OBJECTIVE: To study the characteristics of infections associated with peripheral venous indwelling needles and to explore the best indwelling position in patients with cardiovascular diseases from the perspective of bacteriology. METHODS: A total of 240 hospitalized patients from the Department of Cardiovascular Diseases, Xiangya Hospital, Central South University between November 2009 to July 2010 were randomly selected, and were divided into 3 groups according to the indwelling position and the indwelling time: a back of hand group (n=80), a forearm group (n=80) and a foot group (n=80). The above 3 groups were also divided into 4 subgroups according to the indwelling time (T1: 48 h ≤ t < 72 h; T2: 72 h ≤ t ≤ 96 h; T3: 96 h < t ≤ 120 h; and T4: 120 h < t ≤ 168 h) (20 patients in each subgroup). The bacteria of samples from puncture position of the skin were respectively cultured and identified after skin disinfection, needle pulling out and sample puncture from the indwelling needle catheters, respectively. RESULTS: 1) After the skin disinfection, there was no bacterium in the skin samples of puncture position. 2) When the needles were pulled out, there was bacterial growth in the skin samples of puncture position in 41 patients in the 3 groups, and the bacterium was not detected in samples of the 3 groups at T1 and T2 period. There was no significant difference in the positive rate of bacterial culture in the 3 groups at T3 and T4 period (P<0.05). 3) When the needles were pulled out. There was bacterial growth in the samples of indwelling needle catheters in 10 patients in the 3 groups; no bacterium was detected in the back of hand group and the forearm group at T1, T2, T3 and T4 period. In the foot group, there was no bacterium growth in the samples of indwelling needle catheters at T1 and T2 period, but there was bacterial growth in 4 patients at T3 period and in 6 patients at T4 period. There was significant difference in the positive rate of bacterial culture in the samples of indwelling needle catheters in the 3 groups (P<0.05). CONCLUSION The best indwelling position for peripheral venous indwelling needles is the forearm in patients with cardiovascular diseases.
Bacteria ; isolation & purification ; Cardiovascular Diseases ; complications ; Catheters, Indwelling ; Equipment Contamination ; Foot ; microbiology ; Forearm ; microbiology ; Hand ; microbiology ; Humans ; Needles ; Skin ; microbiology ; Veins ; microbiology

No abstract available.
Catheter-Related Infections/*microbiology ; Catheters, Indwelling/*adverse effects ; Female ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus/*isolation & purification ; Staphylococcal Infections/*microbiology

BACKGROUNDImplanted medical catheter-related infections are increasing, hence a need for developing catheter polymers bonded to antimicrobials. We evaluated preventive effects of levofloxacin-impregnated catheters in catheter-related Psuedomonas aeruginosa (strain PAO1) infection.

METHODSDrug release from levofloxacin-impregnated catheters was measured in vitro. Levofloxacin-impregnated catheters and polyvinyl chloride (PVC) catheters were immersed in 5 ml 50% Luria Bertani medium containing 10(8) CFU/ml Pseudomonas aeruginosa then incubated for 6, 12, 24 or 48 hours at 37°C when bacteria adhering to the catheters and bacteria in the growth culture medium were determined. Impregnated and PVC catheters were singly implanted subcutaneously in mice, 50 µl (10(7)CFU) of PAO1 was injected into catheters. After the first and fifth days challenge, bacterial counts on implanted catheters and in surrounding tissues were determined microbiologically. Bacterial colonization and biofilm formation on implanted catheters were assessed by scanning electron microscopy.

RESULTSDrug release from levofloxacin-impregnated catheters was rapid. Levofloxacin-impregnated catheters had significantly fewer bacteria compared to PVC in vitro. After first and fifth day of challenge, no or significantly fewer bacteria adhered to impregnated catheters or in surrounding tissues compared to PVC. Scanning electron microscopical images after first day displayed from none to significantly fewer bacteria adhering to impregnated implanted catheters, compared to bacteria and microcolonies adhering to PVC catheters. After the fifth day, no bacteria were found on impregnated catheters, compared to clusters surrounding mucus-like substance and coral-shaped biofilms with polymorphonuclear leukocyte on PVC catheters. After the first day of challenge, secretion occurred in all implanted catheters with surrounding tissues mildly hyperaemic and swollen. After the fifth day, minute secretions inside impregnated catheters and no inflammation in tissues, whereas purulent secretion inside PVC catheters and abscesses in surrounding tissues.

CONCLUSIONLevofloxacin-impregnated catheter is a promising new strategy for prevention of catheter-related Psuedomonas aeruginosa infection.

