Nosocomial bacteremia caused by biofilm-forming Bacillus cereus and Bacillus thuringiensis. (25/386)

OBJECTIVE: Bacterial biofilms cause serious problems, such as antibiotic resistance and medical device-related infections. Recent reports indicate that Bacillus species potentially form biofilms and cause nosocomial bacteremia via catheter infection. Our objective was to investigate the relationship between nosocomial bacteremia caused by Bacillus species and biofilm formations. METHODS: Between 2001 and 2006, Bacillus cereus and Bacillus thuringiensis were isolated from blood samples of 21 patients with nosocomial bacteremia in two hospitals. The patients had underlying diseases such as cerebrovascular damage, malignant disease, or chronic obstructive lung disease and had high fever at the onset of bacteremia. After investigation, B. cereus and B. thuringiensis were isolated from patient's catheter tip, gauze, and hospital environment. Pulsed-field gel electrophoresis (PFGE) on 32 B. cereus and 7 B. thuringiensis isolates, microtiter biofilm assay and scanning electron microscopy (SEM) on 22 B. cereus isolates from patient's blood were performed. RESULTS: Molecular analysis by PFGE showed that 32 B. cereus strains had 21 patterns and 7 B. thuringiensis strains had 3 patterns. The PFGE patterns of B. thuringiensis and B. cereus in blood samples from 2 patients blood were similar to those from the same patient's catheter tip. The PFGE pattern of B. cereus from a hospital environment was similar to that from 2 patients' blood samples, and the PFGE pattern of B. thuringiensis from 2 hospital environments was similar to that from 2 patients' blood. The biofilm formations by 22 B. cereus isolates from patients' blood were confirmed by microtiter biofilm assay and SEM even at 24 hours. CONCLUSION: Our data indicate that various types of Bacillus species exist in hospital environments and the biofilm-forming strains potentially cause nosocomial bacteremia by catheter infection.  (+info)

A randomized trial comparing conventional swan-neck straight-tip catheters to straight-tip catheters with an artificial subcutaneous swan neck. (26/386)

OBJECTIVE: To evaluate the safety and efficacy of inserting a straight-tip Tenckhoff catheter configured with a subcutaneous artificial swan neck. DESIGN: Clinical outcomes of conventional swan-neck straight-tip catheters and Tenckhoff straight-tip catheters implanted with an artificial subcutaneous swan neck were compared in a prospective randomized controlled trial in a single-center setting. PATIENTS AND METHODS: Patients undergoing peritoneal dialysis catheter insertion were randomized to receive either a double-cuff straight-tip Tenckhoff catheter with an artificial subcutaneous swan-neck (TC) or a conventional double-cuff straight-tip swan-neck catheter (SN). The primary outcome was catheter exit-site infection rate; the secondary outcomes were catheter-related mechanical events and surgery-related bleeding. RESULTS: A total of 39 consecutive patients were enrolled: 20 into the TC group and 19 into the SN group. More exit-site infections were observed in the SN group than in the TC group, although the difference was not statistically significant (0.97 vs 0.51 episodes per patient-year, p = 0.0657). However, there were more peritonitis episodes in the TC group than in the SN group (0.35 vs 0.15 episodes per patient-year, p = 0.0256). Exit-site and main wound bleeding post surgery were generally mild and similar in the 2 groups. No events of dialysate leakage, catheter tip migration, or subcutaneous cuff protrusion were observed in patients of either group. Outflow failure due to mechanical causes occurred in 2 patients in the TC group and in 1 patient in the SN group during the intermittent peritoneal dialysis period; all were corrected successfully by laparoscopic omentectomy. CONCLUSIONS: Placement of the double-cuff straight-tip Tenckhoff catheter configured with an artificial subcutaneous swan neck appears to be an effective and safe procedure. It may be a good alternative to the conventional swan-neck catheter.  (+info)

The honeypot study protocol: a randomized controlled trial of exit-site application of medihoney antibacterial wound gel for the prevention of catheter-associated infections in peritoneal dialysis patients. (27/386)

