Guidelines for the Prevention of Intravascular Catheter–Related Infections

O’Grady, Naomi P.; Alexander, Mary; Dellinger, E. Patchen; Gerberding, Julie L.; Heard, Stephen O.; Maki, Dennis G.; Masur, Henry; McCormick, Rita D.; Mermel, Leonard A.; Pearson, Michele L.; Raad, Issam; Randolph, Adrienne G.; Weinstein, Robert A.; Siegel, Jane D.; Chinn, Raymond; DeMaria, Alfred; Larson, Elaine; Lee, James T.; Moncada, Ramon E.; Rutala, William A.; Scheckler, William E.; Stover, Beth H.; Underwood, Marjorie A.

doi:10.1086/502007

Cited by 372 publications

(41 citation statements)

References 312 publications

(389 reference statements)

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“…For this reason, the most common microorganisms in our series and elsewhere [4,13,27,33] were coagulase-negative staphylococci and Staphylococcus aureus. Fungi (especially Candida spp.)…”

Section: Discussionmentioning

confidence: 48%

“…Although an extensive body of literature illustrates benefits and adverse effects of CVC in adults [4,10,13,23,26,27,31], there are few prospective studies in children, mostly based on small samples [6, 14-17, 22, 36]. The aims of this study were to assess the incidence and risk factors of major long-term CVC-related complications in a large cohort of children affected by oncological, hematological, or immunological diseases in a 7-year prospective observational study at a single center.…”

Section: Introductionmentioning

confidence: 99%

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A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital

et al. 2009

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The aims of this study were to assess the incidence and risk factors of major central venous catheter (CVC)-related complications in a large cohort of children affected by oncological, hematological, or immunological diseases in a 7-year prospective observational study at a single center. Nine hundred fifteen CVCs were inserted in 748 children for a total period of 307,846 CVC-days. Overall, 298 complications were documented with a complication rate of 0.97/1,000 CVC-days: 105 mechanical complications (dislocations 0.30/1,000 CVC-days, ruptures 0.04/1,000 CVC-days), 174 infections (bloodstream infections 0.46/1,000 CVC-days, tunnel infections 0.10/1,000 CVC-days), and 19 thrombosis (0.06/1,000 CVC-days). Significant risk factors were: diagnosis of acute lymphoblastic leukemia (ALL) and age

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“…For this reason, the most common microorganisms in our series and elsewhere [4,13,27,33] were coagulase-negative staphylococci and Staphylococcus aureus. Fungi (especially Candida spp.)…”

Section: Discussionmentioning

confidence: 48%

Section: Introductionmentioning

confidence: 99%

A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital

et al. 2009

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“…The use of nonantibiotic antimicrobial locks has also been studied extensively, as there are concerns that their use in catheters may also lead to the development of antibiotic-resistant microorganisms (28). The use of ethanol as a ALS has been widely reported.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Approach for Identification of the Most Effective Agents for Antimicrobial Lock Therapy in the Treatment of Intravascular Catheter-Related Infections Caused by Staphylococcus aureus

