This review aimed to examine if there is any difference in the risk of thrombosis and central line-associated bloodstream infection (CLABSI) with the use of peripherally inserted central catheter (PICC) and conventional central venous catheters (CVC) in hematological cancer patients.

We searched the online databases of PubMed, CENTRAL, Scopus, Web of Science, and Embase for all types of studies comparing the risk of thrombosis and CLABSI between PICC and CVC. The search ended on 23rd September 2024.

Eight studies were included. One was a randomized trial while others were observational studies. Meta-analysis showed no statistically significant difference in the risk of thrombosis between PICC and CVC (OR: 1.69 95% CI: 0.75, 3.82 I2 = 78%). However, these results were not stable on sensitivity analysis. The exclusion of two studies indicated a higher risk of thrombosis with PICC. Pooled analysis showed that the risk of CLABSI was significantly lower with PICC as compared to CVC (OR: 0.52 95% CI: 0.40, 0.66 I2 = 0%). Results of subgroup analysis based on study design and diagnosis showed conflicting results.

There is conflicting evidence on the risk of thrombosis between PICC and CVC when used for hematological cancer patients. There could be a tendency of higher risk of thrombosis with PICC which needs to be confirmed by further studies. However, the use of PICC may reduce the risk of CLABSI in such patients. The quality of evidence is low owing to the predominance of observational studies with high inter-study heterogeneity.

To identify the related factors of neonatal catheter-associated bloodstream infection (CABSI), and provide a basis for constructing a scientific and rational strategy for neonatal CABSI prevention.

CNKI, Wanfang, PubMed, MEDLINE-Ovid, Web of Science, Embase, CINAHL, and Cochrane Library were searched for publications on neonatal CABSI from the time the database was established until September 30, 2023. The language of publications was not specified. Unpublished reports and gray studies were excluded. All cohort, case-control, and cross-sectional studies were included. A meta-analysis of the incidence and related factors of neonatal CABSI were made using Revman software. Heterogeneity was evaluated using the I2 statistic method, and the publication bias was analyzed with funnel plot tests.

A total of 35 studies involving 34,743 patients from 13 different countries were included. There were 15 case-control, 15 cohort, and 5 cross-sectional studies, with 14 related factors discussed. All the studies scored high (score ≥ 6) in their overall quality. According to the meta-analysis, the incidence of neonatal CABSI was 5.93/1000 catheter days (OR = 5.29). The risk factors were identified and ranked as follows according to the degree of influence: 5-minute Apgar score (OR = 4.69), the number of punctures during the stay of the line (OR = 3.49), male (OR = 3.17), mechanical ventilation (OR = 2.73), catheter repair (OR = 2.66), lower gestational age at birth (OR = 2.47), femoral vein catheter (OR = 1.92), dwell time of the catheter (OR = 1.34), and lower birth weight (OR = 1.05). Establishing sterile barrier throughout was a protective factor (OR = 0.41). Subgroup analysis suggested that the study design, catheter type and year of publication might be the primary sources of heterogeneity. The sensitivity analysis demonstrated the robustness of the results. However, the funnel plot indicated a potential publication bias.

Neonatal CABSI carries a significant morbidity rate and is influenced by numerous factors.

It is crucial to underscore the necessity for additional longitudinal studies to explore evidence-based approaches to lowering the risk and ultimately reducing the incidence of CABSI. Registration The study protocol has been registered with the PROSPERO: CRD42023443697.

This study aims to evaluate the risk factors, clinical features, and clinical outcomes among pediatric hospitalized patients receiving treatment for Staphylococcus aureus bacteremia and compare the effects of antibiotics used in the treatment on clinical outcomes.

This single-center retrospective study included patients aged between 1 month and 18 years who received treatment for Staphylococcus aureus bacteremia (SAB) betweenSeptember 2019 and September 2022.

SAB was detected in 95 pediatric patients. In MRSA bacteremias, no difference in clinical outcomes was found between patients receiving vancomycin or teicoplanin. In MSSA bacteremias, the recurrence rate of SAB was 0% in the penicillin group and 23.5% in the cephalosporin group. The median duration of bacteremia-related hospital stay (10 vs. 14 days), and the median duration of bacteremia (2 vs. 3 days) were shorter in the ampicillin-sulbactam group than in the piperacillin-tazobactam group (p = 0.016, and p = 0.050, respectively).

Teicoplanin was found to have similar clinical outcomes to vancomycin in treating MRSA bacteremia. In addition, ampicillin sulbactam was found to have better clinical outcomes than other antibiotics in treating MSSA bacteremia. Teicoplanin and ampicillin sulbactam may be considered as a choice in the treatment of pediatric SAB.

Central line-associated bloodstream infection (CLABSI) is an important healthcare-associated infection, particularly in the intensive care unit (ICU). This study aimed to investigate the impact of early infectious disease consultation (IDC) on the quality of care metrics of CLABSI in patients admitted to the ICU.

Patients with CLABSI admitted to the ICU were included and divided into early IDC, and late or never IDC groups. The early IDC group indicated patients whose attending physician received IDC within 72 h of CLABSI onset. The main outcomes were the proportion of patients who received optimal targeted antibiotic treatment and catheter removal within 72 h of CLABSI onset. Propensity score analysis with the inverse probability of the treatment weighting method was used to compare the outcomes.

Among the 197 enrolled patients, 52 (26.4%) underwent early IDC and 145 (63.6%) did not. The early IDC group showed considerably higher proportions of catheter removal (76.9% versus 44.8%; adjusted odds ratio (OR): 3.70, 95% confidence interval (CI): 1.72-7.98; P = 0.001) than the late or never IDC group. The proportions of patients receiving optimal targeted antibiotic treatment were significantly higher in the early IDC group than in the late or never IDC group (67.3% versus 46.9%, adjusted OR: adjusted OR: 2.40, 95% CI: 1.17-4.91, P = 0.016)).

Early IDC was associated with improvement of the quality of care for patients with CLABSI in the ICU. This findings support the implementation of early IDC should be considered as an integral part of care of CLABSI in ICU patients.

