Issam I Raad -United States Of America

Title Diagnosis and Testing

The University of Texas M. D. Anderson Cancer Center

Address Show details Phone Show details Email Show details
Share |

Previous Afiliations

Keywords

  • Salvage Therapy therapeutic use drug therapy drug therapy complications therapeutic use

  • Catheterization pharmacology prevention & control drug effects pharmacology microbiology

  • Catheterization pharmacology drug effects microbiology drug effects methods drug effects

Summary Information

  • Member of Clinical Trials(CT)
  • Member of American Society of Microbiology(ASM).
  • Antimicrobial agents and chemotherapy (8)
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (6)
  • Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America (6)
  • The Journal of antimicrobial chemotherapy (4)
  • Cancer (4)
  • European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (3)
  • Biomaterials (1)
  • Leukemia : official journal of the Leukemia Society of America, Leukemia Research Fund, U.K (1)
  • Current opinion in infectious diseases (1)
  • International journal of antimicrobial agents (1)
  • The Lancet infectious diseases (1)
  • Chest (1)
  • Archives of internal medicine (1)
  • Annals of surgical oncology (1)
  • The American journal of medicine (1)
  • Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (1)
  • Critical care medicine (1)
  • Annals of internal medicine (1)
  • The Journal of infectious diseases (1)
  • Middle East journal of anesthesiology (1)
  • The Journal of hospital infection (1)
  • American journal of infection control (1)
  • Antimicrobial Agents and Chemotherapy (12)
  • Journal of Clinical Microbiology (3)
10,066,017
Maven is an online database of international healthcare professionals. Records are downloadable to Excel or in-house database, with email, postal address and phone/fax contacts.

To view and export full contact details of healthcare professionals you must subscribe to Maven Semantic. To learn more please request a call from our team:

Member of Clinical Trials(CT)


Medical Subjects: Cholelithiasis,Gallstones,Biliary Tract Diseases,Digestive System Diseases Cholecystolithiasis,Gallbladder Diseases,Calculi,Pathological Conditions, Anatomical

Member of American Society of Microbiology(ASM).


Primary Interests : Health Care Epidemiology

Sources

Chelator-based catheter lock solutions in eradicating organisms in biofilm.
(2012)
Journal - Antimicrobial agents and chemotherapy (United States )

Abstract :

Two different chelator-based antimicrobial catheter lock solutions, methylene blue-citrate-parabens (MB-CIT) and minocycline-EDTA-25% ethanol (M-EDTA-25% ETOH), were compared in 2-h biofilm eradication experiments. Eradication of both mature and immature Gram-positive, Gram-negative, and fungal biofilms was assessed. M-EDTA-25% ETOH was able to fully eradicate all biofilms within 2 h. MB-CIT was only effective against immature biofilms but was unable to fully eradicate most of the mature biofilms tested.

ISSN : 1098-6596
The prevention of biofilm colonization by multidrug-resistant pathogens that cause ventilator-associated pneumonia with antimicrobial-coated endotracheal tubes.
(2011)
Journal - Biomaterials

Abstract :

Ventilator-associated pneumonia (VAP) continues to be the nosocomial infection associated with the highest mortality in critically ill patients. Since silver-coated endotracheal tubes (ETT) was shown in a multicenter prospective randomized trials to decrease the risk of VAP, we compared the efficacy of two antiseptic agents such as gardine- and gendine-coated ETTs with that of silver-coated ETTs in preventing biofilm. The ETTs were tested for their ability to prevent the biofilm formation of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Enterobacter cloacae, and Candida albicans. Scanning electron microscopy studies revealed a heavy biofilm on uncoated and silver-coated ETT but not on the gardine-coated ETT. The gardine and gendine ETTs completely inhibited the formation of biofilms by all organisms tested and were more effective in preventing biofilm growth than the silver ETTs (p < 0.001). The gardine- and gendine-coated ETTs were more durable against MRSA than either the silver-coated or uncoated ETTs for up to 2 weeks (p < 0.0001). We have therefore shown that gardine- and gendine-coated ETTs are superior to silver-coated ETTs in preventing biofilm. Future animal and clinical studies are warranted to determine whether the gardine- and gendine-coated ETTs can significantly reduce the risk of VAP.Copyright © 2011 Elsevier Ltd. All rights reserved.

ISSN : 1878-5905
Improved Antibiotic Impregnated Catheters with Extended Spectrum Activity Against Resistant Bacteria and Fungi.
(2011)
Journal - Antimicrobial agents and chemotherapy

Abstract :

Minocycline/rifampin (M/R) central venous catheters (M/R CVC) have been shown to be efficacious in reducing catheter-related bloodstream infections (CRBSI) and inhibiting the biofilm adherence of resistant Gram-positive and Gram-negative pathogens with the exception of Pseudomonas aeruginosa and Candida. To expand the spectrum of antimicrobial activity, a novel second generation M/R-catheter was developed by adding chlorhexidine (CHX-M/R). CVC and peripherally inserted central catheters (PICC) were impregnated with CHX-M/R and compared with first generation M/R catheters, chlorhexidine/silver sulfadiazine treated CVCs (CHX/SS-CVC), chlorhexidine treated PICCs and uncoated catheters. A biofilm catheter colonization model was used to assess the efficacy of catheters against methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE), P. aeruginosa, Candida albicans and Candida glabrata. CHX-M/R impregnated CVC was the only antimicrobial catheters that completely inhibited the biofilm colonization of all resistant bacterial and fungal organisms tested at all time intervals and were significantly superior to uncoated catheters (all p values = 0.003). Furthermore, CHX-M/R coated CVC had a significantly more effective and prolonged antimicrobial activity up to 3 weeks against MRSA, and P. aeruginosa compared to M/R, CHX/SS and uncoated CVC (p < 0.0001). Similarly, CHX-M/R coated PICC was also superior to M/R coated and chlorhexidine PICC in preventing biofilm of MRSA, VRE, P. aeruginosa and Candida species (all p-values= 0.003). Our study shows that novel CHX-M/R catheters have unique properties in completely inhibiting biofilm colonization of MRSA, VRE, and P. aeruginosa and fungi in a manner superior to the M/R and chlorhexidine treated catheters.

ISSN : 1098-6596
Management of the catheter in documented catheter-related coagulase-negative staphylococcal bacteremia: remove or retain?
(2009)
Journal - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (United States )

Abstract :

BACKGROUND:Studies and guidelines recommending the retention of the central venous catheter (CVC) in patients with coagulase-negative staphylococcal bacteremia were based on loose definitions of bacteremia and/or did not evaluate the risk of recurrence. In this study, we used strict definitions of coagulase-negative staphylococcal bacteremia to determine the impact of CVC retention on response to and recurrence of infection. METHODS:During the period from July 2005 through December 2007, we retrospectively evaluated 188 patients with coagulase-negative staphylococcal bacteremia. Bacteremia was defined using the strict Centers for Disease Control and Prevention criteria of 2 positive blood culture results. Catheter-related bacteremia was confirmed by differential quantitative blood cultures (>or=3:1) or time to positivity (>2 h). RESULTS:Resolution of infection within 48 h after commencement of antimicrobial therapy was not influenced by CVC removal or exchange versus retention and occurred in 175 patients (93%). Multiple logistic regression analysis showed that infection was 7.0 times (95% confidence interval [CI], 1.5-32.6 times) more likely to fail to resolve in patients with an intensive care unit stay prior to infection ( P = .013 ) and 3.8 times (95% CI, 1.1-13.3 times) more likely to fail to resolve in patients who had other concurrent sites of infection (P = .041 ). Duration of therapy did not affect recurrence. Multiple logistic regression analysis revealed that patients with catheter retention were 6.6 times (95% CI, 1.8-23.9 times) more likely to have a recurrence than were those whose catheter was removed or exchanged (P = .004). CONCLUSIONS:CVC retention does not have an impact on the resolution of coagulase-negative staphylococcal bacteremia but is a significant risk factor of recurrence.

ISSN : 1537-6591
Novel antifungal agents as salvage therapy for invasive aspergillosis in patients with hematologic malignancies: posaconazole compared with high-dose lipid formulations of amphotericin B alone or in combination with caspofungin.
(2008)
Journal - Leukemia : official journal of the Leukemia Society of America, Leukemia Research Fund, U.K (England )

Abstract :

In patients with hematologic malignancy, invasive aspergillosis continues to be associated with high mortality even when treated with conventional antifungal therapy. To investigate novel antifungal agents, we compared 53 patients who received posaconazole salvage therapy to 52 contemporary control patients who received high-dose lipid formulation of amphotericin B (HD-LPD/AMB at > or = 7.5 mg kg(-1) per day) and 38 other control patients who received caspofungin plus HD-LPD/AMB. Patients in the three groups had similar. The overall response rate to salvage therapy was 40% for posaconazole, 8% for HD-LPD/AMB (P < or = 0.001) and 11% for combination therapy (P < 0.002). Aspergillosis contributed to the death of 40% of posaconazole group, 65% of the HD-LPD/AMB group and 68% of the combination group (P < or = 0.008). By multivariate analysis, posaconazole therapy independently improved response (9.5; 95% confidence interval, 2.8-32.5; P < 0.001). HD-LPD/AMB alone or in combination was associated with a significantly higher rate of nephrotoxicity (P < or = 0.02) and hepatotoxicity (P < 0.03). In conclusion, posaconazole salvage therapy demonstrated greater efficacy and safety than HD-LPD/AMB alone or in combination with caspofungin in the salvage therapy of invasive aspergillosis in hematologic malignancy.

ISSN : 1476-5551
Mesh Heading : Adult Amphotericin B Antifungal Agents Antineoplastic Combined Chemotherapy Protocols Aspergillosis Combined Modality Therapy Drug Combinations Drug Therapy, Combination Echinocandins Female Fungemia Hematologic Neoplasms Hematopoietic Stem Cell Transplantation Humans Itraconazole Male Middle Aged Neutropenia Phosphatidylcholines Phosphatidylglycerols Pyrimidines Treatment Outcome Triazoles administration & dosage therapeutic use administration & dosage adverse effects therapeutic use etiology administration & dosage therapeutic use drug therapy surgery administration & dosage therapeutic use chemically induced complications administration & dosage therapeutic use administration & dosage therapeutic use administration & dosage therapeutic use administration & dosage
Mesh Heading Relevant : Salvage Therapy therapeutic use drug therapy drug therapy complications therapeutic use
The role of chelators in preventing biofilm formation and catheter-related bloodstream infections.
(2008)
Journal - Current opinion in infectious diseases (United States )

Abstract :

PURPOSE OF REVIEW: As metallic cations are essential to microbial adherence, biofilm formation, and bacterial growth, efforts have been directed toward utilizing metal-binding chelators that have the capability of inhibiting bacterial growth by disrupting surface adherence and preventing biofilm production. This review focuses on recent advances in the role of chelators in biofilm disruption and prevention of catheter-related bloodstream infections. RECENT FINDINGS: The most important factor in the pathogenesis of catheter-related bloodstream infections is the intraluminal colonization of the central venous catheters through the formation of bacterial biofilm matrix in which microbial organisms embed themselves and eventually become a source of catheter-related bloodstream infections. It has been demonstrated that high-affinity metal-binding chelators including ethylenediamine-tetraacetic acid and citrate have the capacity of inhibiting microbial growth by disrupting surface adherence and preventing biofilm production. Furthermore, ethylenediamine-tetraacetic acid and citrate have been clinically shown to be highly effective and outperform heparin in the prevention and treatment of catheter-related bloodstream infections when used as a component of antimicrobial catheter lock solutions. SUMMARY: It is suggested that the addition of chelators such as ethylenediamine-tetraacetic acid and citrate to antimicrobial lock solutions provides an innovative and superior alternative to heparin lock solution in the prevention and treatment of catheter-related bloodstream infections.

