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Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter-related infections (CRIs). Moreover, CRIs prolong hospitalization, cause an excess in resource utilization and treatment cost, often delay anti-cancer treatment, and are associated with a significant increase in mortality in cancer patients. We therefore summoned a panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and updated our previous guideline on CRIs in cancer patients. After conducting systematic literature searches on PubMed, Medline, and Cochrane databases, video- and meeting-based consensus discussions were held. In the presented guideline, we summarize recommendations on definition, diagnosis, management, and prevention of CRIs in cancer patients including the grading of strength of recommendations and the respective levels of evidence. This guideline supports clinicians and researchers alike in the evidence-based decision-making in the management of CRIs in cancer patients.

We report a case of catheter associated bloodstream infection due to Enterobacter ludwigii with a massive aggregation on the outside surface of a central venous catheter (CVC). The 57 years old patient with a history of spondylodiscitis and Staphylococcus aureus-associated endocarditis was admitted to the intensive care unit for acute cerebral infarction. The patient developed signs of infections and the CVC was removed 11 days after placement. The infectious agent was identified by standard diagnostics to the genus level as belonging to the Enterobacter cloacae complex, and additional molecular testing determined the species as E. ludwigii. The catheter was selected for a study aiming to identify the influence of blood components on the formation of central venous catheter-associated biofilms. In this course a massive biofilm was recognized and is presented here.

Background: Due to rising vascular comorbidities of patients undergoing dialysis, the prevalence of permanent hemodialysis catheters as hemodialysis access is increasing. However, infection is a major complication of these catheters. Therefore, identification of potential predicting risk factors leading to early infection related complications is valuable, in particular the significance the CRP (C-reactive protein)-value is of interest., Methods: In this retrospective study 151 permanent hemodialysis catheters implanted in 130 patients were examined. The following data were collected at the time of catheter implantation: CRP-value, history of catheter-related infection, microbiological status, immunosuppression and diabetes mellitus. The primary outcomes were recorded over the 3 months following the implantation: catheter-related infection, days of hospital stay and death. Catheter removal or revision, rehospitalization and use of antibiotics were identified as secondary outcomes., Results: We identified a total of 27 (17.9%) infections (systemic infection: 2.26 episodes/ 1000 catheter days, local infection: 0.6 episodes/ 1000 catheter days). The development of an infection was independent of the CRP-value (p = 0.66) as well as the presence of diabetes mellitus (p = 0.64) or immunosuppression (p = 0.71). Univariate analysis revealed that infection was more frequent in patients with MRSA-carriage (p < 0.001), in case of previous catheter-related infection (p < 0.05) and of bacteremia or bacteriuria in the period of 3 months before catheter implantation (p < 0.001). Catheter removal or revision (p = 0.002), rehospitalization (p = 0.001) and use of antibiotics (p = 0.02) were also more often observed in patients with MRSA-carriage., Conclusions: The CRP-value at the time of implantation of a permanent hemodialysis catheter is not associated with the development of early catheter related infections, but an individual history of catheter-related infection, MRSA-carriage and bacteremia or bacteriuria in the period of 3 months prior to catheter implantation are significant risk factors.

Background: Dialysis patients are frequently exposed to Staphylococcus aureus due to stays in dialysis centers, hospitals or rest homes. The hemodialysis vascular access is a potential entry site for S. aureus, in particular when using a central venous catheter (CVC) which increases the risk of sepsis compared to arteriovenous (AV) fistula. We prospectively followed a cohort of 86 hemodialysis patients from an outpatient dialysis center over 25 months analyzing S. aureus carrier status, S. aureus infection rates and mortality., Methods: Demographic data and patients´ medical histories were collected and followed from all hemodialysis patients. Blood samples, nasal swabs and swabs from the hemodialysis vascular access site were taken every six months for a period of 25 months and tested for S. aureus. Strains were cultured and further characterized by spa PCR and microarray-based genotyping. Resulting data were compared with those from the general population., Results: In cross-sectional analyses, an average of 40% of hemodialysis patients were S. aureus carriers compared to 27% in the general population. Longitudinally, a total of 65% were S. aureus carriers: 16% were persistent carriers, 43% were intermittently colonized. The most common S. aureus lineage in the dialysis patient cohort was the clonal complex (CC) 8 and the spa type t008, while in the general population, the clonal complex CC30 dominates. During the study period, we observed six S. aureus-associated blood stream infections with one S. aureus attributable death. S. aureus carriers with an AV fistula were more densely colonized in the nasal mucosa compared to patients with a CVC. Overall mortality was lower for hemodialysis patients with a positive S. aureus carrier status compared to non-carriers (hazard ratio of 0.19)., Conclusions: Compared to the general population, hemodialysis patients were more frequently colonized with S. aureus and displayed both different S. aureus colonization densities as well as lineages, possibly explained by more frequent exposure to health care environments. The lower overall mortality in carriers compared to non-carriers is intriguing and will be investigated in detail in the future., Trial Registration: ISRCTN 14385893 , 2. October 2018, retrospectively registered.