Animals ; Biofilms ; drug effects ; Catheters, Indwelling ; microbiology ; Female ; Levofloxacin ; therapeutic use ; Mice ; Pseudomonas Infections ; prevention & control ; Pseudomonas aeruginosa ; pathogenicity

We report Mycobacterium fortuitum (M. fortuitum) catheter-related sepsis in a five-year-old boy with acute lymphoblastic leukaemia (ALL). This is the first reported case of M. fortuitum infection seen in our paediatric oncology patients. The patient was in haematological remission and receiving maintenance chemotherapy via an indwelling central venous catheter (Port-a-Cath). He was febrile, toxic-looking and was in respiratory distress. Clinically, he had a right pleural effusion and gross hepatomegaly. The patient was lymphopaenic and had deranged liver function test. Repeat paired blood cultures were positive for M. fortuitum. The catheter was promptly removed and he was treated aggressively with intravenous amikacin, cefoxitin, ciprofloxacin, trimethoprim-sulfamethoxazole and oral clarithromycin, with good clinical response. The patient remained well without further complications while on chemotherapy. M. fortuitum is an uncommon cause of catheter-related infection in patients with malignancies. Removal of an infected catheter is necessary for complete control of atypical mycobacterial infection in an immunosuppressed patient.
Acute Disease ; Antineoplastic Agents ; administration & dosage ; Catheters, Indwelling ; microbiology ; Child, Preschool ; Humans ; Immunocompromised Host ; Male ; Mycobacterium Infections, Nontuberculous ; complications ; microbiology ; Mycobacterium fortuitum ; isolation & purification ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; drug therapy ; Sepsis ; etiology ; microbiology

INTRODUCTIONSevere perianal sepsis is often difficult to manage after surgical debridement due to faecal contamination. Diversion of the faecal stream has been attempted with faecal pouches and rectal tubes, and in some cases, a diverting stoma is created. However, reversal of the stoma may be delayed due to prolonged sepsis and this is not without risks. Herein, we review the use of a flexible faecal management system in patients with severe perianal sepsis.

METHODSWe retrospectively evaluated 15 patients who made use of the ConvaTec Flexi-Seal® Fecal Management System (FMS) between 1 January 2007 and 31 December 2010. The demographics and comorbidities of the patients, as well as the treatment received, were recorded and reviewed.

RESULTSNone of the patients required the creation of a stoma to divert the faecal stream. Nursing requirements and wound care were found to be improved with the use of the Flexi-Seal® FMS (fewer changes were needed). No severe complications were observed in our series. Two deaths were encountered, but the cause of death was not directly due to the initial perianal sepsis. Overall, the wound healing rate was 80.0%, with one graft failure (11.1%).

CONCLUSIONThe use of the Flexi-Seal® FMS in patients with perianal sepsis following extensive debridement is feasible and can be considered before stoma creation.

Adult ; Aged ; Anti-Bacterial Agents ; Bacterial Proteins ; isolation & purification ; Catheters, Indwelling ; Debridement ; Enterococcus ; isolation & purification ; Fasciitis, Necrotizing ; microbiology ; surgery ; Feces ; Female ; Fournier Gangrene ; microbiology ; Hemolysin Proteins ; isolation & purification ; Humans ; Klebsiella ; isolation & purification ; Male ; Middle Aged ; Perineum ; microbiology ; Rectum ; microbiology ; Retrospective Studies ; Sepsis ; diagnosis ; drug therapy ; microbiology ; therapy ; Singapore ; Surgical Stomas ; Treatment Outcome ; Wound Healing