ISSN : 1535-3877
Mesh Heading : Anti-Bacterial Agents Bacteremia Bacterial Adhesion Biofilms Chelating Agents Citric Acid Edetic Acid Equipment and Supplies Humans drug effects pharmacology pharmacology
Mesh Heading Relevant : Catheterization pharmacology prevention & control drug effects pharmacology microbiology
Anti-adherence activity and antimicrobial durability of anti-infective-coated catheters against multidrug-resistant bacteria.
(2008)
Journal - The Journal of antimicrobial chemotherapy (England )

Abstract :

OBJECTIVES: To investigate the anti-adherence and antimicrobial durability of anti-infective catheters against multidrug-resistant (MDR) Staphylococcus aureus (resistant to vancomycin, rifampicin and methicillin) and MDR Gram-negative bacteria (Stenotrophomonas maltophilia, Acinetobacter baumannii/calcoaceticus and Enterobacter agglomerans) that are often associated with catheter-related bloodstream infections (CRBSIs). METHODS: Catheters impregnated with minocycline and rifampicin (M/R) or with silver-platinum and carbon (SPC) or with chlorhexidine and silver sulfadiazine (CHX/SS) were compared with non-coated catheters. Adherence of organisms was tested by using an established biofilm colonization model. All isolates were rifampicin-resistant. Antimicrobial durability was tested by soaking 1 cm segments of the catheter in serum and determining zones of inhibition against the tested organisms at weekly intervals. RESULTS: The M/R catheters showed significantly superior anti-adherence activity and more prolonged antimicrobial durability when compared with CHX/SS-central venous catheter (CVC), SPC-CVC and uncoated control catheters against MDR and vancomycin-resistant S. aureus (MDR VRSA) (all P values < or = 0.02), MDR S. maltophilia (all P values < 0.005) and MDR A. baumannii/calcoaceticus (all P values < 0.002), respectively. M/R-CVC and CHX/SS-CVC had comparable anti-adherence and antimicrobial durability against MDR E. agglomerans, and these two were superior to SPC-CVC and the uncoated control catheters (all P values < 0.001). CONCLUSIONS: M/R-CVC demonstrated superior anti-adherence activity and more prolonged antimicrobial durability when compared with other approved anti-infective catheters against MDR VRSA and/or MDR Gram-negative bacteria that are often associated with CRBSIs. This finding could explain their efficacy and better performance in clinical studies.

ISSN : 1460-2091
Mesh Heading : Anti-Infective Agents Bacterial Adhesion Drug Resistance, Multiple, Bacterial Equipment and Supplies Gram-Negative Bacteria Infection Control Staphylococcus aureus
Mesh Heading Relevant : Catheterization pharmacology drug effects microbiology drug effects methods drug effects
Commentary: zero tolerance for catheter-related bloodstream infections: the unnegotiable objective.
(2008)
Journal - Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America (United States )
ISSN : 1559-6834
Mesh Heading : Asepsis Bacteremia Catheterization, Central Venous Catheters, Indwelling Chlorhexidine Cross Infection Equipment Contamination Humans Minocycline Rifampin Silver Sulfadiazine epidemiology microbiology adverse effects therapeutic use epidemiology microbiology therapeutic use therapeutic use therapeutic use
Mesh Heading Relevant : methods prevention & control adverse effects microbiology prevention & control prevention & control
Role of ethylene diamine tetra-acetic acid (EDTA) in catheter lock solutions: EDTA enhances the antifungal activity of amphotericin B lipid complex against Candida embedded in biofilm.
(2008)
Journal - International journal of antimicrobial agents (Netherlands )

Abstract :

Ethylene diamine tetra-acetic acid (EDTA) is an anticoagulant with antibiofilm-enhancing activity. We therefore used an in vitro biofilm model to determine the activity of amphotericin B lipid complex (ABLC) with or without EDTA against Candida embedded in biofilm on silicone disk surfaces. Clinical blood isolates from cancer patients infected with Candida albicans or Candida parapsilosis were used. Silicone disks were colonised with C. albicans or C. parapsilosis and were sequentially incubated in plasma and then in Mueller-Hinton broth containing 10(5) colony-forming units of each organism. All tests were performed in triplicate. The disks were subsequently placed and incubated for 6h and 8h in solutions containing ABLC alone, EDTA alone, ABLC+EDTA or broth (control). Disks were then removed, sonicated and colony counts were determined. ABLC+EDTA (30 mg/mL) was significantly more effective than ABLC, EDTA and control against C. parapsilosis at 6h (P < or = 0.01) and against C. albicans at 8h (P < or = 0.04). In patients with catheter-related candidaemia when catheter removal is not feasible, the combination of ABLC+EDTA may be considered for antifungal catheter lock solution as part of a catheter salvage therapy.

ISSN : 0924-8579
Mesh Heading : Amphotericin B Antibiotics, Antifungal Biofilms Candida Candida albicans Catheter-Related Infections Chelating Agents Colony Count, Microbial Drug Synergism Edetic Acid Pharmaceutical Solutions drug effects
Mesh Heading Relevant : pharmacology pharmacology drug effects drug effects prevention & control pharmacology pharmacology
Comparative activities of daptomycin, linezolid, and tigecycline against catheter-related methicillin-resistant Staphylococcus bacteremic isolates embedded in biofilm.
(2007)
Journal - Antimicrobial agents and chemotherapy (United States )

Abstract :

In the setting of catheter-related bloodstream infections, intraluminal antibiotic lock therapy could be useful for the salvage of vascular catheters. In this in vitro study, we investigated the efficacies of the newer antibiotics daptomycin, linezolid, and tigecycline, in comparison with those of vancomycin, minocycline, and rifampin, against methicillin-resistant Staphylococcus aureus (MRSA) embedded in biofilm. We also assessed the emergence of MRSA strains resistant to these antibiotics, alone or in combination with rifampin, after 4-hour daily use for catheter lock therapy. Minocycline, daptomycin, and tigecycline were more efficacious in inhibiting MRSA in biofilm than linezolid, vancomycin, and the negative control (P < 0.001) after the first day of exposure to these antibiotics, with minocycline being the most active, followed by daptomycin and then tigecycline, and with vancomycin and linezolid lacking activity, similar to the negative control. After 3 days of 4-hour daily exposures, daptomycin was the fastest in eradicating MRSA from biofilm, followed by minocycline and tigecycline, which were faster than linezolid, rifampin, and vancomycin (P < 0.001). When rifampin was used alone, it was the least effective in eradicating MRSA from biofilm after 5 days of 4-hour daily exposures, as it was associated with the emergence of rifampin-resistant MRSA. However, when rifampin was used in combination with other antibiotics, the combination was significantly effective in eliminating MRSA colonization in biofilm more rapidly than each of the antibiotics alone. In summary, daptomycin, minocycline, and tigecycline should be considered further for antibiotic lock therapy, and rifampin should be considered for enhanced antistaphylococcal activity but not as a single agent.

ISSN : 0066-4804
Mesh Heading : Acetamides Anti-Bacterial Agents Bacteremia Biofilms Catheterization, Central Venous Daptomycin Humans Methicillin Resistance Minocycline Oxazolidinones Staphylococcus aureus pharmacology
Mesh Heading Relevant : pharmacology pharmacology microbiology adverse effects pharmacology analogs & derivatives pharmacology drug effects
Sources and outcome of bloodstream infections in cancer patients: the role of central venous catheters.
(2007)
Journal - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (Germany )

Abstract :

Simultaneously drawn quantitative blood cultures are used to diagnose catheter-related bloodstream infections. We conducted this study to determine the frequency with which central venous catheters were the source of bloodstream infections detected through paired positive blood cultures drawn from cancer patients and the potential for quantitative blood cultures to help predict outcome in neutropenic and non-neutropenic patients. From September 1999 to November 2000, we identified 169 patients with bloodstream infections. Of all bloodstream infections, 56% were catheter-related bloodstream infections. Gram-positive bacteremia was found to be catheter-related in 55% and 69% of patients with hematologic malignancy and solid tumors, respectively, whereas gram-negative bacteremia was catheter-related in only 19% of patients with underlying hematologic malignancy and in 60% of patients with solid tumor (P = 0.01). By multivariate analysis, poor response was associated with critical illness and persistent neutropenia (P < 0.01). In neutropenic patients with catheter-related bloodstream infections, peripheral quantitative blood cultures of >or=100 CFU/mL was also associated with poor response (P = 0.05). Central venous catheters were the major source of bloodstream infection, particularly in patients with solid tumors. In addition to critical illness and persistent neutropenia, quantitative blood cultures might be useful in predicting outcomes for neutropenic patients with catheter-related bloodstream infections.

ISSN : 0934-9723
Mesh Heading : Aged Bacteremia Catheterization, Central Venous Critical Illness Cross Infection Female Gram-Negative Bacterial Infections Gram-Positive Bacterial Infections Hospitals, University Humans Incidence Male Middle Aged Neoplasms Neutropenia Prognosis drug therapy epidemiology drug therapy epidemiology complications epidemiology complications epidemiology blood
Mesh Heading Relevant : microbiology adverse effects microbiology complications
Intravascular catheter-related infections: advances in diagnosis, prevention, and management.
(2007)
Journal - The Lancet infectious diseases (United States )

Abstract :

Indwelling vascular catheters are a leading source of bloodstream infections in critically ill patients and cancer patients. Because clinical diagnostic criteria are either insensitive or non-specific, such infections are often overdiagnosed, resulting in unnecessary and wasteful removal of the catheter. Catheter-sparing diagnostic methods, such as differential quantitative blood cultures and time to positivity have emerged as reliable diagnostic techniques. Novel preventive strategies include cutaneous antisepsis, maximum sterile barrier, use of antimicrobial catheters, and antimicrobial catheter lock solution. Management of catheter-related bloodstream infections involves deciding on catheter removal, antimicrobial catheter lock solution, and the type and duration of systemic antimicrobial therapy. Such decisions depend on the identity of the organism causing the bloodstream infection, the clinical and radiographical manifestations suggesting a complicated course, the underlying condition of the host (neutropenia, thrombocytopenia), and the availability of other vascular access sites.

ISSN : 1473-3099
Mesh Heading : Anti-Infective Agents Catheterization, Central Venous Catheterization, Peripheral Catheters, Indwelling Humans administration & dosage therapeutic use diagnosis drug therapy prevention & control adverse effects diagnosis drug therapy prevention & control
Mesh Heading Relevant : Bacteremia Fungemia adverse effects adverse effects classification
Safety of long-term oral posaconazole use in the treatment of refractory invasive fungal infections.
(2006)
Journal - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (United States )

Abstract :

BACKGROUND: Invasive fungal infections are found most frequently in immunosuppressed and critically ill hospitalized patients. Antifungal therapy is often required for long periods. Safety data from the clinical development program of the triazole antifungal agent, posaconazole, were analyzed. METHODS: A total of 428 patients with refractory invasive fungal infections (n = 362) or febrile neutropenia (n = 66) received posaconazole in 2 phase II/III open-label clinical trials. Also, 109 of these patients received posaconazole therapy for > or = 6 months. Incidences of treatment-emergent, treatment-related, and serious adverse events and abnormal laboratory parameters were recorded during these studies. RESULTS: Treatment-emergent, treatment-related adverse events were reported in 38% of the overall patient population. The most common treatment-related adverse events were nausea (8%) and vomiting (6%). Treatment-related serious adverse events occurred in 8% of patients. Low rates of treatment-related corrected QT interval and/or QT interval prolongation (1%) and elevation of hepatic enzymes (2%) were reported as adverse events. Treatment-emergent, treatment-related adverse events occurred at similar rates in patients who received posaconazole therapy for < 6 months and > or = 6 months. CONCLUSIONS: Prolonged posaconazole treatment was associated with a generally favorable safety profile in seriously ill patients with refractory invasive fungal infections. Long-term therapy did not increase the risk of any individual adverse event, and no unique adverse event was observed with longer exposure to posaconazole.

ISSN : 1537-6591
Mesh Heading : Adolescent Adult Aged Antifungal Agents Dose-Response Relationship, Drug Drug Administration Schedule Female Humans Male Middle Aged Mycoses Triazoles therapeutic use therapeutic use
Mesh Heading Relevant : administration & dosage adverse effects drug therapy pathology administration & dosage adverse effects
Efficacy and safety of weekly dalbavancin therapy for catheter-related bloodstream infection caused by gram-positive pathogens.
(2005)
Journal - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (United States )

Abstract :

BACKGROUND: Catheter-related bloodstream infections (CR-BSIs) are associated with substantial mortality, prolongation of hospital stay, and increased cost of care. Dalbavancin, a new glycopeptide antibiotic with unique pharmacokinetic properties that have allowed clinical development of a weekly dosing regimen, possesses excellent activity against clinically important gram-positive bacteria, suggesting utility in the treatment of patients with CR-BSIs. METHODS: A phase 2, open-label, randomized, controlled, multicenter study of 75 adult patients with CR-BSIs compared treatment with intravenous dalbavancin, administered as a single 1000-mg dose followed by a 500-mg dose 1 week later, with intravenous vancomycin, administered twice daily for 14 days. Gram-positive bacteria isolated in this study included coagulase-negative staphylococci (CoNS) and Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA). RESULTS: Infected patients who received weekly dalbavancin (n=33) had an overall success rate (87.0%; 95% confidence interval [CI], 73.2%-100.0%) that was significantly higher than that of those who received vancomycin (n=34) (50.0%; 95% CI, 31.5%-68.5%). Adverse events and laboratory abnormalities were generally mild and were comparable for the 2 drugs. CONCLUSIONS: Dalbavancin thus appears to be an effective and well-tolerated treatment option for adult patients with CR-BSIs caused by CoNS and S. aureus, including MRSA.