Intraluminal infection of central venous catheters, used for long-term treatment, can result in central line-associated bloodstream infection (CLABSI). These infections can be challenging to prevent and treat due to formation of biofilms within catheter lumens, which shield bacteria from the human immune response and conventional antimicrobial therapies. Preventing bacterial colonization of catheter hubs is a strategy to prevent CLABSI. To address this, we developed a nonantibiotic, animal-ready electrochemical catheter hub (e-catheter hub), operated by a wearable, battery-powered micropotentiostat (MP), that internally generates tunable hypochlorous acid (HOCl) for preventing intraluminal infection. The design evaluated three different electrode materials-titanium, platinum, and gold-for HOCl generation and biocidal activity, using working and counter electrodes of the same materials and a silver/silver chloride-plated wire as a quasi-reference electrode. e-catheter hubs operated by MPs at 1.5 VAg/AgCl for 3 h generated HOCl, reducing Acinetobacter baumannii ATCC-17978 below the detection limit (average reduction of 4.40 ± 0.05 log10 CFU/mL). The efficacy of e-catheter hubs operated by MPs in generating HOCl and achieving biocidal activity is comparable to that of a commercial potentiostat. This study represents the first step in developing a localized, nonantibiotic strategy to mitigate CLABSI risk.

We report a retrospective review of pediatric candidal central line-associated bloodstream infections (N = 145) with antifungal lock therapy-based catheter salvage. Rates of recurrence (6%) and mortality (5%) were low at 28 days. At 1 year, earlier catheter removal was associated with lower recurrence rates (21% vs. 45%, P = 0.005), but no significant difference in mortality (13% vs. 5%).

Invasive fungal infections (IFIs) significantly impact morbidity and mortality in kidney transplant recipients (KTR), but their effect on allograft function remains poorly defined. This retrospective study examined adult KTRs transplanted at Johns Hopkins from 2012 to 2018, with follow-up through 2023. The association of IFIs with a composite outcome of graft failure and mortality was assessed using negative binomial regression. The association of IFI exposure on composite outcome was quantified by matching using a stochastic extension stratification method followed by Cox regression. Among 1453 KTRs, 79 were diagnosed with proven/probable IFIs, predominantly invasive candidiasis (46.8%). KTRs with IFIs had worse outcome-free survival with higher composite outcome rates [53/79 (67.1%) vs. 411/1338 (30.7%), p<0.001]. The composite outcome incidence rate was 4.61-fold higher when IFIs occurred in the first 6 months post-transplant and decreased to 2.13-fold higher after 36 months (p<0.001). IFI exposure was associated with 3.45-fold increased hazard of composite outcome (95% CI 1.54-7.70; p<0.01) and a 3.23-fold increased hazard of all-cause mortality (95% CI 1.53-6.83; p<0.01). The association of IFIs with increased risk of poor kidney transplant outcomes, particularly in the early post-transplant period, highlights the need for improved strategies for early IFI detection and management in KTRs.

The aim of this study was to identify catheter-related bloodstream infection (CRBSI) episodes, to determine the causative agents and antibiotic susceptibility profiles, demographic characteristics, and clinical outcomes of patients treated in the pediatric bone marrow transplant (BMT) unit between November 2019 and July 2022. Forty patients were included in the study. The median patient age was 7.5 years (range: 1.5 to 19.9 y) and the most common underlying disease was ALL (77.5%). CRBSI was found to be significantly higher in haploidentic donors (P<0.001). When CRBSI was confirmed, 65% of the patients were neutropenic with a median duration of 17.5 days (range: 3 to 150). It was found that the mean time to CVC infection was 22 days (range: 5 to 118). As a result of multivariate logistic analysis (OR: 1.038 [95% CI: 1.007-1.070], P=0.018) of the time of infection of the catheter and mortality, it was determined that the mortality rate increased as the duration of the catheter remained. CRBSI was detected in 41.2% of transplanted patients and the overall mortality rate attributed to this complication was 10%. Among the patients, 22 (55%) were colonized before hematopoietic stem cell transplantation (HSCT), and gram-negative agents (n=15, 68%) mostly accounted for colonization. Gram-negative pathogens (60%) were found to be statistically significantly more common in CRBSI (P<0.01). The most common causative agent was K. pneumoniae (n=13, 32.5%). Of the gram-negative isolates (n=24), 17 (70.8%) were multidrug-resistant organisms (MDRO). A fluoroquinolone (80%) was used for antibiotic prophylaxis. Among patients with CRBSI, 65% had a fluoroquinolone-resistant isolate. We found a high rate of quinolone resistance among CRBSI isolates after the use of fluoroquinolone prophylaxis at our unit.

Cyberlindnera fabianii, an ascomycetous yeast, is a rare human pathogen. Here, we describe the first reported case of central venous (CV) access port-related blood-stream infection caused by C. fabianii. An 80-year-old Asian man presented to our department with a mass in the pancreas. A diagnosis of pancreatic cancer (cT4N0M0, cStage III) was made. A catheter with CV access port was inserted, and anticancer chemotherapy and radiotherapy was initiated. One year after the first visit, he was urgently admitted to our hospital due to recurrent hematemesis. On day 37, organism cultures of the blood and catheter tip were positive for Candida pelliculosa by the BD PHOENIX™ 100 system. On the basis of these findings, CV port-related blood-stream infection caused by C. pelliculosa was diagnosed, and treatment with micafungin (MCFG) was initiated. On day 51, the blood culture converted to negative. On day 65, MCFG was stopped. The cultured strain was sent to reference laboratory where Cyberlindnera fabianii was identified by MALDI-TOF mass spectrometry and direct sequencing of the internally transcribed spacer region. The present case report describes the first known case of CV access port-related blood-stream infection caused by C. fabianii. MCFG was successfully used to treat the fungemia caused by C. fabianii. Although the incidence of uncommon yeast species causing human infections has gradually increased in recent years, conventional biochemical methods may offer limited usefulness for identifying these rare organisms. Accordingly, MALDI-TOF mass spectrometry or molecular assays may be required to identify these uncommon fungal species.

Sepsis is a common condition associated with significant morbidity and mortality. Emergency physicians play a key role in the diagnosis and management of this condition.

This paper evaluates key evidence-based updates concerning the management of sepsis and septic shock for the emergency clinician.

