Analysis of Risk Factors for Peripherally Inserted Central Venous Catheter-Associated Bloodstream Infection

Ji Young Jang,Sungho Lee,Kwanhoon Park,Kang Yoon Lee,Dongbeen Choi 대한외상중환자외과학회 2024 Journal of Acute Care Surgery Vol.14 No.1

Purpose: Despite guidelines on the prevention of central venous line-associated bloodstream infection, itis left to the clinical judgment of the attending physician to determine the risk of infection and how longa central line should remain in place. This study aimed to identify risk factors for peripherally insertedcentral venous catheter (PICC)-associated infection. Methods: This retrospective study included 1,136 patients with a PICC who were hospitalized at theNational Health Insurance Service Ilsan Hospital (January 2015 to January 2022). Electronic medicalrecords were reviewed for patients with positive blood cultures. Patients with suspicion of infection atthe PICC insertion site or with unclear infection at other sites were defined as having a PICC-associatedinfection. Results: Thirty-five patients (3.08%) had a PICC-associated infection. There were significant differencesin hypertension (p = 0.026), lung disease (p = 0.001), PICC duration > 14 days, and antibiotic use beforePICC insertion (p = 0.016) between no PICC-associated infection, and infection in the bloodstream. Total parenteral nutrition with PICC was not significantly different between groups. Logistic regressionanalysis identified hypertension, lung disease, PICC duration > 14 days (OR 2.088, 95% CI 1.032-4.224, p = 0.041), and antibiotic use before PICC insertion (OR 0.159, 95% CI 0.049-0.515, p = 0.002) asindependent risk factors for PICC-associated infection. Conclusion: The study suggested that PICCs maintained longer than 14 days is a risk factor for PICC-associated infection. Antibiotic use prior to PICC insertion was observed as a negative factor for PICC-associated infection.

진균혈증의 발생과 결과에 대한 고찰

최영화,박윤수,조정호,홍성관,장경희,송영구,김준명 대한감염학회 2000 감염 Vol.32 No.5

Epidemiology and Clinical Features of Post-Transplant Bloodstream Infection: An Analysis of 222 Consecutive Liver Transplant Recipients

김현경,박용근,왕희정,김봉완,신소연,임승관,최영화 대한감염학회 2013 Infection and Chemotherapy Vol.45 No.3

Background: Bloodstream infection (BSI) is a significant cause of morbidity and mortality in liver transplant (LT) recipients. This study aimed to investigate the epidemiology and clinical features of post-transplant BSI in LT recipients. Materials and Methods: The microbiology, frequency, and outcome of post-transplant BSI in the first year after LT were retrospectively analyzed in 222 consecutive patients who had received liver transplants at a single center between 2005 and 2011. The risk factors for post-transplant BSI and death were evaluated. Results: During a 1-year period after LT, 112 episodes of BSI occurred in 64 of the 222 patients (28.8%). A total of 135 microorganisms were isolated from 112 BSI episodes including 18 polymicrobial episodes. The median time to BSI onset ranged from 8 days for Klebsiella pneumoniae to 101 days for enterococci, and the overall median for all microorganisms was 28 days. The most frequent pathogens were Enterobacteriaceae members (32.5%), enterococci (17.8%), yeasts (14.0%), Staphylococcus aureus (10.3%), and Acinetobacter baumannii (10.3%); most of them showed resistance to major antibiotics. The major sources of BSI were biliary tract (36.2%), abdominal and/or wound (28.1%), and intravascular catheter (18.5%) infections. The independent risk factors for post-transplant BSI were biliary complications (odds ratio [OR]: 2.91, 95% confidence interval [CI]: 1.29to 6.59, P = 0.010) and longer hospitalization in the intensive care unit (OR: 1.04, 95% CI: 1.00 to 1.08, P < 0.001) after LT. BSI was an independent risk factor for death (hazard ratio [HR]: 3.92, 95% CI: 2.22 to 6.91, P < 0.001), with a poorer survival rate observed in patients with BSI than in those without BSI (1-year survival rate: 60.0% versus 89.5%, respectively, P < 0.001)after LT. The strongest predictors for death in patients with BSI were hepatocellular carcinoma (HR: 3.82, 95% CI: 1.57 to 9.32,P = 0.003), candidemia (HR: 3.71, 95% CI: 1.58 to 8.71, P = 0.003), polymicrobial bacteremia (HR: 3.18, 95% CI: 1.39 to 7.28,P = 0.006), and post-transplant hemodialysis (HR: 2.44, 95% CI: 1.02 to 5.84, P = 0.044). Conclusions: BSI was a frequent post-transplant complication, and most of the causative pathogens were multi-drug resistant. Biliary complications and BSIs resulting from biliary infection are major problems for LT recipients. The prevention of BSI and biliary complications is critical in improving prognosis in liver transplant recipients.

