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Résumé: Objectifs: Les manifestations des infections liées au cathéter (ILC) pouvant être variées, nous avons étudié les symptômes conduisant au diagnostic. Méthodes: Pendant 14mois, les manifestations cliniques ou biologiques et les germes responsables ont été répertoriés. Les résultats sont exprimés en pourcentage ou médiane, les comparaisons faites avec le test de Fisher. Résultats: Quarante-neuf patients sur 192 ont présenté 60 épisodes d’ILC. Pour 75 %, l’apparition d’une fièvre et/ou de frissons pendant la perfusion a conduit à un diagnostic rapide. Pour 25 % des cas, l’ILC a été évoquée devant un bilan biologique perturbé (16,7 %) ou découverte pendant une hospitalisation pour un autre motif (8,3 %). Une notion de fièvre et/ou des frissons était alors retrouvée dans 73,3 % des cas, sans avoir alerté le patient. Les autres manifestations cliniques, parfois signes d’appel, étaient les céphalées (45 %), les myalgies (40 %), les signes digestifs (33,3 %) et l’hypotension (20 %). Les anomalies biologiques étaient une élévation de la CRP (86,4 %), une baisse des lymphocytes (59,6 %), une variation des plaquettes (43,3 %) ou des leucocytes (40 %), une atteinte rénale (45 %) ou hépatique (37,5 %). Les bacilles à Gram négatif étaient plus souvent responsables des formes typiques alors que les cocci à Gram positif étaient isolés dans 86,7 % des formes frustes (p <0,000). Conclusions: Une ILC peut se manifester par des signes cliniques autres que la fièvre et/ou les frissons. La surveillance biologique peut dépister ces formes frustes. L’éducation du patient est primordiale dans le diagnostic précoce des ILC en nutrition parentérale à domicile. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the incidence of catheter-related bacteremia (CRB) in a Moroccan medical intensive care unit, the microbiological profile of this infection and risk factors associated with its occurrence. Study design: Prospective observational study. Methods: Over a period of 8 months, patients who required central venous catheter (CVC) placement for a duration greater than 48h were included in the study. The CRB has been defined by the criteria of the SRLF Consensus Conference. The proportions of colonization and CRB were expressed as incidence density (ID). Risk factors for colonization were studied in univariate analysis. Results: One hundred and two CVC were inserted in 70 patients. The average age was 54±20 years with an APACHE II of 28±10. The ID of colonization and CRB were respectively 34 for 1000 days of CVC use and 8 for 1000 days of CVC use. The isolated microorganisms were Gram-negative bacilli in 73 %, Gram-positive cocci in 22 % and finally yeast in 5 %. A prolonged duration of catheterization and the absence of systemic antibiotic therapy before catheterization were the main risk factors for colonization. Conclusion: The incidence of CRB was high. These results impose a reflection of the care team to improve protocols for prevention of such nosocomial infections. [Copyright &y& Elsevier]

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Abstract: Introduction. – We report the case of a 48-years patient who is under chimotherapy because of a breast cancer. She was initially found at her place in coma with hyperthermia and neurological deficiency signs. The clinic history and the paraclinical investigations have enabled to detect a catheter-related infection (CRI) as soon as the diagnosis of disseminated infectious endocarditis was made. The resonance imaging confirmed the cerebral blow when it found suspicious images of septic embolus. Exegesis. – The CRI are usually detected at an early stage and if the classical association CRI–infectious endocarditis–systemical embolus is well known, the discovery on a CRI not treated at the stade of a febril coma is exceptional. Conclusion. – More than ever the taking care of infectious endocarditis, still delicate and sometimes perilous, requires a global taking care of the patient. [Copyright &y& Elsevier]

Abstract: Catheter-related infections remain an important cause of nosocomial infection in the ICU. They include colonization of the device, exit-site infection and catheter-related bloodstream infection with or without bacteraemia. Data from clinical studies and surveillance networks should be compared cautiously due to important methodological differences and wide variations of device-utilization ratio between units or countries. In France, two regional networks (C-CLIN Paris-Nord and C-CLIN Sud-Est) produced comparable and reproducible results. Colonization represents five–six cases per 1000 catheter-days and bacteraemia represents one case per 1000 catheter-days. Incidence rates from North American studies are usually four to five times higher. Numerous risk factors have been identified. Some of them could be used to stratify patients according to risk of catheter-related infection and to allow more valid comparison between ICU’s performances. Participation of French ICUs to the recent national surveillance networks (REA RAISIN and REACAT RAISIN) should be encouraged. [Copyright &y& Elsevier]

