To determine the incidence rate of complications associated with vascular catheters in intensive care unit patients and to analyze risk factors for a positive vascular culture, we performed a multicenter study of intensive care unit patients at eight French hospitals. During the study period, 865 intravenous catheters were inserted in 566 patients; 362 (41.8%) were peripheral catheters, and 503 (58.2%) were central catheters. Local complications (i.e., infiltration) occurred significantly more often with peripheral than with central catheters (P < 0.001); in contrast, fever and bacteremia were significantly more often associated with central than with peripheral catheters (P < 0.01 and P < 0.05, respectively). The culture of the vascular-catheter tip was positive for 24% of central catheters (32 of 1,000 catheters days) and for 9% of peripheral catheters (21 of 1,000 catheters days). Staphylococcus epidermidis was the most common microorganism isolated from both peripheral and central catheters, followed by Staphylococcus aureus and Pseudomonas aeruginosa. No significant risk factor associated with positive cultures for peripheral catheters was found by univariate analysis. In contrast, the purpose of the cannula (nutrition and monitoring of central venous pressure), the insertion site (jugular), the dressing type (semipermeable transparent dressing), the antiseptic used to prepare the insertion site (povidone iodine), and routine changing of the intravenous administration set were significantly associated with positive cultures of central catheters. Three factors, duration of catheterization, use of a semipermeable transparent dressing, and the jugular insertion site, were found to be independently associated with positive cultures of central catheters by multivariate analysis.

Summary:The efficacy of preemptive therapy was evaluated in bone marrow transplantation (BMT) recipients associated with Chagas disease (CD). The criterion to include patients in the protocol was the serological reactivity for CD in recipients and/or donors before transplant. After BMT, the monitoring was performed using the direct Strout method (SM), which detects clinical levels of Trypanosome cruzi parasitemia, and CD conventional serological tests. Monitoring took place during 60 days in ABMT and throughout the immunosuppressive period in allogeneic BMT. Reactivation of CD was diagnosed by detecting T. cruzi parasites in blood or tissues. In primary T. cruzi infection, an additional diagnostic criterion was the serological conversion. A total of 25 CD-BMT patients were included. Two ABMT and four allogeneic BMT recipients showed CD recurrences diagnosed by SM. One patient also showed skin lesions with T. cruzi amastigotes. Benznidazole treatment (Roche Lab), an antiparasitic drug, was prescribed at a dose of 5 mg/kg/day during 4-8 weeks with recovery of patients. Primary T. cruzi infection was not observed. This report proves the relevance of monitoring CD in BMT patients and demonstrates that preemptive therapy was able to abrogate the development of clinical and systemic disease.

Summary:and systemic tissue spread are also features of this stage. After the acute phase, patients enter an asymptomatic or indeterminate period, a long-lasting period of up to 10-30 We report the clinical course of five adult patients with chronic Chagas' disease (Cd) who underwent BMT.years in which patients persist with serological reactivity and subclinical parasitemia.3 Trypanosoma cruzi, the etioTwo patients with non-Hodgkin's lymphoma and one with ALL received an ABMT. Allogeneic BMT was perlogic protozoan agent, is transmitted to human beings in the endemic areas by sucking insects. 1 In urban areas of formed in two patients with AML and CML respectively. One donor had chronic Cd. Samples of peripheral developed and underdeveloped non-endemic countries, transmission through blood transfusions has acquired relblood for parasite investigation by the Strout method, blood culture, and immunological studies by indirect evance because infected people migrate to populated cities and are potential blood, bone marrow or organ donors. 4,5immunofluorescent assay, ELISA and indirect hemagglutination tests were performed weekly from the start Detection of high level of parasitemia has not been described during the course of chronic Cd in immunocomof chemotherapy until day +60 for ABMT and during the period of immunosuppression for allogeneic BMT.petent individuals. However, in immunosuppressed patients reactivation of chronic Cd associated with leukemia, 6 lymNo prophylaxis was given to any of these patients. In only one ABMT patient were trypomastigotes detected phoma, 7 heart, 8 BM 9 and kidney transplantation 10 and HIV infection, 11 has been reported. early by blood culture without symptoms of reactivation. Benznidazole as preemptive treatment wasWe report the course of chronic Cd in five patients undergoing BMT and define control measures for early administered at 5-8 mg/kg/daily for 30 days. Parasitemia was rapidly cleared and at the end of therapy detection of parasitemia and/or reactivation using a preemptive approach to avoid the development of clinical disease. xenodiagnosis was negative. The other Cd patients showed no evidence of relapse of parasitemia or signs and symptoms of reactivation. In brief, evidence of Cd should be sought in all BMT patients coming from Materials and methods endemic areas because parasitemia and reactivation are potential complications during the period of neutroBetween January 1989 and December 1996 we performed 28 allogeneic and 206 ABMT. In allogeneic patients penia and immunosuppression. The strategy used for early detection and treatment of parasitemia and reactiimmunosuppressive therapy to prevent acute GVHD included CsA and MTX. Selection criteria for including vation was safe and effective.

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Objetivo: A pneumonia associada à ventilação mecânica (PAVM) é uma séria complicação da ventilação mecânica (VM). Entretanto, dados sobre PAVM em pacientes em VM prolongada (VMP) são escassos. Nosso objetivo foi descrever as características de pacientes com PAVM em VMP e identificar fatores associados à mortalidade. Métodos: Estudo de coorte retrospectivo incluindo pacientes com PAVM em VMP. Foram registradas características basais, bem como as taxas de mortalidade em 30 e 90 dias. As variáveis associadas à mortalidade foram determinadas por meio da análise de sobrevida de Kaplan-Meier e do modelo de regressão de Cox. Resultados: Foram identificados 80 episódios de PAVM em 62 indivíduos em VMP. As medianas de idade, índice de comorbidade de Charlson, pontuação no SOFA, e dias em VM foram, respectivamente, de 69,5 anos, 5, 4 e 56 dias. Os episódios de PAVM ocorreram entre o 21º e o 50º dia de VM em 28 pacientes (45,2%) e até o 90º dia de VM em 48 pacientes (77,4%). As taxas de mortalidade em 30 e 90 dias foram de 30,0% e 52,5%, respectivamente. A mortalidade em 30 dias associou-se a pontuação no SOFA (razão de risco [