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Infectious Disease Clinics of North... Sep 2017Central venous catheters (CVCs) are commonly used in critically ill patients and offer several advantages to peripheral intravenous access. However, indwelling CVCs have... (Review)
Review
Central venous catheters (CVCs) are commonly used in critically ill patients and offer several advantages to peripheral intravenous access. However, indwelling CVCs have the potential to lead to bloodstream infections, with the risk increasing with an array of characteristics, such as catheter choice, catheter location, insertion technique, and catheter maintenance. Evidence-based guidelines have led to a significant reduction in the incidence of bloodstream infections associated with CVCs. The combination of guideline implementation and newer technologies has the potential to further reduce morbidity and mortality from infections related to CVCs.
Topics: Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Catheters, Indwelling; Central Venous Catheters; Cross Infection; Humans; Incidence; Intensive Care Units
PubMed: 28687213
DOI: 10.1016/j.idc.2017.05.007 -
Topics in Spinal Cord Injury... 2019Urinary tract infections (UTIs) are among the most common microbial infections in humans and represent a substantial burden on the health care system. UTIs can be... (Review)
Review
Urinary tract infections (UTIs) are among the most common microbial infections in humans and represent a substantial burden on the health care system. UTIs can be uncomplicated, as when affecting healthy individuals, or complicated, when affecting individuals with compromised urodynamics and/or host defenses, such as those with a urinary catheter. There are clear differences between uncomplicated UTI and catheter-associated UTI (CAUTI) in clinical manifestations, causative organisms, and pathophysiology. Therefore, uncomplicated UTI and CAUTI cannot be approached similarly, or the risk of complications and treatment failure may increase. It is imperative to understand the key aspects of each condition to develop successful treatment options and improve patient outcomes. Here, we will review the epidemiology, pathogen prevalence, differential mechanisms used by uropathogens, and treatment and prevention of uncomplicated UTI and CAUTI.
Topics: Anti-Bacterial Agents; Catheter-Related Infections; Humans; Immunotherapy; Immunotherapy, Active; Urinary Tract Infections
PubMed: 31548790
DOI: 10.1310/sci2503-228 -
Peritoneal Dialysis International :... May 2023Peritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. The 2023 updated recommendations have revised and...
Peritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. The 2023 updated recommendations have revised and clarified definitions and classifications of exit site infection and tunnel infection. A new target for the overall exit site infection rate should be no more than 0.40 episodes per year at risk. The recommendation about topical antibiotic cream or ointment to catheter exit site has been downgraded. New recommendations include clarified suggestion of exit site dressing cover and updated antibiotic treatment duration with emphasis on early clinical monitoring to ascertain duration of therapy. In addition to catheter removal and reinsertion, other catheter interventions including external cuff removal or shaving, and exit site relocation are suggested.
Topics: Humans; Catheter-Related Infections; Peritoneal Dialysis; Catheters, Indwelling; Anti-Bacterial Agents; Risk Factors; Peritonitis
PubMed: 37232412
DOI: 10.1177/08968608231172740 -
Annals of Hematology Jan 2021Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter-related infections... (Review)
Review
Central venous catheter-related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO).
Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter-related infections (CRIs). Moreover, CRIs prolong hospitalization, cause an excess in resource utilization and treatment cost, often delay anti-cancer treatment, and are associated with a significant increase in mortality in cancer patients. We therefore summoned a panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and updated our previous guideline on CRIs in cancer patients. After conducting systematic literature searches on PubMed, Medline, and Cochrane databases, video- and meeting-based consensus discussions were held. In the presented guideline, we summarize recommendations on definition, diagnosis, management, and prevention of CRIs in cancer patients including the grading of strength of recommendations and the respective levels of evidence. This guideline supports clinicians and researchers alike in the evidence-based decision-making in the management of CRIs in cancer patients.
