BACKGROUND & AIMS: Venous access used for parenteral nutrition (PN) application is extremely important for patients with intestinal failure. Potential loss of venous access might be a catastrophy for the patient. Catheter infections are a serious complication of PN application. Systemic administration of antibiotics as well as local antibiotic locks into the catheter to sterilize the catheter are used to treat catheter infections. However, there is no clear recommendation applying use of antibiotic locks, that would specify the type and concentration of antimicrobial medication. Our objective were to compare the efficacy of different types of antimicrobial lock therapy (especially taurolidine) and their concentrations to eradicate infectious agents. METHODS: Bacterial strains of microorganisms (Staphylococcus epidermidis, Staphylococcus aureus, methicillin resistant S. aureus (MRSA), Pseudomonas aeruginosa, multidrug-resistant P. aeruginosa, Candida albicans) were used. Subsequently, the catheter was exposed to the microbes and then was incubated with a specific lock for 2 or 24 h at 37 °C. We used these locks: ethanol 70%, taurolidine, gentamicine in concentrations 0,5, 1 and 10 mg/ml and vancomycine in concentrations 1, 5, and 10 mg/ml. The number of remaining CFU (colony forming units) was compared after incubation. RESULTS: 70% ethanol and taurolidine were most effective for all studied microorganisms. Gentamicine was more effective than vancomycine. CONCLUSIONS: The most effective antimicrobial lock solutions to eradicate selected pathogenic agents were ethanol and taurolidine. Use of antibiotics is often effective after many hours of treatment and there is a risk of inadequate therapy.
- MeSH
- antibakteriální látky farmakologie MeSH
- bakteriemie prevence a kontrola MeSH
- Candida účinky léků MeSH
- design vybavení MeSH
- gentamiciny farmakologie MeSH
- katétrové infekce prevence a kontrola MeSH
- lidé MeSH
- methicilin rezistentní Staphylococcus aureus účinky léků MeSH
- parenterální výživa úplná přístrojové vybavení MeSH
- počet mikrobiálních kolonií MeSH
- Pseudomonas aeruginosa účinky léků MeSH
- taurin analogy a deriváty účinky léků MeSH
- thiadiaziny MeSH
- vankomycin farmakologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- MeSH
- antibakteriální látky aplikace a dávkování MeSH
- antibiotická profylaxe * metody MeSH
- bakteriální endokarditida * mikrobiologie prevence a kontrola MeSH
- bakteriemie epidemiologie farmakoterapie prevence a kontrola MeSH
- extrakce zubů metody normy MeSH
- hodnocení rizik MeSH
- lidé MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Esophageal cancer is a serious diagnosis that has a relative incidence of 4/100,000 inhabitants in the Czech Republic. This disorder is managed predominantly by surgery. The steps to improving the outcome of treatment include a multifactorial approach. The role of operative technique in improving outcomes seems to have reached its limits. However, antibiotic prophylaxis and the treatment of complicating bacterial infections continue to play important roles. METHODS: A total of 85 patients with strictly defined antibiotic prophylaxis during surgical esophagectomy were included in our study. Bacterial strains were isolated from the patient's clinical materials after operation; only one strain from each patient, the first to be isolated, was tested for antibiotic sensitivity. RESULTS: Infectious complications were observed in 15.3% of patients and the mortality rate from infectious complications reached 30.8%. The most frequently documented complicated infection was pneumonia (69.2%) and the most frequent pathogens were enteric bacteria (56.5%). Some bacterial strains producing extended-spectrum beta-lactamases and AmpC beta-lactamases were found. CONCLUSIONS: The infections in our patient set were of endogenous origin. In cases of pneumonia, it is appropriate to begin with antibiotics effective against enteric bacteria and Pseudomonas aeruginosa.