BACKGROUND/AIMS: The high mortality attributable to persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in spite of glycopeptide treatment has heightened the need for early detection and intervention with alternative agents. The purpose of this study was to determine the clinical characteristics of and risk factors for persistent MRSA bacteremia. METHODS: All first episodes of significant MRSA bacteremia at a 710-bed academic medical center from November 2009 through August 2010 were recorded. Blood cultures were conducted at 3 days and every 2 to 3 days thereafter until clearance. Clinical characteristics and outcomes were compared between persistent MRSA bacteremia (> or = 7 days) and nonpersistent MRSA bacteremia (< or = 3 days). RESULTS: Of 79 patients with MRSA bacteremia during the study period, 31 (39.2%) had persistent MRSA bacteremia. The persistent MRSA bacteremia group had significantly higher 30-day mortality than the nonpersistent MRSA bacteremia group (58.1% vs. 16.7%, p < 0.001). Multivariate analysis indicated that metastatic infection at presentation (odds ratio [OR], 14.57; 95% confidence interval [CI], 3.52 to 60.34; p < 0.001) and delayed catheter removal in catheter-related infection (OR, 3.80; 95% CI, 1.04 to 13.88; p = 0.004) were independent predictors of persistent MRSA bacteremia. Patients with a time to blood culture positivity (TTP) of < 11.8 hours were at increased risk of persistent MRSA bacteremia (29.0% vs. 8.3%, p = 0.029). CONCLUSIONS: High mortality in patients with persistent MRSA bacteremia was noted. Early detection of metastatic infection and early removal of infected intravascular catheters should be considered to reduce the risk of persistent MRSA bacteremia. Further studies are needed to evaluate the role of TTP for predicting persistent MRSA bacteremia.
Academic Medical Centers ; Aged ; Anti-Bacterial Agents/therapeutic use ; Catheter-Related Infections/diagnosis/drug therapy/*microbiology/mortality ; Catheters, Indwelling/*adverse effects ; Comorbidity ; Device Removal ; Female ; Hospital Bed Capacity ; Humans ; Logistic Models ; Male ; Methicillin-Resistant Staphylococcus aureus/drug effects/*isolation & purification ; Middle Aged ; Multivariate Analysis ; Neoplasms/microbiology/mortality ; Odds Ratio ; Prospective Studies ; Republic of Korea ; Risk Factors ; Staphylococcal Infections/diagnosis/drug therapy/*microbiology/mortality ; Time Factors ; Treatment Outcome

OBJECTIVE: The purpose of this study was to determine the incidence and risk factors of infections associated with implantable venous access ports (IVAPs). MATERIALS AND METHODS: From August 2003 through November 2011, 1747 IVAPs were placed in our interventional radiology suite. One hundred forty four IVAPs were inserted in patients with hematologic malignancy and 1603 IVAPs in patients with solid tumors. Among them, 40 ports (23 women and 17 men; mean age, 57.1 years; range, 13-83) were removed to treat port-related infections. We evaluated the incidence of port-related infection, patient characteristics, bacteriologic data, and patient progress. Univariable analyses (t test, chi-square test, and Fisher's exact test) and multiple logistic regression analyses were used to determine the risk factors for IVAP related infection. RESULTS: Overall, 40 (2.3%) of 1747 ports were removed for symptoms of infection with an incidence rate of 0.067 events/1000 catheter-days. According to the univariable study, the incidences of infection were seemingly higher in the patients who received the procedure during inpatient treatment (p = 0.016), the patients with hematologic malignancy (p = 0.041), and the patients receiving palliative chemotherapy (p = 0.022). From the multiple binary logistic regression, the adjusted odds ratios of infection in patients with hematologic malignancies and those receiving palliative chemotherapy were 7.769 (p = 0.001) and 4.863 (p = 0.003), respectively. Microorganisms were isolated from 26 (65%) blood samples, and two of the most causative organisms were found to be Staphylococcus (n = 10) and Candida species (n = 7). CONCLUSION: The underlying hematologic malignancy and the state of receiving palliative chemotherapy were the independent risk factors of IVAP-related infection.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Catheter-Related Infections/*epidemiology/microbiology ; Catheters, Indwelling/*adverse effects ; Female ; Hematologic Neoplasms/drug therapy ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasms/drug therapy ; Palliative Care/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Vascular Access Devices/*adverse effects ; Young Adult

Agranulocytosis is a rare adverse effect associated with prolonged vancomycin therapy, and is potentially serious, especially in end stage renal disease (ESRD) patients. We describe a continuous ambulatory peritoneal dialysis (CAPD) patient that developed vancomycin-induced agranulocytosis during treatment for methicillin-resistant Staphylococcus aureus (MRSA) -associated external cuff infection and pneumonia. The agranulocytosis was rapidly resolved by granulocyte colony-stimulating factor (G-CSF) therapy and by the discontinuation of vancomycin.
Aged ; Agranulocytosis/*chemically induced/drug therapy ; Anti-Bacterial Agents/*adverse effects/therapeutic use ; Catheters, Indwelling/microbiology ; Granulocyte Colony-Stimulating Factor/therapeutic use ; Human ; Kidney Failure, Chronic/complications/therapy ; Male ; Peritoneal Dialysis, Continuous Ambulatory ; Staphylococcal Infections/drug therapy ; Vancomycin/*adverse effects/therapeutic use