Risk Factors for Extended-Spectrum-β-Lactamase-Producing Escherichia coli in Community-Onset Bloodstream Infection: Impact on Long-Term Care Hospitals in Korea

Baek Yae Jee,Kim Young Ah,Kim Dokyun,Shin Jong Hee,Uh Young,Shin Kyeong Seob,Shin Jeong Hwan,Jeong Seok Hoon,Lee Geun Woo,Lee Eun Ji,Kim Dong-Sook,Park Yoon Soo 대한진단검사의학회 2021 Annals of Laboratory Medicine Vol.41 No.5

Background: The prevalence of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) in the community has increased worldwide due to multifactorial reasons. ESBL-EC bloodstream infection (BSI) complicates the decision for proper antimicrobial administration. In this multicenter study, we investigated the prevalence, risk factors, and molecular background of community-onset (CO) ESBL-EC BSI. Methods: We included data for all episodes of ESBL-EC BSI of community origin from May 2016 to April 2017 obtained from the Korean national antimicrobial resistance surveillance system, which comprises six sentinel hospitals. Data, including previous history of admission and use of antimicrobials and medical devices before BSI, were collected, along with microbiological analysis results. Results: Among 1,189 patients with CO BSI caused by E. coli, 316 (27%) were identified as ESBL producers. History of admission, especially to a long-term care hospital (LTCH), and previous use of β-lactams/β-lactamase inhibitors, carbapenem, lincosamide, aminoglycoside, and extended-spectrum cephalosporin were independent risk factors for CO ESBL-EC BSI; admission to an LTCH showed the highest odds ratio (3.8, 95% confidence interval 2.3–6.1). The most common genotype was CTX-M-15 (N=131, 41%), followed by CTX-M-14 (N=86, 27%). ST131 was the most common sequence type among ESBL-EC groups (57%). Conclusions: In Korea, 27% of CO E. coli BSI were caused by ESBL producers. From perspectives of empirical treatment and infection control, history of admission to an LTCH and antimicrobial use should be noted.

Duplex dPCR System for Rapid Identification of Gram-Negative Pathogens in the Blood of Patients with Bloodstream Infection: A Culture-Independent Approach

( Juyoun Shin ),( Sun Shin ),( Seung-hyun Jung ),( Chulmin Park ),( Sung-yeon Cho ),( Dong-gun Lee ),( Yeun-jun Chung ) 한국미생물 · 생명공학회 2021 Journal of microbiology and biotechnology Vol.31 No.11

Early and accurate detection of pathogens is important to improve clinical outcomes of bloodstream infections (BSI), especially in the case of drug-resistant pathogens. In this study, we aimed to develop a culture-independent digital PCR (dPCR) system for multiplex detection of major sepsis-causing gram-negative pathogens and antimicrobial resistance genes using plasma DNA from BSI patients. Our duplex dPCR system successfully detected nine targets (five bacteria-specific targets and four antimicrobial resistance genes) through five reactions within 3 hours. The minimum detection limit was 50 ag of bacterial DNA, suggesting that 1 CFU/ml of bacteria in the blood can be detected. To validate the clinical applicability, cell-free DNA samples from febrile patients were tested with our system and confirmed high consistency with conventional blood culture. This system can support early identification of some drug-resistant gram-negative pathogens, which can help improving treatment outcomes of BSI.

Two Cases of Medical Device-Related Corynebacterium striatum Infection: A Meningitis and A Sepsis

박설희,정혜선,서의교,문영철,이미애 대한임상미생물학회 2016 Annals of clinical microbiology Vol.19 No.1

Corynebacterium striatum is a commonly isolated contaminant in the clinical microbiology. However, it can be an opportunistic pathogen in immunocompromised and even immunocompetent hosts. The increasing prevalence of C. striatum infection has been associated with immunosuppression and prosthetic devices. We report a case of meningitis with cerebrospinal fluid drainage and a case of catheter-related bloodstream infection caused by C. striatum. The isolates were identified as nondiphtherial Corynebacterium species by VITEK 2 (bioMérieux, France) anaerobe and Corynebacterium card. The final identification by 16S rRNA gene sequencing analysis was C. striatum with 99.7% identity and 99.6% identity with C. striatum ATCC 6940, respectively. Both strains were sensitive to vancomycin and gentamicin, but multidrug- resistant to ciprofloxacin, penicillin, erythromycin and imipenem.