ISSN : 1537-6591
Mesh Heading : Adult Aged Aged, 80 and over Anti-Bacterial Agents Bacteremia Catheters, Indwelling Drug Administration Schedule Female Humans Male Middle Aged Teicoplanin Vancomycin adverse effects therapeutic use adverse effects therapeutic use
Mesh Heading Relevant : adverse effects therapeutic use adverse effects analogs & derivatives
Catheter-related vancomycin-resistant Enterococcus faecium bacteremia: clinical and molecular epidemiology.
(2005)
Journal - Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America (United States )

Abstract :

OBJECTIVE: To study the clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium organisms causing catheter-related bacteremia in patients with cancer. DESIGN: Retrospective case-control study. SETTING: University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas. PATIENTS: Case-patients were patients with cancer who had catheter-related vancomycin-resistant E. faecium bacteremia and control-patients were patients with cancer and vancomycin-resistant E. faecium gastrointestinal colonization without infection. RESULTS: Ten case-patients with catheter-related vancomycin-resistant E. faecium bacteremia were compared with 30 control-patients with gastrointestinal colonization by vancomycin-resistant E. faecium. Patients with catheter-related vancomycin-resistant E. faecium bacteremia were more likely to have required mechanical ventilation (P < .01), received total parenteral nutrition (P < .01), and had polyurethane catheters (P < .01) inserted in the femoral vein (P = .01). With the use of pulsed-field gel electrophoresis, 4 of the 10 catheter-related vancomycin-resistant E. faecium bacteremia isolates were genetically indistinguishable, whereas only 2 of the 30 control vancomycin-resistant E. faecium isolates displayed this same DNA pattern (P = .03). CONCLUSION: This study suggests that catheter-related vancomycin-resistant E. faecium bacteremia occurs more frequently in patients who receive total parenteral nutrition, mechanical ventilation, and femoral catheters.

ISSN : 0899-823X
Mesh Heading : Adult Bacteremia Bacterial Typing Techniques Case-Control Studies Catheterization Comorbidity DNA, Bacterial Enterococcus faecium Female Gastrointestinal Tract Gram-Positive Bacterial Infections Humans Male Middle Aged Neoplasms Retrospective Studies Risk Factors Texas methods genetics genetics isolation & purification microbiology microbiology epidemiology therapy epidemiology
Mesh Heading Relevant : Vancomycin Resistance epidemiology adverse effects drug effects epidemiology
Vancomycin-resistant Enterococcus faecium: catheter colonization, esp gene, and decreased susceptibility to antibiotics in biofilm.
(2005)
Journal - Antimicrobial agents and chemotherapy (United States )

Abstract :

To evaluate the molecular characteristics and antibiotic susceptibility in biofilm of vancomycin-resistant Enterococcus faecium (VREF) organisms that had caused catheter-related VREF bacteremia (VREF-CRB), we compared 22 isolates causing bacteremia obtained from patients with VREF-CRB with 30 isolates from control patients with gastrointestinal colonization by VREF. Using pulsed-field gel electrophoresis, we identified 17 unique strains among the 22 VREF-CRB isolates and 23 strains among the gastrointestinal isolates. The esp gene was detected in 53% (9 of 17) of the VREF-CRB and 61% (14 of 23) of the control strains (P = 0.6). VREF-CRB produced heavier biofilm colonization of silicone disks than did control organisms (P < 0.001). Daptomycin, minocycline, and quinupristin-dalfopristin were each independently more active than linezolid in reducing biofilm colonization by VREF-CRB (P < 0.01), with daptomycin being the most active, followed by minocycline. In conclusion, the esp gene in VREF is not associated with heavy biofilm colonization or catheter-related bacteremia. In biofilm, daptomycin and minocycline were the most active antibiotics against VREF, and linezolid was the least active.

ISSN : 0066-4804
Mesh Heading : Anti-Bacterial Agents Bacteremia Bacterial Proteins Biofilms Catheterization Enterococcus faecium Gastrointestinal Tract Humans Membrane Proteins Microbial Sensitivity Tests Vancomycin Resistance therapeutic use drug therapy growth & development genetics pathogenicity microbiology
Mesh Heading Relevant : pharmacology microbiology physiology adverse effects drug effects physiology physiology
Prospective, randomized study comparing quinupristin-dalfopristin with linezolid in the treatment of vancomycin-resistant Enterococcus faecium infections.
(2004)
Journal - The Journal of antimicrobial chemotherapy (England )

Abstract :

OBJECTIVES: Quinupristin-dalfopristin and linezolid have been shown to be efficacious in the treatment of vancomycin-resistant Enterococcus faecium (VREF) infections. However, the two antibiotics have not been compared in terms of safety and efficacy in a prospective randomized study. The objective of this study was to compare the safety and efficacy of the two drugs in the treatment of VREF infections in cancer patients. PATIENTS AND METHODS: Forty cancer patients with VREF infection were randomized to receive linezolid 600 mg every 12 h or quinupristin-dalfopristin 7.5 mg/kg every 8 h. All patients were followed up for 30 days after discontinuation of study drugs. RESULTS: Linezolid and quinupristin-dalfopristin had comparable clinical responses (58% and 43%, respectively, P = 0.6). Myalgias and/or arthralgias occurred at a frequency of 33% in patients who received quinupristin-dalfopristin, but were not observed in the linezolid group (P = 0.03). In contrast, drug-related thrombocytopenia occurred in 11% of patients who received linezolid, but was not observed in the quinupristin-dalfopristin group (P = 0.2). CONCLUSION: In cancer patients, quinupristin-dalfopristin treatment is associated with a relatively high frequency of myalgias/arthralgias; however, profound thrombocytopenia might limit the choice of linezolid in a subpopulation of cancer patients.

ISSN : 0305-7453
Mesh Heading : Acetamides Adult Aged Enterococcus faecium Female Gram-Positive Bacterial Infections Humans Male Microbial Sensitivity Tests Middle Aged Oxazolidinones Pilot Projects Prospective Studies Vancomycin Resistance Virginiamycin adverse effects pharmacology growth & development microbiology adverse effects pharmacology physiology adverse effects pharmacology
Mesh Heading Relevant : therapeutic use drug effects drug therapy therapeutic use drug effects therapeutic use
Management of central venous catheters in patients with cancer and candidemia.
(2004)
Journal - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (United States )

Abstract :

To determine the need and appropriate timing of catheter removal in patients with candidemia, the records for 404 patients with cancer and central venous catheters (CVCs) who developed candidemia during the period of 1993-1998 were retrospectively reviewed. Of the total 404 cases of candidemia, 241 (60%) were due to a primary source, 111 (27%) were catheter related, and 52 (13%) were secondary cases of candidemia caused by a source other than the catheter. Multivariate analysis showed that catheter removal < or =72 h after onset improved response to antifungal therapy exclusively in patients with catheter-related candidemia (P=.04). Clinical characteristics that suggested a noncatheter source for the candidemia were disseminated infection (P<.01), previous chemotherapy (P<.01), previous corticosteroid therapy (P=.02), and poor response to antifungal therapy (P<.03). CVC removal < or =72 h after onset should be considered in patients with suspected catheter-related candidemia who have no evidence of dissemination, recent corticosteroid therapy, or chemotherapy.

ISSN : 1537-6591
Mesh Heading : Candidiasis Catheterization, Central Venous Female Fungemia Humans Male Middle Aged Multivariate Analysis Neoplasms Prosthesis-Related Infections Retrospective Studies mortality complications microbiology
Mesh Heading Relevant : complications adverse effects complications complications
Relationship between myalgias/arthralgias occurring in patients receiving quinupristin/dalfopristin and biliary dysfunction.
(2004)
Journal - The Journal of antimicrobial chemotherapy (England )

Abstract :

OBJECTIVES: To determine whether myalgias/arthralgias occurring in cancer patients who receive quinupristin/dalfopristin are associated with biliary tract dysfunction. METHODS: We studied 56 patients with vancomycin-resistant enterococcal infections who were treated with quinupristin/dalfopristin 7.5 mg/kg every 8 h for a mean duration of 12 days (range 2-52 days). Liver function tests, including a test for alkaline phosphatase, were performed before, during and after the end of therapy. All patients were followed for 1 month after completion of therapy. RESULTS: Thirty-eight (68%) of the 56 patients responded. Myalgias/arthralgias were the leading adverse events occurring in 20 (36%) of the patients. Patients with myalgias/arthralgias had significantly higher levels of alkaline phosphatase (mean 318.7 IU/L) during the mid-term therapy cycle compared with patients without any joint or muscular pain (mean 216.3 IU/L, P = 0.05). In addition, 3/18 (16.6%) patients with myalgias/arthralgias had more than five-fold the normal levels of alkaline phosphatase, which did not occur in any of the other patients who did not develop myalgias/arthralgias (P = 0.04). All myalgias/arthralgias resolved after the discontinuation of quinupristin/dalfopristin. By univariate analysis, other factors associated with myalgias/arthralgias were relapse of haematological malignancy (P = 0.01), receiving tacrolimus within 1 month prior to treatment (P = 0.04) and receiving methotrexate during antimicrobial therapy (P = 0.05). CONCLUSIONS: Myalgias/arthralgias occur frequently in cancer patients receiving quinupristin/dalfopristin and may be associated with biliary tract dysfunction, as measured by alkaline phosphatase or other factors that could lead to intra-hepatic cholestasis, such as relapse of haematological malignancy or treatment with tacrolimus or methotrexate.

ISSN : 0305-7453
Mesh Heading : Aged Alkaline Phosphatase Anti-Bacterial Agents Antimetabolites, Antineoplastic Antineoplastic Agents Arthralgia Biliary Tract Diseases Enterococcus Female Gram-Positive Bacterial Infections Humans Immunosuppressive Agents Liver Function Tests Male Methotrexate Middle Aged Muscular Diseases Neoplasms Pain Recurrence Risk Factors Tacrolimus Virginiamycin metabolism adverse effects therapeutic use adverse effects complications drug therapy adverse effects therapeutic use adverse effects therapeutic use complications adverse effects therapeutic use
Mesh Heading Relevant : adverse effects chemically induced complications chemically induced chemically induced adverse effects analogs & derivatives
Clinical-use-associated decrease in susceptibility of vancomycin-resistant Enterococcus faecium to linezolid: a comparison with quinupristin-dalfopristin.
(2004)
Journal - Antimicrobial agents and chemotherapy (United States )

Abstract :

The susceptibility of 135 vancomycin-resistant Enterococcus faecium bacteremic isolates to linezolid and quinupristin-dalfopristin was determined. All were susceptible to linezolid, while 88% were susceptible to quinupristin-dalfopristin prior to the clinical use of the drugs at our hospital. More than 6 months after their clinical use, a decrease in susceptibility was noted for only linezolid at 83%. This was related in part to a single G2576U gene mutation in domain V of the 23S rRNA gene.

ISSN : 0066-4804
Mesh Heading : Acetamides Anti-Bacterial Agents Drug Utilization Electrophoresis, Gel, Pulsed-Field Enterococcus faecium Gram-Positive Bacterial Infections Humans Oxazolidinones Point Mutation RNA, Bacterial RNA, Ribosomal, 23S Virginiamycin genetics genetics genetics
Mesh Heading Relevant : Vancomycin Resistance pharmacology pharmacology drug effects epidemiology microbiology pharmacology analogs & derivatives pharmacology
Treatment of febrile neutropenic patients with cancer who require hospitalization: a prospective randomized study comparing imipenem and cefepime.
(2003)
Journal - Cancer (United States )

Abstract :

BACKGROUND: The objective of the current study was to compare the efficacy and safety of imipenem and cefepime in the treatment of adult patients with cancer who had fever and neutropenia requiring hospitalization according to Infectious Disease Society of America criteria. METHODS: In the current prospective randomized clinical trial at a university-affiliated tertiary cancer center, adult patients with cancer who had fever (> or = 38.3 degrees C or > or = 38.0 degrees C for > 2 hours) and neutropenia (< or = 500/mm(3) or < 1000/mm(3) but declining) requiring hospitalization were randomized to receive either cefepime or imipenem. Vancomycin or amikacin was added on suspicion of gram-positive or gram-negative bacterial infection, respectively. RESULTS: Patients who received an imipenem regimen or a cefepime regimen were comparable in terms of age, gender, underlying malignancy, prior transplantation, degree and trend of neutropenia, and presence of central venous catheters (P > or = 0.3). An intent-to-treat analysis showed a 68% response rate to the imipenem regimen, compared with a 75% response rate to the cefepime regimen (P = 0.2). The rates of antibiotic-related adverse events and superinfections also were comparable (P = 0.6). There was no difference in response among patients who received imipenem or cefepime alone compared with patients who also received vancomycin or amikacin (P = 1.0). Leukemia was the only independent risk factor associated with a poor outcome (odds ratio, 4.6; 95% confidence interval, 1.9-10.7; P < 0.0001). CONCLUSIONS: Imipenem and cefepime had similar efficacy and safety profiles in the treatment of adult cancer patients with fever and neutropenia who required hospitalization. The addition of either vancomycin or amikacin may not be necessary.Copyright 2003 American Cancer Society.

