The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
Robert J Sherertz - One of the best experts on this subject based on the ideXlab platform.
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contribution of vascular Catheter material to the pathogenesis of infection the enhanced risk of silicone in vivo
Journal of Biomedical Materials Research, 1995Co-Authors: Robert J Sherertz, Russ A Johnson, William A Carruth, Randy D Marosok, Mark A Espeland, Donald D SolomonAbstract:There is currently very little information to suggest that polymer materials used to make vascular Catheters differ in their risk of infection. A rabbit model of subcutaneous Staphylococcus aureus infection was used to determine the relative risk of infection associated with silicone, polyurethane, polyvinylchloride, and Teflon® Catheters. Seven days after Catheter implantation and inoculation with S. aureus, Catheters were observed for gross purulence and quantitatively cultured. Silicone Catheters were found to have a greater risk of grossly apparent infection (purulence) and a greater number of organisms removed from Catheters by quantitative culture than the other three Catheter materials (P<.01). The risk of infection associated with silicone Catheters decreased (P<.05) if the S. aureus inoculation was delayed for 2 days or if the Catheters were preincubated in the subcutaneous space prior to insertion. The histology of the inflammatory response around the four Catheter materials was evaluated at either 2 or 7 days after Catheter insertion with or without S. aureus inoculation. Silicone Catheters had greater associated inflammation (P<.05) with or without S. aureus inoculation. These results suggest that silicone Catheter materials may have unique properties that increase the risk of infection after implantation. Further studies should be done to understand the mechanism(s) of these observations
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quantitative tip culture methods and the diagnosis of central venous Catheter related infections
Diagnostic Microbiology and Infectious Disease, 1992Co-Authors: Issam I Raad, Mouin F Sabbagh, Kenneth H Rand, Robert J SherertzAbstract:The diagnostic usefulness of two quantitative Catheter culture methods was compared in a prospective study of central venous and arterial Catheters. The roll-plate method followed by sonication was used to culture 177 Catheters from 85 patients, and the sonication method was used to culture 136 Catheters from 68 patients. All patients were evaluated for Catheter-related infections. Catheter-related infections were associated with ≥100 colony-forming units (CFU) isolated from Catheter tips by either roll plate (p = 0.01) or sonication (p < 0.001). The sensitivity, specificity, and positive and negative predictive values of ≥103 CFU by roll plate for Catheter-related septicemia were 56%, 97%, 63%, and 96% compared with 93%, 95%, 76%, and 99%, respectively, for the same level by sonication. For central venous and arterial Catheters, the sonication method can distinguish infection from contamination and is superior to the roll-plate method in that it may offer a more sensitive and predictive alternative in the diagnosis of Catheter-related septicemia.
Cristina Rincon - One of the best experts on this subject based on the ideXlab platform.
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the challenge of anticipating Catheter tip colonization in major heart surgery patients in the intensive care unit are surface cultures useful
Critical Care Medicine, 2005Co-Authors: Emilio Bouza, Patricia Munoz, Almudena Burillo, Javier Lopezrodriguez, Cristina Fernandezperez, Maria Jesus Perez, Cristina RinconAbstract:Objective: Patients undergoing heart surgery show a high risk of Catheter colonization and Catheter-related bloodstream infections. We evaluated whether skin insertion site and Catheter hub surveillance cultures (surface cultures) could predict Catheter colonization and help establish the origin of bloodstream infections. Design: Prospective cohort study. Setting: An 11-bed heart surgery intensive care unit in a tertiary university hospital. Patients: Heart surgery patients spending >4 days in intensive care over an 11-month period. Interventions: All Catheters were surveyed. Cultures were obtained from the skin insertion site and all hubs on day 5 after surgery, every 72 hrs thereafter, and on Catheter removal. Swabs were processed semiquantitatively by streaking the surface of a Columbia agar plate. Catheters were processed using Maki's method. The observation of ≥15 colonies/plate was taken to indicate a positive skin or Catheter colonization culture result. Measurements and Main Results: Over the study period, 561 Catheters were inserted in 130 patients. The median time a Catheter was in place was 6 days (interquartile range 3-11), and 3,712 surface cultures were obtained (median four per patient). Catheter colonization occurred in 133 Catheters, and there were 15 episodes of Catheter-related bloodstream infection (incidence density of colonization 29.3 and of Catheter-related bloodstream infection 8.8 per 1,000 Catheter-days). Validity indexes for the capacity of surface cultures to predict Catheter colonization and Catheter-related bloodstream infection, respectively, were as follows: accuracy, 71.4, 65.6; sensitivity, 83.5%, 100%; specificity, 67.1%, 64.7%; positive predictive value, 47.6%, 7.2%; negative predictive value, 91.9%, 100%; positive likelihood ratio, 2.5, 2.83; and negative likelihood ratio, 0.2, 0. Surface cultures correctly predicted 77.4% of all bacteremia episodes (Catheter-related and non-Catheter-related). Conclusions: Systematic surveillance cultures of Catheter hub and skin insertion sites in patients admitted to a heart surgery intensive care unit could help identify patients who would benefit from decontamination and preventive measures and establish whether Catheters are the portal of entry of bloodstream infection.