Sepsis is a life-threatening syndrome, and rapid diagnosis and management are essential. Antimicrobials should be administered as soon as possible, as delays are associated with increased mortality. Resuscitation targets include mean arterial pressure ≥ 65 mmHg, mental status, capillary refill time, lactate, and urine output. Intravenous fluid resuscitation plays an integral role in those who are fluid responsive. Balanced crystalloids and normal saline are both reasonable options for resuscitation. Early vasopressors should be initiated in those who are not fluid-responsive. Norepinephrine is the recommended first-line vasopressor, and if hypotension persists, vasopressin should be considered, followed by epinephrine. Administration of vasopressors through a peripheral 20-gauge or larger intravenous line is safe and effective. Steroids such as hydrocortisone and fludrocortisone should be considered in those with refractory septic shock.

An understanding of the recent updates in the literature concerning sepsis and septic shock can assist emergency clinicians and improve the care of these patients.

Central venous access through tunneled central venous catheters (CVCs) are one of the cornerstones of modern oncologic practice in pediatric patients since CVCs provide a reliable access route for the administration of chemotherapy. Establishing best practices for CVC management in children with cancer is essential to optimize care. This article reviews current best practices, including types of devices, their placement, complications, and long-term outcomes. Additionally, nutrition status and nutritional support are also very important determinants of outcomes and care in pediatric surgical oncology patients. We review current nutritional assessment, support, access for enteral and parenteral nutrition delivery, and their complications, mainly from a surgical perspective. Overall, access surgery, whether for CVCs, or for enteral access can be challenging, and best practice guidelines supported by current though limited evidence are necessary to minimize complications and optimize outcomes.

Population pharmacokinetics (PK) models may be effective in improving antibiotic exposure with individualized dosing. The aim of the study is to assess cefazolin exposure using a population PK model in critically ill children.

We conducted a single-centre observational study including children under 18 years old who had cefazolin plasma monitoring before and after a cefazolin model implementation. The first concentration at steady state of each cefazolin course was analysed. The optimal exposure was defined by concentration values ranging from free concentration over four times the minimal inhibitory concentration (MIC) for 100% of the dosing interval to total trough or plateau concentration under 100 mg. L-1.

A total of 58 patients were included, of whom 39 and 19 children received conventional dosing or model-informed dosing, respectively. Median [range] age was 2.3 [0.1-17] years old, and median weight was 14.2 [2.9-72] kg. There were more continuous infusions (CI) in the model group than in the conventional group (n = 19/19 [100%] vs. n = 23/39 [59%]). Compared to conventional dosing, model-informed dosing provided more optimal exposure (n = 17/39 [44%] vs. n = 15/19 [79%], P = .01) and less underexposure (n = 18/39 [46%] vs. n = 2/19 [10%], P = .008), without increasing overexposure (n = 4/39 [10%] vs. n = 2/19 [11%], P = 1). Moreover, the time to C-reactive protein decrease by 50% was significantly shorter in the model group than the conventional group (3 [0.5-13] vs. 4 [1-34]; P = .045).

Use of individualized cefazolin model-informed dosing improves critically ill children's exposure. Further studies are needed to assess the clinical benefit of cefazolin PK model application.

The study aimed to explore a definition for complicated coagulase-negative staphylococci bloodstream infections (CoNS BSIs) and to identify predictors for mortality.

A prospective cohort study was conducted from October 2016 to March 2017 in 26 Spanish hospitals. Complicated CoNS BSI criteria included lack of early catheter removal in catheter-related cases, foreign indwelling implant, persistent bacteraemia, fever ≥72 hours on active therapy, metastatic infection or deep-seated focus, and infective endocarditis. Independent predictors for 30-day mortality were evaluated by Cox regression, and the impact of the definition of complicated bacteraemia was assessed.

Overall, 445 CoNS BSI cases were included; catheter-related infections were predominant (336/445, 75.5%). Complicated bacteraemia was identified in 240 of 445 patients (53.9%); 30-day mortality in complicated and uncomplicated cases was 53 of 240 (22.1%) and 24/205 (11.7%), respectively (p 0.004). Predictors of 30-day mortality identified in the multivariate analysis included age (hazard ratio [HR]: 1.03, 95% CI: 1.01-1.05), cerebrovascular disease (HR: 2.58, 95% CI: 1.45-4.58), immunosuppressive therapy (HR: 2.16, 95% CI: 1.22-3.84), SOFA score (HR: 1.09, 95% CI: 1.03-1.16), and complicated bacteraemia (HR: 2.14, 95% CI: 1.29-3.53). A catheter-related source of bacteraemia was found to be protective (HR: 0.49, 95% CI: 0.30-0.80). When specific criteria to define complicated bacteraemia were included, fever ≥72 hours was associated with an increased risk of death (HR: 2.52, 95% CI: 1.52-4.17) and early catheter removal was protective (HR: 0.47, 95% CI: 0.26-0.83).

A high proportion of patients presented complicated bacteraemia according to the proposed criteria; these patients had higher hazards for mortality. Other mortality predictors were identified. Further studies would be needed to validate the proposed criteria.

Antimicrobial lock therapy is recommended for preventing and treating catheter-related bloodstream infections, but different solutions have uncertain efficacy.

Two locks, 1.35% taurolidine and 4% ethylenediaminetetraacetic acid (EDTA), were tested on Staphylococcus epidermidis, Staphylococcus aureus, methicillin-resistant S. aureus, Pseudomonas aeruginosa, multidrug-resistant P. aeruginosa, vancomycin-resistant Enterococcus faecium, Klebsiella oxytoca (carbapenemase producing), K. pneumoniae (extended-spectrum β-lactamase producing), Candida albicans, and Candida glabrata. Broviac catheter segments were incubated with these organisms and then exposed to various lock solutions. Colony-forming units (CFUs) were counted after 2, 4, and 24 h of incubation.