ISSN : 0008-543X
Mesh Heading : Adolescent Adult Aged Aged, 80 and over Amikacin Anti-Bacterial Agents Bacterial Infections Catheterization, Central Venous Cephalosporins Female Fever Hospitalization Humans Imipenem Male Middle Aged Neoplasms Neutropenia Prospective Studies Risk Factors Vancomycin administration & dosage administration & dosage adverse effects etiology prevention & control administration & dosage adverse effects complications administration & dosage adverse effects complications administration & dosage
Mesh Heading Relevant : Practice Guidelines as Topic pharmacology pharmacology drug therapy etiology pharmacology complications drug therapy etiology
In vitro and ex vivo activities of minocycline and EDTA against microorganisms embedded in biofilm on catheter surfaces.
(2003)
Journal - Antimicrobial agents and chemotherapy (United States )

Abstract :

Minocycline-EDTA (M-EDTA) flush solution has been shown to prevent catheter-related infection and colonization in a rabbit model and in hemodialysis patients. We undertook this study in order to determine the activities of M-EDTA against organisms embedded in fresh biofilm (in vitro) and mature biofilm (ex vivo). For the experiment with the in vitro model, a modified Robbin's device (MRD) was used whereby 25 catheter segments were flushed for 18 h with 10(6) CFU of biofilm-producing Staphylococcus epidermidis, Staphylococcus aureus, and Candida albicans per ml. Subsequently, each of the catheter segments was incubated in one of the following solutions: (i) streptokinase, (ii) heparin, (iii) broth alone, (iv) vancomycin, (v) vancomycin-heparin, (vi) EDTA, (vii) minocycline (high-dose alternating with low-dose), or (viii) M-EDTA (low-dose minocycline alternating with high-dose minocycline were used to study the additive and synergistic activities of M-EDTA). All segments were cultured quantitatively by scrape sonication. For the experiment with the ex vivo model, 54 catheter tip segments removed from patients and colonized with bacterial organisms by roll plate were longitudinally cut into two equal segments and exposed to either saline, heparin, EDTA, or M-EDTA (with high-dose minocycline). Subsequently, all segments were examined by confocal laser electron microscopy. In the in vitro MRD model, M-EDTA (with a low concentration of minocycline) was significantly more effective than any other agent in reducing colonization of S. epidermidis, S. aureus, and C. albicans (P < 0.01). M-EDTA (with a high concentration of minocycline) eradicated all staphylococcal and C. albicans organisms embedded in the biofilm. In the ex vivo model, M-EDTA (with a high concentration of minocycline) reduced bacterial colonization more frequently than EDTA or heparin (P < 0.01). We concluded that M-EDTA is highly active in eradicating microorganisms embedded in fresh and mature biofilm adhering to catheter surfaces.

ISSN : 0066-4804
Mesh Heading : Anti-Bacterial Agents Biofilms Candida Edetic Acid Minocycline Models, Biological Staphylococcus aureus Staphylococcus epidermidis growth & development drug effects growth & development drug effects growth & development drug effects growth & development
Mesh Heading Relevant : Catheterization pharmacology drug effects pharmacology pharmacology
Efficacy of minocycline and EDTA lock solution in preventing catheter-related bacteremia, septic phlebitis, and endocarditis in rabbits.
(2002)
Journal - Antimicrobial agents and chemotherapy (United States )

Abstract :

To determine the efficacy of antibiotic catheter lock solution in preventing catheter-related infections, silicone catheters were tunneled and inserted into the jugular veins of 18 rabbits. The catheters were challenged with an intraluminal injection of 10(5) CFU of slime-producing Staphylococcus epidermidis in 0.1 ml of water. The catheters were maintained on heparin (100 IU/ml) flush for the first 3 days. On day 3, quantitative blood samples for culture were obtained from the catheters and ear veins, which documented catheter-related bacteremia, and the rabbits were randomized to have their catheters flushed as follows: five animals were continued on heparin (100 IU/ml), five animals received vancomycin (3 mg/ml) with heparin (100 IU/ml), and eight animals received 3 mg of minocycline per ml with 30 mg of EDTA per ml (M-EDTA). All animals were killed at day 7. Blood, catheters, jugular veins, and heart valves were cultured quantitatively. Animals maintained on heparin developed catheter-related colonization, bacteremia, septic phlebitis, and endocarditis. Vancomycin-heparin partially prevented catheter colonization, bacteremia, and phlebitis (P = 0.2). M-EDTA completely prevented catheter colonization, catheter-related bacteremia, and phlebitis in all of the animals (P < 0.01). Tricuspid endocarditis was equally prevented by vancomycin-heparin and M-EDTA (P < or = 0.06). In conclusion, the M-EDTA catheter flush solution was highly efficacious in preventing catheter-related colonization, bacteremia, septic phlebitis, and endocarditis in rabbits.

ISSN : 0066-4804
Mesh Heading : Animals Anti-Bacterial Agents Bacteremia Catheterization Disease Models, Animal Edetic Acid Endocarditis Male Minocycline Phlebitis Prosthesis-Related Infections Rabbits prevention & control prevention & control prevention & control
Mesh Heading Relevant : therapeutic use adverse effects therapeutic use therapeutic use prevention & control
Masking of neutropenic patients on transport from hospital rooms is associated with a decrease in nosocomial aspergillosis during construction.
(2002)
Journal - Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America (United States )

Abstract :

To prevent nosocomial pulmonary aspergillosis during hospital construction, neutropenic patients with hematologic malignancy were required to wear high-efficiency masks when leaving their rooms. The rate of nosocomial aspergillosis decreased from 0.73 per 1,000 hospital patient-days during fiscal years 1993 to 1996 to 0.24 per 1,000 hospital patient-days during fiscal years 1996 to 1999 (P < .001). High-efficiency masks reduced nosocomial aspergillosis during hospital construction.

ISSN : 0899-823X
Mesh Heading : Air Pollutants Aspergillosis, Allergic Bronchopulmonary Aspergillus Cross Infection Hospital Design and Construction Humans Respiratory Protective Devices Texas Transportation of Patients isolation & purification epidemiology isolation & purification epidemiology epidemiology
Mesh Heading Relevant : Neutropenia adverse effects prevention & control prevention & control methods
Polymerase chain reaction on blood for the diagnosis of invasive pulmonary aspergillosis in cancer patients.
(2002)
Journal - Cancer (United States )

Abstract :

BACKGROUND: The premortem diagnosis of invasive pulmonary aspergillosis (IPA) is difficult to make and often missed. Several retrospective studies have suggested that Aspergillus polymerase chain reaction (PCR) performed on serum or whole blood is useful in diagnosing IPA. Two prospective studies confirmed this finding but included a small number of IPA cases. METHODS: The current study was performed to determine the diagnostic role of Aspergillus PCR performed on whole blood specimens from 54 patients with cancer and pulmonary infiltrates for which bronchoscopy with fungal stains and cultures were performed. PCR through amplified Aspergillus mitochondrial DNA and alkaline protease genes was performed on whole blood samples. RESULTS: The cohort in the current study was comprised of 4 patients with definite IPA, 7 patients with probable IPA, 7 patients with possible IPA, and 36 control patients with no evidence of IPA. The sensitivity, specificity, and positive and negative predictive values all were 100% for definite IPA cases and 57%, 100%, 100%, and 92%, respectively, for each of the probable and possible IPA cases. CONCLUSIONS: Aspergillus PCR on whole blood samples is highly sensitive for the detection of IPA and is predictive for IPA. The sensitivity appears to be correlated with the certainty of diagnosis as proven by tissue invasion.Copyright 2002 American Cancer Society. DOI 10.1002/cncr.10349

ISSN : 0008-543X
Mesh Heading : Adolescent Adult Aged Aged, 80 and over Aspergillosis Aspergillus Cohort Studies DNA Primers DNA, Fungal Diagnosis, Differential Female Humans Male Middle Aged Neoplasms Polymerase Chain Reaction Predictive Value of Tests Prospective Studies Sensitivity and Specificity etiology pathogenicity
Mesh Heading Relevant : diagnosis genetics analysis complications methods
Diagnosis of invasive pulmonary aspergillosis using polymerase chain reaction-based detection of aspergillus in BAL.
(2002)
Journal - Chest (United States )

Abstract :

STUDY OBJECTIVE: To assess the value of Aspergillus polymerase chain reaction (PCR) test performed on the BAL in diagnosing invasive pulmonary aspergillosis (IPA). DESIGN: Between January 1996 and 1997, we prospectively followed up 249 cancer patients with pulmonary infiltrates suggestive of pneumonia. Bronchoscopy with fungal stains, cultures, and PCR was performed on all patients. PCR was used for the detection of Aspergillus mitochondrial and alkaline protease gene DNA. The PCR products were visualized either directly on polyacrylamide gel or after Southern transfer and probing with specific probes for mitochondrial and alkaline protease DNA. RESULTS: The 249 patients consisted of 10 patients with proven IPA (tissue invasion), 22 patients with probable IPA (microbiologic culture), 18 patients with possible IPA (consistent clinical and radiologic findings), and 199 control patients with no evidence of IPA. PCR positivity was strongly associated with all forms of IPA (p < 0.002). The sensitivity, specificity, positive predictive value, and negative predictive value of PCR were 80%, 93%, 38%, and 99%, respectively, for proven IPA, and 64%, 93%, 52%, and 96%, respectively, for probable IPA. Southern blotting analysis did not improve the diagnostic yield of the PCR test. CONCLUSION: PCR performed on BAL is associated with high specificity and negative predictive value for IPA. The low positive predictive value could be related to the transient colonizing presence of aspergilli in the respiratory tract. The sensitivity correlates with the certainty of the diagnosis based on tissue invasion.

ISSN : 0012-3692
Mesh Heading : Adolescent Adult Aged Aged, 80 and over Aspergillosis Aspergillus fumigatus Blotting, Southern Bronchoalveolar Lavage Fluid DNA, Mitochondrial Diagnosis, Differential Female Humans Lung Diseases, Fungal Male Middle Aged Predictive Value of Tests Prospective Studies Serine Endopeptidases genetics genetics
Mesh Heading Relevant : Polymerase Chain Reaction diagnosis genetics microbiology diagnosis
Intravascular catheter-related infections: new horizons and recent advances.
(2002)
Journal - Archives of internal medicine (United States )

Abstract :

BACKGROUND: Central venous catheters have become essential devices for the management of critically and chronically ill patients; however, their use is often complicated by catheter-related bloodstream infections (CRBSIs), many of which could be prevented. METHODS: This report is based on a literature review of more than 100 published articles in intravascular catheter-related infections. This review focuses on the most recent advances in the methods of diagnosis of CRBSI as they relate to its pathogenesis and on novel preventive techniques and approaches to management. RESULTS: Catheter-related bloodstream infections may be diagnosed by different methods, including simultaneous quantitative blood cultures, with the central blood culture yielding at least 5-fold colony-forming units greater than the peripheral blood culture, and simultaneous blood cultures, whereby the catheter-drawn blood culture becomes positive at least 2 hours before the peripheral blood culture. Novel preventive techniques include the use of ionic silver, an anticoagulant/antimicrobial flush solution, a new aseptic hub, and antimicrobial impregnation of catheters and dressings. Management of CRBSIs should be based on whether the infection is complicated or uncomplicated. CONCLUSIONS: Novel technologies that have been proved to aid in the diagnosis and prevention of CRBSIs should be considered in clinical practice. The management approach should be based on the type of microorganism causing the infection and on whether the infection is complicated or uncomplicated.

