Bloodstream infections can develop late (after day 100) and/or in the absence of neutropenia in children receiving allogeneic bone marrow transplantation.
We retrospectively evaluated the incidence and time from transplantation of bloodstream infections occurring in children receiving bone marrow transplant (BMT) at G Gaslini Children's Hospital between September 1984 and December 1997. During this period the incidence was 35% after allogeneic and 26% after autologous BMT (P=0.08). Among these episodes, 38% after allogeneic BMT and 90% after autologous BMT were detected in the presence of neutropenia within the first 30 days from reinfusion (P < 0.001). Incidence of catheter-related bloodstream infections was 40% after allogeneic and 8% after autologous BMT (P < 0.001). Bloodstream infections in the absence of neutropenia were 55% after allogeneic BMT vs 10% after autologous BMT (P < 0.001) and occurred later after reinfusion (mean 199 vs 41 days, P <0.001). Among the episodes occurring after allogeneic BMT and in the absence of neutropenia, 61% were related to the presence of a central venous catheter, 15% were related to the presence of GVHD, but 23% were not associated with any of major risk factors for infection. Finally, 38% of episodes following allogeneic BMT were detected after day 100 vs 1% after autologous BMT. We concluded that patients receiving allogeneic BMT experience a high incidence of bloodstream infections in the absence of neutropenia and that a significant proportion of these episodes is not clearly associated with well known risk factors such as GVHD or central venous catheters. Moreover, many episodes develop a long time after the transplantation procedure. Therefore, any febrile episode following allogeneic BMT even late and/or in the absence of neutropenia should be intensively managed. (+info)
The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation.
Endotracheal tube colonization in patients undergoing mechanical ventilation was investigated. In the first part of this prospective study, the airway access tube was examined for the presence of secretions, airway obstruction and bacterial colonization, in cases undergoing extubation or tube change. In the second part of the study, the sequence of oropharyngeal, gastric, respiratory tract and endotracheal tube colonization was investigated by sequential swabbing at each site twice daily for 5 days in consecutive noninfected patients. In the first part, it was noted that all airway access tubes of cases undergoing extubation had secretions lining the interior of the distal third of the tube which were shown on scanning electron microscopy to be a biofilm. Gram-negative micro-organisms were isolated from these secretions in all but three cases. In the second part, it was noted that the sequence of colonization in patients undergoing mechanical ventilation was the oropharynx (36 h), the stomach (3660 h), the lower respiratory tract (60-84 h), and thereafter the endotracheal tube (60-96 h). Nosocomial pneumonia occurred in 13 patients and in eight cases identical organisms were noted in lower respiratory tract secretions and in secretions lining the interior of the endotracheal tube. The endotracheal tube of patients undergoing mechanical ventilation becomes colonized rapidly with micro-organisms commonly associated with nosocomial pneumonia, and which may represent a persistent source of organisms causing such infections. (+info)
Adhesive tape and intravascular-catheter-associated infections.
Adhesive tape is placed in close contact with intravascular catheters for extended periods and could theoretically contribute to local infections. We found that 74% of specimens of tape collected in one hospital were colonized by pathogenic bacteria. However, only 5% of specimens had significant growth from an inner layer obtained by discarding the outside layer from each roll. We suggest that adhesive tape is a potential source of pathogenic bacteria and that discarding the outer layer from a partially used roll might be a simple method for reducing the risk of infection to patients. (+info)
Bronchoscopy-related infections and pseudoinfections--New York, 1996 and 1998.
Bronchoscopy is a useful diagnostic technique that can be performed safely by trained specialists when the bronchoscopes in both inpatient and ambulatory-care settings are reprocessed properly to prevent transmission of infection. The New York State Department of Health received reports of three clusters of culture-positive bronchoscopy specimens obtained in 1996 and 1998 from patients at local health-care facilities. This report summarizes the results of investigations of these clusters, which indicated involvement of Mycobacterium tuberculosis, M. intracellulare, or imipenem-resistant Pseudomonas aeruginosa. Between patient uses, bronchoscopes had been cleaned, visually inspected, leak tested, and processed by STERIS System 1 processors (STERIS, Mentor, Ohio). (+info)
The role of syringe filters in harm reduction among injection drug users.