Taurolidine showed a significant decrease in CFUs after 2 h in S. aureus, S. epidermidis, methicillin-resistant S. aureus, vancomycin-resistant E. faecium, P. aeruginosa (both sensitive and multidrug-resistant strains), K. oxytoca, C. albicans, and C. glabrata. After 4 h, significant reductions were noted in S. aureus, S. epidermidis, methicillin-resistant S. aureus, P. aeruginosa, multidrug-resistant P. aeruginosa, K. pneumoniae, K. oxytoca, and C. albicans. Taurolidine was also effective after 24 h, especially against methicillin-resistant S. aureus and multidrug-resistant P. aeruginosa. Four percent EDTA acid showed a significant reduction in CFUs after 2 h in S. aureus, vancomycin-resistant E. faecium, P. aeruginosa, K. oxytoca, C. albicans, and C. glabrata. After 4 h, reductions occurred in P. aeruginosa, multidrug-resistant P. aeruginosa, K. oxytoca, and C. albicans and after 24 h in methicillin-resistant S. aureus, P. aeruginosa, and K. oxytoca.

Taurolidine is more effective than 4% EDTA acid in eradicating Gram-positive and Gram-negative microorganisms and fungi.

Although catheter-related infections are the leading cause of bloodstream infections in patients with sickle cell disease (SCD), data are scarce in adult patients. The objectives of the present study were to describe central-venous-catheter-related bloodstream infections in patients with SCD and identify risk factors.

We conducted a retrospective, observational study of adult patients with SCD diagnosed with central-venous-catheter-related bloodstream infections between 2011 and 2023 in two SCD reference centres. Each patient with SCD and a bloodstream infection related to a totally implantable venous access port was matched with two control patients with SCD and an infection-free totally implantable venous access port.

Thirty-five (6.6%) of the 534 patients experienced a total of 69 central-venous-catheter-related bloodstream infections. Concomitant vaso-occlusive crises were observed for 81.2% of the infections. The 30-day mortality rate was 2.8%, and the infection recurrence rate was 45.7%. We observed 26 totally implantable venous access port-related bloodstream infections in 19 patients, with an incidence rate of 0.31 per 1000 catheter-days. After adjustment, the frequency of hospital admission for a vaso-occlusive crisis (odds ratio (OR) [95% confidence interval (CI)] = 1.6 [1.2-2.4]) and the presence of a psychiatric comorbidity (19.8 [4.0-148.1]) remained significantly associated with totally implantable venous access port-related bloodstream infections. Suboptimal antibiotic levels were observed in five (39%) of the 13 patients having undergone therapeutic drug monitoring. The treatment failed in four (80%) of the five patients, who presented with glomerular hyperfiltration.

A central-venous-catheter-related bloodstream infection is a severe complication in adult patients with SCD and is associated with psychiatric comorbidities and severe SCD.

Burns intensive care units (BICUs) have reduced mortality in patients with burns, but infections and sepsis remain the leading causes of death. Infections with multidrug-resistant (MDR) bacteria increase the risk of death in patients with burns, whose risk of acquiring such infections is higher due to various factors, including prolonged hospitalization and invasive procedures.

A retrospective study was performed in a French BICU over 8 years to analyze the epidemiology and risk factors for bloodstream infections (BSIs).

In total, 1402 patients were admitted to the BICU. Thermal burns were the most common cause of injury, and the median total body surface area burned was 10%. Patients had various comorbid conditions, particularly smoking and hypertension. BSI occurred in 303 (21%) patients. When compared with patients without BSI, patients with BSI were older, had higher severity scores and a larger total body surface area burned, and were more likely to develop complications. The prevalence of monomicrobial and polymicrobial BSI remained stable during hospitalization, with gram-positive pathogens such as Staphylococcus aureus most common during the first week but with gram-negative pathogens, particularly MDR Pseudomonas aeruginosa, becoming more prevalent after 15 days. The distribution of microorganisms remained stable throughout the study, except for a significant decrease in Acinetobacter baumannii rates and an increase in MDR P aeruginosa rates after 2015.

An understanding of the epidemiology of BSI-causing microorganisms over time is crucial for sepsis management to ensure the selection of appropriate empirical antimicrobial therapy and to highlight the need for infection prevention and antimicrobial stewardship.

To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management.

Following board approval, in 2020 the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) commissioned evidence-based guidelines for best practices for infection control. More than 80 research questions were developed and literature searches undertaken by assigned working groups comprising four to five members. Modified US Preventive Services Task Force criteria were used to determine levels of evidence and certainty. Using a modified Delphi method, >50% agreement was needed to accept a recommendation for author review, and >75% agreement for a recommendation to be accepted. The ASRA Pain Medicine Board of Directors reviewed and approved the final guidelines.

After documenting the incidence and infectious complications associated with regional anesthesia and interventional pain procedures including implanted devices, we made recommendations regarding the role of the anesthesiologist and pain physician in infection control, preoperative patient risk factors and management, sterile technique, equipment use and maintenance, healthcare setting (office, hospital, operating room), surgical technique, postoperative risk reduction, and infection symptoms, diagnosis, and treatment. Consensus recommendations were based on risks associated with different settings and procedures, and keeping in mind each patient's unique characteristics.

The recommendations are intended to be multidisciplinary guidelines for clinical care and clinical decision-making in the regional anesthesia and chronic interventional pain practice. The issues addressed are constantly evolving, therefore, consistent updating will be required.

The characteristics of bloodstream infections in patients admitted to long-term care wards remain unclear. This study examined differences in nosocomial-onset urinary tract-related bloodstream infections (UTRBSIs) and catheter-related bloodstream infections (CRBSIs) between patients admitted to long-term and acute care wards.

This retrospective cohort study was conducted at a mixed-care hospital with long-term and acute care wards from April 2015 to March 2024. Patient backgrounds, causative pathogens, antibiotic resistance, and treatment patterns were compared between the two groups.

Among the 252 patients, 108 (42.9 %) were diagnosed with UTRBSIs and 87 (34.5 %) with CRBSIs. In UTRBSIs, the long-term care group had significantly longer hospitalization (721 vs. 16 days, P < 0.001), more frequent use of indwelling urinary catheters (76.7 % vs. 28.6 %, P < 0.001), and higher isolation rates of extended-spectrum β-lactamase-producing Enterobacterales (41.1 % vs. 8.6 %, P < 0.001). Piperacillin/tazobactam and meropenem were significantly more frequently used empirically in the long-term care group. In CRBSIs, the isolation rates of main causative pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) (9.5 % vs. 6.7 %, P = 0.707) and methicillin-resistant coagulase-negative Staphylococcus spp. (40.5 % vs. 48.9 %, P = 0.519), showed no significant differences between the two groups despite differences in patient backgrounds. Anti-MRSA agents were rarely used empirically in both groups (19.0 % vs. 15.6 %, P = 0.779).

