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Juan Antonio Sáez-nieto - One of the best experts on this subject based on the ideXlab platform.
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Outbreak of long-term Intravascular Catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit
European Journal of Clinical Microbiology and Infectious Diseases, 2005Co-Authors: Daniel Tena, R. Carranza, J.r. Barberá, Sylvia Valdezate, J.m. Garrancho, M. Arranz, Juan Antonio Sáez-nietoAbstract:Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term Intravascular Catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under Xba I restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The Catheter was removed in only one patient. The three patients in whom the Catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous Catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous Catheters and should be called into question. Patients with long-term Intravascular Catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without Catheter removal.
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Outbreak of long-term Intravascular Catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit
European Journal of Clinical Microbiology and Infectious Diseases, 2005Co-Authors: Daniel Tena, R. Carranza, J.r. Barberá, Sylvia Valdezate, J.m. Garrancho, M. Arranz, Juan Antonio Sáez-nietoAbstract:Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term Intravascular Catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under Xba I restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The Catheter was removed in only one patient. The three patients in whom the Catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous Catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous Catheters and should be called into question. Patients with long-term Intravascular Catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without Catheter removal.
Leonard A Mermel - One of the best experts on this subject based on the ideXlab platform.
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Preventive Strategies for Intravascular Catheter-Related Infections
Infections Associated with Indwelling Medical Devices, 2014Co-Authors: Leonard A MermelAbstract:Millions of Intravascular Catheters are purchased each year by hospitals and clinics, placing many patients at risk for serious Catheter-related infections. This chapter summarizes the rapidly expanding body of literature concerning prevention of Intravascular Catheter-related infections in the hope of reducing the risk posed to present and future patients. Prophylaxis with vancomycin or teicoplanin during central venous Catheter insertion does not reduce the incidence of Catheter-related bloodstream infection. The addition of prophylactic vancomycin to flush solutions or total parenteral nutrition solutions significantly reduces the incidence of Catheter-related bloodstream infection; however, use of systemic antimicrobial agents to prevent Intravascular Catheter-related infections is not recommended. Administering very low doses of warfarin reduces thrombosis due to long-term central venous Catheters. Use of prophylactic heparin by bolus infusion or when it is added to intravenous solutions does not significantly reduce the risk of central venous Catheter-related bloodstream infection. Prophylactic heparin significantly reduces the incidence of Catheter-related central venous thrombosis in patients with central venous and pulmonary artery Catheters. A number of different strategies can be used to prevent serious Intravascular Catheter-related infections.
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Guidelines for the prevention of Intravascular Catheter-related infections
American Journal of Infection Control, 2011Co-Authors: Naomi P. O'grady, Leonard A Mermel, Mary Alexander, Lillian A. Burns, E. Patchen Dellinger, Jeffrey Garland, Stephen O. Heard, Pamela A. Lipsett, Henry Masur, Michele L. PearsonAbstract:These guidelines have been developed for healthcare personnel who insert Intravascular Catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home healthcare settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, healthcare infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), American Society for Parenteral and Enteral Nutrition (ASPEN), Society of Interventional Radiology (SIR), American Academy of Pediatrics (AAP), Pediatric Infectious Diseases Society (PIDS), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Catheter-Related Infections published in 2002. These guidelines are intended to provide evidence-based recommendations for preventing Intravascular Catheter-related infections. Major areas of emphasis include 1) educating and training healthcare personnel who insert and maintain Catheters; 2) using maximal sterile barrier precautions during central venous Catheter insertion; 3) using a \u3e 0.5% chlorhexidine skin preparation with alcohol for antisepsis; 4) avoiding routine replacement of central venous Catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous Catheters and chlorhexidine impregnated sponge dressings if the rate of infection is not decreasing despite adherence to other strategies (i.e, education and training, maximal sterile barrier precautions, and \u3e0.5% chlorhexidine preparations with alcohol for skin antisepsis). These guidelines also emphasize performance improvement by implementing bundled strategies, and documenting and reporting rates of compliance with all components of the bundle as benchmarks for quality assurance and performance improvement
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What Is The Predominant Source of Intravascular Catheter Infections
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2010Co-Authors: Leonard A MermelAbstract:The predominant source of Intravascular Catheter-related bloodstream infections has been a research and clinical question for more than 30 years. During that time, we've moved from the position of a single source predominating in all clinical scenarios to a more realistic appraisal that both skin at the insertion site and the Catheter hub/connector (ie, an extraluminal and an intraluminal source of infection, respectively) are important and that maximally effective prevention programs must address both sources of infection.
