Epidemiología de las bacteriemias primarias y relacionadas con catéteres vasculares en pacientes críticos ingresados en servicios de medicina intensiva

Lerma, F. Álvarez; Astigarraga, P. Olaechea; Martínez, Mercedes Palomar; Ordeñana, J. Insausti; Pueyo, Miquel

doi:10.1016/j.medin.2010.02.004

Cited by 8 publications

(4 citation statements)

References 43 publications

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“…Compared to other studies, there also is a difference in the type of Gram-negative micro-organism found on the catheter tips. Previous studies found E. coli , Klebsiella species, and, in ICUs, Enterobacter species as the most important micro-organisms on intravascular catheter tips [1, 3, 4]. We found E. cloacae on most of the catheter tips, followed by P. aeruginosa and K. pneumoniae .…”

Section: Discussionsupporting

confidence: 47%

“…Intravascular catheters are a significant source of bloodstream infections in hospitalized patients [1–3]. In Europe, the overall incidence of nosocomial bloodstream infections is five episodes per 1,000 days of in situ central venous catheter (CVC).…”

Section: Introductionmentioning

confidence: 99%

“…In Europe, the overall incidence of nosocomial bloodstream infections is five episodes per 1,000 days of in situ central venous catheter (CVC). [3]. Gram-negative micro-organisms are commonly associated with such catheter-related bloodstream infections, with up to 32% of the bloodstream infections in intensive care units (ICU) being caused by Gram-negative micro-organisms [2, 4, 5].…”

Section: Introductionmentioning

confidence: 99%

“…Gram-negative micro-organisms are commonly associated with such catheter-related bloodstream infections, with up to 32% of the bloodstream infections in intensive care units (ICU) being caused by Gram-negative micro-organisms [2, 4, 5]. Escherichia coli , Klebsiella species, and, in ICUs, Enterobacter species are most commonly isolated [1, 3, 4]. The case–fatality ratios of Gram-negative bloodstream infections are high and range between 9 and 28% [1], with one study even reporting an overall mortality of 35% [5].…”

Section: Introductionmentioning

confidence: 99%

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Bacteremic complications of intravascular catheter tip colonization with Gram-negative micro-organisms in patients without preceding bacteremia

Sluijs

Oosterheert

Ekkelenkamp

et al. 2011

Eur J Clin Microbiol Infect Dis

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Although Gram-negative micro-organisms are frequently associated with catheter-related bloodstream infections, the prognostic value and clinical implication of a positive catheter tip culture with Gram-negative micro-organisms without preceding bacteremia remains unclear. We determined the outcomes of patients with intravascular catheters colonized with these micro-organisms, without preceding positive blood cultures, and identified risk factors for the development of subsequent Gram-negative bacteremia. All patients with positive intravascular catheter tip cultures with Gram-negative micro-organisms at the University Medical Center, Utrecht, The Netherlands, between 2005 and 2009, were retrospectively studied. Patients with Gram-negative bacteremia within 48 h before catheter removal were excluded. The main outcome measure was bacteremia with Gram-negative micro-organisms. Other endpoints were length of the hospital stay, in-hospital mortality, secondary complications of Gram-negative bacteremia, and duration of intensive care admission. A total of 280 catheters from 248 patients were colonized with Gram-negative micro-organisms. Sixty-seven cases were excluded because of preceding positive blood cultures, leaving 213 catheter tips from 181 patients for analysis. In 40 (19%) cases, subsequent Gram-negative bacteremia developed. In multivariate analysis, arterial catheters were independently associated with subsequent Gram-negative bacteremia (odds ratio [OR] = 5.00, 95% confidence interval [CI]: 1.20–20.92), as was selective decontamination of the digestive tract (SDD) (OR = 2.47, 95% CI: 1.07–5.69). Gram-negative bacteremia in patients who received SDD was predominantly caused by cefotaxime (part of the SDD)-resistant organisms. Mortality was significantly higher in the group with subsequent Gram-negative bacteremia (35% versus 20%, OR = 2.12, 95% CI: 1.00–4.49). Patients with a catheter tip colonized with Gram-negative micro-organisms had a high chance of subsequent Gram-negative bacteremia from any cause. This may be clinically relevant, as starting antibiotic treatment pre-emptively in high-risk patients with Gram-negative micro-organisms cultured from arterial intravenous catheters may be beneficial.

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Section: Discussionsupporting

confidence: 47%

Section: Introductionmentioning

confidence: 99%