- MeSH
- antibiotická profylaxe metody MeSH
- bakteriální pneumonie mikrobiologie prevence a kontrola MeSH
- bakteriemie mikrobiologie prevence a kontrola MeSH
- dospělí MeSH
- ezofagektomie škodlivé účinky MeSH
- infekce chirurgické rány mikrobiologie prevence a kontrola MeSH
- lidé středního věku MeSH
- lidé MeSH
- mediastinitida mikrobiologie MeSH
- mikrobiální testy citlivosti MeSH
- nádory jícnu chirurgie MeSH
- plicní mykózy mikrobiologie prevence a kontrola MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
V době od 1. srpna 2010 do 31. července 2011 probíhala v prostorách oddělení 5C Hemato-onkologické kliniky FN Olomouc epidemiologická studie s názvem „Surveillance of Infectious Complications in Hemato-Oncological Patients“. V této době bylo na oddělení hospitalizováno celkem 63 pacientů, z toho byla u 33 pacientů provedena transplantace kmenových buněk. Ve 21 případech se jednalo o autologní transplantaci, u 12 pacientů byla provedena alogenní transplantace. Během této doby na výše uvedeném oddělení byla sledována mikrobiální kontaminace vnitřního vzduchu, vybraných povrchů a mikrobiální osídlení aktuálně přítomného zdravotnického personálu (stěr pravé ruky, výtěr z obou nosních dírek a stěr vlasové kštice). Kultivací prokázané gramnegativní bakterie byly biochemicky identifikovány. Zvýšená pozornost byla věnována gramnegativním nefermentujícím bakteriím, které podle současné literatury je nutné považovat za nastupující původce nemocničních infekcí.
A study entitled „Surveillance of Infectious Complications in Hemato-oncological Patients“ was conducted at the Department of Hemato-Oncology, University Hospital Olomouc from 1 July 2010 to 31 August 2011. During the study period, a total of 63 patients were hospitalized at that department and 33 stem cell transplants were performed, 21 autologous and 12 allogeneic. Microbial contamination was monitored in indoor air, on selected surfaces, and in health care providers (right hand smear, left and right nostril swabs and scalp hair smear). Gram-negative bacteria detected by culture were identified biochemically. Special attention was paid to nonfermentative Gram-negative bacilli which, based on the recent literature, should be considered as emerging causative agents of hospital infections.
- Klíčová slova
- rezistence na antibiotika a biocidy,
- MeSH
- bakteriální infekce etiologie prevence a kontrola MeSH
- bakteriemie etiologie prevence a kontrola MeSH
- Cupriavidus izolace a purifikace MeSH
- Delftia acidovorans izolace a purifikace MeSH
- epidemiologické studie MeSH
- gramnegativní bakterie * izolace a purifikace patogenita MeSH
- imunosupresivní léčba MeSH
- infekce spojené se zdravotní péčí etiologie prevence a kontrola MeSH
- izolátory pro pacienty * mikrobiologie MeSH
- jednotky intenzivní péče MeSH
- kontaminace zdravotnického vybavení MeSH
- lidé MeSH
- monitorování životního prostředí * MeSH
- Ochrobactrum anthropi izolace a purifikace MeSH
- oportunní infekce etiologie MeSH
- Stenotrophomonas maltophilia izolace a purifikace MeSH
- transplantace MeSH
- zdravotničtí pracovníci MeSH
- znečištění vzduchu ve vnitřním prostředí MeSH
- Check Tag
- lidé MeSH
The effectiveness of various solutions instilled into the central venous catheter lumens after each hemodialysis session (catheter locking solutions) to decrease the risk of catheter malfunction and bacteremia in patients undergoing hemodialysis is unknown. METHODS: We randomly assigned 225 patients undergoing long-term hemodialysis in whom a central venous catheter had been newly inserted to a catheter-locking regimen of heparin (5000 U per milliliter) three times per week or recombinant tissue plasminogen activator (rt-PA) (1 mg in each lumen) substituted for heparin at the midweek session (with heparin used in the other two sessions). The primary outcome was catheter malfunction, and the secondary outcome was catheter-related bacteremia. The treatment period was 6 months; treatment assignments were concealed from the patients, investigators, and trial personnel. RESULTS: A catheter malfunction occurred in 40 of the 115 patients assigned to heparin only (34.8%) and 22 of the 110 patients assigned to rt-PA (20.0%)--an increase in the risk of catheter malfunction by a factor of almost 2 among patients treated with heparin only as compared with those treated with rt-PA once weekly (hazard ratio, 1.91; 95% confidence interval [CI], 1.13 to 3.22; P = 0.02). Catheter-related bacteremia occurred in 15 patients (13.0%) assigned to heparin only, as compared with 5 (4.5%) assigned to rt-PA (corresponding to 1.37 and 0.40 episodes per 1000 patient-days in the heparin and rt-PA groups, respectively; P = 0.02). The risk of bacteremia from any cause was higher in the heparin group than in the rt-PA group by a factor of 3 (hazard ratio, 3.30; 95% CI, 1.18 to 9.22; P = 0.02). The risk of adverse events, including bleeding, was similar in the two groups. CONCLUSIONS: The use of rt-PA instead of heparin once weekly, as compared with the use of heparin three times a week, as a locking solution for central venous catheters significantly reduced the incidence of catheter malfunction and bacteremia. (Current Controlled Trials number, ISRCTN35253449.).