OBJECTIVES: Three filters were tested for in situ efficacy in reducing bacterial contamination associated with injection drug use. METHODS: In a self-matched control design with blinded laboratory testing, injection drug users were asked to use 3 filters in random succession when loading their syringes with drug solute. RESULTS: The 0.22-micron filter proved significantly better than both the cigarette filter (relative risk [RR] = 18.0) and the 20-micron filter (RR = 4.5) in rendering syringes bacteria-free. CONCLUSIONS: The 15- to 20-micron syringe filter currently provided injection drug users in Switzerland does not significantly reduce contamination associated with common bacterial infections among users. Filters with pore width 1/100th as large are recommended. (+info)
Cross contamination of blood cultures associated with a multiple use venting device.
AIM: To investigate cross contamination of blood cultures associated with multiple use venting devices, which are widely used in clinical microbiology laboratories to reduce labour costs. METHODS: Systematic analysis of 13,880 blood culture results in a large teaching hospital where multiple use venting devices were employed. RESULTS: Nine series of potential cross contamination were identified in a 12 month period. Four series involved coagulase negative staphylococci and were unlikely to represent true cross contamination. Five series involved blood cultures which had significant bacterial growth at the time of venting. CONCLUSIONS: Multiple use venting devices can be associated with cross contamination of blood cultures. This may result from contamination of the internal lumen of the venting device which is not exposed to the biocide. Medical microbiologists should consider the possibility of cross contamination associated with venting procedures when interpreting blood culture results. Further development of multiple use venting devices is required to reduce the risk of cross contamination of cultures. (+info)
Bacterial spores survive treatment with commercial sterilants and disinfectants.
This study compared the activity of commercial liquid sterilants and disinfectants on Bacillus subtilis spores deposited on three types of devices made of noncorrodible, corrodible, or polymeric material. Products like Renalin, Exspor, Wavicide-01, Cidexplus, and cupric ascorbate were tested under conditions specified for liquid sterilization. These products, at the shorter times indicated for disinfection, and popular disinfectants, like Clorox, Cavicide, and Lysol were also studied. Data obtained with a sensitive and quantitative test suggest that commercial liquid sterilants and disinfectants are less effective on contaminated surfaces than generally acknowledged. (+info)
Injections given in healthcare settings as a major source of acute hepatitis B in Moldova.
BACKGROUND: Reported rates of acute hepatitis B are high in many former Soviet Union republics and modes of transmission are not well defined. METHODS: Two case-control studies were undertaken in Moldova to identify risk factors for acute hepatitis B in people aged 2-15 years (children) and > or =15 years (adults). Serologically confirmed acute hepatitis B cases occurring between 1 January 1994 and 30 August 30 1995, were matched on age, sex, and district of residence to three potential controls who were tested for hepatitis B markers to exclude the immune. Stratified odds ratios (SOR) were calculated using bivariate and multivariate methods. RESULTS: In multivariate analysis, compared with the 175 controls, the 70 adult cases (mean age 25 years, 66% male) were more likely to report receiving injections in the 6 months before illness during a dental visit (SOR = 21; 95% CI: 3.7-120), a hospital visit (SOR = 35; 95% CI: 7.2-170), or a visit to the polyclinic (SOR = 13; 95% CI: 2.4-74). Among children, receiving injections during a hospital visit (SOR = 5.2; 95% CI: 1.2-23) was the only exposure reported significantly more often by the 19 cases (mean age 8 years, 68% male) compared with the 81 controls. CONCLUSION: These results, along with reported unsafe injection practices in Moldova, suggest that injections are a major source of hepatitis B virus transmission and highlight the importance of proper infection-control procedures in preventing transmission of blood-borne infections. (+info)