Interventions for treating catheter-related bloodstream infections in people receiving maintenance haemodialysis.
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ABSTRACT:
SUBMITTER: Almeida BM
PROVIDER: S-EPMC8974891 | biostudies-literature | 2022 Apr
REPOSITORIES: biostudies-literature
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Interventions for treating catheter-related bloodstream infections in people receiving maintenance haemodialysis.
Almeida Beatriz M BM Moreno Daniel H DH Vasconcelos Vladimir V Cacione Daniel G DG
The Cochrane database of systematic reviews 20220401
<h4>Background</h4>Patients with kidney failure require vascular access to receive maintenance haemodialysis (HD), which can be achieved by an arteriovenous fistula or a central venous catheter (CVC). CVC use is related to frequent complications such as venous stenosis and infection. Venous stenosis occurs mainly due to trauma caused by the entrance of the catheter into the venous lumen and repeated contact with the vein wall. A biofilm, a colony of irreversible adherent and self-sufficient mic ...[more]
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Project description:ObjectiveTo identify whether multifaceted interventions, or care bundles, reduce catheter related bloodstream infections (CRBSIs) from central venous catheters used for haemodialysis.DesignStepped wedge, cluster randomised design.Setting37 renal services across Australia.ParticipantsAll adults (age ≥18 years) under the care of a renal service who required insertion of a new haemodialysis catheter.InterventionsAfter a baseline observational phase, a service-wide, multifaceted intervention bundle that included elements of catheter care (insertion, maintenance, and removal) was implemented at one of three randomly assigned time points (12 at the first time point, 12 at the second, and 13 at the third) between 20 December 2016 and 31 March 2020.Main outcomes measureThe primary endpoint was the rate of CRBSI in the baseline phase compared with intervention phase at the renal service level using the intention-to-treat principle.Results1.14 million haemodialysis catheter days of use were monitored across 6364 patients. Patient characteristics were similar across baseline and intervention phases. 315 CRBSIs occurred (158 in the baseline phase and 157 in the intervention phase), with a rate of 0.21 per 1000 days of catheter use in the baseline phase and 0.29 per 1000 days in the intervention phase, giving an incidence rate ratio of 1.37 (95% confidence interval 0.85 to 2.21; P=0.20). This translates to one in 10 patients who undergo dialysis for a year with a catheter experiencing an episode of CRBSI.ConclusionsAmong patients who require a haemodialysis catheter, the implementation of a multifaceted intervention did not reduce the rate of CRBSI. Multifaceted interventions to prevent CRBSI might not be effective in clinical practice settings.Trial registrationAustralia New Zealand Clinical Trials Registry ACTRN12616000830493.
| S-EPMC9002320 | biostudies-literature
Project description:Catheter-related bloodstream infections are a serious problem. Many interventions reduce risk, and some have been evaluated in cost-effectiveness studies. We review the usefulness and quality of these economic studies. Evidence is incomplete, and data required to inform a coherent policy are missing. The cost-effectiveness studies are characterized by a lack of transparency, short time-horizons, and narrow economic perspectives. Data quality is low for some important model parameters. Authors of future economic evaluations should aim to model the complete policy and not just single interventions. They should be rigorous in developing the structure of the economic model, include all relevant economic outcomes, use a systematic approach for selecting data sources for model parameters, and propagate the effect of uncertainty in model parameters on conclusions. This will inform future data collection and improve our understanding of the economics of preventing these infections.