- MeSH
- analýza nákladů a výnosů MeSH
- bakteriemie etiologie prevence a kontrola MeSH
- dialýza ledvin přístrojové vybavení MeSH
- fibrinolytika ekonomika škodlivé účinky terapeutické užití MeSH
- financování organizované MeSH
- heparin ekonomika škodlivé účinky terapeutické užití MeSH
- jednoduchá slepá metoda MeSH
- Kaplanův-Meierův odhad MeSH
- katetrizace centrálních vén přístrojové vybavení MeSH
- krvácení chemicky indukované MeSH
- lidé středního věku MeSH
- lidé MeSH
- muži MeSH
- randomizované kontrolované studie jako téma MeSH
- selhání zařízení MeSH
- senioři MeSH
- trombóza etiologie prevence a kontrola MeSH
- zaváděcí katétry škodlivé účinky MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- multicentrická studie MeSH
- srovnávací studie MeSH
The importance of prevention in late hematogenous infection is well understood but, because responsibility lies with general practitioners and other specialists, the orthopedic surgeon is usually not much interested. In both our and other countries, discussions are taking place on whether and to what extent antibiotic prevention should be carried out. Antibiotic prophylaxis of hematogenous infection is not indicated for all patients with joint arthroplasty, but only for a limited, defined group of patients at high risk. In these, however, the present state of knowledge suggests that prevention is necessary. A preventive treatment of late hematogenous infection is used for a procedure or a disease associated with risks in all the patients involved within two years of prosthetic joint implantation and, after this period, only in immunosuppressed patients. Surgery on the urogenital tract associated with the risk of bacteremia includes prostate gland surgery, operations for urinary bladder tumors, nephrolithotomy, extracorporeal lithotripsy and prostate biopsy. Certain conditions, such as urinary catheter presence, intermittent catheterization, urethral stent presence, urine retention and a history of urinary tract infection or prostate inflammation, pose an increased risk of bacterial colonization for the urogenital system. Dental procedures associated with a risk of bacteremia include tooth extraction, surgery on the parodontium, surgical extraction of an impacted tooth, dental implant treatment, procedures in a tooth's apical region, initial application of an orthodontic apparatus, intraligamentous blocks and also cleaning teeth and implants expected to bleed. Gynecological surgery with a risk of bacteremia are abdominal, vaginal and laparoscopic hysterectomies, surgery for cancer contaminated with vaginal bacteria, reconstruction surgery, operations on the pelvic floor for defects associated with urinary incontinence and use of xenotransplants. In obstetrics, a cesarean section carries some risks. In general surgery, the preventive administration of antibiotics is indicated, apart from situations always requiring antibiotic therapy, also for advanced forms of acute appendicitis, perirectal abscess, invasive endoscopy procedures on the colon, soft tissue phlegmona or abscess, surgical treatment of venous ulceration and pressure sores, and limb amputation. When inserting any piercing in patients with joint replacement at risk, it is recommended to do it with antibiotic administration; also, it is necessary to responsibly treat any inflammatory complication. The system of prevention for the late hematogenous infections of prosthetic joints is not developed as thoroughly as, for instance, it is in cardiology for patients with valve reconstruction. Because of the reasons given above, it is advisable to set up unambiguous guidelines for the prevention of late hematogenous infection in patients with joint replacement.