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the challenge of anticipating Catheter tip colonization in major heart surgery patients in the intensive care unit are surface cultures useful
Critical Care Medicine, 2005Co-Authors: Emilio Bouza, Patricia Munoz, Almudena Burillo, Javier Lopezrodriguez, Cristina Fernandezperez, Maria Jesus Perez, Cristina RinconAbstract:OBJECTIVE: Patients undergoing heart surgery show a high risk of Catheter colonization and Catheter-related bloodstream infections. We evaluated whether skin insertion site and Catheter hub surveillance cultures ("surface cultures") could predict Catheter colonization and help establish the origin of bloodstream infections. DESIGN: : Prospective cohort study. SETTING: An 11-bed heart surgery intensive care unit in a tertiary university hospital. PATIENTS: Heart surgery patients spending >4 days in intensive care over an 11-month period. INTERVENTIONS: All Catheters were surveyed. Cultures were obtained from the skin insertion site and all hubs on day 5 after surgery, every 72 hrs thereafter, and on Catheter removal. Swabs were processed semiquantitatively by streaking the surface of a Columbia agar plate. Catheters were processed using Maki's method. The observation of > or = 15 colonies/plate was taken to indicate a positive skin or Catheter colonization culture result. MEASUREMENTS AND MAIN RESULTS: Over the study period, 561 Catheters were inserted in 130 patients. The median time a Catheter was in place was 6 days (interquartile range 3-11), and 3,712 surface cultures were obtained (median four per patient). Catheter colonization occurred in 133 Catheters, and there were 15 episodes of Catheter-related bloodstream infection (incidence density of colonization 29.3 and of Catheter-related bloodstream infection 8.8 per 1,000 Catheter-days). Validity indexes for the capacity of surface cultures to predict Catheter colonization and Catheter-related bloodstream infection, respectively, were as follows: accuracy, 71.4, 65.6; sensitivity, 83.5%, 100%; specificity, 67.1%, 64.7%; positive predictive value, 47.6%, 7.2%; negative predictive value, 91.9%, 100%; positive likelihood ratio, 2.5, 2.83; and negative likelihood ratio, 0.2, 0. Surface cultures correctly predicted 77.4% of all bacteremia episodes (Catheter-related and non-Catheter-related). CONCLUSIONS: Systematic surveillance cultures of Catheter hub and skin insertion sites in patients admitted to a heart surgery intensive care unit could help identify patients who would benefit from decontamination and preventive measures and establish whether Catheters are the portal of entry of bloodstream infection.
G D Kotulak - One of the best experts on this subject based on the ideXlab platform.
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are clinical signs accurate indicators of the cause of central venous Catheter occlusion
Journal of Parenteral and Enteral Nutrition, 1995Co-Authors: L C Stephens, William D Haire, G D KotulakAbstract:Background: Two hundred dysfunctional central venous Catheters used for total parenteral nutrition and administration of cancer chemotherapy were radiographically examined in order to objectively identify thrombotic occlusions as the cause of Catheter dysfunction. Methods: Outcomes of radiographic dye injections were compared with factors such as the inability to aspirate blood or to infuse fluids, Catheter type, and duration of Catheter placement. Results: Catheter type and duration of placement were not significant factors for predicting the type of dysfunction. Failure to withdraw blood was associated with 96% of the thrombosed Catheters; this was also associated with 65% of the Catheters with nonthrombotic dysfunctions. Once the cause of Catheter occlusion was correctly identified, 90% of the Catheters were restored to normal function. Conclusions: Inability to withdraw blood from a Catheter does not necessarily mean it is occluded by thrombus. Mechanical complications account for a significant portio...
Edward J Quebbeman - One of the best experts on this subject based on the ideXlab platform.
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pinch off syndrome a rare etiology for central venous Catheter occlusion
Journal of Parenteral and Enteral Nutrition, 1994Co-Authors: Deborah A. Andris, Elizabeth A. Krzywda, William Schtlte, Robert K Ausman, Edward J QuebbemanAbstract:Background: Catheter pinch-off syndrome is a rare and often misdiagnosed complication of tunneled Silastic central venous Catheters. Pinch-off syndrome occurs when the Catheter is compressed between the first rib and the clavicle, causing an intermittent mechanical occlusion for both infusion and withdrawal. We report its incidence in a large series of Catheter insertions and describe the clinical presentation, radiographic findings, and recommended treatment. Methods: A total of 1457 tunneled Silastic central venous Catheters that were inserted using the percutaneous subclavian approach were prospectively studied. Indications for Catheter placement included bone marrow transplant, continuous or intermittent chemotherapy, long-term antibiotics, and parenteral nutrition. Catheters were evaluated for clinical presentation of an occlusion relieved by postural changes and radiographic findings of luminal narrowing. Results: Pinch-off syndrome was identified in 16 (1.1%) Catheters. Radiographic findings were p...