| S-EPMC2792862 | biostudies-literature
Project description:IntroductionAlthough the seasonality of infectious diseases has been widely reported, the seasonality of peripheral venous catheter-related bloodstream infection (PV-CRBSI) has not been investigated. This study investigated the seasonality of PV-CRBSI and its relationship with meteorological conditions.MethodsA retrospective cohort study of PV-CRBSI at Tokyo Medical University Hospital (Tokyo, Japan), from 2009 to 2019, provided the data for descriptive and time series analyses used to evaluate the number of PV-CRBSI cases per 1000 admissions that occurred each month for each causative organism. By performing univariate and multivariate analyses, the researchers investigated the seasonality of cases and the relationships between meteorological conditions, other external factors, and PV-CRBSIs.ResultsThis study included a total of 184 PV-CRBSI cases. The mean numbers of PV-CRBSI cases per 1000 admissions caused by all organisms, Bacillus cereus, Gram-positive cocci, and Gram-negative rods were 0.67, 0.15, 0.37, and 0.16 per month, respectively, during the study period. The time series analysis showed that the incidences of PV-CRBSI cases associated with B. cereus and Gram-negative rods were significantly different in the winter/spring from those in the summer/autumn (P < 0.05). The incidence of PV-CRBSI cases caused by B. cereus peaked during summer. The incidence of PV-CRBSI cases caused by B. cereus was significantly positively associated with average monthly temperature, whereas the incidence of PV-CRBSIs caused by Gram-negative rods was significantly negatively associated with average daylight hours.ConclusionThe incidence of PV-CRBSIs caused by B. cereus showed seasonality, peaking during the summer, and a significant correlation was found between PV-CRBSIs caused by B. cereus and average monthly temperature.
| S-EPMC7954888 | biostudies-literature
Project description:BackgroundParenteral nutrition administered via central venous catheter is an established treatment option for people with intestinal failure. A serious complication of central venous catheters is the high risk of catheter-related bloodstream infections (CRBSIs). Catheter-locking solutions are one strategy for CRBSI prevention, with the solution taurolidine showing beneficial effects. The aim of this meta-analysis was to identify and synthesize evidence to assess taurolidine efficacy against comparators for the prevention of CRBSI for people with intestinal failure receiving parenteral nutrition.MethodsSix health literature databases were searched for efficacy data of rate of CRBSI for taurolidine vs control among our study population; no study design limits were applied. Individual study data were presented for the number of CRBSIs and catheter days, and rate ratio. Overall data were synthesized as a pooled risk ratio, with subgroup analyses by study design, control type, and taurolidine solution.ResultsThirty-four studies were included in the final analysis. At the individual level, all studies showed superior efficacy of taurolidine vs control for prevention of CRBSIs. When the data were synthesized, the pooled risk ratio was 0.49 (95% CI, 0.46-0.53; P ≤ 0.0001), indicating a 51% decreased risk of CRBSI through the use of taurolidine. Subgroup analysis showed no difference depending on study design (P = 0.23) or control type (P = 0.37) and a significant difference for taurolidine type (P = 0.0005).ConclusionTaurolidine showed superior efficacy over controls regardless of study design or comparator group. The results show that taurolidine provides effective CRBSI reduction for people with intestinal failure receiving parenteral nutrition.
| S-EPMC9541343 | biostudies-literature
Project description:BackgroundCentral venous catheters (CVC) are used for dialysis in end-stage renal disease patients, presenting a significant risk for Catheter-Related Bloodstream Infections (CRBSI). While Lean Six Sigma has been effective in reducing CRBSI, its efficacy outside intensive care units (ICU) remains less explored. This study aims to evaluate the effectiveness of Lean Six Sigma in mitigating CRBSI risks among non-ICU hemodialysis patients.MethodsThe study was conducted in a nephrology department, focusing on patients undergoing hemodialysis with temporary CVC from February to December 2021. The Lean Six Sigma method, using Define-Measure-Analyze-Improve-Control (DMAIC) methodology, was implemented in 2022 to reduce CRBSI incidence. The 2021 CRBSI rate served as the benchmark, with a goal to reduce it by the end of 2022. Value-stream mapping, Fishbone Diagrams, and Root Cause Analysis identified potential CRBSI causes. After implementing targeted improvements, CRBSI rates before and after the intervention were compared.ResultsThe Lean Six Sigma method significantly decreased CRBSI incidence from 12.79 to 2.32 per 1,000 catheter-days following the implementation of targeted interventions ([Formula: see text]=4.60, P = 0.05). This improvement was observed comparing February-December 2021 with January-December 2022.ConclusionThe findings demonstrate the effectiveness of the Lean Six Sigma method in non-ICU settings, suggesting broader applicability in hemodialysis patient care.