Topics: Catheter-Related Infections; Central Venous Catheters; Communicable Diseases; Disease Management; Germany; Hematologic Neoplasms; Hematology; Humans; Medical Oncology; Practice Guidelines as Topic; Societies, Medical
PubMed: 32997191
DOI: 10.1007/s00277-020-04286-x -
Clinical Journal of the American... Jan 2020Bloodstream infections are an important cause of hospitalizations, morbidity, and mortality in patients receiving hemodialysis. Eliminating bloodstream infections in the... (Review)
Review
Bloodstream infections are an important cause of hospitalizations, morbidity, and mortality in patients receiving hemodialysis. Eliminating bloodstream infections in the hemodialysis setting has been the focus of the Centers for Disease Control and Prevention (CDC) Making Dialysis Safer for Patients Coalition and, more recently, the CDC's partnership with the American Society of Nephrology's Nephrologists Transforming Dialysis Safety Initiative. The majority of vascular access-associated bloodstream infections occur in patients dialyzing with central vein catheters. The CDC's core interventions for bloodstream infection prevention are the gold standard for catheter care in the hemodialysis setting and have been proven to be effective in reducing catheter-associated bloodstream infection. However, in the United States hemodialysis catheter-associated bloodstream infections continue to occur at unacceptable rates, possibly because of lapses in adherence to strict aseptic technique, or additional factors not addressed by the CDC's core interventions. There is a clear need for novel prophylactic therapies. This review highlights the recent advances and includes a discussion about the potential limitations and adverse effects associated with each option.
Topics: Anti-Infective Agents; Catheter-Related Infections; Catheterization, Central Venous; Catheters, Indwelling; Central Venous Catheters; Equipment Design; Humans; Infection Control; Renal Dialysis; Risk Assessment; Risk Factors; Self Care; Sepsis; Treatment Outcome
PubMed: 31806658
DOI: 10.2215/CJN.06820619 -
Clinical Infectious Diseases : An... Jul 2009These updated guidelines replace the previous management guidelines published in 2001. The guidelines are intended for use by health care providers who care for patients...
These updated guidelines replace the previous management guidelines published in 2001. The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them.
Topics: Case Management; Catheter-Related Infections; Cross Infection; Humans; United States
PubMed: 19489710
DOI: 10.1086/599376 -
The Journal of Hospital Infection May 2022The incidence of central venous catheter (CVC)-related bloodstream infections is high in patients requiring a long-term CVC. Therefore, infection prevention is of the... (Meta-Analysis)
Meta-Analysis Review
The incidence of central venous catheter (CVC)-related bloodstream infections is high in patients requiring a long-term CVC. Therefore, infection prevention is of the utmost importance. The aim of this study was to provide an updated overview of randomized controlled trials (RCTs) comparing the efficacy of taurolidine containing lock solutions (TL) to other lock solutions for the prevention of CVC-related bloodstream infections in all patient populations. On 15 February 2021, PubMed, Embase and The Cochrane Library were searched for RCTs comparing the efficacy of TLs for the prevention of CVC-related bloodstream infections with other lock solutions. Exclusion criteria were non-RCTs, studies describing <10 patients and studies using TLs as treatment. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool. A random effects model was used to pool individual study incidence rate ratios (IRRs). Subgroup analyses were performed based on the following factors: CVC indication, comparator lock and bacterial isolates cultured. A total of 14 articles were included in the qualitative synthesis describing 1219 haemodialysis, total parenteral nutrition and oncology patients. The pooled IRR estimated for all patient groups together (nine studies; 918 patients) was 0.30 (95% confidence interval 0.19-0.46), favouring the TLs. Adverse events (10 studies; 867 patients) were mild and scarce. The quality of the evidence was limited due to a high risk of bias and indirectness of evidence. The use of TLs might be promising for the prevention of CVC-related bloodstream infections. Large-scale RCTs are needed to draw firm conclusions on the efficacy of TLs.