Patients admitted to long-term care wards may require empirical therapy for UTRBSIs targeting drug-resistant Enterobacterales, while for CRBSIs, empirical use of anti-MRSA agents may be considered, similar to patients admitted to acute care wards.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is crucial for treating high-risk hematological cancers. Posttransplant infections are a leading cause of mortality and morbidity, especially before engraftment. This study evaluated the effects of granulocyte transfusion (GT) therapy on neutrophil and platelet (PLT) engraftment in patients with febrile neutropenia during the pre-engraftment phase following allo-HSCT with a control group.

We retrospectively analyzed 56 patients who underwent allo-HSCT from January 2019 to January 2024, dividing them into two groups: those who received GT (GTG) and those who did not (non-GTG).

A total of 76 GTs were administered to 28 patients with febrile neutropenia during the pre-engraftment period. The median granulocyte dose was 5.4 × 108/kg. Median engraftment times in the GTG were 13 days for both PLT and neutrophil engraftment, compared to 15.5 days (PLT) and 19 days (neutrophil) in the non-GTG (p < 0.001 for neutrophil and p = 0.007 for PLT). Additionally, 89.3% of patients in the GTG showed improved infection status. Overall survival (OS) at 2 year was 61.4% for GTG and 73.2% for non-GTG, respectively. No significant difference in OS between the groups (p > 0.05). In the non-GTG, the OS rate was 47.5%, with no significant difference in OS and mortality rates between the groups. GT did not affect the incidence of graft-versus-host disease or cytomegalovirus infection.

This study is the first to include a control group and demonstrate a statistically significant association between GT therapy in the pre-engraftment period and shortened engraftment times in allo-HSCT recipients.

Central line-associated bloodstream infections (CLABSI) are among the most common and preventable hospital-acquired infections in pediatric and neonatal intensive care units (PICU-NICU). CLABSI is a common etiology of late-onset sepsis and is associated with high morbidity and mortality. The aim of this study was to describe the incidence of CLABSI in PICUs and NICUs in our geographical setting.

Descriptive study conducted as part of the VINCat program, investigating the incidence of CLABSI in NICUs and PICUs at acute care hospitals in Catalonia from 2013 to 2022. The annual CLABSI incidence rate was calculated by multiplying the total detected cases in a year by 1000 and dividing by the total patient-days with central venous catheter (CVC).

NICU: The overall incidence rate was 5.59 per 1000 patient-days. Peripherally inserted CVC was involved in 59.8% of catheter-related infection, and an overall median duration of 7 days from catheter insertion to the onset of infection. PICU: The overall incidence rate was 3.62 per 1000 patient-days. Jugular venous access (44.1%) was the most common location of infections, with a median of 12 days to CLABSI. Gram-positive bacteria, especially coagulase-negative Staphylococci, were the most prevalent in both units.

A standardized surveillance system based on the calculation of the incidence rate of CLABSI in PICUs and NICUs can broaden our understanding of this HAI and will guide the implementation of measures of infection control and prevention.

Accidental vascular catheter removal (AVCR) by patients with cognitive impairment can result in loss of access for infusion therapy, significant blood loss, air embolism with large bore catheters, and withholding life-sustaining dialysis treatment. Chest-to-back (CTB) tunneling of central venous catheters is a technique described in the Rapid Assessment of Vascular Access Exit Site and Tunneling Options (RAVESTO) for patients at risk for AVCR. In this retrospective review, data was collected for all venous access devices inserted using CTB tunneling in patients requiring medium to long term intravenous access for infusion or hemodialysis, who had a history of self-removing medical devices due to an alteration in mental status, or patients with severely impaired skin integrity. Vascular access devices were placed using real-time ultrasound and intracavitary electrocardiography (ECG) guidance. In this case series, from January 2020 to October 2024, a total of 46 out of 47 patients successfully received CTB-tunneled venous access devices. There was no reported symptomatic deep vein thrombosis. CTB tunneling was unable to be completed in one case due to severe patient agitation. The mean dwell was 23 days (ranging from 1 to 130 days). Nineteen patients completed their prescribed therapy, 18 patients were discharged with the catheter but were lost to follow up, four patients self-removed their catheter, three patients developed fungal infections receiving TPN, one patient experienced a primary catheter malposition which was removed after unsuccessful attempts at repositioning, and one patient receiving dialysis had a catheter exchange on day 32 due to poor flow. CTB tunneling is useful in patients with cognitive impairment who are at risk for AVCR and require medium to long term intravenous access. This retrospective review suggests that the use of ultrasound and intracavitary ECG makes the bedside CTB tunneling a safe and minimally invasive procedure.

Candida species are major pathogens of bloodstream infections (BSIs) in hospitalized patients, with high mortality. This study examined Candida species distribution, clinical characteristics, and the mortality of patients with Candida BSIs. Adult patients (≥16 years) with Candida BSIs at a teaching hospital (2014-2023) were retrospectively reviewed. Over 10 years, 487 Candida isolates were obtained from 462 patients. C. albicans was the most frequent (38.2%), followed by C. glabrata (21.1%), C. parapsilosis (20.5%), and C. tropicalis (13.3%). The annual incidence of Candida BSIs remained stable (p = 0.525). However, non-albicans species BSIs increased 1.61-fold compared to C. albicans (95% CI: 1.19-2.19, p = 0.002). Fluconazole-non-susceptible Candida isolates increased after 2021 (p = 0.040). The overall 30-day mortality was 40.6%. In the multivariate analysis, a high Charlson comorbidity index (aHR: 1.20, 95% CI: 1.07-1.35, p = 0.001) and high SOFA score (aHR: 1.12, 95% CI: 1.02-1.23, p = 0.022) were the strongest predictors of 30-day mortality. Meanwhile, C. parapsilosis BSIs (aHR: 0.46, 95% CI: 0.22-0.99, p = 0.047) and central venous catheter removal at any time (aHR: 0.22, 95% CI: 0.13-0.37, p < 0.001) were associated with reduced 30-day mortality. The mortality of patients with Candida BSIs was mainly determined by disease severity, while catheter removal was associated with improved survival.