| S-EPMC11430130 | biostudies-literature
Project description:AbstractUncomplicated bacteremia and catheter-related bloodstream infection (CRBSI) are frequently suggested as factors associated with low risk of infective endocarditis in Staphylococcus aureus bacteremia (SAB). Nevertheless, guidelines recommend that echocardiography in all patients with SAB. We evaluated the effects of echocardiography on patient outcomes. Patients with uncomplicated S. aureus CRBSI were retrospectively identified between January 2013 and June 2018 at a 1950-bed, tertiary-care university hospital. Treatment failure was defined as any case of relapse or all-cause death within 90 days. Of 890 SAB patients, 95 with uncomplicated S. aureus CRBSI were included. Thirty-two patients underwent echocardiography within 30 days of their first positive blood culture. Two patients who underwent echocardiography revealed right-sided infective endocarditis. One patient who did not undergo echocardiography experienced recurrent SAB (peripheral CRBSI) 85 days after his first positive blood culture. There were no SAB-related deaths. The Kaplan-Meier curves of treatment failure showed no significant differences between patients who did and did not undergo echocardiography (P = .77). In multivariable analysis, risk factors for treatment failure were liver cirrhosis (hazard ratio: 9.60; 95% confidence interval: 2.13-43.33; P = .003) and other prostheses (hazard ratio: 63.79; 95% confidence interval: 5.05-805.40; P = .001). This study did not verify the putative association between treatment failure and implementation of echocardiography in patients with uncomplicated S. aureus CRBSI. Given the low observed rates of adverse outcomes, routine echocardiography might not be obligatory and could be performed on an individual basis.
| S-EPMC8104220 | biostudies-literature
Project description:BackgroundWe aimed to describe the epidemiology of catheter-related bloodstream infections (CRBSIs) in onco-hematological neutropenic patients during a 25-year study period, to evaluate the risk factors for Gram-negative bacilli (GNB) CRBSI, as well as rates of inappropriate empirical antibiotic treatments (IEAT) and mortality.Materials/methodsAll consecutive episodes of CRBSIs were prospectively collected (1994-2018). Changing epidemiology was evaluated comparing five-year time spans. A multivariate regression model was built to evaluate risk factors for GNB CRBSIs.Results482 monomicrobial CRBSIs were documented. The proportion of CRBSIs among all BSIs decreased over time from 41.2% to 15.8% (p<0.001). CRBSIs epidemiology has been changing: the rate of GNB increased over time (from 11.9% to 29.4%; p<0.001), as well as the absolute number and rate of multidrug-resistant (MDR) GNB (from 9.5% to 40.0%; p = 0.039). P. aeruginosa increased and comprised up to 40% of all GNB. Independent factors related with GNB-CRBSIs were: longer duration of in-situ catheter (OR 1.007; 95%CI 1.004-1.011), older age (OR 1.016; 95%CI 1.001-1.033), prior antibiotic treatment with penicillins (OR 2.716; 95%CI 1.306-5.403), and current antibiotic treatment with glycopeptides (OR 1.931; 95%CI 1.001-3.306). IEATs were administered to 30.7% of patients, with the highest percentage among MDR P. aeruginosa (76.9%) and S. maltophillia (92.9%). Mortality rate was greater among GNB than GPC-CRBSI (14.4% vs 5.4%; p = 0.002), with mortality increasing over time (from 4.5% to 11.2%; p = 0.003).ConclusionA significant shift towards GNB-CRBSIs was observed. Secondarily, and coinciding with an increasing number of GNB-MDR infections, mortality increased over time.
