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Biofilms on right heart flow-directed catheters
72
ABSTRACTS
A prospective study was done, looking at the efficacy of intestinal decontamination with nonabsorbable antimicrobial agents in controlling outbreak of colonization and infection with multiresistant gram negative bacteria. The effect of this regimen on nosocomial infection rate was examined as well. Patients admitted to the KU for a period of 2 or more days were assessed.In the first study period, 124 patients (Group 1) were followed and baseline incidence of intestinal contamination, colonization and infection at clinical sites and overall rate of nosocomial infections were obtained. In the second study period, newly admitted patients were allocated, on odd and even birth year, to receive either no prophylaxis (Group 2) or intestinal decontamination (Group 3) (Polymyxin E 50 mg, Neomycin 1 gm and Nalidixic acid 1 gm, liquid form, 4 times a day orally or through NC tube). In the first group, intestinal colonization with multiresistant strains occurred in 19.6%. In groups 2 and 3, colonization was respectively 10% and 3%. Infection rates were 9% (Group l), 3% (Group 2) and 0 (Group 3). For 4 months, there was no new reported cases. Colonization with gram positive cocci was higher in group 3 than group 2; overall rate of nosocomial infections was not different between the 3 groups. This antimicrobial regimen can help to control an outbreak of colonization and infection with resistant bacteria but doesn’t prevent endemic nosocomial infections. (Reprinted with permission.) Bacterial Colonization and Infection in an Intensive Care Unit. Nystrom B, Frederici H. von Euler C. Intensive Care
Med 14:34, 1988. 101 patients admitted to ICU were surveyed in order to assesstheir bacterial colonization and to correlate the latter with clinical infections. Monitoring of colonization and infection included a once weekly specimen for culture from nasopharynx throat urine, used if applicable, tracheostomy, wounds and drains. Colonization rate for staph aureus was 18%: the acquisition rate in ICU being 14%. Total colonization rate for coagulanenegative staphylocci was 174, 14% acquired in the ICU. Corresponding figures for gram negative were 23% and 12% respectively. The colonization rate was lower than usually described. Infection rate of 16% is reported in the literature contrast with low rate of colonization. Varying species of staph and Gram negative suggest low dissemination between patients. The antibiotic (AB) sensitivity pattern for bacterial colonization strains was favorable. The use of penicillins in most cases may explain this finding. Strict nursing barrier technics and judicious use of AB may explain the low rate of bacterial dissemination in the unit. (Reprinted with permission.) Daytime
Variations
in Energy
Expenditure
Patients.
Swinamer
DL.
RL,
Jones
Grace
in Critically
GA.
Ill
et al. J Crit
Care 3:190, 1988. The purpose of the study is to determine if a diurnal variation in energy expenditure (EE) exists in mechanically ventilated critically ill patients. 12 patients with a mean age of 63 * 14 years were prospectively studied. Apache II and sepsis scores were respectively 16 f 6 and 12 * 6. They were
studied 2 + 1 day following admission. Indirect calorimetry was used to determine EE during three 30 minute measurements performed at 7 AM, 12 noon and 6 PM. Predicted EE was determined for each patient using the Harris and Benedict Equation. The measured EE was 42% * 11% higher than predicted EE. There were large variations in resting EE between the three measurements in some patients but no definitive consistent diurnal variation could be underlined. Factors that are specific to ICU (pain, anxiety, large single room) may alter normal diurnal change in EE. These critically ill patients showed evidence of hypermetabolism and significant variations between their EE measurements. More than one resting measurement may be desirable in order to obtain accurate EE estimates. (Reprinted with permission.) Biofilms
on Right
L, Phang
Heart
Flow-Directed
PT. Jackson
FL, et al.
Passerini
Catheters.
Chest 92:440, 1987.
Catheter-related infection is one of the several complications associated to pulmonary artery catheter use. This study examines the incidence of biofilms on Row-directed catheters and tries to correlate the phenomenon with clinical observations and cultures obtained by sonication and scanning EM techniques. Twenty flow-directed catheters from 18 patients were studied: meticulous culture of the insertion site and division of the catheter in four 4 cm long sections for microbiology and scanning electron microscopy studies were performed. Nine of the 20 patients had clinical evidence of infection from another site with the catheter in place; the remaining 11 patients had no evidence of infection. 17 of the catheters were associated with antibioticcoverage (therapeutic or prophylactic). Using the sonication culture method, 8 of the 20 catheters grew a variety of organisms. One of those 8 was considered infected as there were positive catheter tip and blood cultures with the same organism. Biofilms were revealed on all catheters. Bacteria were detected by SEM on 50% of the catheters. Combining SEM with sonication culture, the bacteria detection rate was 75%. Despite the low incidence of catheter related sepsis in this study, the worrisome presence of colonization bacteria reemphasize the risk of invasive monitoring devices. (Reprinted with permission.) Low
Dose
Norepinephrine
and Oliguria: Effects Transport. Hesselvik
in Patients
on Afterload,
JF. Brodin
With
Urine
B.