The rising burden of fungal infections presents a significant challenge to global healthcare, particularly with increasing antifungal resistance limiting treatment efficacy. Early detection and timely intervention remain critical, yet fungal pathogens employ diverse mechanisms to evade host immunity and develop resistance, undermining existing therapeutic options. Limited antifungal options and rising resistance necessitate novel treatment strategies. This review provides a comprehensive overview of conventional antifungal agents, their mechanisms of action, and emerging resistance pathways. Furthermore, it highlights recently approved and investigational antifungal compounds while evaluating innovative approaches such as nanotechnology, drug repurposing, and immunotherapy. Addressing antifungal resistance requires a multifaceted strategy that integrates novel therapeutics, enhanced diagnostic tools, and future research efforts to develop sustainable and effective treatment solutions.

Subsequent bacteremia developed in 14 % of patients with positive catheter tip cultures but concurrent negative blood cultures. The occurrence of subsequent bacteremia did not differ significantly by pathogens (Staphylococcus aureus, Gram-negative rods [GNR], and Candida spp.). Mortality was higher in patients with GNR and Candida spp. than with S. aureus.

Piperacillin is commonly used off-label in neonates for the treatment of bacterial infections. This study aimed to assess a dried blood spots (DBS)-based microsampling strategy for supporting population pharmacokinetics and treatment optimization of piperacillin in Chinese neonates. DBS samples from neonatal patients were collected at predefined intervals. Drug blood concentrations were quantified using a validated ultra-high-performance liquid chromatography-tandem mass spectrometry method. A population pharmacokinetic model was developed using a nonlinear mixed-effects modeling approach. The pharmacokinetic/pharmacodynamics (PK/PD) target was 75% of the time with the unbound drug plasma concentration above the minimum inhibitory concentration (fT>MIC), with a toxicity threshold of unbound drug plasma trough concentration above 64 mg/L. A total of 45 piperacillin samples from 24 neonates were collected. The pharmacokinetics of piperacillin was described using a one-compartment model with postmenstrual age (PMA) as the most significant covariate on clearance. Simulations showed that dosing regimens achieving >90% PK/PD target attainment with <10% risk of possible toxicity were: PMA 33-35 weeks (50 mg/kg q12h), 35-37 weeks (50 mg/kg q8h), and 37-41 weeks (50 mg/kg q6h). In conclusion, Using DBS sampling, we developed a population pharmacokinetic model of piperacillin in Chinese neonates, incorporating PMA to determine optimal dosing regimens.

Breast cancer is the most prevalent malignancy affecting women. However, the optimal strategy for patients requiring long-term central venous catheters in breast cancer treatment remains uncertain. Previous investigations involving a mixed cancer population have shown a higher frequency of adverse events among patients receiving peripherally implanted central catheters (PICCs) compared with totally implanted central catheters (PORTs). Our study aimed to compare catheter-related adverse events in breast cancer patients.

We conducted a post hoc analysis of a previously published multicentre RCT known as PICCPORT. Data pertaining to baseline characteristics, insertion specifics, complication rates, and patient satisfaction were collected for breast cancer patients who required long-term central venous catheters for cancer treatment. The primary endpoint was a composite variable encompassing thrombotic, occlusive, infectious, or mechanical complications, while patient satisfaction served as a secondary endpoint.

Our analysis included 80 patients receiving PORT and 78 patients receiving PICC. There was no statistically significant difference in the incidence of complications between the PICC and PORT groups. Interestingly, PICC insertion was less painful than PORT insertion, although both groups reported low levels of pain.

While acknowledging the limitations of an underpowered post hoc subgroup analysis, our findings suggest that the well-established superiority of PORTs in terms of adverse events among cancer patients might not be as substantial for breast cancer patients in particular. Ultimately, the optimal strategy for selecting long-term access devices in breast cancer patients remains to be determined.

NCT01971021.

This report documents the first human case of Eidernor doerrieniae colonization in a peritoneal dialysis catheter, identified through DNA sequencing after a 52-year-old man observed brownish particles within his catheter. Despite the absence of peritonitis symptoms, prompt catheter removal and antifungal therapy successfully resolved the infection. Fungal cultures revealed cerebriform (brain-like) colonies, confirmed as E. doerrieniae using multi-targeted molecular diagnostics. A wet contamination event three weeks earlier was identified as the likely source. This case underscores the importance of recognizing intraluminal particles as an indicator of fungal colonization and highlights the critical role of timely intervention and advanced diagnostics in preventing fungal peritonitis.

Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality rates. This multicenter study aimed to identify mortality risk factors associated with SSIs after heart surgery.

Conducted from January to March 2023, this prospective study included 167 patients aged >16 years with post-heart surgery SSIs. The primary focus was the 30-day mortality. Univariate analysis and multivariate logistic regression utilizing the backward elimination method were used to establish the final model.

Several factors significantly correlated with mortality. These included urinary catheterization (odds ratio [OR] 14.197; 90% confidence interval [CI] 12.198-91.721]), emergent surgery (OR 8.470 [90% CI 2.028-35.379]), valvular replacement (OR 4.487 [90% CI 1.001-20.627]), higher quick Sequential Organ Failure Assessment scores (OR 3.147 [90% CI 1.450-6.827]), advanced age (OR 1.075 [90% CI 1.020-1.132]), and postoperative re-interventions within 30 days after SSI (OR 14.832 [90% CI 2.684-81.972]). No pathogens were isolated from the wound cultures of 53 (31.7%) patients. A total of 43.1% of SSIs (n = 72) were due to gram-positive microorganisms, whereas 27.5% of cases (n = 46) involved gram-negatives. Among the gram-positive bacteria, Staphylococci (n = 30, 17.9%) were the predominant microorganisms, whereas Klebsiella (n = 16, 9.6%), Escherichia coli (n = 9, 5.4%), and Pseudomonas aeruginosa (n = 7, 4.2%) were the most prevalent.

To mitigate mortality after heart surgery, stringent infection control measures and effective surgical antisepsis are crucial, particularly, in the elderly. The clinical progression of the disease is reflected by the quick Sequential Organ Failure Assessment score and patient re-intervention, and effective treatment is another essential component of SSI management.

