Guidelines for the Management of Intravascular Catheter-Related Infections

Mermel, Leonard A.; Farr, Barry M.; Sherertz, Robert J.; Raad, Issam; O’Grady, Naomi P.; Harris, Jo-Ann S.; Craven, Donald E.

doi:10.1086/320001

Cited by 1,228 publications

(303 citation statements)

References 176 publications

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“…13,14 Thus, when present in urine, SA could be a marker of deep tissue dissemination with the potential to cause complications. Guidelines for the management of intravascular device-associated bacteremia have been published by the Infectious Diseases Society of America (IDSA) and other organizations, 15,16 and recent studies have demonstrated the effectiveness of newer agents for the management of SAB. 17 Nevertheless, there is still controversy regarding some aspects of the management of SAB (eg, duration of therapy, criteria for echocardiographic evaluation, role of combination therapy).…”

Section: Discussionmentioning

confidence: 99%

Staphylococcus aureus bacteremia (SAB) with associated S. aureus bacteriuria (SABU) as a predictor of complications and mortality

Perez-Jorge

Burdette

Markert

et al. 2010

Journal of Hospital Medicine

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BACKGROUND AND OBJECTIVES:Staphylococcus aureus (SA) bacteremia (SAB) is associated with a high rate of complications, most of which are related to hematogenous seeding into deep tissues or prosthetic material. SA bacteriuria (SABU) has been described in association with SAB, but has not been evaluated as a predictor for complicated bacteremia, which was the objective of our study.METHODS (DESIGN, SETTING, AND PATIENTS):We conducted a retrospective study of patients admitted to the hospital with SAB. The 118 patients included in the study were divided in 2 cohorts: a group with SABU and a group without SA in the urine. We followed the 2 cohorts for an average of 8 months and evaluated the differences in complications and mortality.RESULTS:SABU was found in 28 of 118 patients with SAB. Eighteen patients (64%) in this group had complications from the bacteremia, while in the group without SABU only 33% (30/90 patients) had complications (P = 0.004). The SABU group also had more deaths (32% vs. 14%; P = 0.036).CONCLUSIONS:In this population of hospitalized patients with SAB, the presence of SABU was associated with an increased risk of early complications, including septic shock, and with higher mortality. A routine urine culture in search of SABU may be a helpful tool for detection of those patients with SAB who are at increased risk of complications and death. Journal of Hospital Medicine 2010;5:208–211. © 2010 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

Staphylococcus aureus bacteremia (SAB) with associated S. aureus bacteriuria (SABU) as a predictor of complications and mortality

Perez-Jorge

Burdette

Markert

et al. 2010

Journal of Hospital Medicine

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“…A definitive diagnosis of CRB can only be made when blood cultures obtained from both the TCC and a peripheral vein grow the same organism. In addition, the Infectious Diseases Society of America has proposed that the colony count of the TCC blood culture should be more than five-fold greater than that of the peripheral vein [30], as a positive blood culture only from the TCC may simply represent colonization [25]. It was shown in oncology patients that a positive blood culture drawn through an indwelling central venous catheter with no confirmation from a culture from a peripheral vein had low positive predictive value.…”

Section: The Role Of the Biofilmmentioning

confidence: 99%

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

Stefanidis

2009

Pediatr Nephrol

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This editorial commentary discusses the strategies for prevention of catheter-related bacteremia (CRB) in children on hemodialysis, which is associated with high morbidity and the increase of hospital cost. There is evidence that the use of arteriovenous fistulae in children on hemodialysis is associated with lower infection rates. Therefore, the use of catheters in these patients should be decreased by improving arteriovenous fistulae use rates or by increasing peritoneal dialysis patient recruitment. However, despite the wide adoption of such policies, hemodialysis catheters are still being used in a significant number of cases. For these patients, implementation of effective strategies for preventing contamination of the catheter hub should be a priority. The appropriate recording and evaluation of CRB rates are important for assessing preventive policies. In addition, the successful management of a CRB is essential for preventing recurrence of bacteremia. Recently it was documented in a number of randomized clinical trials that antimicrobial lock solutions were effective for preventing CRB. It is suggested that the use of antimicrobial locks should be considered in children who are at high risk of developing CRB, with caution for their long-term use, because of the possibility of bacterial resistance. Now is the time for action, and all preventive steps should be performed simultaneously to minimize the risk of CRB.

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“…Several open trials of antibiotic lock therapy of tunneled catheter-related bacteremia, with or without concomitant parenteral therapy, have reported a response and catheter salvage without relapse in 138 (82.6%) of 167 episodes (Messing et al 1988;Capdevila et al 1993;Johnson et al 1994;Williams et al 1994;Benoit et al 1995;Krzywda et al 1995;Mermel et al 2001). Compared with parenteral therapy used in the aforementioned open trials, therapy including AL was significantly more likely to result in catheter salvage.…”

Section: Discussionmentioning

confidence: 99%

“…The AL technique encompasses the filling of a catheter lumen with high concentrations of antibiotics for a period of time, in order to sterilize the device. With this method, a high local concentration of an appropriate antibiotic can be applied in the catheter lumen while avoiding systemic toxicity and the need to monitor serum drug levels (Mermel et al 2001;Carratala 2002). This study examined the effect of selected antibiotics on intraluminal colonization and the sterilization time of the catheters with AL technique.…”

Section: Discussionmentioning

confidence: 99%

Elimination of Intraluminal Colonization by Antibiotic Lock in Catheters

Öncü

Öztürk

et al. 2004

Tohoku J. Exp. Med.

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Antibiotic lock (AL) technique for catheter related infection encompasses the filling of a catheter lumen with high concentrations of antibiotics for hours. The goal of AL therapy is to decontaminate the intraluminal surface of the catheter. However the duration of antibiotic therapy is not established. An in vitro model was designed to establish the time needed to eliminate intraluminal microbial colonization and to evaluate the efficacy of vancomycin in comparison with teicoplanin by using laboratory AL model. Human plasma was instilled into the catheters to allow deposition of fibrin and other products on the catheter wall. After 48 hours, the catheters were drained and inoculated with bacteria in tryptic soy broth. The catheters were then drained and filled with either (a) vancomycin saline solution (VSS) lock (b) teicoplanin saline solution (TSS) lock or (c) saline solution (SS) as the control and then incubated for 12 hours. After 12 hours incubation all the catheter were drained and filled with human plasma. Instillation of human plasma and AL was alternated every 12 hours to simulate clinical conditions. For each day three catheters, locked with VSS, TSS and SS were cultured for colony count. Microbial counts were expressed as total colony-forming units per longitudinal centimeters of catheter surface. A significant decrease in intraluminal catheter colonization started as early as day 1. At the end of 7th day catheters treated with VSS and TSS lock were completely sterile. The decrease of intraluminal colonization was similar in catheters treated with VSS and TSS lock. Also the decrease of intraluminal colonization were similar in catheter colonized with slime forming S. epidermidis and nonslime-forming S. epidermidis. antibiotic lock; catheter; teicoplanin; vancomycin

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Guidelines for the Management of Intravascular Catheter-Related Infections

Cited by 1,228 publications

References 176 publications

Staphylococcus aureus bacteremia (SAB) with associated S. aureus bacteriuria (SABU) as a predictor of complications and mortality

Staphylococcus aureus bacteremia (SAB) with associated S. aureus bacteriuria (SABU) as a predictor of complications and mortality

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

Elimination of Intraluminal Colonization by Antibiotic Lock in Catheters

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