Comparison of transthoracic echocardiography with second harmonic imaging with transesophageal echocardiography in the detection of right to left shunts (original) (raw)
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[Conservative methods for diagnosing catheter-associated bacteremia]
Medicina intensiva / Sociedad Española de Medicina Intensiva y Unidades Coronarias, 2012
Catheter-associated bacteremia (CAB) is a frequent cause of nosocomial infection in the critical patient 1-4 and implies an increase in both morbidity-mortality and healthcare costs. 5-8 The classical method for confirming CAB involves the concomitant isolation of the microorganism in blood cultures obtained by percutaneous puncture and from catheter tip cultures. This conventional procedure has the inconvenience of requiring catheter withdrawal in order to allow tip culture. In this context, there are arguments both in favor and against systematic catheter removal when suspecting CAB. In favor of withdrawal is the fact that many studies have reported a lesser mortality or duration of CAB when the catheter is removed. 9-14 However, these studies pose the limitation of having a non-randomized design. In turn, the arguments against catheter withdrawal include: (I) the low yield of systematic catheter tip culture, with positive cultures in under 10% of all cases according to different series 15-17 ; (II) a randomized study has shown that routine catheter removal is not necessary in stable patients. 18 The study included patients with suspected CAB, and excluded hemodynamically unstable subjects, immune depressed patients and individuals with signs of local infection. The patients were randomized to either routine catheter removal or catheter maintenance until the ଝ Please cite this article as: Lorente L. Métodos conservadores para el diagnóstico de bacteriemia asociada a catéter. Med Intensiva. 2012
Bacteremia related with arterial catheter in critically ill patients
Journal of Infection, 2011
Objective: Catheter-related bloodstream infections (CR-BSI) are an increasing problem in the management of critically ill patients. Our objective was to analyze the incidence and epidemiology of CR-BSI in arterial catheters (AC) in a population of critically ill patients. Methods: We conducted a two-year, prospective, non-randomized study of patients admitted for > 24 h in a 24-bed medical-surgical major teaching ICU. We analyzed the arterial catheters and differentiated between femoral and radial locations. Difference testing between groups was performed using the two-tailed t-test and chi-square test as appropriate. Multivariate logistic regression analyses were conducted to identify independent predictors of CR-BSI occurrence and type of micro-organism responsible. Results: The study included 1456 patients requiring AC placement for ! 24 h. A total of 1543 AC were inserted for 14,437 catheter days. The incidence of AC-related bloodstream infections (ACR-BSI) was 3.53 episodes per 1000 catheter days. In the same period the incidence of central venous catheter (CVC)-related bloodstream infections was 4.98 episodes per 1000 catheter days. Logistic regression analysis showed that days of insertion (OR: 1.118 95% confidence interval (CI) 1.026e1.219) and length of ICU stay (OR: 1.052 95% CI: 1.025e1.079) were associated with a higher risk of ACR-BSI. Comparing 705 arterial catheters in femoral location with 838 in radial location, no significant differences in infection rates were found, although there was a trend toward a higher rate among femoral catheters (4.13 vs. 3.36 episodes per 1000 catheter days) (p Z 0.72). Among patients with ACR-BSI, Gram-negative bacteria were isolated in 16 episodes (61.5%) in the femoral location and seven (28%) in radial location (OR: 2.586; 95% CI: 1.051e6.363).
Medicina Intensiva, 2014
Objective: To evaluate the clinical usefulness and safety of the differential-time-to-positivity (DTP) method for managing the suspicion of catheter-related bloodstream infection (CR-BSI) in comparison with a standard method that includes catheter removal in critically ill patients. Methods-Design: A prospective randomized study was carried out. Setting: A 16-bed clinicalsurgical ICU (July 2007-February 2009). Interventions: Patients were randomly assigned to one of two groups at the time CR-BSI was suspected. In the standard group, a standard strategy requiring catheter withdrawal was used to confirm or rule out CR-BSI. In the DTP group, DTP without catheter withdrawal was used to confirm or rule out CR-BSI. Measurements: clinical and microbiological data, CR-BSI rates, unnecessary catheter removals, and complications due to new puncture or to delays in catheter removal. Results: Twenty-six patients were analyzed in each group. In the standard group, 6 of 37 suspected episodes of CR-BSI were confirmed and 5 colonizations were diagnosed. In the DTP group, 5 of 26 suspected episodes of CR-BSI were confirmed and four colonizations were diagnosed. In the standard group, all catheters (58/58, 100%) were removed at the time CR-BSA was suspected, whereas in the DTP group, only 13 catheters (13/41, 32%) were removed at diagnosis, and 10 due to persistent septic signs (10/41, 24%). In cases of confirmed CR-BSI, there were no differences between the two groups in the evolution of inflammatory parameters during the 48 hours following the suspicion of CR-BSI. Conclusions: In critically ill patients with suspected CR-BSI, the DTP method makes it possible to keep the central venous catheter in place safely. Documento descargado de http://www.medintensiva.org el 08/10/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato. 136 C. Sabatier et al. KEYWORDS Catheter-related infections; Diagnosis; Central venous catheter; Critical care
Neurosurgery, 2012