Interventions to Prevent Catheter-Associated Bloodstream Infections: A Multicenter Study in Korea

유선미,정숙인,김광숙,임덕순,손장욱,김정연,김지은,장윤숙,정선주,배현주 대한감염학회 2010 Infection and Chemotherapy Vol.42 No.4

Background: The purpose of this study was to determine the efficacy of infectioncontrol interventions to decrease the incidence of catheter-associated bloodstream infections (CA-BSI) and to examine the sustainability of its effect during and after the intervention in Korea. Materials and Methods: We conducted a prospective multi-strategy intervention in intensive care units (ICUs) at 3 university hospitals in Korea. The intervention consisted of education and on-site training for medical personnel involved in catheter care, active surveillance, and reinforcement of current intervention in each unit. After the intervention of 3 months, we identified CA-BSI cases of each hospital using the electronic database for 6 months. Results: During the intervention, the number of CA-BSI decreased significantly compared to pre-interventional period (8.7 vs. 2.3 per 1,000 catheter days; rate ratio 0.28; 95% CI, 0.13-0.61). After the intervention, CA-BSI rate increased slightly,but was still significantly lower than that of pre-interventional period (4.3 per 1,000catheter days; rate ratio, 0.49; 95% CI, 0.31-0.78). Reduction of gram-negative bacterial infections was noted during and after the intervention. Conclusions: A multi-strategy approach to reduce CA-BSI could be implemented in diverse settings of medical and surgical units in Korea and decreased CA-BSI rates during the intervention.

의료관련감염에서 감시 개선을 위한 평가

박창은 대한임상검사과학회 2019 대한임상검사과학회지(KJCLS) Vol.51 No.1

The development of reliable and objective definitions as well as automated processes for the detection of health care-associated infections (HAIs) is crucial; however, transformation to an automated surveillance system remains a challenge. Early outbreak identification usually requires clinicians who can recognize abnormal events as well as ongoing disease surveillance to determine the baseline rate of cases. The system screens the laboratory information system (LIS) data daily to detect candidates for health care-associated bloodstream infection (HABSI) according to well-defined detection rules. The system detects and reserves professional autonomy by requiring further confirmation. In addition, web-based HABSI surveillance and classification systems use discrete data elements obtained from the LIS, and the LIS-provided data correlates strongly with the conventional infection-control personnel surveillance system. The system was timely, acceptable, useful, and sensitive according to the prevention guidelines. The surveillance system is useful because it can help health care professionals better understand when and where the transmission of a wide range of potential pathogens may be occurring in a hospital. A national plan is needed to strengthen the main structures in HAI prevention, Healthcare Associated Prevention and Control Committee (HAIPCC), sterilization service (SS), microbiology laboratories, and hand hygiene resources, considering their impact on HAI prevention. 감염감시를 위한 신뢰성 있고 객관적인 의료관련 감염의 정의 및 자동화 된 프로세스를 개발하는 것이 중요하다. 그러나 자동화 된 감시 시스템으로의 전환은 여전히 어려운 과제이다. 초기의 발생 확인은 대개 비정상적인 사건과 진행중인 질병 감시를 인식하는 임상 검사자들이 기준선 비율을 결정하도록 요구한다. 이 시스템은 잘 정의 된 감시 규칙에 따라 의료 관련 혈류감염의 후보를 감시하기 위해 매일 검사정보 시스템 데이터를검사한다. 시스템은 추가 확인을 요구함으로써 전문적인 자율성을 탐지하고 예약한다. 또한 웹 기반 혈류감염 감시 및 분류 시스템은 검사실 정보 시스템에서 얻은 개별 데이터 요소를 사용할 수 있고 검사정보 시스템은 기존의 감염 제어 인력 감시 시스템과 높은 상관관계가 있는 데이터를 제공한다. 이런 시스템은예방 지침에 따를 경우 적절하고, 수용 가능하며, 유용하고 민감하다. 감시 시스템은 병원에서 광범위한 병원균의 전파가 언제어디서 발생하는지에 대한 이해를 획기적으로 향상시키기 때문에 유용하다. 국가적 차원의 계획은 의료관련감염 예방, 보건 관련 예방 통제위원회(HAIPCC), 살균 서비스(SS), 미생물학 실험실, 손 위생 차원의 주요 구조를 강화하기 위해 추진되어야하며해당 지역은 의료관련 감염 예방에 미치는 영향을 고려하여 선정해야 한다.