PURPOSE OF THE STUDY To design a prophylactic strategy for late hematogenous infection is not an easy task. It requires the assessment of risk factors for the patient as well as of a potential source of bacteremia. Cost effectiveness, efficacy of the antibiotic selected and complications associated with antibiotic treatment, such as allergic reactions and development of resistance to the antibiotic given, should also be considered. The aim of this retrospective study is to evaluate the occurrence of late hematogenous infection in our large group of patients, to analyze risk factors and to suggest an optimal system of antibiotic prophylaxis in order to prevent the development of this unwelcome complication. MATERIAL AND METHODS Since our objective was to include a large number of patients, a retrospective study was chosen as the method used. The patients treated for infectious complications of total joint replacement at the 1st Department of Orthopaedics, Teaching Hospital in Motol, 1st Faculty of Medicine, Charles University, in the years 1991 through 2004, were evaluated with the use of a targeted questionnaire and complete medical records. The group comprised 229 patients, 149 women and 80 men. Of these, 123 were treated for infection of total hip replacement, 102 for total knee replacement, two had infection of prosthetic shoulder joints and two had infection of elbow joint alloplasty. RESULTS Medical history of 37 patients (16.3 %) included infection of or a risk-associated procedure on the urogenital system (endoscopic or open surgery, prostate gland biopsy, extracorporeal lithotripsy). Six patients (2.6 %) underwent surgery with possible bacteremia (intestine resection for tumor, 2x; surgery for paronychium, 2x; cholecystectomy, 1x; and appendectomy, 1x). Dental surgery or mouth disease was recorded in 11 patients (4.8 %). DISCUSSION The authors suggest that the orthopedic surgeons performing joint replacement should assume their deal of responsibility and should provide relevant, comprehensive information to both the patient and the attending physician. These surgeons should be ready to remain involved in their patients' further therapies and, after assessing all risks, should be able to recommend an optimal prophylactic treatment. The introduction of a new preventive approach requires a simple and uncomplicated scheme. Any complicated and expensive system of preventive antibiotic administration will only meet with lack of understanding and with trivialization. The requirement that antibiotic treatment should be selected according to the site and type of risk-associated disease is logical, but, in our opinion, rather formal and unrealistic. The authors prefer a simple system permitting a rapid and overall introduction of preventive measures. CONCLUSIONS The groups of patients indicated for prevention of late hematogenous infection of prosthetic joints are clearly defined and, by no means, do they involve all patients with total joint replacement.
- MeSH
- amoxicilin aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- antibakteriální látky aplikace a dávkování farmakologie terapeutické užití MeSH
- artroplastiky kloubů škodlivé účinky MeSH
- bakteriemie farmakoterapie mikrobiologie prevence a kontrola MeSH
- cefalexin aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- financování organizované využití MeSH
- infekce spojené s protézou komplikace prevence a kontrola terapie MeSH
- klindamycin aplikace a dávkování terapeutické užití MeSH
- retrospektivní studie MeSH
- MeSH
- antibakteriální látky aplikace a dávkování terapeutické užití MeSH
- antibiotická profylaxe metody MeSH
- bakteriální endokarditida diagnóza etiologie prevence a kontrola MeSH
- bakteriemie diagnóza etiologie prevence a kontrola MeSH
- echokardiografie MeSH
- hodnocení rizik MeSH
- Publikační typ
- přehledy MeSH
