What’s new: prevention of acute dialysis catheter-related infection

Schneider, Antoine; Baldwin, Ian; Souweine, Bertrand

doi:10.1007/s00134-017-4833-x

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…Our study included both: CVCs and DCs. They differ in design, use (with more manipulations for DCs) and insertion site [ 42 ]. The subclavian vein, while preferred to reduce the CVC infection rate, is discouraged for DCs insertion because of the risk of central-vein stenosis [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials

et al. 2022

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Background The majority of central venous catheters (CVC) removed in the ICU are not colonized, including when a catheter-related infection (CRI) is suspected. We developed and validated a predictive score to reduce unnecessary CVC removal. Methods We conducted a retrospective cohort study from five multicenter randomized controlled trials with systematic catheter-tip culture of consecutive CVCs. Colonization was defined as growth of ≥103 colony-forming units per mL. Risk factors for colonization were identified in the training cohort (CATHEDIA and 3SITES trials; 3899 CVCs of which 575 (15%) were colonized) through multivariable analyses. After internal validation in 500 bootstrapped samples, the CVC-OUT score was computed by attaching points to the robust (> 50% of the bootstraps) risk factors. External validation was performed in the testing cohort (CLEAN, DRESSING2 and ELVIS trials; 6848 CVCs, of which 588 (9%) were colonized). Results In the training cohort, obesity (1 point), diabetes (1 point), type of CVC (dialysis catheter, 1 point), anatomical insertion site (jugular, 4 points; femoral 5 points), rank of the catheter (second or subsequent, 1 point) and catheterization duration (≥ 5 days, 2 points) were significantly and independently associated with colonization . Area under the ROC curve (AUC) for the CVC-OUT score was 0.69, 95% confidence interval (CI) [0.67–0.72]. In the testing cohort, AUC for the CVC-OUT score was 0.60, 95% CI [0.58–0.62]. Among 1,469 CVCs removed for suspected CRI in the overall population, 1200 (82%) were not colonized. The negative predictive value (NPV) of a CVC-OUT score < 6 points was 94%, 95% CI [93%–95%]. Conclusion The CVC-OUT score had a moderate ability to discriminate catheter-tip colonization, but the high NPV may contribute to reduce unnecessary CVCs removal. Preference of the subclavian site is the strongest and only modifiable risk factor that reduces the likelihood of catheter-tip colonization and consequently the risk of CRI. Clinical Trials Registration: NCT00277888, NCT01479153, NCT01629550, NCT01189682, NCT00875069.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials

et al. 2022

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“…CRI is distinguished from bacterial colonization when the catheter tip culture yielding is higher than 10 3 cfu in quantitative culture 68 . The bacteria that cause the infection may be from the patient's bacterial flora, which is called endogenous infection.…”

Section: Catheter‐related Infections (Cri)mentioning

confidence: 99%

“…67 CRI is distinguished from bacterial colonization when the catheter tip culture yielding is higher than 10 3 cfu in quantitative culture. 68 The bacteria that cause the infection may be from the patient's bacterial flora, which is called endogenous infection. In some cases, the source of infection may come from other patients, health care personnel, contaminated dialysis fluids, equipment, and inadequate hospital and surgery conditions.…”

Section: Catheter-related Infections (Cri)mentioning

confidence: 99%

Surface modification strategies for hemodialysis catheters to prevent catheter‐related infections: A review

et al. 2020

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Insertion of a central venous catheter is one of the most common invasive procedures applied in hemodialysis therapy for end‐stage renal disease. The most important complication of a central venous catheter is catheter‐related infections that increase hospitalization and duration of intensive care unit stay, cost of treatment, mortality, and morbidity rates. Pathogenic microorganisms, such as, bacteria and fungi, enter the body from the catheter insertion site and the surface of the catheter can become colonized. The exopolysaccharide‐based biofilms from bacterial colonies on the surface are the main challenge in the treatment of infections. Catheter lock solutions and systemic antibiotic treatment, which are commonly used in the treatment of hemodialysis catheter‐related infections, are insufficient to prevent and terminate the infections and eventually the catheter needs to be replaced. The inadequacy of these approaches in termination and prevention of infection revealed the necessity of coating of hemodialysis catheters with bactericidal and/or antiadhesive agents. Silver compounds and nanoparticles, anticoagulants (e.g., heparin), antibiotics (e.g., gentamicin and chlorhexidine) are some of the agents used for this purpose. The effectiveness of few commercial hemodialysis catheters that were coated with antibacterial agents has been tested in clinical trials against catheter‐related infections of pathogenic bacteria, such as Staphylococcus aureus and Staphylococcus epidermidis with promising results. Novel biomedical materials and engineering techniques, such as, surface micro/nano patterning and the conjugation of antimicrobial peptides, enzymes, metallic cations, and hydrophilic polymers (e.g., poly [ethylene glycol]) on the surface, has been suggested recently.

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“…Around 64% of hospital-acquired infections are caused by viable bacteria attaching to medical devices and implants [18]. Catheter-related infections are typically distinguished from colonisation-tip culture yielding >103 CFU [19]. Therefore, it is important to find a solution that prevents bacteria from attaching to the surface of medical devices, such as catheters with antimicrobial properties that prevent bacteria from being able to proliferate.…”

Section: Infectionsmentioning

confidence: 99%

“…Heparin-coated catheters have been shown to decrease fibrin deposits that may increase biofilm formation and are the form of catheter used currently in hospitals to minimise infection. Antimicrobial coated catheters are associated with a lower rate of colonisation and catheter-related infection [19]. Animal studies have shown a decreased rate in thrombus formation with heparin-coated catheters.…”

Section: Heparin Coatingmentioning

confidence: 99%

Fused Deposition Modelling as a Potential Tool for Antimicrobial Dialysis Catheters Manufacturing: New Trends vs. Conventional Approaches

et al. 2019

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The rising rate of individuals with chronic kidney disease (CKD) and ineffective treatment methods for catheter-associated infections in dialysis patients has led to the need for a novel approach to the manufacturing of catheters. The current process requires moulding, which is time consuming, and coated catheters used currently increase the risk of bacterial resistance, toxicity, and added expense. Three-dimensional (3D) printing has gained a lot of attention in recent years and offers the opportunity to rapidly manufacture catheters, matched to patients through imaging and at a lower cost. Fused deposition modelling (FDM) in particular allows thermoplastic polymers to be printed into the desired devices from a model made using computer aided design (CAD). Limitations to FDM include the small range of thermoplastic polymers that are compatible with this form of printing and the high degradation temperature required for drugs to be extruded with the polymer. Hot-melt extrusion (HME) allows the potential for antimicrobial drugs to be added to the polymer to create catheters with antimicrobial activity, therefore being able to overcome the issue of increased rates of infection. This review will cover the area of dialysis and catheter-related infections, current manufacturing processes of catheters and methods to prevent infection, limitations of current processes of catheter manufacture, future directions into the manufacture of catheters, and how drugs can be incorporated into the polymers to help prevent infection.

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What’s new: prevention of acute dialysis catheter-related infection

Cited by 6 publications

References 15 publications

Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials

Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials

Surface modification strategies for hemodialysis catheters to prevent catheter‐related infections: A review

Fused Deposition Modelling as a Potential Tool for Antimicrobial Dialysis Catheters Manufacturing: New Trends vs. Conventional Approaches

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