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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...

CD4+RTE% predicts disease progression and may reflect history of disease in HIV-positive patients and adolescents. They are easy to measure in the clinical setting and may be helpful markers in guiding treatment decisions.

Background A growing number of parents refuse vaccination due to concerns about side effects. Influenza vaccine is no exception and remains one of the most controversial vaccines. Data regarding influenza vaccine uptake and parental knowledge, attitude and practice towards vaccination in the Lebanese population is lacking. The aim of this study was to assess the rate of vaccination refusal and potential associated factors among Lebanese parents of school-aged children, in general and with a focus on influenza vaccine. Methods A parent questionnaire was distributed in randomly selected 2 public and 2 private schools from the greater Beirut area during the school year 2017–2018. Questionnaires covered knowledge, attitude (including themes of efficacy, hesitancy and trust), and practice of vaccination in general and influenza vaccine in particular. Results The response rate was 76.5% (306/400). Overall, 29.4% parents reported vaccinating their children against influenza (62.2% in private and 37.7% in public schools). Younger age, paternal employment and higher household income were associated with higher vaccination rates (p = 0.01, 0.02 and <0.0001 respectively). Lack of vaccine recommendation by the physician was the most common reason for not taking it (47%). Parents who accepted influenza vaccination had higher scores in efficacy, hesitancy and trust and were more compliant with other vaccinations. Conclusion One third of parents of school aged children in the greater Beirut area vaccinate their children against influenza. This rate is likely lower in rural remote areas. Physician’s recommendation is the single most important predictor of such vaccination. Future studies tackling physicians’ attitude and practice are needed to help improve influenza vaccination rates in the Lebanese population.

Our predictive model can be used to identify children for whom Enterovirus PCR testing is warranted. Such testing could avoid unnecessary hospitalization and antibiotic administration.