Hub Colonization as the Initial Step in an Outbreak of Catheter‐Related Sepsis Due to Coagulase Negative Staphylococci during Parenteral Nutrition

Sitges‐Serra, Antonio; Puig, P. Aguirre; Liñares, Josefina; Pérez, José Luís; Farreró, N.; Jaurrieta, Eduardo; Garau, Javier

doi:10.1177/0148607184008006668

Cited by 199 publications

(75 citation statements)

References 19 publications

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“…8 They reported that the hub of a catheter was the most important source of catheter-related infections. 9 This hypothesis has been supported by several studies. [23][24][25][26] Consequently, we adopted the closed hub system for the catheter connection in our patients.…”

Section: Discussionmentioning

confidence: 61%

Prevention of Catheter-Related Infections Using A Closed Hub System in Patients With Pulmonary Arterial Hypertension

Akagi

Matsubara

Ogawa

et al. 2007

Circ J

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ulmonary arterial hypertension (PAH) is a rare disease of poor prognosis. Recently, continuous intravenous epoprostenol (EPO) was introduced as a treatment for PAH with the consequent improvement of the patients' quality of life. 1 Although therapy with EPO improves the patients' exercise capacity and prognosis, various complications related to the central venous catheters arise during long-term treatment with EPO. 2,3 Among them, catheter-related infection is a serious problem, because the infections aggravate the primary disease.The incidence of catheter-related infections was reported to be 0.3-9.1 infections per 1,000 patient-days in patients with long-term, indwelling central venous catheters for various diseases. [4][5][6] According to a recent report by Oudiz et al, at least 10% of their patients with a catheter infection required admission to critical care wards and several patients died as a direct consequence of the catheter infection, although the incidence of catheter-related infections in patients with PAH receiving EPO was lower than that in patients with other diseases. It has already been reported that the catheter hub was the most important source of catheter-related infections 8,9 and thus several closed hub systems have been introduced. 10,11 In the present study, we adopted the closed hub system for patients with PAH receiving EPO to prevent bacterial invasion from the catheter hub. Methods Closed Hub SystemWe introduced the closed hub system after March 2002. This system consists of 2 parts (Fig 1). One part is the Hickman catheter connected to an extension tube (Figs 1A, B,D), and the other part is the infusion port for EPO in medication baggage (Fig 1C). The connection between the Hickman catheter and extension tube is a commercially available catheter connection system (I-system; Nipro Corporation, Japan). The I-system consists of an I-plug (a cap with a latex end injection plug with a male screw) and an I-set (a 21-gauge needle with a Luer -Lock female screw) (Fig 1B). The I-plug is applied to the hub of the Hickman catheter (Fig 1A). The needle of the I-set is inserted into the latex end of the I-plug. Then, the I-plug and I-set are fixed together by the Luer -Lock. The infusion port for EPO in the medication baggage consists of a plug made of latex (Fig 1C). Study PopulationFrom Background Most of the patients with pulmonary arterial hypertension (PAH) receiving intravenous epoprostenol have experienced catheter-related infections during long-term treatment. Catheter hub was reported to be the most important source of catheter-related infections. To prevent the catheter-related infections, we have introduced a closed hub system and compared the incidence of catheter-related infections with that in patients using a non-closed hub system. Methods and ResultsWe evaluated the results obtained on 24 occasions in 20 patients with PAH between June 1999 and December 2005. On 11 occasions, a non-closed hub system was used and on 13 cases a closed hub system. We classified the catheter-related ...

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Section: Discussionmentioning

confidence: 61%

Prevention of Catheter-Related Infections Using A Closed Hub System in Patients With Pulmonary Arterial Hypertension

Akagi

Matsubara

Ogawa

et al. 2007

Circ J

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“…3) (107). However, investigators from Barcelona, Spain, have suggested that this figure omits an additional route of catheterrelated infection: contamination of the catheter hub (45,99,175). In one study of 135 subclavian catheters, 14 (70%) of 20 episodes of bacteremia were thought to have originated from a contaminated hub, with secondary colonization of the catheter tip (99).…”