ISSN : 0003-9926
Mesh Heading : Bacteremia Catheterization, Central Venous Humans diagnosis
Mesh Heading Relevant : etiology prevention & control adverse effects trends
Epidemiology, molecular mycology, and environmental sources of Fusarium infection in patients with cancer.
(2002)
Journal - Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America (United States )

Abstract :

OBJECTIVE: To investigate the epidemiology and environmental sources of Fusarium infections in patients with cancer. DESIGN: Retrospective case-control study conducted following surveillance environmental cultures and DNA analysis of isolated organisms. SETTING: A tertiary-care, university cancer center. METHODS: In 1996 and 1997, environmental cultures were performed on air samples and water systems. A retrospective chart review was performed for 70 patients with cancer identified with fusariosis between 1987 and 1997. Patients with fusariosis were compared with 49 uninfected control patients who occupied hospital rooms with positive environmental cultures for Fusarium. With the use of random amplification of polymorphic DNA, organisms isolated from infected patients were compared with environmental organisms. RESULTS: Most of the patients with Fusarium (40, 57%) were infected on or within 3 days of admission, indicating community rather than nosocomial acquisition. Patients were comparable in terms of underlying immunocompromised status to 49 uninfected control patients. However, the duration from admission to infection in the patients with fusariosis tended to be shorter than the duration from admission to discharge in the exposed control patients (P = .06). Water cultured from the hospital tanks and from sinks and water fountains was negative for Fusarium. With the use of polymerase chain reaction, environmental isolates did not match clinical ones. Quantitative air sampling showed that the quantitative outdoor Fusarium levels were eightfold higher than the indoor levels. During the rainy summer season, outdoor air concentrations of Fusarium were at their highest, coinciding with the peak incidence of fusariosis at our center. CONCLUSION: The most likely source of fusariosis was the external environment rather than nosocomial sources, such as water.

ISSN : 0899-823X
Mesh Heading : Adolescent Adult Aged Aged, 80 and over Air Microbiology Cancer Care Facilities Case-Control Studies Child Community-Acquired Infections Cross Infection DNA, Fungal Environmental Exposure Environmental Monitoring Female Humans Immunocompromised Host Infection Control Male Middle Aged Mycoses Neoplasms Seasons Texas Water Microbiology transmission transmission genetics analysis genetics transmission epidemiology
Mesh Heading Relevant : Epidemiology, Molecular Fusarium epidemiology etiology epidemiology etiology adverse effects epidemiology etiology complications
Treatment of nosocomial postoperative pneumonia in cancer patients: a prospective randomized study.
(2001)
Journal - Annals of surgical oncology (United States )

Abstract :

BACKGROUND: Nosocomial pneumonia continues to be associated with high morbidity and mortality in cancer patients. METHODS: In an attempt to find an optimal treatment for this infection, nonneutropenic cancer patients with postoperative nosocomial pneumonia were randomized to receive either piperacillin/tazobactam (P/T) 4.5 g i.v. every 6 hours (30 patients) or clindamycin (Cl) 900 mg plus aztreonam (Az) 2 g i.v. every 8 hours (22 patients). Amikacin 500 mg i.v. every 12 hours was given to all patients for the first 48 hours. RESULTS: The two groups were comparable for the characteristics of pneumonia that included gram-negative etiology and duration of intubation. Response rates were 83% for patients who received P/T and 86% for those who received Cl/Az (P > .99). There were no serious adverse events; however, at our center the cost of the P/T regimen was $73.86 compared with $99.15 for the Cl/Az regimen. CONCLUSIONS: The two regimens had comparable high efficacy, and P/T had a slight cost advantage. Either of these antibiotic regimens combined with an aminoglycoside could lead to favorable outcome in cancer patients at high risk for nosocomial pneumonia.

ISSN : 1068-9265
Mesh Heading : Aged Amikacin Aztreonam Chi-Square Distribution Clindamycin Cross Infection Drug Therapy, Combination Humans Middle Aged Neoplasms Opportunistic Infections Penicillanic Acid Piperacillin Pneumonia, Bacterial Postoperative Complications Prognosis Prospective Studies administration & dosage administration & dosage administration & dosage administration & dosage administration & dosage
Mesh Heading Relevant : drug therapy therapeutic use complications drug therapy analogs & derivatives drug therapy drug therapy
Treatment of vancomycin-resistant enterococcal infections in the immunocompromised host: quinupristin-dalfopristin in combination with minocycline.
(2001)
Journal - Antimicrobial agents and chemotherapy (United States )

Abstract :

Between February 1994 and November 1998, 56 oncology patients infected with vancomycin-resistant enterococci (VRE) were treated with quinopristin-dalfopristin (Q-D) plus minocycline (MIN). Infections included bacteremia, urinary tract infection, pneumonia, and wound infection. The response rate was 68%, and the most frequent adverse event was arthralgia or myalgia (36%). Q-D-MIN is effective for VRE infection in cancer patients but is associated with a substantial frequency of arthralgia or myalgia.

ISSN : 0066-4804
Mesh Heading : Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents Antineoplastic Agents Child Drug Therapy, Combination Enterococcus Enterococcus faecalis Enterococcus faecium Female Gram-Positive Bacterial Infections Humans Immunity Male Middle Aged Minocycline Neoplasms Pain Virginiamycin adverse effects adverse effects adverse effects complications chemically induced adverse effects
Mesh Heading Relevant : Vancomycin Resistance therapeutic use drug effects drug therapy drug effects therapeutic use analogs & derivatives therapeutic use
Diagnosis of catheter-related bloodstream infections: is it necessary to culture the subcutaneous catheter segment?
(2001)
Journal - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (Germany )

Abstract :

In order to determine the diagnostic usefulness of culturing the subcutaneous catheter segment, an analysis was performed using data derived from two prospective, randomized studies that included 479 patients with central venous catheters and 13 episodes of catheter-related bacteremia. The results indicate that quantitative culture, using the roll-plate and sonication methods, of the subcutaneous catheter segment did not add to the diagnostic yield (sensitivity, 83-100%; specificity, 82-97%; negative predictive value, 100%) of semiquantitative and quantitative catheter-tip cultures or aid in identifying catheter-related bloodstream infections.

ISSN : 0934-9723
Mesh Heading : Bacteremia Bacteria Bacterial Infections Bacteriological Techniques Blood Catheterization, Central Venous Catheters, Indwelling Culture Media Humans Skin microbiology classification diagnosis microbiology microbiology microbiology
Mesh Heading Relevant : diagnosis isolation & purification adverse effects microbiology
Management of intravascular catheter-related infections.
(2000)
Journal - The Journal of antimicrobial chemotherapy (ENGLAND )
ISSN : 0305-7453
Mesh Heading : Anti-Infective Agents Bacteremia Catheterization Cross Infection Humans therapeutic use etiology microbiology microbiology
Mesh Heading Relevant : adverse effects drug therapy
Infection control of nosocomial respiratory viral disease in the immunocompromised host.
(2000)
Journal - The American journal of medicine (UNITED STATES )

Abstract :

Among immunocompromised adults, such as bone marrow transplant recipients, more than half of respiratory viral infections are complicated by pneumonia, with an associated mortality rate > 50%. Nosocomial transmission of respiratory viral pathogens, such as respiratory syncytial virus (RSV) and influenza, in the immunocompromised patient has been reported frequently and usually occurs during a community outbreak. In view of the poor outcome in this subset of patients, intensive efforts should be directed at instituting prevention measures that would interrupt nosocomial transmission. At M.D. Anderson Cancer Center, a multifaceted infection control strategy resulted in a significant decrease in and almost complete interruption of the nosocomial transmission of RSV infections in immunocompromised patients over a 3-year period (1994-1996). For influenza virus, special emphasis should be given to vaccination of hospital personnel before the influenza season to prevent and control nosocomial transmission. In highly immunocompromised patients, prophylactic use of antiviral agents should be considered during an outbreak or when the frequency of nosocomial transmission is high. An aggressive multifaceted infection control strategy appears to be effective in reducing the frequency of nosocomial transmission of respiratory viral infections in immunocompromised patients. Universal and timely influenza vaccination of hospital personnel who care for immunocompromised patients is necessary.

ISSN : 0002-9343
Mesh Heading : Adenoviridae Infections Bone Marrow Transplantation Cross Infection Diagnosis, Differential Humans Infection Control Influenza Vaccines Influenza, Human Respiratory Syncytial Virus Infections Respiratory Tract Infections Seasons Texas United States Virus Diseases prevention & control adverse effects immunology diagnosis prevention & control prevention & control diagnosis transmission diagnosis transmission
Mesh Heading Relevant : Immunocompromised Host Personnel, Hospital prevention & control methods administration & dosage prevention & control virology prevention & control
Intravascular catheters impregnated with antimicrobial agents: a milestone in the prevention of bloodstream infections.
(1999)
Journal - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (GERMANY )

Abstract :

Vascular catheters impregnated with antimicrobial agents have been shown to decrease the risk of catheter-related colonization and bloodstream infections. Various antimicrobials and antiseptics have been used. In a recent meta-analysis of 12 studies, catheters coated with chlorhexidine and silver sulfadiazine (CH/SS) were shown to be significantly less likely to be associated with catheter-related bloodstream infections than uncoated catheters. However, these catheters were coated only on the external surface and they are associated with short antimicrobial durability (3-7 days). In addition, anaphylactic reactions to them were reported in Japan. Vascular catheters impregnated with minocycline and rifampin (M/R) were found to be highly efficacious in preventing catheter-related infections. In a recent prospective, randomized trial, the likelihood of catheter-related bloodstream infections associated with the use of M/R catheters was one-twelfth of that observed with catheters coated with CH/SS. The M/R catheters are coated on the external and internal surfaces and have an antimicrobial durability of 4 weeks. Although no resistance to either minocycline or rifampin has been seen in two trials, further studies are required to determine whether the risk of resistance outweighs the benefits derived from their use. In conclusion, antimicrobial catheters have been shown to be highly cost effective in decreasing the risk of catheter-related bloodstream infection.

ISSN : 0941-4355
Mesh Heading : Anaphylaxis Anti-Bacterial Agents Anti-Infective Agents Anti-Infective Agents, Local Bacteremia Bacterial Infections Chlorhexidine Enzyme Inhibitors Humans Minocycline Rifampin Risk Assessment Risk Factors Silver Sulfadiazine chemically induced therapeutic use administration & dosage adverse effects therapeutic use prevention & control adverse effects microbiology adverse effects therapeutic use therapeutic use therapeutic use therapeutic use adverse effects therapeutic use
Mesh Heading Relevant : Catheters, Indwelling Coated Materials, Biocompatible therapeutic use prevention & control
A prospective crossover randomized trial of novobiocin and rifampin prophylaxis for the prevention of intravascular catheter infections in cancer patients treated with interleukin-2.
(1998)
Journal - Cancer (UNITED STATES )

Abstract :

BACKGROUND. The aim of this study was to determine the efficacy of novobiocin and rifampin as oral antibiotic prophylaxis for the prevention of catheter-related infection in melanoma patients treated with interleukin-2 (IL-2) plus interferon-alpha and chemotherapy (biochemotherapy). METHODS. Patients with advanced melanoma who were treated with biochemotherapy at the University of Texas M. D. Anderson Cancer Center were randomized in a crossover study to receive either oral antibiotic prophylaxis consisting of novobiocin and rifampin or observation alone over a 35-day course period. Patients were subsequently "crossed over" to the opposite arm of the study for an additional 35-day period, with each serving as his or her own control. RESULTS. Twenty-six patients were enrolled. Nine patients (35%) failed to tolerate oral antibiotics because of severe nausea and vomiting; 17 patients (65%) were crossed over and considered evaluable. During the control patient courses, 71% of evaluable patients had infectious complications, 41% had a catheter-associated bacteremia, and 53% had a local catheter infection. In contrast, of the patients treated with antibiotic prophylaxis, only 12% had an infectious complication (P = 0.001), 12% had a local catheter infection (P = 0.008), and 6% had catheter-associated bacteremias (P = 0.04). Thirty-six episodes of catheter infections occurred during the 17 control courses, whereas only 3 episodes occurred during antibiotic prophylaxis (P < 0.001). CONCLUSIONS. Although more than one-third of patients receiving IL-2 treatment with biochemotherapy failed to tolerate novobiocin and rifampin, this oral antibiotic regimen was efficacious in preventing the infectious complications, especially those associated with vascular catheters, in this high risk patient population.

