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Background. Ethanol lock therapy (ELT) with systemic antimicrobial therapy is a promising therapy for catheter-related infection (CRI). The impact of ELT timing on treatment efficacy and costs is unknown. Procedures. A prospective study was conducted in the Hematology/Oncology Unit at the Children’s Hospital of Michigan. Patients with suspected CRI were randomized to Preemptive ELT arm or Rescue ELT arm after positive culture. Results. Five cases in Preemptive arm and 9 in Rescue arm had a confirmed CRI. All cases cleared infection with line salvage with no adverse events due to ELT or recurrence within 14 days. Our data showed a trend toward 36% reduction in average hospital costs and 40% reduction in average length of stay in Preemptive arm over Rescue arm. Conclusion. Although a small study, our data on preemptive ELT with systemic antimicrobial therapy suggest a potentially important treatment strategy in reducing length of stay as well as hospital costs.

The success of peritoneal dialysis (PD) as renal replacement therapy depends upon a safe, functional, and durable catheter access to the peritoneal cavity provided in a timely fashion. Catheter complications often lead to catheter loss and contribute to technique failure. With improvements in prevention and treatment of peritonitis, the impact of catheter-related infections and mechanical problems on PD technique survival has become more apparent. Guideline committees under the sponsorship of the International Society for Peritoneal Dialysis (ISPD) periodically update best practices for optimal peritoneal access (1–4). Recent advances in our understanding of the key aspects of providing successful placement and maintenance of peritoneal catheters compels the current update. Assessment of evidence for guidelines recommendations is made using a modification of the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system for classification of the level of evidence and grade of recommendations (5). Where scientific evidence is not available, recommendations are based on a consensus opinion. The bibliography supporting the recommendations is not intended to be comprehensive. When there are multiple similar reports on the same subject, the committee prefers to cite the more recent publications. Within each recommendation, strength is indicated as Level 1 (we recommend), Level 2 (we suggest), or not graded, and the quality of the supporting evidence is shown as A (high quality), B (moderate quality), C (low quality), or D (very low quality). The recommendations are not meant to be implemented indiscriminately in every instance but adapted as necessary according to local circumstances and the clinical situation. While many of the general principles presented here may be applied to pediatric patients, the focus of these guidelines is on adults. Clinicians who take care of pediatric PD patients should refer to the latest ISPD guidelines covering this patient group (6).

Introduction Two opening methods are used for injection needle products: the “peel-apart method” where the adhesive surface of the packaging mount is peeled off, and the “push-off top method,” where the needle hub is pressed against the mount to break it. However, the risks of bacterial contamination as a result of opening method remain unknown. The aim of our study was to evaluate the bacterial contamination of needle hubs upon the opening of injection needles by the peel-apart or push-off top method under various conditions. Methods Bacterial contamination upon the opening of injection needles was examined in two materials, paper and plastic. Various concentrations of Staphylococcus aureus were applied to the mount and were maintained under wet or dry conditions. Injection needles were opened using the peel-apart or push-off top method. Needle hub contamination was examined using agar medium colony counting. Clinically assumed conditions (the hands and saliva of anesthesiologists) were also evaluated. Data were statistically examined using the Cochran-Mantel-Haenszel, Jonckheere, and Fisher’s exact tests. Results The lateral surfaces of needle hubs were contaminated using the push-off top method, but not by the peel-apart method, in a manner that was dependent on S. aureus concentrations. No significant differences were observed between mount materials. Needle hub contamination was significantly more severe for the wet than for the dry opening portion. The clinically assumed condition study revealed that the lateral and bottom surfaces of the needle hub were contaminated significantly more in the saliva contamination group than in the dry and wet hand groups. Conclusions The bacterial contamination of needle hubs may occur upon the opening of injection needles when the push-off top method is used and may be affected by hands contaminated with saliva under clinical conditions.

ObjectivesTo estimate the incidence and epidemiology of catheter-related bloodstream infections (CRBSIs) on a national scale by using prospective epidemiological data from the SwissAntibiotic Resistance Surveillance System(ANRESIS).DesignObservational study.SettingNational surveillance from 2008 to 2015 of acute hospitals in Switzerland.ParticipantsWe included acute Swiss hospitals that sent blood cultures and catheter tip culture results on a regular basis during the entire study period to the ANRESIS database.Outcome measureA catheter-related bloodstream infection (termed ‘modified CRBSI’, mCRBSI) was defined as isolating the same microorganism with identical antibiogram from ≥1 blood cultures (performed ±7 days around the catheter removal) as the one recovered from the catheter tip. Incidence rates of mCRBSI were calculated per 1000 admissions.ResultsFrom 2008 to 2015, the mCRBSI incidence rate decreased from 0.83 to 0.58 episodes/1000 admissions (−6% per year, pStaphylococcus aureusand fungi all exhibited decreasing trends, while rates of enterococci and Gram-negative bacteria remained stable.ConclusionsThe overall incidence of mCRBSI in Switzerland is decreasing; however, the incidence of mCRBSI due to Enterococci and Gram-negative micro-organisms did not change over time. These pathogens may grow in importance in catheter-related infections, which would have clinical implications for the choice of empirical treatment.

