Central venous catheters (CVCs) contribute disproportionately to bloodstream infection (BSI) and, by extension, to infection-related hospitalization, mortality, and health care costs in patients undergoing dialysis. Recent product advancements may reduce BSIs, but a sufficiently powered comparative-effectiveness study is needed to facilitate evidence-based patient care decisions. In a 13-month, prospective, cluster-randomized, open-label trial, we compared BSI rates in facilities using ClearGuard HD antimicrobial barrier caps (ClearGuard group) with those in facilities using Tego hemodialysis connectors plus Curos disinfecting caps (Tego+Curos group). Forty DaVita dialysis facilities in the United States were pair-matched by BSI rate, number of patients using CVCs, and geographic location, and then cluster randomized 1:1. We enrolled all adult patients undergoing dialysis with CVCs at these facilities, except those allergic to heparin or chlorhexidine. Overall, 1671 patients participated in the study, accruing >183,000 CVC-days. The study outcome was positive blood culture (PBC) rate as an indicator of BSI rate. We calculated results at the cluster level and adjusted for the facility cluster effect. During a 3-month run-in period immediately before study interventions, the groups had similar BSI rates (=0.8). During the 13-month intervention period that immediately followed, the ClearGuard group had a BSI rate significantly lower than that of the Tego+Curos group (0.28 versus 0.75 PBCs per 1000 CVC-days, respectively; =0.001). No device-related adverse events were reported. In conclusion, compared with Tego connectors plus Curos caps, ClearGuard HD antimicrobial barrier caps significantly lowered the rate of catheter-related BSIs in patients undergoing hemodialysis using CVCs, representing an important advancement in hemodialysis patient care.

This study characterizes the prevalence of drug use among Filipino street children compared with Filipino non-street children. A cross-sectional survey was administered to 311 street children and 528 non-street children aged 13 to 17 years. Participants were enrolled through 4 nonprofit organizations and 3 high schools located in Manila, Philippines. After adjustment for age and sex, street children with little or no contact with their families were 2.0 (95% confidence interval [CI] = 1.7-2.3) times more likely to smoke tobacco, 1.3 (95% CI = 1.2-1.5) times more likely to use alcohol, 36.7 (95% CI = 16.4-82.0) times more likely to use inhalants, and 5.5 (95% CI = 3.6-8.2) times more likely to use illegal drugs than their non-street counterparts. Street children who maintained contact with their families, compared with non-street children, were 8.7 (95% CI = 3.9-19.4) times more likely to use inhalants and 2.8 (95% CI = 1.7-4.6) times more likely to use illegal drugs. There was no significant difference in tobacco or alcohol use between street children who maintained contact with their families and non-street children. All street children were significantly more likely to have been given or sold a drug in the past 30 days and to have received drug education compared with non-street children. Filipino street children are at greater risk of abusing drugs than are non-street children, with street children who do not maintain family contact being at greatest risk.

Purpose: To describe health problems and social, environmental, and health behavior characteristics among street children in Manila, Philippines. Methods: A cross-sectional survey and clinical tests that included chest radiographs blood, urine, and stool samples were completed with 179 street children, ages 8-17 years, served by Childhope-Asia Philippines. Results: The most frequently occurring health problem was coughing, followed by fever, dyspnea, diarrhea, and then blood in the stools. Males compared with females were more likely to be kicked, punched, or slapped by an adult. Among males, 65% are current smokers and 52% have consumed alcohol. Among females, 37% are current smokers and 67% have consumed alcohol. The percentage of children with low hemoglobin was 91% for males and 16% for females. The percentage of children with low hematocrit was 69% for males and 22% for females. Of all children tested, 7.9% had hepatitis B, 12.3% had pneumonia, and 25.5% had ascariasis. Conclusions: Filipino street children have a high level of infectious disease, with females experiencing higher levels of coughing, dyspnea, and fever whereas males had higher levels of diarrhea. Males are more likely to be physically abused and to smoke tobacco whereas females are more likely to drink alcohol. Both males and females experienced depression and anxiety and many children were sexually active. Diseases common among the population are pneumonia, anemia, hepatitis Β and ascariasis, primarily due to their lack of adequate nutrition, close living proximity, and unsanitary living conditions.

Reports of bloodstream infections caused by methicillin-resistant Staphylococcus aureus among chronic hemodialysis patients to 2 Centers for Disease Control and Prevention surveillance systems (National Healthcare Safety Network Dialysis Event and Emerging Infections Program) were compared to evaluate completeness of reporting. Many methicillin-resistant S. aureus bloodstream infections identified in hospitals were not reported to National Healthcare Safety Network Dialysis Event.

Background and objectivesCatheter-related bloodstream infections (CRBSIs) are common in hemodialysis patients using central venous catheters, and catheter occlusion also occurs frequently. The Tego needlefree connector was developed to reduce the incidence of these complications; however, existing studies of its effectiveness and safety are limited.Materials and methodsThis retrospective analysis compared outcomes among patients of a large dialysis organization receiving in-center hemodialysis using a central venous catheter with either the Tego connector or standard catheter caps between October 1 and June 30, 2013. Incidence rates for intravenous (IV) antibiotic starts, receipt of an IV antibiotic course, positive blood cultures, mortality, and missed dialysis treatments were calculated, and incidence-rate ratios (IRRs) were estimated using Poisson regression models. Utilization of erythropoiesis-stimulating agents (ESAs) and thrombolytics was described for each patient-month and compared using mixed linear models. Models were run without adjustment, adjusted for covariates that were imbalanced between cohorts, or fully adjusted for all potential confounders.ResultsThe analysis comprised 10,652 Tego patients and 6,493 controls. Tego use was independently associated with decreased risk of CRBSI, defined by initiation of IV antibiotics (adjusted IRR 0.92, 95% confidence interval [CI] 0.87–0.97) or initiation of IV antibiotic course (adjusted IRR 0.89, 95% CI 0.84–0.95). Tego use was independently associated with decreased rate of missed dialysis treatments (adjusted IRR 0.98, 95% CI 0.97–1.00); no significant difference between Tego and control cohorts was observed with respect to mortality. Tego use was associated with decreased likelihood of thrombolytic use (adjusted per-month probability of 5.6% versus 6.2% for controls) and lower utilization of ESAs in study months 7–9.ConclusionUse of the Tego connector may reduce the risk of CRBSI and result in lower utilization of thrombolytics, antibiotics, and ESAs, as well as fewer missed dialysis treatments.