Section: Sources Of Microorganisms Causing Infusion-related Infectionsmentioning

confidence: 99%

Pathogenesis of infections related to intravascular catheterization

1993

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Over the past few decades, there have been major technological improvements in the manufacture of intravenous solutions and the manufacture and design of catheter materials. However, the risk of infection in patients receiving infusion therapy remains substantial, in part because of host factors (for example, increased use of immunosuppressive therapy, more aggressive surgery and life support, and improved survival at the extremes of life) and in part because of the availability of catheters that can be left in place for very long periods. Microbial components of normal skin flora, particularly coagulase-negative staphylococci, have emerged as the predominant pathogens in catheter-associated infections. Therefore, efforts to prevent skin microorganisms from entering the catheter wound (such as tunnelling of catheters and use of catheter cuffs and local antimicrobial agents) are logical and relatively effective. The specific properties of microorganisms that transform normally harmless commensals such as coagulase-negative staphylococci into formidable pathogens in the presence of a plastic foreign body are being explored. For example, Staphylococcus epidermidis elaborates a polysaccharide adhesin that also functions as a capsule and is a target for opsonic killing. However, the interactions between microorganism and catheter that lead to adherence, persistence, infection, and dissemination appear to be multifactorial.

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“…Blood culture contamination rates are considerably increased due to hub colonization if the blood is withdrawn from central venous lines as opposed to by venipuncture. (3,16,26,(40)(41)(42)52) The purpose of the current retrospective case-control study was four fold. First, we desired to determine, over a period of 1 year, the rate of CoNS blood contamination and infection in a group of patients from a unit (adult oncology) with a high frequency of central lines and thus high contamination and infection rates.…”

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confidence: 99%

Clonal Dissemination of Staphylococcus epidermidis in an Oncology Ward

Muldrew¹,

Tang

et al. 2008

J Clin Microbiol

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Coagulase-negative staphylococci (CoNS) are the main cause of catheter-related infections, especially among immunosuppressed and neutropenic patients, as well as a source of bacterial contamination in blood cultures. Using biochemical identification and pulsed-field gel electrophoresis (PFGE), we sought to identify possible clonal isolates of bacteremia in patients with central lines in an oncology ward (OW), with comparison to isolates that were recovered by venipuncture from an adult emergency room (ER Coagulase-negative staphylococci (CoNS) are the main cause of catheter-related infections, especially among immunosuppressed and neutropenic patients (6,43,48,50). Moreover, studies have used biochemical identification and genotypic analysis to illustrate clonal infections that occur in specific units. (2, 5, 6, 12, 17-19, 23, 24, 28-30, 33-35, 38, 43, 44, 48, 49, 51) Other studies have shown differences in the production of possible virulence factors such as lipase, esterase, elastase, and biofilm (polysaccharide intercellular adhesin [ica operon]) among strains seen in patients with catheter-related infections versus a nonseptic control groups (7,11,13,29,32,43,53). Production of biofilm may allow these isolates to preferentially colonize the catheter, catheter hub, and other indwelling medical devices while escaping the immune system and antibiotics This may lead to an increased frequency of bacteremia, falsepositive blood cultures, and catheter-related septicemia due to hub colonization (7,9,13,15,21,32,52,53). Still, other studies suggest that gut translocation with its resultant bacteremia leads to a significant number of cases of CoNS septicemia, particularly in cancer patients (8,9,17,33).Blood culture contamination by CoNS is also a significant cause of positive blood cultures, leading to a problem in the determination of true bacteremia (9, 34, 36, 37, 52). As a result, there is a marked increased in the financial burden, with an estimated cost of $5,000 to $10,000 per false-positive blood culture due to more extensive laboratory testing, pharmacy costs, radiological procedures (echocardiograms), and unnecessary increased lengths of stay (4, 36, 37). Blood culture contamination rates are considerably increased due to hub colonization if the blood is withdrawn from central venous lines as opposed to by venipuncture. (3,16,26,(40)(41)(42)52) The purpose of the current retrospective case-control study was four fold. First, we desired to determine, over a period of 1 year, the rate of CoNS blood contamination and infection in a group of patients from a unit (adult oncology) with a high frequency of central lines and thus high contamination and infection rates. Second, we sought to identify to species level the study group CoNS isolates (those from central lines in the oncology ward [OW]) and isolates from a control group (samples obtained from peripheral venipuncture from the adult emergency room [ER]) and compare the colonization/infection rates between the two groups of patients by examination of the m...

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Hub Colonization as the Initial Step in an Outbreak of Catheter‐Related Sepsis Due to Coagulase Negative Staphylococci during Parenteral Nutrition

Cited by 199 publications

References 19 publications

Prevention of Catheter-Related Infections Using A Closed Hub System in Patients With Pulmonary Arterial Hypertension

Prevention of Catheter-Related Infections Using A Closed Hub System in Patients With Pulmonary Arterial Hypertension

Pathogenesis of infections related to intravascular catheterization

Clonal Dissemination of Staphylococcus epidermidis in an Oncology Ward

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