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Dennis G Maki - One of the best experts on this subject based on the ideXlab platform.
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chlorhexidine impregnated dressing for prevention of catheter related Bloodstream Infection a meta analysis
Critical Care Medicine, 2014Co-Authors: Nasia Safdar, John C Ohoro, Aiman Ghufran, Allison Bearden, Maria Eugenia Didier, Dan Chateau, Dennis G MakiAbstract:Objective:To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter–related colonization and catheter-related Bloodstream Infection using meta-analysis.Data Sources:Multiple computerized database searches supplemented by manual searches including releva
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a review of risk factors for catheter related Bloodstream Infection caused by percutaneously inserted noncuffed central venous catheters implications for preventive strategies
Medicine, 2002Co-Authors: Nasia Safdar, Daniel M Kluger, Dennis G MakiAbstract:Strategies for preventing central venous catheter (CVC)-related Bloodstream Infection are most likely to be effective if guided by an understanding of the risk factors associated with these Infections. In this critical review of published studies of risk factors for CVC-related Bloodstream Infection that were prospective and used multivariable techniques of data analysis or that were randomized trials of a preventive measure, a significantly increased risk of catheter-related Bloodstream Infection was associated with inexperience of the operator and nurse-to-patient ratio in the intensive care unit, catheter insertion with less than maximal sterile barriers, placement of a CVC in the internal jugular or femoral vein rather than subclavian vein, placement in an old site by guidewire exchange, heavy colonization of the insertion site or contamination of a catheter hub, and duration of CVC placement > 7 days. Prospective studies or randomized trials of control measures focusing on these risk factors have been shown to reduce risk significantly: formal training in CVC insertion and care, use of maximal sterile barriers at insertion, use of chlorhexidine rather than povidone-iodine for cutaneous antisepsis, applying a topical anti-infective cream or ointment or a chlorhexidine-impregnated dressing to the insertion site, and the use of novel catheters with an anti-infective surface or a contamination resistant hub. Better prospective studies of sufficient size to address all potential risk factors, including insertion site and hub colonization, insertion technique, and details of follow-up care, would enhance our understanding of the pathogenesis of CVC-related Bloodstream Infection and guide efforts to develop more effective strategies for prevention.
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prevention of central venous catheter related Bloodstream Infection by use of an antiseptic impregnated catheter
Annals of Internal Medicine, 1997Co-Authors: Dennis G Maki, Susan M Stolz, Susan Wheeler, Leonard A MermelAbstract:Background: Bloodstream Infection related to short-term use of noncuffed central venous catheters is a common and serious problem. Technologic innovations to reduce the risk for these Infections ar...
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prevention of central venous catheter related Bloodstream Infection by use of an antiseptic impregnated catheter a randomized controlled trial
Annals of Internal Medicine, 1997Co-Authors: Dennis G Maki, Susan M Stolz, Susan Wheeler, Leonard A MermelAbstract:Background Bloodstream Infection related to short-term use of noncuffed central venous catheters is a common and serious problem. Technologic innovations to reduce the risk for these Infections are needed. Objective To determine 1) the efficacy of a novel antiseptic catheter in preventing central venous catheter-related Infection, 2) patient tolerance of this catheter, and 3) the sources of Bloodstream Infection originating from noncuffed, multilumen central venous catheters. Design Randomized, controlled clinical trial. Setting Medical-surgical intensive care unit of a 450-bed university hospital. Participants 158 adults scheduled to receive a central venous catheter; 403 catheters were studied. Intervention Participants received either a standard triple-lumen polyurethane catheter or a catheter that was indistinguishable from the standard catheter and was impregnated with chlorhexidine and silver sulfadiazine. Measurements Catheters were studied for colonization and catheter-related Bloodstream Infection at removal; local and systemic effects of catheters were assessed. The origin of each catheter-associated Bloodstream Infection was sought by culturing all potential sources (skin, catheter segments, hubs, and infusate) and confirmed by restriction-fragment DNA subtyping. Results Antiseptic catheters were less likely to be colonized at removal than control catheters (13.5 compared with 24.1 colonized catheters per 100 catheters; relative risk, 0.56 [95% CI, 0.36 to 0.89]; P = 0.005) and were nearly fivefold less likely to produce Bloodstream Infection (1.0 compared with 4.7 Infections per 100 catheters; 1.6 compared with 7.6 Infections per 1000 catheter-days; relative risk, 0.21 [CI, 0.03 to 0.95]; P = 0.03). In the control group, 8 catheter-related Bloodstream Infections were caused by Staphylococcus aureus, gram-negative bacilli, enterococci, or Candida species; no Infections with these organisms occurred in the antiseptic catheter group (P = 0.003). No adverse effects from the antiseptic catheter were seen, and none of the 122 isolates obtained from infected catheters in either group showed in vitro resistance to chlorhexidine-silver sulfadiazine. Cost-benefit analysis indicated that the antiseptic catheter should prove cost-beneficial if an institution's rate of catheter-related bacteremia with noncuffed central venous catheters is at least 3 Infections per 1000 catheter-days). Conclusions The chlorhexidine-silver sulfadiazine catheter is well tolerated, reduces the incidence of catheter-related Infection, extends the time that noncuffed central venous catheters can be safely left in place for the short term, and should allow cost savings.
