The Experts below are selected from a list of 183 Experts worldwide ranked by ideXlab platform
Issam I Raad - One of the best experts on this subject based on the ideXlab platform.
-
diagnosis of Triple Lumen Catheter infection comparison of roll plate sonication and flushing methodologies
Journal of Clinical Microbiology, 1997Co-Authors: Robert J Sherertz, Stephen O Heard, Issam I RaadAbstract:In a recent clinical trial, 248 Triple-Lumen Catheters were removed from patients in an intensive care unit, and their tip and subcutaneous segments were cultured by both the sonication and roll plate methods; for 191 of these Catheters, flush cultures of all three Catheter Lumens were also performed. Previously published quantitative endpoints were used to define significant Catheter colonization. By using a composite index as a definition of colonization (any of the seven types of cultures meeting quantitative criteria), sonication of the subcutaneous segment was the most sensitive at detecting colonization (58%), followed by sonication of the Catheter tip (53%). Sonication of both the subcutaneous and tip segments was 20% more sensitive than sonication of an adjacent Catheter segment by the roll plate method (P < 0.05). The greater sensitivity of the sonication method could be attributed to its greater ability than the roll plate method to detect Catheter Lumen colonization (82 versus 57%, respectively; P = 0.01). A greater number of positive Catheter segment cultures were found for colonized Catheters from patients with associated bacteremia than for colonized Catheters from patients without bacteremia (57 versus 37%; P = 0.004), making any culture method more likely to identify them. For Catheters with significant colonization of only one site, the localization was as follows: 36.7% subcutaneous segment, 36.7% Catheter Lumen, and 26.6% tip segment. These findings suggest that the current practice of culturing a single segment of a central vascular Catheter is inadequate and needs to be reexamined. They further suggest that initial colonization of the Catheter Lumen and tip segments may be more important than previously thought and may require a change in thinking of strategies designed to prevent Catheter infection.
-
Roll Plate, Sonication, and Flushing Methodologies
1996Co-Authors: Clin J. Microbiol, Robert J Sherertz, Stephen O Heard, S O Heard, I I Raad, Issam I RaadAbstract:flushing methodologies. comparison of roll plate, sonication, and Diagnosis of Triple-Lumen Catheter infection
Stephen O Heard - One of the best experts on this subject based on the ideXlab platform.
-
influence of Triple Lumen central venous Catheters coated with chlorhexidine and silver sulfadiazine on the incidence of Catheter related bacteremia
JAMA Internal Medicine, 1998Co-Authors: Stephen O Heard, Manisha Wagle, E Vijayakumar, S Mclean, Angela B Brueggemann, Lena M Napolitano, L P EdwardsAbstract:Objective To evaluate the efficacy of Triple-Lumen central venous Catheters coated with a combination product of chlorhexidine and silver sulfadiazine (CSS) in reducing the incidence of local Catheter infection and Catheter-related bacteremia. Design Randomized, controlled trial. Setting The surgical intensive care units in a university hospital. Patients All patients who needed central venous Catheterization were randomized to receive either an uncoated Triple-Lumen Catheter (n=157) or a Catheter coated with CSS (n=151). Main Outcome Measure Catheters were removed when no longer needed or suspected as a cause of infection. The tip and a 5-cm segment of the intradermal portion of the Catheter were cultured semiquantitatively. Blood cultures were obtained when clinically indicated. The remaining segment of Catheters coated with CSS were cut and incubated on an agar plate with strains of Staphylococcus aureus and Enterococcus . Zone of inhibition was determined 24 hours later. Data were analyzed by survival and logistic multivariate regression methods. Results Catheters coated with CSS were effective in reducing the rate of significant bacterial growth on either the tip or intradermal segment (40%) compared with control Catheters (52%; P =.04). However, there was no difference in the incidence of Catheter-related bacteremia (3.8% [uncoated] vs 3.3% [coated]; P =.81). In vitro activity of Catheters with CSS against S aureus was evident up to 25 days but activity against Enterococcus dissipated more quickly over time and was absent by day 4. The most common colonizing organisms were coagulase-negative staphylococcus and enterococcus. Variables that were associated with a significant amount of growth on the tip or intradermal segment were a duration of Catheterization of longer than 7 days, jugular insertion site, and the absence of a CSS coating. The use of a guidewire when the Catheter was removed was associated with a lower risk of significant bacterial growth. Conclusions The use of CSS reduces the incidence of significant bacterial growth on either the tip or intradermal segments of coated Triple-Lumen Catheters but has no effect on the incidence of Catheter-related bacteremia. In this patient population, Catheters coated with CSS provide no additional benefit over uncoated Catheters.