OBJECTIVES: The primary objective of this study is to determine whether daily exit-site application of standardized antibacterial honey (Medihoney Antibacterial Wound Gel; Comvita, Te Puke, New Zealand) results in a reduced risk of catheter-associated infections in peritoneal dialysis (PD) patients compared with standard topical mupirocin prophylaxis of nasal staphylococcal carriers. DESIGN: Multicenter, prospective, open label, randomized controlled trial. SETTING: PD units throughout Australia and New Zealand. PARTICIPANTS: The study will include both incident and prevalent PD patients (adults and children) for whom informed consent can be provided. Patients will be excluded if they have had (1) a history of psychological illness or condition that interferes with their ability to understand or comply with the requirements of the study; (2) recent (within 1 month) exit-site infection, peritonitis, or tunnel infection; (3) known hypersensitivity to, or intolerance of, honey or mupirocin; (4) current or recent (within 4 weeks) treatment with an antibiotic administered by any route; or (5) nasal carriage of mupirocin-resistant Staphylococcus aureus. METHODS: 370 subjects will be randomized 1:1 to receive either daily topical exit-site application of Medihoney Antibacterial Wound Gel (all patients) or nasal application of mupirocin if staphylococcal nasal carriage is demonstrated. All patients in the control and intervention groups will perform their usual exit-site care according to local practice. The study will continue until 12 months after the last patient is recruited (anticipated recruitment time is 24 months). MAIN OUTCOME MEASURES: The primary outcome measure will be time to first episode of exit-site infection, tunnel infection, or peritonitis, whichever comes first. Secondary outcome measures will include time to first exit-site infection, time to first tunnel infection, time to first peritonitis, time to infection-associated catheter removal, catheter-associated infection rates, causative organisms, incidence of mupirocin-resistant microbial isolates, and other adverse reactions. CONCLUSIONS: This multicenter Australian and New Zealand study has been designed to provide evidence to help nephrologists and their PD patients determine the optimal strategy for preventing PD catheter-associated infections. Demonstration of a significant improvement in PD catheter-associated infections with topical Medihoney will provide clinicians with an important new prophylactic strategy with a low propensity for promoting antimicrobial resistance.  (+info)

Exit-site care in Austrian peritoneal dialysis centers -- a nationwide survey. (28/386)

BACKGROUND: Catheter-associated infections markedly contribute to treatment failure in peritoneal dialysis (PD) patients. There is much controversy surrounding prophylactic strategies to prevent these infections. METHODS: In this nationwide multicenter study we analyzed strategies to prevent catheter-associated infections as performed in Austrian PD centers in 2006. A questionnaire was sent to all 23 PD centers in Austria. RESULTS: Ten different catheter models were used in the 332 patients being treated in the 23 Austrian PD centers. Systemic antibiotics prior to catheter placement were given by 17 of the 23 PD centers (glycopeptides, n = 7; cephalosporins, n = 10). Nasal swabs were taken preoperatively by 17 PD centers; nasal Staphylococcus aureus carriers were treated prophylactically with mupirocin cream in 15 of these centers. Dressing change was routinely performed in 318 of 332 chronic PD patients (nonocclusive film dressing, n = 58; gauze dressing, n = 260). Disinfectants for chronic exit-site care included povidone iodine (n = 155), sodium hypochlorite (n = 31), povidone iodine + sodium hypochlorite together (n = 102), and octenidine dihydrochloride/phenoxyethanol (n = 17). Water + non-disinfectant soap or 0.9% sodium chloride was administered as a cleansing agent to the exit site by 27 patients. Routine S. aureus screening (nasal and/or exit-site swabs) in chronic PD patients was performed in 12 PD centers; carriers were treated with mupirocin cream in 11 of these centers. Dialysis staff members were screened for S. aureus in 8 PD centers and spouses were screened for S. aureus in 5 PD centers. The overall exit-site infection rate was 1 episode/43.9 patient-months, tunnel infection rate was 1 episode/88.9 patient-months, and peritonitis rate was 1 episode/51.0 patient-months. Patients of centers that have installed a prophylaxis protocol for treating S. aureus carriers had lower mean infection rates compared with those not using such a protocol. CONCLUSION: Various individual prophylactic strategies are used to prevent catheter-associated infections in Austrian PD centers. Infection rates are within the range reported in the literature. There is still scope for improvement in some centers (e.g., by establishing a prophylaxis protocol).  (+info)

Randomised comparison of complications from three different permanent central venous access systems. (29/386)

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A nationwide survey to measure practice variation of catheterisation management in patients undergoing vaginal prolapse surgery. (30/386)

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Five cases of bacteraemia due to Gordonia species. (31/386)

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Catheter-associated urinary tract infection and the Medicare rule changes. (32/386)

Catheter-associated urinary tract infection, a common and potentially preventable complication of hospitalization, is 1 of the hospital-acquired complications chosen by the Centers for Medicare & Medicaid Services (CMS) for which hospitals no longer receive additional payment. To help readers understand the potential consequences of the recent CMS rule changes, the authors examine the preventability of catheter-associated infection, review the CMS rule changes regarding catheter-associated urinary tract infection, offer an assessment of the possible consequences of these changes, and provide guidance for hospital-based administrators and clinicians. Although the CMS rule changes related to catheter-associated urinary tract infection are controversial, they may do more good than harm, because hospitals are likely to redouble their efforts to prevent catheter-associated urinary tract infection, which may minimize unnecessary placement of indwelling catheters and facilitate prompt removal. However, even if forcing hospitals to increase efforts to prevent complications stemming from hospital-acquired infection is commendable, these efforts will have opportunity costs and may have unintended consequences. Therefore, how hospitals and physicians respond to the CMS rule changes must be monitored closely.  (+info)