Resistant Gram-negative bacteria are increasing central-line-associated bloodstream infection threats. To better combat this, chlorhexidine (CHX) was added to minocycline-rifampin (M/R) catheters. The in vitro antimicrobial activity of CHX-M/R catheters against multidrug resistant, Gram-negative Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia was tested. M/R and CHX-silver sulfadiazine (CHX/ SS) catheters were used as comparators. The novel CHX-M/R catheters were significantly more effective (P < 0.0001) than CHX/SS or M/R catheters in preventing biofilm colonization and showed better antimicrobial durability. Central venous catheters (CVCs) are essential medical devices in the care of critically ill and cancer patients. Despite their significant usefulness, CVCs are also the source of 87% of the bloodstream infections that occur in intensive care units (1), with attributable mortality rates ranging from 13 to 25% and increases in hospital stays ranging from 7 to 12 days (2, 3). In the United States, more than 5 million CVCs are inserted annually (4, 5) and are responsible for 250,000 to 400,000 annual cases of health careassociated bloodstream infections (6, 7). Hence, central-line-associated bloodstream infections (CLABSIs) are the most common and serious complications associated with indwelling CVCs (5).CVCs coated with antimicrobial agents have been proven to considerably reduce the risk of CLABSIs, and the use of antimicrobial CVCs has become a standard of care (8, 9). Two antimicrobial CVCs, minocycline-rifampin (M/R) and chlorhexidinesilver sulfadiazine (CHX/SS), were clinically proven to reduce CLABSIs at a time when skin-derived, Gram-positive bacteria were the most significant pathogens and were given CDC category 1A recommendations in the most recent guidelines for the prevention of intravascular-catheter-related infections (8-10). However, significant advances in skin antisepsis and sterile barrier precautions have shifted the epidemiologic threat increasingly to Gram-negative bacteria (11). The in vitro efficacy of M/R and CHX/SS against emerging Gram-negative pathogens is limited. In this report, we describe the development of a chlorhexidine-minocycline-rifampin (CHX-M/R) CVC. We compared the antimicrobial adherence activity and durability of M/R, CHX/SS, and CHX-M/R CVCs in a well-established in vitro model for the preventing biofilm colonization by multidrug-resistant clinical isolates of A. baumannii, E. cloacae, E. coli, K. pneumoniae, P. aeruginosa, and S. maltophilia. These organisms were found to contribute to the majority of Gram-negative CLABSIs in the United States from 2009 to 2010 (12). Developing an antimicrobial catheter with broad-spectrum antifungal and antibacterial activity that includes resistant Gram-negative bacteria is of paramount importance because of the mortality rates associated with Gram-negative bacteremia, which may exceed 40% (13,14).CHX-M/R was prepared by a proprietary ...

In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies showed that a minocycline-EDTA-ethanol (M-EDTA-EtOH) lock solution may eradicate microbial organisms in biofilms, hence enabling the treatment of central line-associated bloodstream infections (CLABSI) while retaining the catheter in situ. Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted. Each catheter lumen was locked with an M-EDTA-EtOH solution for 2 h administered once daily, for a total of 7 doses. Patients who received locks had clinical characteristics that were comparable to those of the control group. The times to fever resolution and microbiological eradication were similar in the two groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy than that of the control patients (median, 11 days versus 16 days, respectively; P < 0.0001), and they were able to retain their CVCs for a median of 74 days after the onset of bacteremia. The M-EDTA-EtOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to that of the CVC removal/reinsertion group, who received a longer duration of systemic antimicrobial therapy. (This study has been registered at ClinicalTrials.gov under registration no. NCT01539343.) L ong-term central venous catheters have become a lifeline for patients with cancer, those undergoing transplant, or longterm hemodialysis patients. More than five million central venous catheters (CVCs) are inserted annually in the United States, resulting in approximately 400,000 episodes of central line-associated bloodstream infections (CLABSI) and catheter-related bloodstream infections (CRBSI) (1, 2), each associated with an attributable mortality of 12 to 35% (3, 4) and an attributable cost of $34,508 to $56,000 per episode (5). For CLABSI/CRBSI associated with long-term CVCs (including cuffed/tunneled CVCs or ports with a dwell time of Ͼ30 days), the lumen of the catheter is the major source of colonization and subsequent bacteremia (6).The conventional standard of care in the management of CLABSI/CRBSI involves removal of the infected CVC and replacement with a new catheter at a different vascular site (7). However, in cancer, transplant, and hemodialysis patients with long-term catheters, removal of the CVC and reinsertion of a new catheter at a different site might be difficult or even impossible because of the unavailability of accessible vascular sites. Furthermore, these seriously ill patients with CLABSI/CRBSI and sepsis often have underlying thrombocytopenia or coagulopathy, which would make reinsertion of a new CVC at a different site risky given these comorbidities and related mechanical complications, such as blee...

We present a case of fatal hemorrhagic pneumonia secondary to Stenotrophomonas maltophilia in a patient with acute myeloid leukemia. S. maltophilia is commonly a non-virulent pathogen. However, in the immunocompromised, it is generally associated with bacteremia after central venous catheter placement or pneumonia. Hemorrhagic pneumonia is a rare presentation of this bacteria, with only 31 cases reported in the literature, and has 100% mortality within 72 hours. Rapid recognition and early suspicion should be key in the treatment of these patients.

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