Andrew J Stewardson - One of the best experts on this subject based on the ideXlab platform.
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effect of carbapenem resistance on outcomes of Bloodstream Infection caused by enterobacteriaceae in low income and middle income countries panorama a multinational prospective cohort study
Lancet Infectious Diseases, 2019Co-Authors: Andrew J Stewardson, Kalisvar Marimuthu, Sharmila Sengupta, Arthur Allignol, Maisra M Elbouseary, Maria J Carvalho, Brekhna HassanAbstract:Summary Background Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a Bloodstream Infection due to Enterobacteriaceae. Methods The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) Bloodstream Infections. We excluded patients who had previously been enrolled in the study and those not treated with curative intent at the time of Bloodstream Infection onset. There were no age restrictions. Central laboratories in India and the UK did confirmatory testing and molecular characterisation, including strain typing. We applied proportional subdistribution hazard models with inverse probability weighting to estimate the effect of carbapenem resistance on probability of discharge alive and in-hospital death, and multistate modelling for excess length of stay in hospital. All patients were included in the analysis. Findings Between Aug 1, 2014, and June 30, 2015, we recruited 297 patients from 16 sites in ten countries: 174 with CSE Bloodstream Infection and 123 with CRE Bloodstream Infection. Median age was 46 years (IQR 15–61). Crude mortality was 20% (35 of 174 patients) for patients with CSE Bloodstream Infection and 35% (43 of 123 patients) for patients with CRE Bloodstream Infection. Carbapenem resistance was associated with an increased length of hospital stay (3·7 days, 95% CI 0·3–6·9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio 1·75, 95% CI 1·04–2·94), and decreased probability of discharge alive (0·61, 0·45–0·83). Multilocus sequence typing showed various clades, with marginal overlap between strains in the CRE and CSE clades. Interpretation Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with Bloodstream Infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE Infections in LMICs. Funding bioMerieux.
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effect of carbapenem resistance on outcomes of Bloodstream Infection caused by enterobacteriaceae in low income and middle income countries panorama a multinational prospective cohort study
Lancet Infectious Diseases, 2019Co-Authors: Andrew J Stewardson, Kalisvar Marimuthu, Sharmila Sengupta, Arthur Allignol, Maisra M Elbouseary, Maria J Carvalho, Brekhna HassanAbstract:Background Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a Bloodstream Infection due to Enterobacteriaceae. Methods The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) Bloodstream Infections. We excluded patients who had previously been enrolled in the study and those not treated with curative intent at the time of Bloodstream Infection onset. There were no age restrictions. Central laboratories in India and the UK did confirmatory testing and molecular characterisation, including strain typing. We applied proportional subdistribution hazard models with inverse probability weighting to estimate the effect of carbapenem resistance on probability of discharge alive and in-hospital death, and multistate modelling for excess length of stay in hospital. All patients were included in the analysis. Findings Between Aug 1, 2014, and June 30, 2015, we recruited 297 patients from 16 sites in ten countries: 174 with CSE Bloodstream Infection and 123 with CRE Bloodstream Infection. Median age was 46 years (IQR 15–61). Crude mortality was 20% (35 of 174 patients) for patients with CSE Bloodstream Infection and 35% (43 of 123 patients) for patients with CRE Bloodstream Infection. Carbapenem resistance was associated with an increased length of hospital stay (3·7 days, 95% CI 0·3–6·9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio 1·75, 95% CI 1·04–2·94), and decreased probability of discharge alive (0·61, 0·45–0·83). Multilocus sequence typing showed various clades, with marginal overlap between strains in the CRE and CSE clades. Interpretation Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with Bloodstream Infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE Infections in LMICs.
Gianna Zuccotti - One of the best experts on this subject based on the ideXlab platform.