ISSN : 0008-543X
Mesh Heading : Administration, Oral Adult Anti-Bacterial Agents Antineoplastic Agents Antineoplastic Combined Chemotherapy Protocols Bacteremia Bacterial Infections Catheterization, Central Venous Catheterization, Peripheral Catheters, Indwelling Chemoprevention Cross-Over Studies Equipment Contamination Female Humans Immunologic Factors Interferon-gamma Interleukin-2 Male Melanoma Middle Aged Nausea Novobiocin Prospective Studies Rifampin Vomiting administration & dosage therapeutic use therapeutic use etiology prevention & control adverse effects instrumentation adverse effects instrumentation therapeutic use therapeutic use drug therapy chemically induced administration & dosage administration & dosage chemically induced
Mesh Heading Relevant : therapeutic use prevention & control adverse effects therapeutic use therapy therapeutic use therapeutic use
Antimicrobial durability and rare ultrastructural colonization of indwelling central catheters coated with minocycline and rifampin.
(1998)
Journal - Critical care medicine (UNITED STATES )

Abstract :

OBJECTIVE: To determine the duration of antimicrobial activity and the efficacy of indwelling catheters coated with minocycline and rifampin in preventing ultrastructural colonization. DESIGN: Multicenter, prospective, randomized, clinical trial. SETTING: Five university-based medical centers. PATIENTS: Cohort 1 consisted of 40 randomized patients in whom an equal number of minocycline- and rifampin-coated and uncoated catheters were inserted and studied using scanning electron microscopy. Cohort 2 consisted of 118 patients who received coated catheters that were tested for the antimicrobial activity and levels of the antibiotics at the time of removal. INTERVENTIONS: Catheters pretreated with tridodecylmethylammonium chloride and subsequently coated with minocycline and rifampin; uncoated catheters (control). MEASUREMENTS AND MAIN RESULTS: Quantitative scanning electron microscopy was utilized to determine both the ultrastructural colonization in biofilm on coated and uncoated catheters. The zones of inhibition of coated catheters from studied patients against Staphylococcus epidermidis was used to determine the antimicrobial durability. High-performance liquid chromatography was used to determine antibiotic levels on indwelling coated catheters and in serum. Mild-to-heavy ultrastructural colonization was detected in 7 (35%) of 20 coated catheters and in 16 (80%) of 20 uncoated catheters (p = .004). Significant antimicrobial inhibitory activity against S. epidermidis was maintained for 16 days. Rifampin and minocycline continued to be detected on the surfaces of coated catheters for at least 2 wks after placement. Neither antibiotic was detected in the 60 serum samples obtained from 15 patients during catheterization. CONCLUSION: Coating catheters with minocycline and rifampin inhibits ultrastructural colonization of indwelling catheters and maintains effective antimicrobial activity for at least 2 wks.

ISSN : 0090-3493
Mesh Heading : Adult Aged Aged, 80 and over Anti-Bacterial Agents Antibiotics, Antitubercular Catheterization, Central Venous Catheters, Indwelling Drug Stability Equipment Contamination Female Humans Male Microscopy, Electron, Scanning Middle Aged Minocycline Prospective Studies Rifampin Texas Time Factors microbiology
Mesh Heading Relevant : administration & dosage administration & dosage instrumentation prevention & control administration & dosage administration & dosage
How should imipenem-cilastatin be used in the treatment of fever and infection in neutropenic cancer patients?
(1998)
Journal - Cancer (UNITED STATES )

Abstract :

BACKGROUND: Imipenem-cilastatin (referred to hereafter as imipenem) is administered at different doses as monotherapy or with other agents. Limited comparisons of the alternatives exist. The authors compared the efficacy and safety of several imipenem-containing regimens (ICRs) to determine the appropriate dose and the need for combination therapy. METHODS: Between 1985 and 1994, febrile neutropenic patients were given ICRs according to the same methodology on prospective trials at a referral cancer center. The ICRs were high dose imipenem (HIP), high dose imipenem and amikacin (HIPA), high dose imipenem and vancomycin (HIPV), and low dose imipenem and vancomycin (LIPV). RESULTS: The overall response rates were comparable (70-77%). There was a univariate trend toward better response among patients with pneumonia and documented infections with unidentified organisms who received HIPV versus LIPV (P=0.06), as well as a significantly better response among patients with gram positive infections who received HIPV versus HIP (P=0.02) and HIPA (P=0.002). HIPV was a more effective treatment for documented infections with identified organisms (P=0.05) and bloodstream infections (P=0.04) than HIP; there was a univariate trend toward better response among patients infected with gram negative organisms who received HIPA versus HIP (P=0.12). Multivariate adjustment for baseline and prognostic factors did not reveal a relative advantage for any regimen. No differences in overall toxicities were observed between HIPV and LIPV. CONCLUSIONS: Imipenem monotherapy is adequate treatment for most febrile neutropenic cancer patients. Low dose imipenem could be effective and safe in uncomplicated cases without pneumonia. Further studies are needed to establish the usefulness of low dose imipenem in this context.

ISSN : 0008-543X
Mesh Heading : Adolescent Adult Aged Cilastatin Dose-Response Relationship, Drug Drug Therapy, Combination Female Fever Humans Imipenem Male Middle Aged Neoplasms Neutropenia Protease Inhibitors Retrospective Studies Thienamycins Treatment Outcome adverse effects etiology adverse effects
Mesh Heading Relevant : administration & dosage administration & dosage complications drug therapy administration & dosage administration & dosage
The risk of infection associated with intra-arterial catheters for cancer chemotherapy.
(1998)
Journal - Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America (UNITED STATES )

Abstract :

OBJECTIVE: To determine the frequency of, and risk factors for, infections associated with intra-arterial catheters used for cancer chemotherapy. METHODS: Between September 1992 and September 1995, we conducted a surveillance study of all 807 intra-arterial catheters placed for chemotherapy at our center. The insertion site was disinfected with povidone iodine and alcohol, and the arterial catheter was placed using maximal sterile barrier precautions. Upon removal, all intravascular segments were submitted for semi-quantitative culture. RESULTS: No episodes of catheter-related bloodstream infection (95% confidence interval [CI95], 0%-1.6%) were observed. However, the risk of colonization (>15 colony-forming units) of arterial catheters was 15% (CI95, 12%-17%). Retrospective risk-factor analysis conducted on 224 intra-arterial catheters placed for chemotherapy in 1993 showed that colonization was associated significantly with duration of catheterization (median of 1 day for culture-negative catheters vs median of 4 days for culture-positive catheters, P<.001). Age, gender, prior radiotherapy, underlying cancer, neutropenia, and hypoalbuminemia were not associated with catheter colonization. CONCLUSION: Intra-arterial catheters for cancer chemotherapy placed under maximal sterile barrier precautions for a short period of time are associated with a very low risk of bloodstream infection.

ISSN : 0899-823X
Mesh Heading : Adolescent Adult Aged Aged, 80 and over Antineoplastic Agents Cancer Care Facilities Catheters, Indwelling Colony Count, Microbial Cross Infection Female Humans Incidence Infection Control Infusions, Intra-Arterial Male Middle Aged Prospective Studies Retrospective Studies Risk Factors Texas Time Factors methods
Mesh Heading Relevant : Equipment Contamination therapeutic use adverse effects etiology instrumentation
Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections. A randomized, double-blind trial. The Texas Medical Center Catheter Study Group.
(1997)
Journal - Annals of internal medicine (UNITED STATES )

Abstract :

BACKGROUND: Central venous catheters are a principal source of nosocomial bloodstream infections, which are difficult to control. OBJECTIVE: To determine the efficacy of catheters coated with minocycline and rifampin in preventing catheter-related colonization and bloodstream infections. DESIGN: Multicenter, randomized clinical trial. SETTING: Five university-based medical centers. PATIENTS: 281 hospitalized patients who required 298 triple-lumen, polyurethane venous catheters. INTERVENTION: 147 catheters were pretreated with tridodecylmethyl-ammonium chloride and coated with minocycline and rifampin. Untreated, uncoated catheters (n = 151) were used as controls. MEASUREMENTS: Quantitative catheter cultures, blood cultures, and molecular typing of organisms to determine catheter-related colonization and bloodstream infections. RESULTS: The group with coated catheters and the group with uncoated catheters were similar with respect to age, sex, underlying diseases, degree of immunosuppression, therapeutic interventions, and risk factors for catheter infections. Colonization occurred in 36 (26%) uncoated catheters and 11 (8%) coated catheters (P < 0.001). Catheter-related bloodstream infection developed in 7 patients (5%) with uncoated catheters and no patients with coated catheters (P < 0.01). Multivariate logistic regression analysis showed that coating catheters with minocycline and rifampin was an independent protective factor against catheter-related colonization (P < 0.05). No adverse effects related to the coated catheters or antimicrobial resistance were seen. An estimate showed that the use of coated catheters could save costs. CONCLUSIONS: Central venous catheters coated with minocycline and rifampin can significantly reduce the risk for catheter-related colonization and bloodstream infections. The use of these catheters may save costs.

ISSN : 0003-4819
Mesh Heading : Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents Antibiotics, Antitubercular Catheterization, Central Venous Catheters, Indwelling Cost-Benefit Analysis DNA, Bacterial DNA, Viral Double-Blind Method Electrophoresis, Gel, Pulsed-Field Female Humans Male Middle Aged Minocycline Rifampin Risk Sepsis Treatment Outcome economics economics economics adverse effects economics microbiology analysis analysis economics economics economics etiology
Mesh Heading Relevant : therapeutic use therapeutic use adverse effects therapeutic use therapeutic use prevention & control
The broad-spectrum activity and efficacy of catheters coated with minocycline and rifampin.
(1996)
Journal - The Journal of infectious diseases (UNITED STATES )

Abstract :

The in vitro and in vivo activities of catheters coated with minocycline and rifampin and with chlorhexidine gluconate and silver sulfadiazine were evaluated. When incubated in serum at 37 degrees C, the half-life of the inhibitory activity of catheters coated with minocycline and rifampin was 25 days compared with 3 days for catheters coated with chlorhexidine gluconate and silver sulfadiazine. In a rabbit model, catheters coated with minocycline and rifampin were significantly more efficacious than catheters coated with chlorhexidine and silver sulfadiazine in preventing colonization and infection with Staphylococcus aureus (P < .05). Catheters coated with minocycline and rifampin demonstrated broad-spectrum in vitro inhibitory activity against gram-positive bacteria, gram-negative bacteria, and Candida albicans that was significantly superior to the inhibitory activity of catheters coated with chlorhexidine gluconate and silver sulfadiazine (P < .01). Minocycline and rifampin were also highly efficacious in preventing colonization and infection in vivo.

ISSN : 0022-1899
Mesh Heading : Animals Anti-Bacterial Agents Anti-Infective Agents, Local Bacterial Adhesion Bacterial Infections Candida albicans Candidiasis Catheterization, Central Venous Catheters, Indwelling Chlorhexidine Colony Count, Microbial Drug Combinations Gram-Negative Bacteria Gram-Positive Bacteria Half-Life Microbial Sensitivity Tests Minocycline Rabbits Rifampin Silver Sulfadiazine pharmacology prevention & control drug effects prevention & control adverse effects analogs & derivatives pharmacology drug effects drug effects pharmacology
Mesh Heading Relevant : pharmacology drug effects microbiology pharmacology pharmacology
Treatment of central venous catheter-related fungemia due to Fusarium oxysporum.
(1995)
Journal - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (UNITED STATES )

Abstract :

We report a case of Fusarium oxysporum fungemia that was related to the presence of a central venous catheter and was confirmed by quantitative cultures and scanning electron microscopy of the catheter hub, subcutaneous segment and cuff, and tip. Despite progressive neutropenia, the infection responded to antifungal therapy within 1 day after the catheter was removed. The removal of the catheter could have contributed to the patient's early favorable response.

ISSN : 1058-4838
Mesh Heading : Catheterization, Central Venous Fever Fungemia Humans Male Middle Aged Neutropenia Triazoles instrumentation etiology drug therapy immunology microbiology etiology therapeutic use
Mesh Heading Relevant : Fusarium adverse effects etiology
The pathogenesis and prevention of central venous catheter-related infections.
(1994)
Journal - Middle East journal of anesthesiology (LEBANON )

Abstract :

Vascular catheters are a major source of nosocomial infections. Definite diagnosis of catheter-related infections should include the use of quantitative catheter cultures or differential quantitative blood cultures. The skin and catheter hub are the two major sources for the introduction of the colonizing organisms. Both microbial (slime) and host (fibrin and fibrinectin) factors contribute to the formation of the biofilm which is essential for the adherence and maintenance of the colonization. Staphylococci and Candida are the leading causative agents. Prolonged duration of catheterization, thrombogenic catheter material, frequent manipulation of the catheter, improper aseptic insertion and maintenance techniques, tranparent plastic dressings, contaminated skin solutions, location of the catheter, and possibly multilumen central venous catheters (CVC) are risk factors predisposing to infections. Preventive measures include a skilled infusion therapy team, topical disinfectants such as chlorhexidine and topical antibiotics, silver impregnated cuffs (for short term CVC), coating catheters with antiseptic agents and maximal barrier precautions during insertion. Exchanging central venous catheters over a guidewire might be useful diagnostically but have not been proven to be of any therapeutic or preventive potential.

