Candida Infections in Critically Ill Patients

Pittet, Didier

doi:10.1007/978-3-642-85068-4_58

Cited by 9 publications

(9 citation statements)

References 22 publications

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“…ICU patients pose a higher risk and usually have multiple intravenous lines 16 . Prevention is a key issue in order to control mortality associated with catheter use and an increase in costs 16,17 .…”

Section: Discussionmentioning

confidence: 99%

Catheter-Related Infections: Diagnosis and Intravascular Treatment

Bouza

Burillo

Muñóz

2001

Journal of Chemotherapy

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The diagnosis of catheter-related infections relies on the presence of clinical manifestations of infection and the evidence of colonization of the catheter tip by bacteria, mycobacteria or fungi. The reference method to confirm the latter requires the withdrawal of the catheter for culturing, which frequently turns out to be inconvenient, unnecessary and costly. New methods try to avoid these inconveniences and to assess the presence of tip colonization without withdrawal. One of these methods uses quantitative blood cultures with a jump (> or = 5) in colony counts between blood obtained from the catheter lumen and simultaneously from a peripheral vein. It has a high sensitivity (>80%) and specificity (94%-100%) but is cumbersome and requires both an easy backflow of blood in the catheter and the existence of bacteremia. Cytocentrifugation and acridine orange staining of blood withdrawn from an infected catheter lumen has a sensitivity and a specificity of over 90% for the diagnosis of tip colonization. "Superficial cultures" consist in the semiquantitative culture of the hub, of the skin surrounding the catheter entrance and of the first (1 cm) subcutaneous portion of the catheter after swabbing. Sensitivity of this method is >90% and specificity is >80%, and positive and negative predictive values for catheters (considering together those with and without clinical data of infection) are 66% and 97%, respectively. Endoluminal brushing has turned out to be an impractical and unreliable procedure, at least in our experience. New methods based on the speed of bacterial growth to detectable levels of microorganisms in conventional blood cultures are a new and interesting way of assessing catheter-related infections. Besides, as use of antimicrobial-coated catheters becomes more prevalent, the existing definitions of catheter colonization and catheter-related infection may need to be modified, because such coatings may lead to false-negative culture results. Many catheter infections, diagnosed without catheter withdrawal, can be handled nowadays with the so-called "antibiotic lock-in technique", which consists in locking the infected catheter lumen with a solution containing antibiotics. A high proportion of infected catheters, mainly those with coagulase-negative staphylococci, can be maintained in place and sterilized with this technique, including catheters in patients with therapeutic failure after receiving conventional intravenous antibiotic therapy. New diagnostic and therapeutic techniques may avoid the unnecessary withdrawal of thousands of efficient, difficult to replace and expensive intravascular lines.

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Section: Discussionmentioning

confidence: 99%

Catheter-Related Infections: Diagnosis and Intravascular Treatment

Bouza

Burillo

Muñóz

2001

Journal of Chemotherapy

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“…49,50 The traditional method for determining catheter colonization utilizes a semiquantitative culture technique in which a 5-cm segment of catheter is rolled across blood agar. 51 Sonication/enrichment culture has been shown to be equally sensitive.…”

Section: Catheter Infectionmentioning

confidence: 99%

The Role of Bacterial Biofilms in Device-Associated Infection

Deva

Adams

Vickery

2013

Plastic and Reconstructive Surgery

222

121

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There is increasing evidence that bacterial biofilm is responsible for the failure of medical devices, leading to device-associated infection. As plastic surgeons, we are among the leading users of prostheses in surgery, and it is important that we are kept informed of this growing problem. This article summarizes the pathogenesis of device-associated infection, outlines the evidence for such infection in a number of medical devices, and outlines operative strategies aimed at reducing the risk of bacterial contamination at the time of device deployment. It also outlines strategies under investigation to combat the development of device-associated infection.

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“…[1][2][3][4][5] Several risk factors affecting ICU mortality other than nosocomial infection have been reported, such as diagnosis on admission, invasive procedures and treatments, severity of illness scores and the length of ICU stay. [6][7][8][9] Few of the studies evaluating the effect of nosocomial infection on mortality examined the relationship in a neurology ICU.…”

Section: Introductionmentioning

confidence: 99%