Chlorhexidine and silver sulfadiazine coating on central venous catheters is not sufficient for protection against catheter-related infection: Simulation-based laboratory research with clinical validation

Choi, Yoon Ji,Lim, Jae Kwan,Park, Jeong Jun,Huh, Hyub,Kim, Dong-Joo,Gong, Chang-Hoon,Yoon, Seung Zhoo Cambridge Medical Publications Ltd 2017 The Journal of international medical research Vol.45 No.3

<P><B>Objective</B></P><P>The efficacy of chlorhexidine- and silver sulfadiazine-coated central venous catheters (CSS-CVC) against catheter-related infection remains controversial. We hypothesized that the loss of silver nanoparticles may reduce the antibacterial efficacy of CSS-CVCs and that this loss could be due to the frictional force between the surface of the CVC and the bloodstream. The objective of this study was to investigate whether the antimicrobial effect of CSS-CVCs decreases with increasing exposure time in a bloodstream model and quantitatively assay the antimicrobial effect of CSS-CVCs compared with polyurethane and antiseptic-impregnated CVCs.</P><P><B>Methods</B></P><P>Each CVC was subjected to 120 hours of saline flow and analyzed at intervals over 24 hours. The analyses included energy-dispersive X-ray spectroscopy, scanning electron microscopy, and optical density after a <I>Staphylococcus aureus</I> incubation test.</P><P><B>Results</B></P><P>The weight percentage of silver in the CSS-CVCs significantly decreased to 56.18% (44.10% ± 3.32%) with 48-hour catheterization and to 18.88% (14.82% ± 1.33%) with 120-hour catheterization compared with the initial weight percentage (78.50% ± 6.32%). In the <I>S. aureus</I> incubation test, the antibacterial function of CSS-CVCs was lost after 48 hours [3 (N/D) of OD]. Similar results were observed in a pilot clinical study using 18 CSS-CVCs.</P><P><B>Conclusions</B></P><P>We found that the efficacy of CSS-CVCs decreased over time and that the antibacterial function was lost after 48 hours of simulated wear-out. Therefore, antibiotic-impregnated CVCs may be a better option when longer (>48 hours) indwelling is needed.</P>

Secular Trends of Species and Antimicrobial Resistance of Blood Isolates in a Tertiary Medical Center for Ten Years: 2003~2012

Kyeong Seob Shin,Young Il Son,Yong Dae Kim,Seung Bok Hong,Je-Seop Park,Sunghyun Kim,Young-Bin Yu,Young Kwon Kim 대한의생명과학회 2014 Biomedical Science Letters Vol.20 No.2

Periodic analysis of local epidemiologic data of prevalent pathogens of blood culture can provide clinicians with relevant information to guide empirical antibiotic therapy. In this study, we analyzed a pattern of change of causative microorganisms and antimicrobial resistance at a tertiary medical center in Chungcheong province from 2003 to 2012, retrospectively. Of 70,258 blood specimens cultured, 6,063 (8.6%) were positive. Among the positive isolates, 95.9% were aerobic or facultative anaerobic bacteria, 0.1% were anaerobes, and 3.9% were fungi. Coagulase-negative Staphylococci (CoNS) (32.9%), Escherichia coli (16.7%), Staphylococcus aureus (9.1%), Klebsiella pneumoniae (6.4%), and α-hemolytic Streptococcus (5.9%) were commonly isolated bacteria, and Candida albicans (1.4%) was the most commonly isolated fungi. Enterococcus faecium progressively increased but Streptococcus pneumoniae, Acinetobacter baumannii and Proteus species gradually decreased over a period of 10 years. The multidrug-resistant microorganisms such as methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci (VRE), cefotaxime-resistant E. coli, imipenem-resistant Pseudomonas aeruginosa (IRPA) and imipenem-resistant A. baumannii (IRAB), were significantly increased. Therefore, there is a need for a more strict control of antibiotics and a more updated guideline for the treatment of bloodstream infection.