ISSN : 0544-0440
Mesh Heading : Catheterization, Central Venous Cross Infection Humans epidemiology
Mesh Heading Relevant : adverse effects etiology prevention & control
The duration of placement as a predictor of peripheral and pulmonary arterial catheter infections.
(1993)
Journal - The Journal of hospital infection (ENGLAND )

Abstract :

To determine the appropriate time for removal or replacement of peripheral and pulmonary arterial catheters in critically ill cancer patients, we prospectively studied 71 peripheral arterial catheters and 71 pulmonary artery (Swan-Ganz) catheters from 110 consecutive cancer patients. All catheters were cultured semiquantitatively, by the roll-plate culture technique. Of the 71 peripheral arterial catheters, 11 (15%) produced local infections (> or = 15 colonies) and four (5.5%) produced catheter-related septicaemia. Ten of the 11 local infections and all four septicaemias occurred after 4 days of catheter placement (P < 0.05). Likewise, of the 71 Swan-Ganz catheters, 12 (17%) produced local infection and four (5.6%) led to septicaemia. Swan-Ganz catheter-related septicaemia occurred at rates of 2% and 16%, before and after 7 days of catheter placement, respectively (P = 0.056). Duration of placement was a risk factor for the development of catheter infections, independent of the patient's neutropenic status, administration of antibiotics such as vancomycin during catheterization, and the presence of concurrent central venous catheters. Life-table analysis showed that the cumulative risks of developing a catheter infection increased from 7% to 17% after 6 days of peripheral arterial catheter placement and from 9% to 18% after 4 days of placement of the Swan-Ganz catheter. We conclude that in the critically ill cancer patient in our unit, peripheral arterial catheters should be changed to a new site every 4-6 days and pulmonary artery catheters every 4-7 days.

ISSN : 0195-6701
Mesh Heading : Adolescent Adult Aged Aged, 80 and over Bacterial Infections Catheterization, Peripheral Catheterization, Swan-Ganz Catheters, Indwelling Cross Infection Equipment Contamination Humans Middle Aged Neoplasms Prospective Studies Risk Factors Sepsis Texas Time Factors instrumentation instrumentation adverse effects etiology complications etiology
Mesh Heading Relevant : etiology adverse effects adverse effects
Serious complications of vascular catheter-related Staphylococcus aureus bacteremia in cancer patients.
(1992)
Journal - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (GERMANY )

Abstract :

Over the period 1986 to 1989, 53 cancer patients were identified with catheter-related Staphylococcus aureus bacteremia at the University of Texas M.D. Anderson Cancer Center. Septic thrombosis was diagnosed in 12 (23%) patients and was suspected in another 3 (6%). Of the 12 patients, five developed deep-seated infections (septic emboli, endocarditis, meningitis, abscess), compared with 2 of the 38 other patients with no septic thrombosis (p < 0.01). Fever persisted for more than three days after antibiotic initiation in 52% of the patients with complications (septic thrombosis and/or deep-seated infections), compared with 19% of those without complications (p < 0.02). Of the three patients with complications who were treated for 14 days with intravenous antistaphylococcal antibiotics, two relapsed; in contrast, all of the nine patients with complications who were treated for more than 14 days (mean 4 weeks) were cured, and none relapsed (p < 0.05). Of the nine patients with complications who were treated with a long course of therapy, only one required surgery. The possibility of septic thrombosis and/or deep-seated infections should be considered in all cancer patients with catheter-related Staphylococcus aureus bacteremia, and if present, the condition should be treated with appropriate intravenous antibiotics for at least four weeks.

ISSN : 0934-9723
Mesh Heading : Adult Aged Bacteremia Catheterization, Central Venous Female Humans Male Middle Aged Neoplasms Retrospective Studies Staphylococcal Infections Thrombosis microbiology etiology epidemiology etiology
Mesh Heading Relevant : complications adverse effects therapy complications
Infectious complications of indwelling vascular catheters.
(1992)
Journal - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (UNITED STATES )
ISSN : 1058-4838
Mesh Heading : Catheters, Indwelling Humans Sepsis diagnosis epidemiology therapy
Mesh Heading Relevant : adverse effects etiology
Impact of central venous catheter removal on the recurrence of catheter-related coagulase-negative staphylococcal bacteremia.
(1992)
Journal - Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America (UNITED STATES )

Abstract :

OBJECTIVE: To determine the impact of catheter management on the acute and long-term outcome of catheter-related coagulase-negative staphylococcal bacteremia. DESIGN: Retrospective surveillance of catheter-related sepsis using quantitative blood and catheter cultures. SETTING: University-affiliated tertiary cancer center. PATIENTS AND METHODS: Seventy patients with catheter-related coagulase-negative staphylococcal bacteremia were studied by retrospective chart review. The clinical characteristics of the patients and the management of the bacteremias were determined. The impact of immunosuppressive risk factors, antibiotic therapy, and catheter management on the recurrence of the bacteremia was investigated. RESULTS: Acute sepsis-related morbidity and mortality were not related to catheter management. However, during a 12-week followup period, the bacteremia recurred in 20% of the patients whose catheters remained in place, compared with only 3% of those whose catheters were removed (p less than .05). By multivariate analysis, patients whose catheters remained in place were 2.9 times more likely to experience a recurrence than those whose catheters were removed (odds ratio = 2.9, 95% confidence interval = 1.2-8.8, p = .03). All other potential risk factors were equally distributed between patients, with and without a recurrence. CONCLUSIONS: Although patients with catheter-related coagulase-negative staphylococcal bacteremia could be treated successfully while the catheter remains in place with the majority remaining free of recurrence, catheter retention results in a significantly higher risk for the recurrence of the bacteremia.

ISSN : 0899-823X
Mesh Heading : Adolescent Adult Aged Bacteremia Catheterization, Central Venous Child Child, Preschool Coagulase Cross Infection Female Humans Male Middle Aged Multivariate Analysis Population Surveillance Recurrence Retrospective Studies Risk Factors Staphylococcal Infections
Mesh Heading Relevant : microbiology adverse effects microbiology microbiology
Uncontrolled nosocomial rotavirus transmission during a community outbreak.
(1990)
Journal - American journal of infection control (UNITED STATES )

Abstract :

Between Jan. 11 and March 31, 1983, 60 pediatric patients were diagnosed with rotavirus gastroenteritis. Of these cases 24 were community acquired, 29 were nosocomial, and 7 were of undetermined origin. Despite intensive infection control efforts, nosocomial transmission continued as long as patients with community-acquired cases were admitted. The use of disinfectants and germicides that were ineffective against rotavirus may have contributed to the continued nosocomial spread during a community outbreak.

ISSN : 0196-6553
Mesh Heading : Communicable Disease Control Cross Infection Diarrhea Disease Outbreaks Florida Hospitals Humans Infant Rotavirus Rotavirus Infections methods microbiology physiology
Mesh Heading Relevant : transmission transmission
Utility of Galactomannan Enzyme Immunoassay and (1,3) ß-d-Glucan in Diagnosis of Invasive Fungal Infections: Low Sensitivity for Aspergillus fumigatus Infection in Hematologic Malignancy Patients
(2009)
Journal - Journal of Clinical Microbiology

Abstract :

Previous studies have reported that galactomannan (GM) enzyme immunoassay and 1,3 beta-glucan (BG) assay may be useful diagnostic tools, but their sensitivities are variable. We compared the performances of both tests. Between October 2002 and May 2005, 82 patients were prospectively monitored for 12 weeks. A total of 414 samples were tested by GM assay and 409 samples were tested by BG assay for the following four groups of patients: those with invasive aspergillosis (IA), those with other mold infections (Fusarium, scedosporium, zygomycosis, etc.), those with candidemia, and control patients. Blood samples were obtained twice on week 1 and once every other week for a total of 12 weeks. Patients in the invasive fungal infection groups had comparable risk factors. The sensitivity of the GM test was significantly higher for patients with IA due to non-fumigatus Aspergillus species than for patients with IA due to Aspergillus fumigatus (49% versus 13%; P < 0.0001) or with other mold infections (49% versus 6%; P < 0.0001). However, the sensitivity range (47% to 64%) and specificity (88%) of the BG assay were comparable among all patients tested, regardless of the infecting pathogen. The performance of GM-based diagnosis appears to be better for detecting non-fumigatus Aspergillus species. The diagnostic marker BG was shown to have a higher sensitivity than that of GM in detecting IA and other mold infections in hematologic malignancy patients.


ISSN : 0095-1137
Optimal Antimicrobial Catheter Lock Solution, Using Different Combinations of Minocycline, EDTA, and 25-Percent Ethanol, Rapidly Eradicates Organisms Embedded in Biofilm
(2007)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

Antimicrobial lock solutions may be needed to salvage indwelling catheters in patients requiring continuous intravenous therapy. We determined the activity of minocycline, EDTA, and 25% ethanol, alone or in combination, against methicillin-resistant Staphylococcus aureus and Candida parapsilosis catheter-related bloodstream infection strains in two established models of biofilm colonization. Biofilm-colonized catheter segments from a modified Robbins device and a silicone disk biofilm colonization model were exposed to these antimicrobial agents for 15 or 60 min, respectively. After exposure, segments were sonicated and cultured. To determine regrowth after incubation at 37°C, following the brief exposure to the antimicrobial agents, an equal number of segments were washed, reincubated for 24 h, and then sonicated and cultured. The triple combination of minocycline-EDTA (M-EDTA) in 25% ethanol was the only antimicrobial lock solution that completely eradicated S. aureus and C. parapsilosis in biofilm of all segments tested in the two models, and it completely prevented regrowth. In addition, M-EDTA in 25% ethanol was significantly more effective in rapidly eradicating the growth or regrowth of methicillin-resistant S. aureus and C. parapsilosis biofilm colonization in the two models than the other solutions—minocycline, EDTA, M-EDTA, 25% ethanol, and EDTA in ethanol. We conclude that M-EDTA in 25% ethanol is highly effective at rapidly eradicating S. aureus and C. parapsilosis embedded in biofilm adhering to catheter segments.


ISSN : 0066-4804
blaVIM-2 and blaVIM-7 Carbapenemase-Producing Pseudomonas aeruginosa Isolates Detected in a Tertiary Care Medical Center in the United States: Report from the MYSTIC Program
(2007)
Journal - Journal of Clinical Microbiology

Abstract :

Two Pseudomonas aeruginosa strains resistant to beta-lactams, fluoroquinolones, aminoglycosides, tetracyclines, and carbapenems and susceptible only to polymyxin B (MIC = 2 µg/ml) were identified as part of the Meropenem Yearly Susceptibility Test Information Collection program. Metallo-ß-lactamase screening tests were positive, PCR yielded products with blaVIM primers, and sequence analysis revealed blaVIM-7 and blaVIM-2. The isolates had distinct ribotype and pulsed-field gel electorphoresis patterns and appeared independently, remote in time and location, at the same cancer center.


ISSN : 0095-1137
Comparative Activities of Daptomycin, Linezolid, and Tigecycline against Catheter-Related Methicillin-Resistant Staphylococcus Bacteremic Isolates Embedded in Biofilm
(2007)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

In the setting of catheter-related bloodstream infections, intraluminal antibiotic lock therapy could be useful for the salvage of vascular catheters. In this in vitro study, we investigated the efficacies of the newer antibiotics daptomycin, linezolid, and tigecycline, in comparison with those of vancomycin, minocycline, and rifampin, against methicillin-resistant Staphylococcus aureus (MRSA) embedded in biofilm. We also assessed the emergence of MRSA strains resistant to these antibiotics, alone or in combination with rifampin, after 4-hour daily use for catheter lock therapy. Minocycline, daptomycin, and tigecycline were more efficacious in inhibiting MRSA in biofilm than linezolid, vancomycin, and the negative control (P < 0.001) after the first day of exposure to these antibiotics, with minocycline being the most active, followed by daptomycin and then tigecycline, and with vancomycin and linezolid lacking activity, similar to the negative control. After 3 days of 4-hour daily exposures, daptomycin was the fastest in eradicating MRSA from biofilm, followed by minocycline and tigecycline, which were faster than linezolid, rifampin, and vancomycin (P < 0.001). When rifampin was used alone, it was the least effective in eradicating MRSA from biofilm after 5 days of 4-hour daily exposures, as it was associated with the emergence of rifampin-resistant MRSA. However, when rifampin was used in combination with other antibiotics, the combination was significantly effective in eliminating MRSA colonization in biofilm more rapidly than each of the antibiotics alone. In summary, daptomycin, minocycline, and tigecycline should be considered further for antibiotic lock therapy, and rifampin should be considered for enhanced antistaphylococcal activity but not as a single agent.