Emilio Bouza - One of the best experts on this subject based on the ideXlab platform.
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the challenge of anticipating Catheter tip colonization in major heart surgery patients in the intensive care unit are surface cultures useful
Critical Care Medicine, 2005Co-Authors: Emilio Bouza, Patricia Munoz, Almudena Burillo, Javier Lopezrodriguez, Cristina Fernandezperez, Maria Jesus Perez, Cristina RinconAbstract:Objective: Patients undergoing heart surgery show a high risk of Catheter colonization and Catheter-related bloodstream infections. We evaluated whether skin insertion site and Catheter hub surveillance cultures (surface cultures) could predict Catheter colonization and help establish the origin of bloodstream infections. Design: Prospective cohort study. Setting: An 11-bed heart surgery intensive care unit in a tertiary university hospital. Patients: Heart surgery patients spending >4 days in intensive care over an 11-month period. Interventions: All Catheters were surveyed. Cultures were obtained from the skin insertion site and all hubs on day 5 after surgery, every 72 hrs thereafter, and on Catheter removal. Swabs were processed semiquantitatively by streaking the surface of a Columbia agar plate. Catheters were processed using Maki's method. The observation of ≥15 colonies/plate was taken to indicate a positive skin or Catheter colonization culture result. Measurements and Main Results: Over the study period, 561 Catheters were inserted in 130 patients. The median time a Catheter was in place was 6 days (interquartile range 3-11), and 3,712 surface cultures were obtained (median four per patient). Catheter colonization occurred in 133 Catheters, and there were 15 episodes of Catheter-related bloodstream infection (incidence density of colonization 29.3 and of Catheter-related bloodstream infection 8.8 per 1,000 Catheter-days). Validity indexes for the capacity of surface cultures to predict Catheter colonization and Catheter-related bloodstream infection, respectively, were as follows: accuracy, 71.4, 65.6; sensitivity, 83.5%, 100%; specificity, 67.1%, 64.7%; positive predictive value, 47.6%, 7.2%; negative predictive value, 91.9%, 100%; positive likelihood ratio, 2.5, 2.83; and negative likelihood ratio, 0.2, 0. Surface cultures correctly predicted 77.4% of all bacteremia episodes (Catheter-related and non-Catheter-related). Conclusions: Systematic surveillance cultures of Catheter hub and skin insertion sites in patients admitted to a heart surgery intensive care unit could help identify patients who would benefit from decontamination and preventive measures and establish whether Catheters are the portal of entry of bloodstream infection.
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the challenge of anticipating Catheter tip colonization in major heart surgery patients in the intensive care unit are surface cultures useful
Critical Care Medicine, 2005Co-Authors: Emilio Bouza, Patricia Munoz, Almudena Burillo, Javier Lopezrodriguez, Cristina Fernandezperez, Maria Jesus Perez, Cristina RinconAbstract:OBJECTIVE: Patients undergoing heart surgery show a high risk of Catheter colonization and Catheter-related bloodstream infections. We evaluated whether skin insertion site and Catheter hub surveillance cultures ("surface cultures") could predict Catheter colonization and help establish the origin of bloodstream infections. DESIGN: : Prospective cohort study. SETTING: An 11-bed heart surgery intensive care unit in a tertiary university hospital. PATIENTS: Heart surgery patients spending >4 days in intensive care over an 11-month period. INTERVENTIONS: All Catheters were surveyed. Cultures were obtained from the skin insertion site and all hubs on day 5 after surgery, every 72 hrs thereafter, and on Catheter removal. Swabs were processed semiquantitatively by streaking the surface of a Columbia agar plate. Catheters were processed using Maki's method. The observation of > or = 15 colonies/plate was taken to indicate a positive skin or Catheter colonization culture result. MEASUREMENTS AND MAIN RESULTS: Over the study period, 561 Catheters were inserted in 130 patients. The median time a Catheter was in place was 6 days (interquartile range 3-11), and 3,712 surface cultures were obtained (median four per patient). Catheter colonization occurred in 133 Catheters, and there were 15 episodes of Catheter-related bloodstream infection (incidence density of colonization 29.3 and of Catheter-related bloodstream infection 8.8 per 1,000 Catheter-days). Validity indexes for the capacity of surface cultures to predict Catheter colonization and Catheter-related bloodstream infection, respectively, were as follows: accuracy, 71.4, 65.6; sensitivity, 83.5%, 100%; specificity, 67.1%, 64.7%; positive predictive value, 47.6%, 7.2%; negative predictive value, 91.9%, 100%; positive likelihood ratio, 2.5, 2.83; and negative likelihood ratio, 0.2, 0. Surface cultures correctly predicted 77.4% of all bacteremia episodes (Catheter-related and non-Catheter-related). CONCLUSIONS: Systematic surveillance cultures of Catheter hub and skin insertion sites in patients admitted to a heart surgery intensive care unit could help identify patients who would benefit from decontamination and preventive measures and establish whether Catheters are the portal of entry of bloodstream infection.