BACKGROUND: External ventricular drainage (EVD) catheters provide reliable and accurate means of monitoring intracranial pressure and alleviating elevated pressures via drainage of cerebrospinal fluid (CSF). CSF infections occur in approximately 9% of patients. Antibiotic-impregnated (AI) EVD catheters were developed with the goal of reducing the occurrence of EVD catheter-related CSF infections and their associated complications. OBJECTIVE: To present an international, prospective, randomized, open-label trial to evaluate infection incidence of AI vs standard EVD catheters. METHODS: Infection was defined as (1) proven infection, positive CSF culture and positive Gram stain or (2) suspected infection: (A) positive CSF culture with no organisms identified on initial Gram stain; (B) negative CSF culture with a gram-positive or-negative stain; (C) CSF leukocytosis with a white blood cell/red blood cell count .0.02. RESULTS: Four hundred thirty-four patients underwent implantation of an EVD catheter. One hundred seventy-six patients in the AI-EVD cohort and 181 in the standard EVD catheter cohort were eligible for evaluation of infection. The 2 groups were similar in all clinical characteristics. Proven infection was documented in 9 (2.5%) patients (AI: 4 [2.3%] vs standard: 5 [2.8%], P = 1.0). Suspected infection was documented in 31 (17.6%) patients receiving AI and 37 (20.4%) patients receiving standard EVD catheters, P = .504. Duration of time to suspected infection was prolonged in the AI cohort (8.8 6 6.1 days) compared with the standard EVD cohort (4.6 6 4.2 days), P = .002. CONCLUSION: AI-EVD catheters were associated with an extremely low rate of catheter-related infections. AI catheters were not associated with risk reduction in EVD infection compared to standard catheters. Use of AI-EVD catheters is a safe option for a wide variety of patients requiring CSF drainage and monitoring, but the efficacy of AI-EVD catheters was not supported in this trial.
J Dairy Res, 2009
J Cardiovasc Thorac Res / 13 Backgraound: Venous and arterial catheters are used ordinary for continuous hemodynamic evaluation in cardiac surgery intensive care units. The catheters are one of the most important risk factors for nosocomial infection and mortality of hospitalized patients. The aim of this study was to evaluate the rate of bacterial colonization of intravascular catheters and catheter related bloodstream infection in Shahid Madani intensive care unit. Methods: 150 admitted patients that had intravascular catheter for more than 48 hours were enrolled in this study during one year period. The tip segment of catheters and insertion site cultures were assessed. Results: The rate of colonization was 13(8.7%). The isolated bacteria were Escherichia coli(23.1%), Pseudomonas aeroginosa(23.1%) staphylococcus aureus(7.7%), coagulase negative staphylococcus(7.7%), Proteus vulgaris(7.7%), Stenotrophomonas maltophilia(7.7%), Candida albikans(7.7%), nonfermentative gram negative bacilli(7.7%) and Acinetobacter spp(7.7%). Conclusion: The rate of catheter colonization was acceptable in comparison to the other studies. The most common isolated bacteria were Escherichia coli and Pseudomonas aeroginosa. In this study, the important risk factors were duration of catheter use, duration of hospitalization and positive blood culture.
International Journal of Advances in Medicine
Background: Mortality from bacteraemia related to indwelling Central Venous Pressure (CVP) lines could be as high as 12 - 25% and that due to indwelling urinary catheters about 5%, in critically ill patients. Hence, initiation of early and aggressive antibiotic therapy, often even before the culture- sensitivity reports are available is necessary. Objectives of the study was to find out the incidence of bacteraemia related to indwelling CVP catheters &/or Foley’s catheters in post operative patients in Cardio-thoracic Intensive Theraputic Unit (ITU) and to understand the antibiotic sensitivity patterns against the organisms causing such bacteraemiaMethods: 48 hours after their insertion, CVP catheter tips, Foley’s catheter tips and Peripheral blood samples were collected for cultures in 50 patients who underwent elective cardiothoracic surgery, over a period of one year and results were interpreted.Results: Incidence of bacteraemia associated with indwelling CVP catheters was 8% a...
Guidelines for the Management of Intravascular Catheter-Related Infections
Clinical Infectious Diseases, 2001
These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications. Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci, Staphylococcus aureus, aerobic gram-negative bacilli, and Candida albicans most commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical i.v. antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen(s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed. For management of bacteremia and fungemia from a tunneled catheter or implantable device, such as a port, the decision to remove the catheter or device should be based on the severity of the patient's illness, documentation that the vascular-access device is infected, assessment of the specific pathogen involved, and presence of complications, such as endocarditis, septic thrombosis, tunnel infection, or metastatic seeding. When a catheter-related infection is documented and a specific pathogen is identified, systemic antimicrobial therapy should be narrowed and consideration given for antibiotic lock therapy, if the CVC or implantable device is not removed. These guidelines address the issues related to the management of catheter-related bacteremia and associated complications. Separate guidelines will address specific issues related to the prevention of catheter-related infections. Performance indicators for the management of catheter-related infection are included at the end of the document. Because the pathogenesis of catheter-related infections is complicated, the virulence of the pathogens is variable, and the host factors have not been well defined, there is a notable absence of compelling clinical data to make firm recommendations for an individual patient. Therefore, the recommendations in these guidelines are intended to support, and not replace, good clinical judgment. Also, a section on selected, unresolved clinical issues that require further study and research has been included. There is an urgent need for large, well-designed clinical studies to delineate management strategies more effectively, which will improve clinical outcomes and save precious health care resources.