Úvod: Centrálny žilový katéter (CŽK) predstavuje okrem výrazných výhod pre pacienta aj riziko možnej infekčnej komplikácie. Cieľom práce bolo zhodnotiť z mikrobiologického hladiska 5-ročný súbor detských pacientov so zavedeným UŽK. Súbor a metódy: Súbor tvorilo 218 CŽK zavedených 165 deťom v priebehu 5 rokov. Viaclúmenových katétrov bolo 26 (11,927 %) a 192 jednolúmenových (88,073 %). Priemerná doba ponechania katétra bola 10,1 dní na 1 CŽK. Krv na mikrobiologické vyšetrenie odoberal lekár z CŽK po dezinfekcii ústia katétra za dodržaní sterilných štandardných podmienok do komerčnej odberovej nádoby HEMO D (Imuna, Šarišské Michaľany, SR) alebo do nádoby automatizovaného hemokultivačného systému Bactec Peds PLUS/F (Becton Dickinson and Comp., Spark, MA, USA). Pri odoberaní špičky CŽK sme okolie vpichu dezinfikovali pred vybratím CŽK isopropylom alebo etylénalkoholom. CŽK sme uvolnili od fixácie a po 1 min. od dezinfekcie CŽK vytiahli a koniec katétra resp. špičku (cca 1-3 cm zo špičky katétra) sterilné odstrihli do sterilnej skúmavky. Na stanovenie diagnózy infekčných komplikácií bola použitá klasifikácia podľa Sirges-Serra z roku 1995 a CDC kritéria. Výsledky: V priebehu 5 rokov (1995-1999) sme zaznamenaU celkom 71 infekčných komplikácií. Kontaminovaných katétrov bolo 31, katétrových sepsí 27 a llx išlo o katétrovú bakteriémiu. Infekčné komplikácie sme nezistili pri 147 katétroch (67,43 %.). Dominantnými mikróbami boli Staphylococcus epidermidis (celkom 32 prípadov - U z hemokultúry (HK) a 21 z CŽK) a Candida spp. (celkom analyzovaného súboru chorých zomrelo celkom 41 (24,8 %) detí. Kauzálna súvislosť medzi CŽK a príčinou smrti sa dokázala u 6 detí (3,636 % pacientov s CŽK). Záver. Mikrobiologické nálezy v tomto súbore zodpovedajú literárnym údajom. Významným faktorom zníženia výskytu infekčných komplikácií je minimalizovanie odberov z CŽK V prípade dodržania sterilných podmienok pri zavádzaní CŽK a dodržaní zásad aseptického ošetrovania vstupov do centrálneho riečiska riziko vzniku infekčnej komplikácie sa minimalizuje.
Introduction: Besides their obvious advantages for the patient, central venous catheters (CVC) also carry the risk of possible infectious complications. The purpose of our investigation was to carry out a microbiological evaluation of a 5-year set of paediatric patients with indwelling CVC.s Patients and methods: In the group were 218 CVCs inserted to 165 children over a period of 5 years. There were 26 multi-lumen catheters (11.927 %) and 192 single-lumen catheters (88.073 %). The mean indwelling period was 10.1 days per 1 CVC. Blood for microbiology was removed by a physician from the CVC after disinfecting its opening under standard sterile conditions into a commercial sampling vessel HEMOD (Imuna, Šarišské Michaľany, Slovak Republic) or into a vessel of an automated haemoculture system BactecPeds PLUS/F (Becton Dickinson and Comp., Spark,MA, USA). When removing the tip of the CVC we disinfected, before removing the CVC, the area around the insertion with isopropyl or ethyl alcohol. We released the fixed CVC and 1 minute after disinfection we pulled out the CVC and cut off the end or rather the tip of the catheter (approx. 1-3 cm of the tip) into a sterile test tube. To establish the diagnosis of infectious complications we used the 1995 Sirges-Serra classification and the CDC criteria. Results: In 5 years (1995-1999) we had 71 infectious complications. There were 31 contaminated catheters, 27 cases of catheter sepsis and II cases of catheter bacteraemia. With 147 catheters (67.43%) there were no infectious complications. Dominant microbes were StaphyJococcus epidermidis (32 cases - 11 from haemocultures and 21 from CVCs) and Candida spp. (30 cases, 17 from haemocultures and 13 from CVCs). Among the microbiological agents of catheter sepsis predominated Gram-negative bacteria. Out of the whole analysed group 41 children (24.8 %) died. CVC as the cause of death was demonstrated in 6 children (3.636 % of patients with CVC). Conclusions: Microbiological findings in our group are in line with literary data. To reduce the incidence of infectious complications it is important to limit samphng from CVC to a minimum. Insertion of CVCs under strict sterile conditions and aseptic handling of all entries into the central bloodstream reduces to a minimum the risk of infectious complications.
- MeSH
- bakteriální endokarditida diagnóza mikrobiologie prevence a kontrola MeSH
- bakteriemie diagnóza mikrobiologie prevence a kontrola MeSH
- dítě MeSH
- infekce diagnóza mikrobiologie MeSH
- jednotky intenzivní péče pediatrické MeSH
- lidé MeSH
- mikrobiologické techniky metody MeSH
- sepse diagnóza mikrobiologie prevence a kontrola MeSH
- zaváděcí katétry MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- srovnávací studie MeSH
