combat S. aureus biofilm-related infections. We identified that the flavonoids, quercetin, myricetin and scutellarein specifically inhibited Bap-mediated biofilm formation of S. aureus and other staphylococcal species. By using in vitro aggregation assays and the cell-based methodology for generation of amyloid aggregates based on the Curli-Dependent Amyloid Generator system (C-DAG), we demonstrated that these polyphenols prevented the assembly of Bap-related amyloid-like structures. Finally, using an in vivo catheter infection model, we showed that quercetin and myricetin significantly reduced catheter colonization by S. aureus. These results support the use of polyphenols as anti-amyloids molecules that can be used to treat biofilm-related infections.

Frequency and antimicrobial susceptibility pattern of isolates in central venous catheter colonization.

Colonization of central venous catheters increases the risk of blood stream infections and is associated with increased morbidity, mortality and excess hospital costs. Objectives: To estimate frequency of central venous catheter colonization. Study Design: Cross Sectional study. Setting: Microbiology Laboratory of Punjab Institute of Cardiology, Lahore. Period: May 2018 to December 2018. Material and Methods: Total 116 specimens of central venous catheters were received in the laboratory and processed to isolate various organisms. Organisms were identified on the basis of colonial morphology, Gram staining and biochemical tests. Antimicrobial sensitivity testing was performed and results were recorded. Results: Out of total 116 specimens of central venous catheters, bacterial growth was obtained from 74.1% of central venous catheter tips. From 86 cultures yielding growth, 94 micro-organisms were isolated. The most frequent organisms isolated from central venous catheter tip culture in decreasing order of frequency were Coagulase negative staphylococci (29.8%), S. aureus (24.5%), Candida species (23.4%), Klebsiella species (12.8%), and Acinetobacter spp. (4.3%). Drug susceptibility pattern of isolates was recorded. Conclusion: Central venous catheters can get colonized and lead to catheter related infections. Implementation of prevention programs can result in decrease in colonization rate of catheters and thus Catheter related infections.