Objective:To investigate the effectiveness and feasibility of using a central line bundle(CLB)guideline with a standard checklist in the prevention of peripherally inserted central catheter(PICC)-related infections(CR...Objective:To investigate the effectiveness and feasibility of using a central line bundle(CLB)guideline with a standard checklist in the prevention of peripherally inserted central catheter(PICC)-related infections(CRIs)in very low-birth-weight infants(VLBWIs).Methods:Fifty-seven VLBWIs who underwent PICC insertion at a hospital in Qingdao,China,between November 2012 and June 2013,were monitored with the CLB guideline and a standard checklist.Fifty-three VLBWIs who underwent PICC insertion were monitored by standard hospital procedures.The incidence of CRIs was compared between the two groups.Results:The incidence of infection significantly decreased from 10.0%catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The indwelling catheter time significantly increased in the study group compared to the control group(31.9±15.0days vs.24.8±7.4 days,respectively,p<0.05).Colonization infections also decreased from 6.9% catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The incidence of catheter-related bloodstream infections decreased from 3.1%catheter days in the control group to 0%catheter days in the study group.Conclusion:The use of a CLB guideline with a standard checklist could be an effective and feasible protocol for preventing CRIs and prolonging indwelling catheter timein VLBWIs.展开更多
BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutriti...BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone,and parenteral nutrition(PN) may be indicated.While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation,less is known about the risks,particularly infectious,associated with this therapy among this specific group of patients.AIM To describe the incidence,microbiology,and risk factors of central line-associated bloodstream infection(CLABSI) among children with BA listed for liver transplantation.METHODS Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children's Hospital from 2008 through2015(n = 96).Patients with a central line for administration of PN(n = 63) were identified and details of each CLABSI event were abstracted.We compared the group of patients who experienced CLABSI to the group who did not,to determine whether demographic,clinical,or laboratory factors correlated with development of CLABSI.RESULTS Nineteen of 63 patients(30%,95%CI:19,43) experienced 29 episodes of CLABSI during 4800 line days(6.04 CLABSI per 1000 line days).CLABSI was predominantly associated with Gram-negative organisms(14/29 episodes,48%)including Klebsiella spp.,Enterobacter spp.,and Escherichia coli.The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae.Grampositive organisms(all Staphylococcus spp.) and fungus(all Candida spp.)comprised 9/29(31%) and 6/29(21%) episodes,respectively.No demographic,clinical,or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION There is substantial risk for CLABSI among children with BA listed for liver transplantation.No clinical,demographic,or laboratory factor we tested emerged as an independent predictor of CLABSI.While our data did not show an impact of CLABSI on the short-term clinical outcome,it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization,unnecessary healthcare dollar expenditures,and may exact an opportunity cost,in terms of missed allograft offers.展开更多
BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidit...BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.展开更多
Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically...Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.展开更多
目的针对肿瘤患者经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染(central line associated bloodstream infection,PICC-CLABSI)风险预测问题,利用Logistic回归和极限学习机(extreme learning ...目的针对肿瘤患者经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染(central line associated bloodstream infection,PICC-CLABSI)风险预测问题,利用Logistic回归和极限学习机(extreme learning machine,ELM)分别建立预测模型并验证其预测效果。方法回顾性收集2019年1月至2023年3月在山西省某三级甲等综合医院肿瘤科接受PICC置管的1146例患者的临床病历资料,将2019年1月至2021年12月收集的786例PICC置管患者的临床病历资料作为建模组,将2022年1月2023年3月收集的360例患者的临床资料作为验证组。采用χ^(2)检验对建模组数据进行分析,将有统计学意义的变量进行Logistic回归分析,构建风险预测模型,并绘制列线图,采用Hosmer-Lemeshow检验和受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)评价该预测模型的拟合度及预测效果;将Logistic回归分析具有统计学意义的危险因素作为ELM预测模型的输入参数,肿瘤患者PICC-CLABSI发生风险作为输出参数,构建ELM预测模型;利用验证组数据对预测性能进行比较。结果(有)糖尿病史、化疗次数(≥3次)、维护周期(>7day)、维护地点(院外)、白细胞计数(<3.5×10^(9)/L)、白蛋白(<40g/L)是肿瘤患者发生经外周静脉置入中心静脉导管相关血流感染的风险因素(均P<0.05)。Logistic风险预测模型的Hosmer-Lemeshow检验结果显示:χ^(2)=5.201,P=0.736,AUC为0.860(95%CI:0.799~0.922),灵敏度是0.893,特异度是0.704,正确率为72.8%,表明模型具有良好的预测能力。ELM预测模型的决定系数为0.823,均方误差为0.051,模型的拟合度良好,正确率为74.5%,表明模型具有良好的预测能力。结论在Logistic回归分析筛选指标基础上建立的Logistic风险预测模型与ELM模型均具有较高的预测精度,可为临床医护人员筛查肿瘤PICC相关血流感染高危患者提供参考。展开更多
基金This project was funded by the National Natural Science Foundation of China(NSFC:81171774,81272056)。
文摘Objective:To investigate the effectiveness and feasibility of using a central line bundle(CLB)guideline with a standard checklist in the prevention of peripherally inserted central catheter(PICC)-related infections(CRIs)in very low-birth-weight infants(VLBWIs).Methods:Fifty-seven VLBWIs who underwent PICC insertion at a hospital in Qingdao,China,between November 2012 and June 2013,were monitored with the CLB guideline and a standard checklist.Fifty-three VLBWIs who underwent PICC insertion were monitored by standard hospital procedures.The incidence of CRIs was compared between the two groups.Results:The incidence of infection significantly decreased from 10.0%catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The indwelling catheter time significantly increased in the study group compared to the control group(31.9±15.0days vs.24.8±7.4 days,respectively,p<0.05).Colonization infections also decreased from 6.9% catheter days in the control group to 2.2%catheter days in the study group(p<0.05).The incidence of catheter-related bloodstream infections decreased from 3.1%catheter days in the control group to 0%catheter days in the study group.Conclusion:The use of a CLB guideline with a standard checklist could be an effective and feasible protocol for preventing CRIs and prolonging indwelling catheter timein VLBWIs.