-
diagnosis of Triple Lumen Catheter infection comparison of roll plate sonication and flushing methodologies
Journal of Clinical Microbiology, 1997Co-Authors: Robert J Sherertz, Stephen O Heard, Issam I RaadAbstract:In a recent clinical trial, 248 Triple-Lumen Catheters were removed from patients in an intensive care unit, and their tip and subcutaneous segments were cultured by both the sonication and roll plate methods; for 191 of these Catheters, flush cultures of all three Catheter Lumens were also performed. Previously published quantitative endpoints were used to define significant Catheter colonization. By using a composite index as a definition of colonization (any of the seven types of cultures meeting quantitative criteria), sonication of the subcutaneous segment was the most sensitive at detecting colonization (58%), followed by sonication of the Catheter tip (53%). Sonication of both the subcutaneous and tip segments was 20% more sensitive than sonication of an adjacent Catheter segment by the roll plate method (P < 0.05). The greater sensitivity of the sonication method could be attributed to its greater ability than the roll plate method to detect Catheter Lumen colonization (82 versus 57%, respectively; P = 0.01). A greater number of positive Catheter segment cultures were found for colonized Catheters from patients with associated bacteremia than for colonized Catheters from patients without bacteremia (57 versus 37%; P = 0.004), making any culture method more likely to identify them. For Catheters with significant colonization of only one site, the localization was as follows: 36.7% subcutaneous segment, 36.7% Catheter Lumen, and 26.6% tip segment. These findings suggest that the current practice of culturing a single segment of a central vascular Catheter is inadequate and needs to be reexamined. They further suggest that initial colonization of the Catheter Lumen and tip segments may be more important than previously thought and may require a change in thinking of strategies designed to prevent Catheter infection.
-
Roll Plate, Sonication, and Flushing Methodologies
1996Co-Authors: Clin J. Microbiol, Robert J Sherertz, Stephen O Heard, S O Heard, I I Raad, Issam I RaadAbstract:flushing methodologies. comparison of roll plate, sonication, and Diagnosis of Triple-Lumen Catheter infection
Robert J Sherertz - One of the best experts on this subject based on the ideXlab platform.
-
diagnosis of Triple Lumen Catheter infection comparison of roll plate sonication and flushing methodologies
Journal of Clinical Microbiology, 1997Co-Authors: Robert J Sherertz, Stephen O Heard, Issam I RaadAbstract:In a recent clinical trial, 248 Triple-Lumen Catheters were removed from patients in an intensive care unit, and their tip and subcutaneous segments were cultured by both the sonication and roll plate methods; for 191 of these Catheters, flush cultures of all three Catheter Lumens were also performed. Previously published quantitative endpoints were used to define significant Catheter colonization. By using a composite index as a definition of colonization (any of the seven types of cultures meeting quantitative criteria), sonication of the subcutaneous segment was the most sensitive at detecting colonization (58%), followed by sonication of the Catheter tip (53%). Sonication of both the subcutaneous and tip segments was 20% more sensitive than sonication of an adjacent Catheter segment by the roll plate method (P < 0.05). The greater sensitivity of the sonication method could be attributed to its greater ability than the roll plate method to detect Catheter Lumen colonization (82 versus 57%, respectively; P = 0.01). A greater number of positive Catheter segment cultures were found for colonized Catheters from patients with associated bacteremia than for colonized Catheters from patients without bacteremia (57 versus 37%; P = 0.004), making any culture method more likely to identify them. For Catheters with significant colonization of only one site, the localization was as follows: 36.7% subcutaneous segment, 36.7% Catheter Lumen, and 26.6% tip segment. These findings suggest that the current practice of culturing a single segment of a central vascular Catheter is inadequate and needs to be reexamined. They further suggest that initial colonization of the Catheter Lumen and tip segments may be more important than previously thought and may require a change in thinking of strategies designed to prevent Catheter infection.