The aim of this study was to evaluate the effects of cefepime, meropenem, piperacillin/tazobactam (TZP) and vancomycin on strains of Candida albicans and Candida tropicalis in planktonic and biofilm forms. Twenty azole-derivative-resistant strains of C. albicans ( n =10) and C. tropicalis ( n =10) were tested. The susceptibility of planktonic Candida spp. to the antibacterial agents was investigated by broth microdilution. The XTT reduction assay was performed to evaluate the viability of growing and mature biofilms following exposure to these drugs. Minimum inhibitory concentrations (MICs) ranged from 0.5mg/mL to 2mg/mL for cefepime, TZP and vancomycin and from 0.5mg/mL to 1mg/mL for meropenem and the drugs also caused statistically significant reductions in biofilm cellular activity both in growing and mature biofilm. Since all of the tested drugs are commonly used in patients with hospital-acquired infections and in those with catheter-related infections under antibiotic-lock therapy, it may be possible to obtain an additional benefit from antibiotic-lock therapy with these drugs, namely the control of Candida biofilm formation.

© 2015 Published by Elsevier B.V. Catheter-associated urinary tract infection (CAUTI) is the commonest hospital-acquired infection, accounting for over 100,000 hospital admissions within the USA annually. Biomaterials and processes intended to reduce the risk of bacterial colonization of the catheters for long-term users have not been successful, mainly because of the need for long duration of activity in flow conditions. Here we report the results of impregnation of urinary catheters with a combination of rifampicin, sparfloxacin and triclosan. In flow experiments, the antimicrobial catheters were able to prevent colonization by common uropathogens Proteus mirabilis, Staphylococcus aureus and Escherichia coli for 7 to 12 weeks in vitro compared with 1-3 days for other, commercially available antimicrobial catheters currently used clinically. Resistance development was minimized by careful choice of antimicrobial combinations. Drug release profiles and distribution in the polymer, and surface analysis were also carried out and the process had no deleterious effect on the mechanical performance of the catheter or its balloon. The antimicrobial catheter therefore offers for the first time a means of reducing infection and its complications in long-term urinary catheter users.

Summary– Infective endocarditis (IE) is a serious infectious condition with high morbidity and mortality in patients with end-stage renal disease (ESRD). It has been particularly associated with recurrent bacteremia due to vascular access via lumen catheters. The most common pathogen is Staphylococcus (S.) aureus, and most affected valve is mitral valve, which frequently calcified. Two patients with ESRD who received hemodialysis treatment via tunneled catheters, aged 56 and 88 years, were admitted with fever and high troponin level. Blood cultures revealed growth of S. aureus. Good quality transthoracic echocardiography (TTE) displayed calcified mitral and aortic valves with no vegetation or abscess formation. Myocardial necrosis as result of catheter infection was considered. Both patients had persistent positive blood cultures 3 and 5 days after initiation of antibiotic treatment. Therefore, transesophageal echocardiogram (TEE) was scheduled. Results revealed perivalvular abscess in the older patient, and highly mobile vegetation in the younger patient. The older patient refused surgery and died soon after due to refractory shock. Mitral valve surgery was planned for the other patient; however, she developed left ventricular failure and bleeding, and also subsequently died as result of refractory shock. Patient evaluations were particularly unfavorable: they had catheter infection as primary focus, and TTE did not detect vegetation or annular abscess. Diagnosis of IE in patients with ESRD using Duke criteria is problematic; we have to keep use of TEE in mind to detect vegetation or abscess formation when there is clinical suspicion regarding ESRD patients even after good quality TTE.