Flow
Septic
Shock
and Oxygen
Crit Care Med 17~179,
1989. The authors report their observations in 5 septic patients, using norepinephrine (NE) to increase blood pressure and improve diuresis. The 5 septic patients were monitored with a pulmonary artery catheter and arterial line-volume expansion was performed up to a RA pressure of 13 & 1.3mm Hg and wedge pressures of 17 + 1.6mm Hg. Dopamine infusion (7-20 pg/kg/min) was present in all patients, 3 patients received Dobutamine (7-14 Gg/kg/min). NE was added (average 0.23 k 0.07 rg/kg/min) and titrated to keep urine output >O.S ml/kg/hr and systolic blood pressure >lOOmm Hg. NE
ABSTRACTS
A prospective study was done, looking at the efficacy of intestinal decontamination with nonabsorbable antimicrobial agents in controlling outbreak of colonization and infection with multiresistant gram negative bacteria. The effect of this regimen on nosocomial infection rate was examined as well. Patients admitted to the KU for a period of 2 or more days were assessed.In the first study period, 124 patients (Group 1) were followed and baseline incidence of intestinal contamination, colonization and infection at clinical sites and overall rate of nosocomial infections were obtained. In the second study period, newly admitted patients were allocated, on odd and even birth year, to receive either no prophylaxis (Group 2) or intestinal decontamination (Group 3) (Polymyxin E 50 mg, Neomycin 1 gm and Nalidixic acid 1 gm, liquid form, 4 times a day orally or through NC tube). In the first group, intestinal colonization with multiresistant strains occurred in 19.6%. In groups 2 and 3, colonization was respectively 10% and 3%. Infection rates were 9% (Group l), 3% (Group 2) and 0 (Group 3). For 4 months, there was no new reported cases. Colonization with gram positive cocci was higher in group 3 than group 2; overall rate of nosocomial infections was not different between the 3 groups. This antimicrobial regimen can help to control an outbreak of colonization and infection with resistant bacteria but doesn’t prevent endemic nosocomial infections. (Reprinted with permission.) Bacterial Colonization and Infection in an Intensive Care Unit. Nystrom B, Frederici H. von Euler C. Intensive Care
Med 14:34, 1988. 101 patients admitted to ICU were surveyed in order to assesstheir bacterial colonization and to correlate the latter with clinical infections. Monitoring of colonization and infection included a once weekly specimen for culture from nasopharynx throat urine, used if applicable, tracheostomy, wounds and drains. Colonization rate for staph aureus was 18%: the acquisition rate in ICU being 14%. Total colonization rate for coagulanenegative staphylocci was 174, 14% acquired in the ICU. Corresponding figures for gram negative were 23% and 12% respectively. The colonization rate was lower than usually described. Infection rate of 16% is reported in the literature contrast with low rate of colonization. Varying species of staph and Gram negative suggest low dissemination between patients. The antibiotic (AB) sensitivity pattern for bacterial colonization strains was favorable. The use of penicillins in most cases may explain this finding. Strict nursing barrier technics and judicious use of AB may explain the low rate of bacterial dissemination in the unit. (Reprinted with permission.) Daytime
Variations
in Energy
Expenditure
Patients.
Swinamer
DL.
RL,
Jones
Grace
in Critically
GA.
Ill
et al. J Crit
Care 3:190, 1988. The purpose of the study is to determine if a diurnal variation in energy expenditure (EE) exists in mechanically ventilated critically ill patients. 12 patients with a mean age of 63 * 14 years were prospectively studied. Apache II and sepsis scores were respectively 16 f 6 and 12 * 6. They were
studied 2 + 1 day following admission. Indirect calorimetry was used to determine EE during three 30 minute measurements performed at 7 AM, 12 noon and 6 PM. Predicted EE was determined for each patient using the Harris and Benedict Equation. The measured EE was 42% * 11% higher than predicted EE. There were large variations in resting EE between the three measurements in some patients but no definitive consistent diurnal variation could be underlined. Factors that are specific to ICU (pain, anxiety, large single room) may alter normal diurnal change in EE. These critically ill patients showed evidence of hypermetabolism and significant variations between their EE measurements. More than one resting measurement may be desirable in order to obtain accurate EE estimates. (Reprinted with permission.) Biofilms
on Right
L, Phang
Heart
Flow-Directed
PT. Jackson
FL, et al.
Passerini
Catheters.
Chest 92:440, 1987.
Catheter-related infection is one of the several complications associated to pulmonary artery catheter use. This study examines the incidence of biofilms on Row-directed catheters and tries to correlate the phenomenon with clinical observations and cultures obtained by sonication and scanning EM techniques. Twenty flow-directed catheters from 18 patients were studied: meticulous culture of the insertion site and division of the catheter in four 4 cm long sections for microbiology and scanning electron microscopy studies were performed. Nine of the 20 patients had clinical evidence of infection from another site with the catheter in place; the remaining 11 patients had no evidence of infection. 17 of the catheters were associated with antibioticcoverage (therapeutic or prophylactic). Using the sonication culture method, 8 of the 20 catheters grew a variety of organisms. One of those 8 was considered infected as there were positive catheter tip and blood cultures with the same organism. Biofilms were revealed on all catheters. Bacteria were detected by SEM on 50% of the catheters. Combining SEM with sonication culture, the bacteria detection rate was 75%. Despite the low incidence of catheter related sepsis in this study, the worrisome presence of colonization bacteria reemphasize the risk of invasive monitoring devices. (Reprinted with permission.) Low
Dose
Norepinephrine
and Oliguria: Effects Transport. Hesselvik
in Patients
on Afterload,
JF. Brodin
With
Urine
B.
Flow
Septic
Shock
and Oxygen
Crit Care Med 17~179,
1989. The authors report their observations in 5 septic patients, using norepinephrine (NE) to increase blood pressure and improve diuresis. The 5 septic patients were monitored with a pulmonary artery catheter and arterial line-volume expansion was performed up to a RA pressure of 13 & 1.3mm Hg and wedge pressures of 17 + 1.6mm Hg. Dopamine infusion (7-20 pg/kg/min) was present in all patients, 3 patients received Dobutamine (7-14 Gg/kg/min). NE was added (average 0.23 k 0.07 rg/kg/min) and titrated to keep urine output >O.S ml/kg/hr and systolic blood pressure >lOOmm Hg. NE