-
Roll Plate, Sonication, and Flushing Methodologies
1996Co-Authors: Clin J. Microbiol, Robert J Sherertz, Stephen O Heard, S O Heard, I I Raad, Issam I RaadAbstract:flushing methodologies. comparison of roll plate, sonication, and Diagnosis of Triple-Lumen Catheter infection
Jean Carlet - One of the best experts on this subject based on the ideXlab platform.
-
single versus Triple Lumen central Catheter related sepsis a prospective randomized study in a critically ill population
The American Journal of Medicine, 1992Co-Authors: Jeanchristophe Farkas, J P Bleriot, Sylvie Chevret, F W Goldstein, Jean CarletAbstract:Abstract purpose: A prospective randomized study was conducted over a 23-month period in an adult medical-surgical intensive care unit to determine whether Triple-Lumen Catheters reduce the need for peripheral vascular access and whether they are associated with a higher rate of infection than single-Lumen Catheters. patients and methods: After the insertion route, internal jugular or subclavian, was selected by the physician, patients were randomized either to single-Lumen or Triple-Lumen Catheter groups. Complementary peripheral vascular access was allowed in both groups. Catheters were removed according to preestablished defined reasons: suspicion of Catheter-related sepsis, uselessness of central venous access, duration of Catheterization of more than 21 days, discharge from the intensive care unit, or death. results: Data on 129 central venous Catheters were collected from 91 consecutive patients. Twenty-five of 68 patients from the single-Lumen group and 1 of 61 patients from the Triple-Lumen group needed peripheral vascular access (p conclusion: In intensive care units, the use of Triple-Lumen Catheters is associated with a dramatic decrease in the need for peripheral vascular access. The incidence of central venous Catheter-related sepsis appears identical for single- and Triple-Lumen Catheters.
L P Edwards - One of the best experts on this subject based on the ideXlab platform.
-
influence of Triple Lumen central venous Catheters coated with chlorhexidine and silver sulfadiazine on the incidence of Catheter related bacteremia
JAMA Internal Medicine, 1998Co-Authors: Stephen O Heard, Manisha Wagle, E Vijayakumar, S Mclean, Angela B Brueggemann, Lena M Napolitano, L P EdwardsAbstract:Objective To evaluate the efficacy of Triple-Lumen central venous Catheters coated with a combination product of chlorhexidine and silver sulfadiazine (CSS) in reducing the incidence of local Catheter infection and Catheter-related bacteremia. Design Randomized, controlled trial. Setting The surgical intensive care units in a university hospital. Patients All patients who needed central venous Catheterization were randomized to receive either an uncoated Triple-Lumen Catheter (n=157) or a Catheter coated with CSS (n=151). Main Outcome Measure Catheters were removed when no longer needed or suspected as a cause of infection. The tip and a 5-cm segment of the intradermal portion of the Catheter were cultured semiquantitatively. Blood cultures were obtained when clinically indicated. The remaining segment of Catheters coated with CSS were cut and incubated on an agar plate with strains of Staphylococcus aureus and Enterococcus . Zone of inhibition was determined 24 hours later. Data were analyzed by survival and logistic multivariate regression methods. Results Catheters coated with CSS were effective in reducing the rate of significant bacterial growth on either the tip or intradermal segment (40%) compared with control Catheters (52%; P =.04). However, there was no difference in the incidence of Catheter-related bacteremia (3.8% [uncoated] vs 3.3% [coated]; P =.81). In vitro activity of Catheters with CSS against S aureus was evident up to 25 days but activity against Enterococcus dissipated more quickly over time and was absent by day 4. The most common colonizing organisms were coagulase-negative staphylococcus and enterococcus. Variables that were associated with a significant amount of growth on the tip or intradermal segment were a duration of Catheterization of longer than 7 days, jugular insertion site, and the absence of a CSS coating. The use of a guidewire when the Catheter was removed was associated with a lower risk of significant bacterial growth. Conclusions The use of CSS reduces the incidence of significant bacterial growth on either the tip or intradermal segments of coated Triple-Lumen Catheters but has no effect on the incidence of Catheter-related bacteremia. In this patient population, Catheters coated with CSS provide no additional benefit over uncoated Catheters.