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colonization Bloodstream Infection and mortality caused by vancomycin resistant enterococcus early after allogeneic hematopoietic stem cell transplant
Biology of Blood and Marrow Transplantation, 2007Co-Authors: David M Weinstock, Mary Conlon, Christine Scura Iovino, Tanya Aubrey, Carlota Gudiol, Timothy E Kiehn, James W. Young, Elyn Riedel, Gianna ZuccottiAbstract:Abstract Bloodstream Infection caused by vancomycin-resistant enterococcus (VRE) is associated with very high mortality among allogeneic hematopoietic stem cell transplant (alloHSCT) recipients. However, it remains unclear whether VRE Bloodstream Infection directly causes mortality in the early posttransplant period or is simply a marker of poor outcome. To determine the risk factors for VRE Bloodstream Infection and its effect on outcome, we followed 92 patients screened for stool colonization by VRE upon admission for alloHSCT. Patient records were reviewed to determine outcomes, including mortality and microbiologic failure. Colonization by VRE was extremely common, occurring in 40.2% of patients. VRE Bloodstream Infection developed in 34.2% of colonized patients by day +35, compared to 1.8% without VRE colonization ( P
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colonization Bloodstream Infection and mortality caused by vancomycin resistant enterococcus early after allogeneic hematopoietic stem cell transplant
Biology of Blood and Marrow Transplantation, 2007Co-Authors: David M Weinstock, Mary Conlon, Christine Scura Iovino, Tanya Aubrey, Carlota Gudiol, Timothy E Kiehn, James W. Young, Elyn Riedel, Gianna ZuccottiAbstract:Bloodstream Infection caused by vancomycin-resistant enterococcus (VRE) is associated with very high mortality among allogeneic hematopoietic stem cell transplant (alloHSCT) recipients. However, it remains unclear whether VRE Bloodstream Infection directly causes mortality in the early posttransplant period or is simply a marker of poor outcome. To determine the risk factors for VRE Bloodstream Infection and its effect on outcome, we followed 92 patients screened for stool colonization by VRE upon admission for alloHSCT. Patient records were reviewed to determine outcomes, including mortality and microbiologic failure. Colonization by VRE was extremely common, occurring in 40.2% of patients. VRE Bloodstream Infection developed in 34.2% of colonized patients by day +35, compared to 1.8% without VRE colonization (P < .01). VRE Bloodstream Infection was associated with a significant decrement in survival and frequent microbiologic failure, despite treatment with linezolid and/or daptomycin. Five (35.7%) of 14 patients with VRE Bloodstream Infection had attributable mortality or contributing mortality from the Infection. Strain typing by pulsed-field gel electrophoresis identified 9 different VRE strains among the 37 colonized patients and 5 patients with different strains recovered from the stool and the blood. In conclusion, stool screening effectively identified patients at extremely high risk for VRE Bloodstream Infection. The high mortality of VRE in the early posttransplant period supports the use of empiric antibiotics with activity against VRE during periods of fever and neutropenia in colonized patients.
Leonard A Mermel - One of the best experts on this subject based on the ideXlab platform.
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prevention of central venous catheter related Bloodstream Infection by use of an antiseptic impregnated catheter
Annals of Internal Medicine, 1997Co-Authors: Dennis G Maki, Susan M Stolz, Susan Wheeler, Leonard A MermelAbstract:Background: Bloodstream Infection related to short-term use of noncuffed central venous catheters is a common and serious problem. Technologic innovations to reduce the risk for these Infections ar...
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prevention of central venous catheter related Bloodstream Infection by use of an antiseptic impregnated catheter a randomized controlled trial
Annals of Internal Medicine, 1997Co-Authors: Dennis G Maki, Susan M Stolz, Susan Wheeler, Leonard A MermelAbstract:Background Bloodstream Infection related to short-term use of noncuffed central venous catheters is a common and serious problem. Technologic innovations to reduce the risk for these Infections are needed. Objective To determine 1) the efficacy of a novel antiseptic catheter in preventing central venous catheter-related Infection, 2) patient tolerance of this catheter, and 3) the sources of Bloodstream Infection originating from noncuffed, multilumen central venous catheters. Design Randomized, controlled clinical trial. Setting Medical-surgical intensive care unit of a 450-bed university hospital. Participants 158 adults scheduled to receive a central venous catheter; 403 catheters were studied. Intervention Participants received either a standard triple-lumen polyurethane catheter or a catheter that was indistinguishable from the standard catheter and was impregnated with chlorhexidine and silver sulfadiazine. Measurements Catheters were studied for colonization and catheter-related Bloodstream Infection at removal; local and systemic effects of catheters were assessed. The origin of each catheter-associated Bloodstream Infection was sought by culturing all potential sources (skin, catheter segments, hubs, and infusate) and confirmed by restriction-fragment DNA subtyping. Results Antiseptic catheters were less likely to be colonized at removal than control catheters (13.5 compared with 24.1 colonized catheters per 100 catheters; relative risk, 0.56 [95% CI, 0.36 to 0.89]; P = 0.005) and were nearly fivefold less likely to produce Bloodstream Infection (1.0 compared with 4.7 Infections per 100 catheters; 1.6 compared with 7.6 Infections per 1000 catheter-days; relative risk, 0.21 [CI, 0.03 to 0.95]; P = 0.03). In the control group, 8 catheter-related Bloodstream Infections were caused by Staphylococcus aureus, gram-negative bacilli, enterococci, or Candida species; no Infections with these organisms occurred in the antiseptic catheter group (P = 0.003). No adverse effects from the antiseptic catheter were seen, and none of the 122 isolates obtained from infected catheters in either group showed in vitro resistance to chlorhexidine-silver sulfadiazine. Cost-benefit analysis indicated that the antiseptic catheter should prove cost-beneficial if an institution's rate of catheter-related bacteremia with noncuffed central venous catheters is at least 3 Infections per 1000 catheter-days). Conclusions The chlorhexidine-silver sulfadiazine catheter is well tolerated, reduces the incidence of catheter-related Infection, extends the time that noncuffed central venous catheters can be safely left in place for the short term, and should allow cost savings.