Topics: Catheter-Related Infections; Catheterization, Central Venous; Central Venous Catheters; Humans; Randomized Controlled Trials as Topic; Sepsis; Taurine; Thiadiazines
PubMed: 34767871
DOI: 10.1016/j.jhin.2021.10.022 -
Infectious Disease Clinics of North... Mar 2014Catheter-associated urinary tract infection (CAUTI) is common, costly, and causes significant patient morbidity. CAUTIs are associated with hospital pathogens with a... (Review)
Review
Catheter-associated urinary tract infection (CAUTI) is common, costly, and causes significant patient morbidity. CAUTIs are associated with hospital pathogens with a high propensity toward antimicrobial resistance. Treatment of asymptomatic patients with CAUTI accounts for excess antimicrobial use in hospitals and should be avoided. Duration of urinary catheterization is the predominant risk for CAUTI; preventive measures directed at limiting placement and early removal of urinary catheters have an impact on decreasing CAUTI rates. The use of bladder bundles and collaboratives, coupled with the support and active engagement from both hospital leaders and followers, seem to help prevent this common problem.
Topics: Bacteriuria; Catheter-Related Infections; Catheters, Indwelling; Humans; Practice Guidelines as Topic; Risk Factors; Urinary Tract Infections
PubMed: 24484578
DOI: 10.1016/j.idc.2013.09.002 -
BMJ Open Quality Dec 2021Catheter-associated urinary tract infections (CAUTIs) represent approximately 9% of all hospital acquired infections, and approximately 65%-70% of CAUTIs are believed to...
Catheter-associated urinary tract infections (CAUTIs) represent approximately 9% of all hospital acquired infections, and approximately 65%-70% of CAUTIs are believed to be preventable. In the spring of 2013, Boston Medical Center (BMC) began an initiative to decrease CAUTI rates within its intensive care units (ICUs). A CAUTI taskforce convened and reviewed process maps and gap analyses. Based on Centers for Disease Control and Prevention (CDC) and Institute for Healthcare Improvement (IHI) guidelines, and delineated by the Healthcare Infection Control Practices Advisory Committee 2009 guidelines, all BMC ICUs sequentially implemented plan-do-study-act cycles based on which measures were most easily adaptable and believed to have the highest impact on CAUTI rates. Implementation of five care bundles spanned 5 years and included (1) processes for insertion and maintenance of foley catheters; (2) indications for indwelling foley catheters; (3) appropriate testing for CAUTIs; (4) alternatives to indwelling devices; and (5) sterilisation techniques. Daily rounds by unit nursing supervisors and inclusion of foley catheter necessity on daily ICU checklists held staff accountable on a daily basis. With these interventions, the total number of CAUTIs at BMC decreased from 53 in 2013 to 9 in 2017 (83% reduction) with a 33.8% reduction in indwelling foley catheter utilisation during the same time period. Adapted protocols showed success in decreasing the CAUTI rate and indwelling foley catheter usage in all of the BMC ICU's. While all interventions had favourable and additive trends towards decreasing the CAUTI rate, the CAUTI awareness education, insertion and removal protocols and implementation of PureWick female incontinence devices had clear and significant effects on decreasing CAUTI rates. Our project provides a framework for improving HAIs using rapid cycle testing and U-chart data monitoring. Targeted education efforts and standardised checklists and protocols adapted sequentially are low-cost and high yield efforts that may decrease CAUTIs in ICU settings.
Topics: Catheter-Related Infections; Catheters; Critical Care; Female; Humans; Intensive Care Units; Urinary Tract Infections
PubMed: 34949580
DOI: 10.1136/bmjoq-2021-001534 -
Peritoneal Dialysis International :... Jun 2012
Review
Topics: Catheter-Related Infections; Child; Consensus; Humans; Peritoneal Dialysis; Peritonitis; Practice Guidelines as Topic
PubMed: 22851742
DOI: 10.3747/pdi.2011.00091