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guidelines for the management of Intravascular Catheter related infections
Clinical Infectious Diseases, 2001Co-Authors: Leonard A Mermel, Naomi P Ogrady, Barry M Farr, Robert J Sherertz, Issam I Raad, Joann S Harris, Donald E CravenAbstract:These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous Catheters (CVCs), pulmonary artery Catheters, tunneled central Catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of Catheter, the infecting organism, and the associated complications. Intravascular Catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci, Staphylococcus aureus, aerobic gram-negative bacilli, and Candida albicans most commonly cause Catheter-related bloodstream infection. Management of Catheter-related infection varies according to the type of Catheter involved. After appropriate cultures of blood and Catheter samples are done, empirical i.v. antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen(s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed. For management of bacteremia and fungemia from a tunneled Catheter or implantable device, such as a port, the decision to remove the Catheter or device should be based on the severity of the patient's illness, documentation that the vascular-access device is infected, assessment of the specific pathogen involved, and presence of complications, such as endocarditis, septic thrombosis, tunnel infection, or metastatic seeding. When a Catheter-related infection is documented and a specific pathogen is identified, systemic antimicrobial therapy should be narrowed and consideration given for antibiotic lock therapy, if the CVC or implantable device is not removed. These guidelines address the issues related to the management of Catheter-related bacteremia and associated complications. Separate guidelines will address specific issues related to the prevention of Catheter-related infections. Performance indicators for the management of Catheter-related infection are included at the end of the document. Because the pathogenesis of Catheter-related infections is complicated, the virulence of the pathogens is variable, and the host factors have not been well defined, there is a notable absence of compelling clinical data to make firm recommendations for an individual patient. Therefore, the recommendations in these guidelines are intended to support, and not replace, good clinical judgment. Also, a section on selected, unresolved clinical issues that require further study and research has been included. There is an urgent need for large, well-designed clinical studies to delineate management strategies more effectively, which will improve clinical outcomes and save precious health care resources.
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New technologies to prevent Intravascular Catheter-related bloodstream infections.
Emerging infectious diseases, 2001Co-Authors: Leonard A MermelAbstract:Most Intravascular Catheter-related infections are associated with central venous Catheters. Technologic advances shown to reduce the risk for these infections include a Catheter hub containing an iodinated alcohol solution, short-term chlorhexidine-silver sulfadiazine- impregnated Catheters, minocycline-rifampin-impregnated Catheters, and chlorhexidine- impregnated sponge dressings. Nontechnologic strategies for reducing risk include maximal barrier precautions during Catheter insertion, specialized nursing teams, continuing quality improvement programs, and tunneling of short-term internal jugular Catheters.
Daniel Tena - One of the best experts on this subject based on the ideXlab platform.
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Outbreak of long-term Intravascular Catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit
European Journal of Clinical Microbiology and Infectious Diseases, 2005Co-Authors: Daniel Tena, R. Carranza, J.r. Barberá, Sylvia Valdezate, J.m. Garrancho, M. Arranz, Juan Antonio Sáez-nietoAbstract:Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term Intravascular Catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under Xba I restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The Catheter was removed in only one patient. The three patients in whom the Catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous Catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous Catheters and should be called into question. Patients with long-term Intravascular Catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without Catheter removal.
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Outbreak of long-term Intravascular Catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit
European Journal of Clinical Microbiology and Infectious Diseases, 2005Co-Authors: Daniel Tena, R. Carranza, J.r. Barberá, Sylvia Valdezate, J.m. Garrancho, M. Arranz, Juan Antonio Sáez-nietoAbstract:Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term Intravascular Catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under Xba I restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The Catheter was removed in only one patient. The three patients in whom the Catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous Catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous Catheters and should be called into question. Patients with long-term Intravascular Catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without Catheter removal.
R. Carranza - One of the best experts on this subject based on the ideXlab platform.
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Outbreak of long-term Intravascular Catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit
European Journal of Clinical Microbiology and Infectious Diseases, 2005Co-Authors: Daniel Tena, R. Carranza, J.r. Barberá, Sylvia Valdezate, J.m. Garrancho, M. Arranz, Juan Antonio Sáez-nietoAbstract:Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term Intravascular Catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under Xba I restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The Catheter was removed in only one patient. The three patients in whom the Catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous Catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous Catheters and should be called into question. Patients with long-term Intravascular Catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without Catheter removal.
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Outbreak of long-term Intravascular Catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit
European Journal of Clinical Microbiology and Infectious Diseases, 2005Co-Authors: Daniel Tena, R. Carranza, J.r. Barberá, Sylvia Valdezate, J.m. Garrancho, M. Arranz, Juan Antonio Sáez-nietoAbstract:Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term Intravascular Catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under Xba I restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The Catheter was removed in only one patient. The three patients in whom the Catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous Catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous Catheters and should be called into question. Patients with long-term Intravascular Catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without Catheter removal.
M. Arranz - One of the best experts on this subject based on the ideXlab platform.
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Outbreak of long-term Intravascular Catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit
European Journal of Clinical Microbiology and Infectious Diseases, 2005Co-Authors: Daniel Tena, R. Carranza, J.r. Barberá, Sylvia Valdezate, J.m. Garrancho, M. Arranz, Juan Antonio Sáez-nietoAbstract:Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term Intravascular Catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under Xba I restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The Catheter was removed in only one patient. The three patients in whom the Catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous Catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous Catheters and should be called into question. Patients with long-term Intravascular Catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without Catheter removal.
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Outbreak of long-term Intravascular Catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit
European Journal of Clinical Microbiology and Infectious Diseases, 2005Co-Authors: Daniel Tena, R. Carranza, J.r. Barberá, Sylvia Valdezate, J.m. Garrancho, M. Arranz, Juan Antonio Sáez-nietoAbstract:Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term Intravascular Catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under Xba I restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The Catheter was removed in only one patient. The three patients in whom the Catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous Catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous Catheters and should be called into question. Patients with long-term Intravascular Catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without Catheter removal.