Brucella anthropi, an aerobic, glucose-nonfermenting gram-negative rod, is predominantly an opportunistic pathogen affecting immunosuppressed patients. This case report describes a 27-year-old woman with systemic lupus erythematosus who developed persistent B. anthropi bacteremia following a pregnancy termination. Despite her stable condition and minimal symptoms, including transient fever, blood cultures revealed persistent bacteremia. Initial treatment with ceftazidime was ineffective due to resistance, leading to a switch to ciprofloxacin, which ultimately resolved the bacteremia. This case underscores the challenges in identifying the source of infection in the absence of typical symptoms and highlights the importance of vigilance in monitoring for persistent bacteremia, even in clinically stable patients. Our findings suggest that symptom improvement does not guarantee the resolution of bacteremia, propose follow-up blood cultures to ensure effective management of B. anthropi bacteremia.

Tunneled dialysis catheters (TDCs) are preferred over temporary noncuffed catheters for access in patients on maintenance hemodialysis. The removal of TDC after catheter-related blood stream infections (CRBSIs) is often not practiced even when indicated, and the adverse outcomes after such salvage are presently unclear.

The study aimed to evaluate adverse outcomes after the first episode of definite or probable CRBSI. The composite adverse outcome was recorded as the presence of at least one of three adverse outcomes-death in the index hospital admission, occurrence of recurrent bacteremia, and death within 3 months.

During the study period, the TDC CRBSI incidence rate was 6.9/1000 catheter days. Of the 110 study participants, majority were male (63%), with a median age of 35 years, belonging to rural (56%) and agrarian (39%) communities, and 66% were getting dialyzed at stand-alone dialysis units. Gram-negative infections predominated (64%), with 37% of isolates showing resistance to carbapenems. Catheter salvage was practiced in 80%, and immediate catheter removal was done only in the sickest of patients (in seven of eight with in-hospital mortality). Predictors of composite adverse outcomes included sites other than right internal jugular vein (OR 3.6) and resistance to β lactam-β lactamase inhibitors (OR 16.2). At a median follow-up of 7 months, all survivors at 3 months were alive and 46% had recurrent TDC CRBSIs.

Up to one-half of patients with end-stage kidney disease experienced composite adverse outcomes after the first episode of TDC CRBSI, with infection-related 3-month mortality of 15%.

Clinical trial number: CTRI/2023/10/058556.

This report describes a 6-year-old boy who developed non-tuberculosis mycobacteria (NTM) catheter-related bloodstream infection (CRBSI) during treatment for B-cell precursor acute lymphoblastic leukemia. A Hickman catheter was inserted before starting treatment. He developed a fever during chemotherapy, and blood culture was drawn from the catheter. Blurred Gram-positive bacilli were found in Gram stain, looked positive in Ziehl-Neelsen stain, and were identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry as Mycobacterium mucogenicum phocaicum group. The administration of clarithromycin and amikacin was started and the Hickman catheter was removed. We performed genomic sequencing to obtain accurate identification, demonstrating that this microorganism was identified as "M. toneyamachuris" calculated by the average nucleotide identity index. Finally, a clinical diagnosis of CRBSI caused by "M. toneyamachuris" was made. Our findings suggest that genomic sequencing is available for the accurate identification of NTM species.

Catheter-related bloodstream infections represent one of the most prevalent complications in patients with peripherally inserted central venous catheters (PICCs). The application of antibiotic lock therapy (ALT), particularly in patients with hematological malignancies, has not been well documented. We aim to share our experience on ALT for these patients and to evaluate its effectiveness and safety. All cases of patients with hematological malignancies who had PICC from January 2018 to October 2024 were retrospectively reviewed. Microbiologic data of PICC-related bloodstream infections (PRBSIs) were collected. A comparison was made between patients managed with ALT and those without it. Factors affecting PICC removal were also explored. A total of 45 patients experienced 67 episodes of PRBSIs, yielding an incidence rate of 2.98 per 1,000 PICC days. The median time of PRBSI onset was 42 days. Predominant pathogens included Gram-negative bacilli (49.3%) and Gram-positive cocci (35.8%). The catheter salvage rate was significantly higher at 76.5% when ALT was combined with systemic antibiotic therapy (SAT), compared to 51.5% for SAT alone (p = 0.033). 3 death events (3/34) compared with 4 death events (4/33) occurred in each therapeutic regimen (p = 0.709). Elevated procalcitonin levels (> 2ng/ml) and inadequate empirical therapy were risk factors for PICC removal; conversely, ALT served as a protective factor against it. ALT in combination with systemic antibiotics is a safe and effective approach for managing PRBSIs in patients with hematological malignancies, helping to avoid unnecessary catheter removal and could be considered in clinical practice when catheter retention is desired.

Bloodstream infections with the non-fermenting Gram-negative organisms Stenotrophomonas maltophilia, Elizabethkingia spp. or Chryseobacterium spp. are observed in nosocomial settings. Comparative description of their clinical presentation, microbiological characteristics, treatment options and outcomes remain to be investigated.

We performed a retrospective single-centre analysis of bloodstream infections with the abovementioned three organisms from 1 Jan 2012 to 30 Jun 2024.

A total of 349 distinct encounters (from 322 unique patients) were identified with bacteraemia. Stenotrophomonas maltophilia was the commonest (197/349, 56.4%), followed by Elizabethkingia spp. (127/349, 36.4%) and Chryseobacterium spp. (25/349, 7.2%). Prior carbapenem exposure was observed in 59.9% of cases. The majority were related to central lines (58.2%). Most cases were nosocomial in onset (82.5%), and a third were from the intensive care unit (32.1%). A significant proportion of our Stenotrophomonas maltophilia (32.8%) and Chryseobacterium spp. (22.7%) isolates were resistant to levofloxacin, while a majority of the organisms retained susceptibility to trimethoprim-sulfamethoxazole (TMP-SMX) and minocycline. Dual antibiotics were used in a minority of encounters (23/349, 6.6%). Mortality was high across infections with the three organisms, but highest amongst those with Stenotrophomonas maltophilia bacteraemia (41.6%), followed by Elizabethkingia spp. (29.9%) and Chryseobacterium spp. (20.0%).