Objective. – To evaluate infectious complications related to non-tunneled central venous catheter in immunocompromised patients, in a bone marrow unit.Methods. – From July to April 2002, we inserted 210 non-tunneled central venous catheters in 139 immunocompromised patients (52 F/87 M). The mean age was 26 years (3–56 years). Our study included 33 children aged from 3 to 15 years, on whom 46 catheters were placed. The catheters were placed for the following indications: 145 catheters were used in subjects who received a bone marrow transplantation, 58 catheters were placed in subjects who received chemotherapy for acute leukemia and seven catheters were used in patients who received immunosuppressive therapy.Results. – The mean duration of catheterization was 33 days (7–114 days). There were 3.1 catheter-related infections per 1000 catheter-days. Coagulase-negative Staphylococci were implicated in 64% of cases. We observed two pneumothorax (0.9%), one arterial puncture (0.4%) and two catheter-related thrombosis (0.9%).Conclusion. – Non-tunneled catheters in immunocompromised patients (adults and children) is a safe technique, and is an alternative to the Hickman catheters which are most widely used today in patients undergoing bone marrow transplantation. [Copyright &y& Elsevier]

Patients in hemodialysis on central venous catheter as vascular access are at risk of infections. Catheter-related bloodstream infection is one of the most serious catheter-complications in hemodialysis patients. Its clinical and microbiological diagnosis is challenging. The implementation of empiric antibiotic therapy is based on old recommendations proposing the combination of a molecule targeting methicillin-resistant Staphylococcus aureus and a betalactamin active on P. aeruginosa, and also adapting this probabilistic treatment by carrying out a microbiological register on a local scale, which is rarely done. In our hemodialysis center at Bordeaux University Hospital, an analysis of the microorganisms causing all catheter-related bloodstream infection over the period 2018-2020 enabled us to propose, in agreement with the infectious disease specialists, an adapted probabilistic antibiotic therapy protocol. This approach allowed us to observe a low incidence of meticillinoresistance of Staphylococcus. For catheters inserted more than 6 months ago, we observed no Staphylococcus, no multi-resistant Pseudomonas, and only 2% of Enterobacteria resistant to cephalosporins. A frequent updating of the microbiological epidemiology of catheter-related bloodstream infection, in partnership with the infectious diseases team in each hemodialysis center, allowing an adaptation of the probabilistic antibiotic therapy, and seems to have a good feasibility. This strategy might favor the preservation of microbial ecology on an individual and collective scale in maintenance hemodialysis patients., (Copyright © 2021 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Abstract: Peripherally inserted central catheter (PICC) is a new device in France, at least for home parenteral nutrition (HPN). As a central intravenous line entering the organism via a peripheral vein of the arm, it offers some advantages on classic tunneled catheter: mainly reduced risk of mechanical or anatomical complications during insertion. Infection rate is identical but thrombosis risk is higher. PICC is appropriate for short or medium duration HPN (less 6months), particularly in case of contra-indication to large vein puncture. [Copyright &y& Elsevier]

Abstract: Subcutaneous tunnelling of short-term catheters and the choice of site of catheter insertion are the two factors which influence the risk of catheter-related infection. Catheters inserted into a femoral vein have been associated with a higher risk of infection than those inserted into a subclavian vein. However, a meta-analysis comparing the internal jugular and subclavian sites did not report any difference. Regarding tunnelling, two randomized studies showed a benefit in terms of infection rates for the jugular and femoral sites when the blood sampling was not performed via the catheters. For the subclavian site tunnelling does not seem to bring any advantage compared to conventional insertion. [Copyright &y& Elsevier]

Introduction: Catheter-related infection by non-tuberculous mycobacteria is rare but difficult to diagnose and the treatment is not standardized., Case Report: A 64-year-old woman treated for lung cancer with intravenous chemotherapy developed an infection of her totally implanted perfusion device with Mycobacterium chelonae. The infection was cured after surgical removal of the device and treatment with oral clarithromycin., Conclusion: Mycobacteria may infect vascular access devices. Rapid diagnosis of such infections allows early treatment., (Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.)