文摘BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone,and parenteral nutrition(PN) may be indicated.While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation,less is known about the risks,particularly infectious,associated with this therapy among this specific group of patients.AIM To describe the incidence,microbiology,and risk factors of central line-associated bloodstream infection(CLABSI) among children with BA listed for liver transplantation.METHODS Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children's Hospital from 2008 through2015(n = 96).Patients with a central line for administration of PN(n = 63) were identified and details of each CLABSI event were abstracted.We compared the group of patients who experienced CLABSI to the group who did not,to determine whether demographic,clinical,or laboratory factors correlated with development of CLABSI.RESULTS Nineteen of 63 patients(30%,95%CI:19,43) experienced 29 episodes of CLABSI during 4800 line days(6.04 CLABSI per 1000 line days).CLABSI was predominantly associated with Gram-negative organisms(14/29 episodes,48%)including Klebsiella spp.,Enterobacter spp.,and Escherichia coli.The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae.Grampositive organisms(all Staphylococcus spp.) and fungus(all Candida spp.)comprised 9/29(31%) and 6/29(21%) episodes,respectively.No demographic,clinical,or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION There is substantial risk for CLABSI among children with BA listed for liver transplantation.No clinical,demographic,or laboratory factor we tested emerged as an independent predictor of CLABSI.While our data did not show an impact of CLABSI on the short-term clinical outcome,it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization,unnecessary healthcare dollar expenditures,and may exact an opportunity cost,in terms of missed allograft offers.
文摘BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.
文摘Objective:To evaluate the complications of central venous catheterization(CVC).Methods:A prospective,observational study was conducted at a tertiary care center in India from December 2018 to September 2020.Critically ill patients(aged≥18 years)in the intensive care unit undergoing CVC procedures were included in the study.Baseline demographics and detailed medical history were recorded.Chest X-rays and electrocardiography were performed on all the patients.Complications associated with CVC were recorded.Results:A total of 100 patients with the indication for central venous catheter insertion were included.The majority(81%)of the patients were inserted with CVC at the right internal jugular vein.Complications such as arterial puncture(2%),hematoma(4%),blood clot formation(4%),catheter kinking(3%),thoracic injury(1%),thrombophlebitis(6%),sepsis(9%)and nerve injury(1%)were reported.Conclusions:Though central venous access is preferred in management of critically ill patients,it has its risks.However,early recognition and prompt management of complications may reduce mortality and morbidity.Physicians and intensive care unit intensivists should be vigilant for central venous catheter-related complications.Suitable site selection,operator experience,and proper catheter maintenance are associated with optimal outcomes.
文摘目的针对肿瘤患者经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)相关血流感染(central line associated bloodstream infection,PICC-CLABSI)风险预测问题,利用Logistic回归和极限学习机(extreme learning machine,ELM)分别建立预测模型并验证其预测效果。方法回顾性收集2019年1月至2023年3月在山西省某三级甲等综合医院肿瘤科接受PICC置管的1146例患者的临床病历资料,将2019年1月至2021年12月收集的786例PICC置管患者的临床病历资料作为建模组,将2022年1月2023年3月收集的360例患者的临床资料作为验证组。采用χ^(2)检验对建模组数据进行分析,将有统计学意义的变量进行Logistic回归分析,构建风险预测模型,并绘制列线图,采用Hosmer-Lemeshow检验和受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)评价该预测模型的拟合度及预测效果;将Logistic回归分析具有统计学意义的危险因素作为ELM预测模型的输入参数,肿瘤患者PICC-CLABSI发生风险作为输出参数,构建ELM预测模型;利用验证组数据对预测性能进行比较。结果(有)糖尿病史、化疗次数(≥3次)、维护周期(>7day)、维护地点(院外)、白细胞计数(<3.5×10^(9)/L)、白蛋白(<40g/L)是肿瘤患者发生经外周静脉置入中心静脉导管相关血流感染的风险因素(均P<0.05)。Logistic风险预测模型的Hosmer-Lemeshow检验结果显示:χ^(2)=5.201,P=0.736,AUC为0.860(95%CI:0.799~0.922),灵敏度是0.893,特异度是0.704,正确率为72.8%,表明模型具有良好的预测能力。ELM预测模型的决定系数为0.823,均方误差为0.051,模型的拟合度良好,正确率为74.5%,表明模型具有良好的预测能力。结论在Logistic回归分析筛选指标基础上建立的Logistic风险预测模型与ELM模型均具有较高的预测精度,可为临床医护人员筛查肿瘤PICC相关血流感染高危患者提供参考。