Stenotrophomonas, Elizabethkingia or Chryseobacterium spp bacteraemia was associated with significant mortality. Most cases were nosocomial in acquisition, with prior carbapenem exposure or indwelling central catheters. Fluoroquinolone resistance was common for Stenotrophomonas maltophilia and Chryseobacterium spp., but less prevalent in Elizabethkingia spp., while TMP-SMX and minocycline retained susceptibility. Monitoring these trends would be critical in guiding empiric therapy for these organisms.

Antimicrobial lock therapy (ALT) prevents microbial colonization in central vein catheters and treats existing catheter-related bloodstream infections (CRBSIs); the ALT assessment involves several key considerations. First, identifying which patients are suitable candidates is crucial. Additionally, understanding the clinical contexts in which is utilised provides insight into its applications. Examining when ALT has been employed and analyzing trends in its use over time can highlight its evolving role in patient care. Equally important is understanding how ALT is administered, including the specific agents used. Lastly, determining whether there is sufficient existing literature is essential to evaluate the feasibility of conducting future systematic reviews. This study is a scoping review adhered to the PRISMA-ScR guidelines and followed a five-stage methodological framework. Of the 1024 studies identified, 336 were included in the analysis. Findings highlight the widespread use of ethanol and taurolidine for CRBSIs prevention and the concurrent use of ALT with systemic antimicrobials to treat CRBSIs without catheter removal. ALT improves clinical outcomes, including post-infection survival and catheter retention. From our analysis, we have concluded that both an umbrella review of systematic reviews and a network meta-analysis comparing lock solutions can provide clearer guidance for clinical practice.

The purpose of this review is to describe important considerations with local antimicrobial therapies such as locks, beads, and cement for adjunctive infection management or prevention.

Local delivery of antimicrobials with locks, beads, and cement has been used for infection management with retained devices in an effort to improve clinical success. However, their use has been controversial due to conflicting clinical data and logistical issues. Antimicrobial lock therapy (ALT) has been used for both adjunctive treatment and prevention of catheter-related bloodstream infections for certain pathogens and based on patient-specific scenarios. ALT has been a controversial method for sterilizing the catheter lumen by delivering high concentrations of antibiotics with or without heparin into the catheter for prolonged durations. Studies differ regarding the selection and concentrations of antibiotics, dwell duration, presence of heparin in the ALT, clinical outcomes/definitions, and use for prevention or treatment of catheter-related bloodstream infections. Antibiotic beads and cement have been used for various surgical procedures but are predominately considered in orthopedic surgeries. Despite the widespread use of the antibiotic-loaded bone cement in orthopedics, studies differ regarding the selection and concentrations of antibiotics, clinical outcomes/definitions, and use for prevention or treatment of infections.

Although antimicrobial locks, beads, and cement are commonly used for adjunctive treatment or prevention of infections, more data are needed to support their use to provide clinical efficacy and safety with consistent antimicrobial selection and logistics.

Although vancomycin is commonly used to treat methicillin-resistant coagulase-negative staphylococci (MRCoNS) infections, there are no clear guidelines for the optimal 24 h AUC24/MIC ratio. This study aimed to determine the target AUC24/MIC ratio associated with vancomycin-treated MRCoNS infection outcomes.

This multicentre retrospective cohort study included adult patients who received vancomycin for ≥5 days for bloodstream infections caused by MRCoNS between January 2018 and December 2023. Primary outcome was treatment success, defined as a composite of survival beyond 30 days, clinical success and microbiological eradication. Secondary outcomes included 30-day mortality, clinical success, microbiological eradication and nephrotoxicity. Receiver operating characteristic (ROC) curve analysis was used to identify the AUC24/MIC cut-off for treatment success. Multivariate regression analysis was used to determine the association between AUC24/MIC and outcomes.

This study included 147 patients. ROC analysis identified a target AUC24/MIC ≥373 for treatment success. The overall treatment success rate (70.1%) was significantly higher in the above-average AUC24/MIC cut-off group (83.1%) than that in the below AUC24/MIC cut-off group (57.9%). Multivariate analysis confirmed that AUC24/MIC ≥373 was an independent predictor (adjusted OR = 10.227; 95% CI = 3.585-29.171). The 30-day mortality and microbiological eradication rates differed significantly between the below- and above-cut-off groups, whereas nephrotoxicity rates were comparable among the groups.

In treating MRCoNS infections, vancomycin AUC24/MIC ratio ≥373 was independently associated with favourable treatment outcomes. However, further prospective studies are required to confirm this target owing to the retrospective nature of this study.

Empiric antibiotics active against Pseudomonas aeruginosa are recommended by professional societies for certain infections and are commonly prescribed for hospitalized patients. The effect of this practice on mortality is uncertain.

A systematic literature search was conducted using Embase, Medline, PubMed, Web of Science, Cochrane, Scopus and Google Scholar from earliest entry through 9 October 2023. We included studies of patients hospitalized with P. aeruginosa infections that compared mortality rates depending on whether patients received active empiric antibiotics.

We found 27 studies of 12 522 patients that reported adjusted OR of active empiric antibiotics on mortality. The pooled adjusted OR was 0.40 (95% CI, 0.32-0.50), favouring active empiric antibiotics. In practice, the mortality effect of empiric antibiotics against P. aeruginosa depends on the prevalence of P. aeruginosa and baseline mortality. The estimated absolute mortality benefit was 0.02% (95% CI, 0.02-0.02) for soft tissue infections, 0.12% (95% CI, 0.10-0.13) for urinary tract infections and community-acquired pneumonia, 0.3% (0.25-0.34) for sepsis without shock, 1.1% (95% CI, 0.9-1.4) for septic shock and 2.4% (95% CI, 1.9-2.8) for nosocomial pneumonia.

The mortality effect for empiric antibiotics against P. aeruginosa depends crucially on the prevalence of P. aeruginosa and baseline mortality by type of infection. For soft tissue infections, urinary tract infections and community-acquired pneumonia, the mortality benefit is low. Meaningful benefit of empiric antibiotics against P. aeruginosa is limited to patients with approximately 30% mortality and 5% prevalence of P. aeruginosa, which is largely limited to patients in intensive care settings.