Brekhna Hassan - One of the best experts on this subject based on the ideXlab platform.
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effect of carbapenem resistance on outcomes of Bloodstream Infection caused by enterobacteriaceae in low income and middle income countries panorama a multinational prospective cohort study
Lancet Infectious Diseases, 2019Co-Authors: Andrew J Stewardson, Kalisvar Marimuthu, Sharmila Sengupta, Arthur Allignol, Maisra M Elbouseary, Maria J Carvalho, Brekhna HassanAbstract:Summary Background Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a Bloodstream Infection due to Enterobacteriaceae. Methods The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) Bloodstream Infections. We excluded patients who had previously been enrolled in the study and those not treated with curative intent at the time of Bloodstream Infection onset. There were no age restrictions. Central laboratories in India and the UK did confirmatory testing and molecular characterisation, including strain typing. We applied proportional subdistribution hazard models with inverse probability weighting to estimate the effect of carbapenem resistance on probability of discharge alive and in-hospital death, and multistate modelling for excess length of stay in hospital. All patients were included in the analysis. Findings Between Aug 1, 2014, and June 30, 2015, we recruited 297 patients from 16 sites in ten countries: 174 with CSE Bloodstream Infection and 123 with CRE Bloodstream Infection. Median age was 46 years (IQR 15–61). Crude mortality was 20% (35 of 174 patients) for patients with CSE Bloodstream Infection and 35% (43 of 123 patients) for patients with CRE Bloodstream Infection. Carbapenem resistance was associated with an increased length of hospital stay (3·7 days, 95% CI 0·3–6·9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio 1·75, 95% CI 1·04–2·94), and decreased probability of discharge alive (0·61, 0·45–0·83). Multilocus sequence typing showed various clades, with marginal overlap between strains in the CRE and CSE clades. Interpretation Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with Bloodstream Infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE Infections in LMICs. Funding bioMerieux.
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effect of carbapenem resistance on outcomes of Bloodstream Infection caused by enterobacteriaceae in low income and middle income countries panorama a multinational prospective cohort study
Lancet Infectious Diseases, 2019Co-Authors: Andrew J Stewardson, Kalisvar Marimuthu, Sharmila Sengupta, Arthur Allignol, Maisra M Elbouseary, Maria J Carvalho, Brekhna HassanAbstract:Background Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a Bloodstream Infection due to Enterobacteriaceae. Methods The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) Bloodstream Infections. We excluded patients who had previously been enrolled in the study and those not treated with curative intent at the time of Bloodstream Infection onset. There were no age restrictions. Central laboratories in India and the UK did confirmatory testing and molecular characterisation, including strain typing. We applied proportional subdistribution hazard models with inverse probability weighting to estimate the effect of carbapenem resistance on probability of discharge alive and in-hospital death, and multistate modelling for excess length of stay in hospital. All patients were included in the analysis. Findings Between Aug 1, 2014, and June 30, 2015, we recruited 297 patients from 16 sites in ten countries: 174 with CSE Bloodstream Infection and 123 with CRE Bloodstream Infection. Median age was 46 years (IQR 15–61). Crude mortality was 20% (35 of 174 patients) for patients with CSE Bloodstream Infection and 35% (43 of 123 patients) for patients with CRE Bloodstream Infection. Carbapenem resistance was associated with an increased length of hospital stay (3·7 days, 95% CI 0·3–6·9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio 1·75, 95% CI 1·04–2·94), and decreased probability of discharge alive (0·61, 0·45–0·83). Multilocus sequence typing showed various clades, with marginal overlap between strains in the CRE and CSE clades. Interpretation Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with Bloodstream Infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE Infections in LMICs.