| S-EPMC8087001 | biostudies-literature
Project description:BackgroundCatheter-related bloodstream infection (CR-BSI) stands as one of the leading causes of hospital-acquired infections, often resulting in high healthcare expenditure and mortality rates. Despite efforts, reducing the incidence of CR-BSI remains a significant challenge.ObjectiveThis study aimed to assess the impact of a multidisciplinary organizational intervention on reducing intravenous CR-BSI.MethodsA quality improvement team was established to implement various interventions, utilizing the FOCUS-PDCA continuous quality improvement model and fishbone diagram for analysis and improvement.ResultsAfter the interventions, operational indicators for catheter insertion, maintenance, and removal improved from 82.50% ± 1.15%, 83.60% ± 1.60%, and 81.60% ± 1.80-95.30% ± 1.00%, 96.20% ± 1.62%, and 97.25% ± 0.50%, respectively. Additionally, catheter dwell time decreased from 7.50 ± 0.85 days to 3.50 ± 0.75 days, and the quarterly infection rate was reduced from 2.328% ± 1.85-0.305% ± 0.95% following the implementation of the intervention.DiscussionDespite the available evidence, there remains a noticeable gap between the ideal evidence-based practices and their practical implementation. We aim to eradicate CR-BSIs within the surgical intensive care units (ICUs) of hospitals. To achieve this goal, we have introduced a comprehensive quality improvement framework designed not only to benefit our own ICU but also to serve as a model for implementation in other similar healthcare settings.
| S-EPMC11754313 | biostudies-literature
Project description:Intravenous (IV) catheter-related bloodstream infections (CRBSIs) cause significant risks in healthcare, necessitating advancements in catheter design and materials. This study investigates the effectiveness of Ecoflex, a silicone-based material, in studying CRBSIs through the development of skin-like replicas that mimic human skin properties for use in wearable sensing devices. We characterized the replica's bioinspired surface roughness, wettability, bacterial adhesion, and mechanical properties and validated its performance using in vitro IV simulation. The results demonstrated that the bioinspired model replicates human skin textures with less than 7.5% error for surface roughness ranging from 0.05 μm to 6.3 μm. Wettability tests revealed that the artificial sebum application significantly reduced the static contact angles for deionized water and artificial sweat. Comprehensive mechanical testing revealed material high elasticity and resilience, suitable for dynamic biomedical applications. Bacterial adhesion studies using Staphylococcus epidermidis showed varying adhesion patterns influenced by surface roughness, highlighting the potential for material texture to impact infection risk. In IV therapy simulations, we observed bacterial growth dynamics over the incubation period. Our findings suggest that Ecoflex-based skin-like replicas can serve as a valuable tool for developing and testing new catheters, while the potential for use in other medical innovation devices, including wearable sensing devices, ultimately contributes to improved patient outcomes and infection control strategies.
| S-EPMC11526004 | biostudies-literature
Project description:BackgroundIn the critically ill, catheter-related bloodstream infection can result from bacterial contamination of infusion hubs of intravascular catheters. Needle-free connectors (NFC) have been suggested to reduce the rate of bacterial contamination and subsequent catheter-related bloodstream infection (CRBSI), but data remains ambiguous. Thus, we tested if a novel NFC would reduce bacterial contamination and subsequent CRBSI.ResultsIn a prospective, randomized controlled trial, surgical ICU patients were randomized to three-way hubs closed by caps or Bionecteur® (Vygon, Inc.) of central venous catheters. Every 72 h, infusion lines were renewed and microbiological samples were taken. Bacterial growth was analyzed by blinded microbiologists. Incidence of bacterial contamination and CRSBI were assessed. Outcome parameters like length of stay on ICU and outcome were retrospectively assessed. Two thousand seven hundred patients were screened, 111 were randomized to the NFC, and 109 into the control group. Finally, 24 patients in the NFC and 23 control patients were analyzed. The majority of samples (NFC 77%; control 70%) found no bacterial growth. Coagulase-negative staphylococci were most commonly detected on CVC samples (NFC 17%; control 21%). We found CRBSI (defined as identical pathogens in blood culture and catheter line tip culture, and clinical manifestations of infection) in two control patients and one patient of the NFC group. Their length of ICU stay did not differ between groups (NFC 19 days; control 23 days).ConclusionThe use of NFC does not influence the rate of bacterial contamination of infusion hubs of central venous catheters.Trial registrationClinicaltrials.gov, NCT02134769. Registered 09 May 2014.
| S-EPMC6888779 | biostudies-literature