Background: Blood cultures (BCs) are the gold standard for diagnosing sepsis and are prerequisite for a targeted antibiotic treatment and essential for patient outcomes. Aim of the study was to analyze the frequency of BCs, the rate of central line-associated bloodstream infections (CLABSIs) and to study the association between both parameters on intensive care units in Germany over time., Methods: Cross-sectional studies at two points in time (2006, 2015) on ICUs participating in the German hospital infection surveillance system. CLABSIs were defined according to the Center for Disease Control and Prevention (CDC). Univariable and multivariable analyses were performed using generalized linear models., Results: A total of 639 ICUs participated in 2006 or 2015 and 90 ICUs (" core group ") in both years. Overall, 2,427,921 patient days from 644,575 patients were analyzed. In the ICU core group the frequency of BCs per 1000 patient days doubled from 57.8 (interquartile range [IQR] 29.8-101.2; 2006) to 128.2 (IQR 71.6-183.2; 2015). In the same time, the pooled median CLABSI rate decreased from 0.8 (IQR 0-1.9; 2006) per 1000 central-line catheter days to 0.2 (IQR 0-0.9; 2015)., Conclusions: From 2006 to 2015 the frequency of BCs increased on ICUs in Germany and is now within the recommended 100 to 200 BCs sets per 1000 patient days., Competing Interests: Not applicable, because all data were surveillance based data which were obtained within the German Law on Protection against Infection (“Infektionsschutzgesetz”).Not applicable, because all data were surveillance based data which were obtained within the German Law on Protection against Infection (“Infektionsschutzgesetz”).The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

In patients with indwelling urethral catheters significant bacteriuria develops within 4 weeks of indwelling time in practically 100% of the cases. Catheter encrustation and obstruction can occur in approximately 40% of patients. Symptomatic ascending urinary tract infections, urethral complications and urolithiasis can occur in significant numbers in the long term. Regular educational and surveillance programs in nursing homes, hospitals and in home care are important to instruct personnel in hygiene procedures, to learn the indications for catheterization, to keep the indwelling time of catheters as short as possible, to detect any complications early and to initiate appropriate diagnostics and therapy by the urologist.

Background and Objectives: The incidence of infectious complications associated with continuous regional anesthesia techniques is a matter of concern. Our objective was to determine whether patients suffering from diabetes are at an increased risk of catheter-related infectious complications., Methods: The German Network for Regional Anaesthesia database was analyzed between 2007 and 2012. After proof of plausibility, data of 36,881 patients undergoing continuous regional anesthesia were grouped in I: no diabetes (n = 32,891) and II: any diabetes (n = 3990). The analysis focused on catheter-related infections after strict definition. Differences among the groups were tested with t and χ tests. Odds ratios were calculated with logistic regression and adjusted for potential confounders., Results: Patients with a diagnosis of diabetes had an increased incidence of catheter-related infections (no diabetes 3.0% vs any diabetes 4.2%; P < 0.001). Among all patients, diabetes remained an independent risk factor for infections for all sites after the adjustment for potential confounders (odds ratio [OR] = 1.26; 95% confidence interval [95% CI], 1.02-1.55; P = 0.036). The risk of infection was significantly increased in peripheral catheters only in the lower limb (adjusted OR = 2.42; 95% CI, 1.05-5.57; P = 0.039). If neuraxial catheters were used, the risk was significantly increased only in lumbar epidural (adjusted OR = 2.09; 95% CI, 1.18-3.73; P = 0.012) for diabetic patients compared with nondiabetic patients., Conclusions: The presence of diabetes is associated with an increased risk for catheter-related infections in lower limb and lumbar epidural. Specific care should be taken to avoid and detect infections in this population.

Background: Infants with very low birthweight (< 1 500 g, VLBW) are at increased risk for nosocomial infections (NI). In 2 000, we implemented a surveillance system for VLBW infants in Germany: NEO-KISS. In 2005, a joint committee of healthcare providers and insurance companies required German neonatology departments to participate. As a result, NEO-KISS is now a nationwide surveillance system for NI in VLBW infants., Patients and Methods: We present NEO-KISS data collected between 2007 and 2011 by 228 neonatology departments. Rates of sepsis, pneumonia and necrotising enterocolitis (NEC) were calculated. In order to evaluate the department-specific infection rate we introduced a new indicator: the Standardised Infection Rate (SIR). The SIR considers the department-specific patient distribution (based on the patients' birthweight) and describes the ratio of observed and expected infections (calculated from the reference data for this individual patient distribution). The data presented comprise 33 048 VLBW infants.The incidence density of CVC-associated sepsis 8.6 per 1 000 CVC-days., Results and Conclusion: The incidence of pneumonia among mechanically ventilated patients was 2.7/1 000 ventilator days. The incidence of NEC was 0.8. The SIR showed strong variation among the participating departments. It is an excellent tool for identifying outliers in nosocomial infection rates and for stimulating activities to decrease the risk of nosocomial infections., (© Georg Thieme Verlag KG Stuttgart · New York.)