ISSN : 0066-4804
Colistin Is Effective in Treatment of Infections Caused by Multidrug-Resistant Pseudomonas aeruginosa in Cancer Patients
(2007)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

The increasing incidence of infections caused by multidrug-resistant Pseudomonas aeruginosa is a worldwide health problem. Because no new antipseudomonal agents are expected to be available in the near future, we evaluated the safety and efficacy of colistin, an old drug with bactericidal activity against this organism. We collected clinical and demographic data on 95 cancer patients diagnosed with infections caused by multidrug-resistant P. aeruginosa between January 2001 and January 2004 and treated with either colistin (colistin group) or at least one active antipseudomonal agent (a beta-lactam antibiotic or a quinolone) (control group). We compared the results obtained for both groups. Thirty-one patients had been treated with colistin and 64 had been treated with an antipseudomonal non-colistin-containing regimen. Compared with the control group, patients in the colistin group had a lower median age (52 and 62 years, respectively; P = 0.012) but were more likely to have had nosocomial infections (87% and 64%, respectively; P = 0.02). Twenty-five patients (81%) in the colistin group and 40 patients (63%) in the control group had an APACHE II score of >15 (P = 0.074). The overall clinical response rates were 52% in the colistin group and 31% in the control group (P = 0.055). Multiple logistic regression analysis showed that those patients treated with colistin were 2.9 times (95% confidence interval, 1.1 to 7.6 times) more likely than those in the control group to experience a clinical response to therapy (P = 0.026). Colistin therapy was at least as effective and as safe a beta-lactam antibiotic or a quinolone in the treatment of infections caused by multidrug-resistant P. aeruginosa and, hence, may be a useful or preferred alternative therapy for this infection in cancer patients.


ISSN : 0066-4804
Posaconazole as Salvage Therapy for Zygomycosis
(2006)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

Zygomycosis, an infection that is associated with significant morbidity and mortality, is becoming common in immunocompromised patients. Posaconazole is a new extended-spectrum azole antifungal that has demonstrated in vitro and in vivo activity against zygomycetes. This report provides the results from the first 24 patients with active zygomycosis who were enrolled in two open-label, nonrandomized, multicentered compassionate trials that evaluated oral posaconazole as salvage therapy for invasive fungal infections. Posaconazole was usually given as an oral suspension of 200 mg four times a day or 400 mg twice a day. Eleven (46%) of the infections were rhinocerebral. Duration of posaconazole therapy ranged from 8 to 1,004 days (mean, 292 days; median, 182 days). Rates of successful treatment (complete cure and partial response) were 79% in 19 subjects with zygomycosis refractory to standard therapy and 80% in 5 subjects with intolerance to standard therapy. Overall, 19 of 24 subjects (79%) survived infection. Survival was also associated with surgical resection of affected tissue and stabilization or improvement of the subjects' underlying illnesses. Failures either had worsening of underlying illnesses or requested all therapy withdrawn; none of the failures received more than 31 days of posaconazole. Posaconazole oral solution was well tolerated and was discontinued in only one subject due to a drug rash. Posaconazole appears promising as an oral therapy for zygomycosis in patients who receive required surgery and control their underlying illness.


ISSN : 0066-4804
Pentamidine Is Active in a Neutropenic Murine Model of Acute Invasive Pulmonary Fusariosis
(2006)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

We studied the efficacy of pentamidine (PNT) as prophylaxis or early treatment in acute pulmonary fusariosis in neutropenic mice. PNT-preexposed mice had significantly improved survival and reduced fungal burden compared to amphotericin B-preexposed and untreated mice. PNT-treated mice had increased survival but no difference in fungal burden versus untreated mice.


ISSN : 0066-4804
Pharmacokinetics, Safety, and Efficacy of Posaconazole in Patients with Persistent Febrile Neutropenia or Refractory Invasive Fungal Infection
(2006)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

The pharmacokinetic profiles, safety, and efficacies of different dosing schedules of posaconazole oral suspension in patients with possible, probable, and proven refractory invasive fungal infection (rIFI) or febrile neutropenia (FN) were evaluated in a multicenter, open-label, parallel-group study. Sixty-six patients with FN and 32 patients with rIFI were randomly assigned to one of three posaconazole regimens: 200 mg four times a day (q.i.d.) for nine doses, followed by 400 mg twice a day (b.i.d.); 400 mg q.i.d. for nine doses, followed by 600 mg b.i.d.; or 800 mg b.i.d. for five doses, followed by 800 mg once a day (q.d.). Therapy was continued for up to 6 months in patients with rIFI or until neutrophil recovery occurred in patients with FN. The 400-mg-b.i.d. dose provided the highest overall mean exposure, with 135% (P = 0.0004) and 182% (P < 0.0001) greater exposure than the 600-mg-b.i.d. and 800-mg-q.d. doses, respectively. However, exposure in allogeneic bone marrow transplant (BMT) recipients (n = 12) was 52% lower than in non-BMT patients. Treatment-related adverse events (occurring in 24% of patients) were mostly gastrointestinal in nature. Twenty-four percent of patients had adverse events leading to premature discontinuation (none were treatment related). In efficacy-evaluable patients, successful clinical response was observed in 43% with rIFI (56% of patients receiving 400 mg b.i.d., 17% receiving 600 mg b.i.d., and 50% receiving 800 mg q.d.) and 77% with FN (74% receiving 400 mg b.i.d., 78% receiving 600 mg b.i.d., and 81% receiving 800 mg q.d.). Posaconazole is well tolerated and absorbed. Divided doses of 800 mg (400 mg b.i.d.) provide the greatest posaconazole exposure.


ISSN : 0066-4804
Comparative In Vitro Efficacies of Various Catheter Lock Solutions
(2006)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

MEDTA (minocycline-edetate calcium disodium), taurolidine (2%)-polyvinylpyrolidine (5%) (T/PVP), and ethanol as potential catheter lock solutions have a unique mechanism of action, broad-spectrum activity, and anticoagulant properties. Traditional lock solutions minocycline (M), rifampin (R), ciprofloxacin (C), and vancomycin, except pharmacologic concentrations of C and R and of M and R, were less effective than MEDTA and T/PVP.


ISSN : 0066-4804
Prospective Study of the Value of Quantitative Culture of Organisms from Blood Collected through Central Venous Catheters in Differentiating between Contamination and Bloodstream Infection
(2006)
Journal - Journal of Clinical Microbiology

Abstract :

Collection of blood through a central venous catheter for the diagnosis of bacteremia is a debated topic. Quantitative cultures of organisms from blood collected through central venous catheters were found to be highly sensitive, specific, and predictive of bacteremia, especially when a cutoff point of 15 colonies of skin organisms was used.


ISSN : 0095-1137
Vancomycin-Resistant Enterococcus faecium: Catheter Colonization, esp Gene, and Decreased Susceptibility to Antibiotics in Biofilm
(2005)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

To evaluate the molecular characteristics and antibiotic susceptibility in biofilm of vancomycin-resistant Enterococcus faecium (VREF) organisms that had caused catheter-related VREF bacteremia (VREF-CRB), we compared 22 isolates causing bacteremia obtained from patients with VREF-CRB with 30 isolates from control patients with gastrointestinal colonization by VREF. Using pulsed-field gel electrophoresis, we identified 17 unique strains among the 22 VREF-CRB isolates and 23 strains among the gastrointestinal isolates. The esp gene was detected in 53% (9 of 17) of the VREF-CRB and 61% (14 of 23) of the control strains (P = 0.6). VREF-CRB produced heavier biofilm colonization of silicone disks than did control organisms (P < 0.001). Daptomycin, minocycline, and quinupristin-dalfopristin were each independently more active than linezolid in reducing biofilm colonization by VREF-CRB (P < 0.01), with daptomycin being the most active, followed by minocycline. In conclusion, the esp gene in VREF is not associated with heavy biofilm colonization or catheter-related bacteremia. In biofilm, daptomycin and minocycline were the most active antibiotics against VREF, and linezolid was the least active.


ISSN : 0066-4804
In Vitro and Ex Vivo Activities of Minocycline and EDTA against Microorganisms Embedded in Biofilm on Catheter Surfaces
(2003)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

Minocycline-EDTA (M-EDTA) flush solution has been shown to prevent catheter-related infection and colonization in a rabbit model and in hemodialysis patients. We undertook this study in order to determine the activities of M-EDTA against organisms embedded in fresh biofilm (in vitro) and mature biofilm (ex vivo). For the experiment with the in vitro model, a modified Robbin’s device (MRD) was used whereby 25 catheter segments were flushed for 18 h with 106 CFU of biofilm-producing Staphylococcus epidermidis, Staphyloccocus aureus, and Candida albicans per ml. Subsequently, each of the catheter segments was incubated in one of the following solutions: (i) streptokinase, (ii) heparin, (iii) broth alone, (iv) vancomycin, (v) vancomycin-heparin, (vi) EDTA, (vii) minocycline (high-dose alternating with low-dose), or (viii) M-EDTA (low-dose minocycline alternating with high-dose minocycline were used to study the additive and synergistic activities of M-EDTA). All segments were cultured quantitatively by scrape sonication. For the experiment with the ex vivo model, 54 catheter tip segments removed from patients and colonized with bacterial organisms by roll plate were longitudinally cut into two equal segments and exposed to either saline, heparin, EDTA, or M-EDTA (with high-dose minocycline). Subsequently, all segments were examined by confocal laser electron microscopy. In the in vitro MRD model, M-EDTA (with a low concentration of minocycline) was significantly more effective than any other agent in reducing colonization of S. epidermidis, S. aureus, and C. albicans (P < 0.01). M-EDTA (with a high concentration of minocycline) eradicated all staphylococcal and C. albicans organisms embedded in the biofilm. In the ex vivo model, M-EDTA (with a high concentration of minocycline) reduced bacterial colonization more frequently than EDTA or heparin (P < 0.01). We concluded that M-EDTA is highly active in eradicating microorganisms embedded in fresh and mature biofilm adhering to catheter surfaces.


ISSN : 0066-4804
Efficacy of Minocycline and EDTA Lock Solution in Preventing Catheter-Related Bacteremia, Septic Phlebitis, and Endocarditis in Rabbits
(2002)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

To determine the efficacy of antibiotic catheter lock solution in preventing catheter-related infections, silicone catheters were tunneled and inserted into the jugular veins of 18 rabbits. The catheters were challenged with an intraluminal injection of 105 CFU of slime-producing Staphylococcus epidermidis in 0.1 ml of water. The catheters were maintained on heparin (100 IU/ml) flush for the first 3 days. On day 3, quantitative blood samples for culture were obtained from the catheters and ear veins, which documented catheter-related bacteremia, and the rabbits were randomized to have their catheters flushed as follows: five animals were continued on heparin (100 IU/ml), five animals received vancomycin (3 mg/ml) with heparin (100 IU/ml), and eight animals received 3 mg of minocycline per ml with 30 mg of EDTA per ml (M-EDTA). All animals were killed at day 7. Blood, catheters, jugular veins, and heart valves were cultured quantitatively. Animals maintained on heparin developed catheter-related colonization, bacteremia, septic phlebitis, and endocarditis. Vancomycin-heparin partially prevented catheter colonization, bacteremia, and phlebitis (P = 0.2). M-EDTA completely prevented catheter colonization, catheter-related bacteremia, and phlebitis in all of the animals (P < 0.01). Tricuspid endocarditis was equally prevented by vancomycin-heparin and M-EDTA (P = 0.06). In conclusion, the M-EDTA catheter flush solution was highly efficacious in preventing catheter-related colonization, bacteremia, septic phlebitis, and endocarditis in rabbits.


ISSN : 0066-4804
Lack of Catheter Infection by the efg1/efg1cph1/cph1 Double-Null Mutant, a Candida albicans Strain That Is Defective in Filamentous Growth
(2002)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

The molecular controls regulating the successful colonization of Candida albicans on foreign materials are not known. Here we show that a mutant C. albicans strain defective in filamentous growth and lacking the transcription factors Efg1p and Cph1p has a profoundly deficient potential for colonizing on polyurethane catheters.


ISSN : 0066-4804
Durability of Anti-Infective Effect of Long-Term Silicone Sheath Catheters Impregnated with Antimicrobial Agents
(2001)
Journal - Antimicrobial Agents and Chemotherapy

Abstract :

This study was performed to test the long-term antimicrobial efficacy of impregnated silicone catheters comprising an antimicrobial layer sandwiched between an external surface sheath and a luminal surface silicone sheath. The design of the catheter permits the introduction of various antimicrobials in addition to anticoagulants or antifibrins in the antimicrobial layer and allows their gradual release over a period of months after insertion. The in vitro data presented show that the catheter can provide antimicrobial activity for 90 days, after being replated for 15 7-day cycles of replating. When the catheters were immersed in human serum and incubated at 37°C, they demonstrated significant antimicrobial activity after more than 325 days of incubation. The significant long-term in vitro antimicrobial activity observed may imply effective in vivo activity for almost 1 year after insertion and could serve as a cost-effective alternative to surgically implantable silicone catheters.


ISSN : 0066-4804


Loading ...