Hogan

Zapotoczna

Stevens

et al. 2016

Antimicrob Agents Chemother

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Infection of intravascular catheters byStaphylococcus aureus is a significant risk factor within the health care setting. To treat these infections and attempt salvage of an intravascular catheter, antimicrobial lock solutions (ALSs) are being increasingly used. However, the most effective ALSs against these biofilm-mediated infections have yet to be determined, and clinical practice varies greatly. The purpose of this study was to evaluate and compare the efficacies of antibiotics and antiseptics in current clinical use against biofilms produced by reference and clinical isolates of S. aureus. Static and flow biofilm assays were developed using newly described in vivo-relevant conditions to examine the effect of each agent on S. aureus within the biofilm matrix. The antibiotics daptomycin, tigecycline, and rifampin and the antiseptics ethanol and Taurolock inactivated established S. aureus biofilms, while other commonly used antistaphylococcal antibiotics and antiseptic agents were less effective. These findings were confirmed by live/dead staining of S. aureus biofilms formed and treated within a flow cell model. The results from this study demonstrate the most effective clinically used agents and their concentrations which should be used within an ALS to treat S. aureus-mediated intravascular catheter-related infections.T he use of intravascular catheters (IVCs) in modern health care has increased over the last decades. Infection of these devices by surface-adhering bacteria, resulting in catheter-related bloodstream infection (CRBSI), is associated with significant patient morbidity and mortality, prolonged hospitalization, and excess hospital-related costs. The Centers for Disease Control and Prevention (CDC) attributes 12 to 25% mortality among critically ill patients alone to CRBSI (1).Biofilms formed by staphylococci, in particular Staphylococcus epidermidis and Staphylococcus aureus, have for many years been recognized as the most frequent cause of CRBSI (2, 3). These biofilms are highly resistant both to the action of the innate and adaptive immune defense systems and to the action of antimicrobial agents, resulting in persistent infections and treatment failure.The majority of guidelines recommend catheter removal and systemic antimicrobial treatment on suspicion or confirmation of a CRBSI (4). However, clinical circumstances, for example, lack of alternative venous access, bleeding disorders, or comorbid conditions, often preclude device removal. Alternative strategies, such as the use of antimicrobial lock therapy (ALT), to treat these biofilm-related IVC infections, have generated considerable interest in recent years. Antimicrobial lock solutions (ALSs) have been used with variable success to fill the lumen of the IVC in order to eradicate biofilms (5). This technique provides very high concentrations of antimicrobial agents at the site of infection. However, concerns around selection of resistant organisms, toxicity, and treatment failure have thus far limited their widespread application in the ...

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“…Bloodstream infections originating from device-associated infections account for 11% of all health care-associated infections. An estimation of 250,000 catheter-related bloodstream infections occur in the United States per year, resulting in significant morbidity, mortality, and costs for health care delivery (3)(4)(5). S. aureus is frequently associated with such infections, and therefore a great effort is being made to prevent and/or obtain effective treatments against this bacterium.…”

mentioning

confidence: 99%

Biofilm Matrix Exoproteins Induce a Protective Immune Response against Staphylococcus aureus Biofilm Infection

et al. 2014

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The Staphylococcus aureus biofilm mode of growth is associated with several chronic infections that are very difficult to treat due to the recalcitrant nature of biofilms to clearance by antimicrobials. Accordingly, there is an increasing interest in preventing the formation of S. aureus biofilms and developing efficient antibiofilm vaccines. Given the fact that during a biofilm-associated infection, the first primary interface between the host and the bacteria is the self-produced extracellular matrix, in this study we analyzed the potential of extracellular proteins found in the biofilm matrix to induce a protective immune response against S. aureus infections. By using proteomic approaches, we characterized the exoproteomes of exopolysaccharide-based and proteinbased biofilm matrices produced by two clinical S. aureus strains. Remarkably, results showed that independently of the nature of the biofilm matrix, a common core of secreted proteins is contained in both types of exoproteomes. Intradermal administration of an exoproteome extract of an exopolysaccharide-dependent biofilm induced a humoral immune response and elicited the production of interleukin 10 (IL-10) and IL-17 in mice. Antibodies against such an extract promoted opsonophagocytosis and killing of S. aureus. Immunization with the biofilm matrix exoproteome significantly reduced the number of bacterial cells inside a biofilm and on the surrounding tissue, using an in vivo model of mesh-associated biofilm infection. Furthermore, immunized mice also showed limited organ colonization by bacteria released from the matrix at the dispersive stage of the biofilm cycle. Altogether, these data illustrate the potential of biofilm matrix exoproteins as a promising candidate multivalent vaccine against S. aureus biofilm-associated infections.

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Guidelines for the Prevention of Intravascular Catheter–Related Infections

Abstract: Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection.

Cited by 372 publications

References 312 publications

A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital

A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital

In Vitro Approach for Identification of the Most Effective Agents for Antimicrobial Lock Therapy in the Treatment of Intravascular Catheter-Related Infections Caused by Staphylococcus aureus

Biofilm Matrix Exoproteins Induce a Protective Immune Response against Staphylococcus aureus Biofilm Infection

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