Introduction: Coagulase-negative staphylococci (CNS) can protect themselves from the effects of antibiotics by producing biofilms through breeding on biomaterials, medical equipment and devices. It is possible to influence biofilm formation with the aid of various surface modifications. In our study, plasma polymerization method, which is a surface modification technique, was used. The plasma polymerization technique is an environmentally-friendly technique that allows you to modify the nanometer level only at the surface without affecting the stack using the fourth state of the material. The possibility to generate surfaces with different properties (hydrophilic, hydrophobic, biocompatible etc.) by the help of various monomers and gases has made this technique more popular. In this study, the effect of the microplate surfaces modified by three different monomers on the biofilm formation of CNS was investigated. Materials and Methods: A total of 60 isolated CNS isolates from blood and hand cultures were included into the study. As control strains, Staphylococcus epidermidis ATCC 35984, known to be biofilm positive, and S. epidermidis ATCC 12228 which do not form biofilm, were used. Slime formation was determined by the quantitative plaque assay method described by Christensen. In microplates, which were plain or modified by three different monomers, the biofilm formation behavior of all strains was investigated simultaneously and comparatively. Results: There was no difference in biofilm positivity between strains isolated from hand and blood. A total of 71.6% biofilm formation was observed on microplates, which were not coated with plasma technique, and on plasma-modified microplated surfaces, 80% (monomer: 3- mercaptopropionic acid), 65% (monomer: 2-hydroxyethyl methacylate) and 31.6% (monomer: ethylene glycol dimethacylate) biofilm formation was observed, respectively. It was found that ethylene glycol dimethacrylate in three monomers significantly inhibited biofilm formation when compared to other monomers. Conclusion: In recent years CNS, especially S. epidermidis has become the most frequently isolated bacteria in catheter infections and responsible for the 28% of nosocomial bacteremia. The widespread use of prosthetic and permanent devices has been shown as a reason for the increase in the frequency of this effect. In 90% of patients with S. epidermidis bacteremia, there is an intravascular catheter history. Biofilm is an extracellular structure containing water, proteins and carbohydrates and is responsible for the unwanted adhesion of microorganisms to host cells and artificial surfaces. The biofilm mechanism can be altered by the interaction between the material surface and the bacterial surface. In our study, in-vitro results were obtained showing the potential to reduce the risk of biofilm-associated infection by microorganism biofilm formation on modified surfaces with appropriate monomer selection., Giriş: Koagülaz-negatif stafilokoklar (KNS) biyolojik malzeme, medikal cihaz ve araçlar üzerinde üreyip biyofilm oluşturarak kendilerini antibiyotik etkilerinden koruyabilirler. Çeşitli yüzey modifikasyonları yardımıyla biyofilm oluşumunu etkilemek mümkündür. Çalışmamızda, bir yüzey modifikasyon tekniği olan plazma polimerizasyon yöntemi kullanılmıştır. Plazma polimerizasyon tekniği, maddenin dördüncü hali kullanılarak malzeme iç yapısını değiştirmeden nano seviyede sadece yüzey modifikasyonu yapmaya olanak veren çevre dostu bir tekniktir. Çeşitli monomer ve gazlar yardımıyla farklı özellikler gösteren (hidrofilik, hidrofobik, biyouyumlu vb.) yüzeylerin elde edilebilmesi bu tekniği oldukça popüler yapmıştır. Bu çalışmada üç farklı monomer yardımıyla modifiye edilen mikroplak yüzeylerin, KNS’lerin oluşturduğu biyofilm formasyonu üzerine etkisi araştırılmıştır. Materyal ve Metod: Kan ve el kültüründen izole edilen toplam 60 adet KNS izolatı çalışmaya dahil edilmiştir. Kontrol suşları olarak biyofilm oluşturduğu bilinen Staphylococcus epidermidis ATCC 35984 ile biyofilm oluşturmayan S. epidermidis ATCC 12228 suşları kullanılmıştır. Biyofilm oluşumu Christensen tarafından tarif edilmiş olan kantitatif plak test yöntemiyle belirlenmiştir. Plazma polimerizasyon yoluyla üç farklı monomerle modifiye edilmiş ve modifiye edilmemiş mikroplaklarda tüm suşların biyofilm oluşturma davranışı eş zamanlı ve karşılaştırmalı olarak gerçekleştirilmiştir. Bulgular: El ve kandan izole suşlar arasında biyofilm pozitifliği açısından fark belirlenmemiştir. Plazma tekniği ile modifiye edilmemiş mikroplakta %71.6 oranında biyofilm oluşumu gözlenirken, plazma ile modifiye edilmiş mikroplak yüzeylerde sırasıyla; %80 (monomer: 3-merkaptopropiyonik asit), %65 (monomer: 2-hidroksietilmetakrilat) ve %31.6 (monomer: etilen glikol dimetakrilat) oranında biyofilm oluştuğu gözlenmiştir. Üç monomer içinde etilen glikol dimetakrilatın diğer monomerlere kıyasla biyofilm oluşumunu belirgin olarak inhibe ettiği saptanmıştır. Sonuç: Son yıllarda kateter infeksiyonlarında KNS’ler, özellikle S. epidermidis, en sık izole edilen bakteri olup nozokomiyal bakteremilerin %28’inden sorumludur. KNS sıklığındaki artışın nedeni olarak prostetik ve kalıcı cihazların kullanımının yaygınlaşması gösterilmektedir. S. epidermidis bakteremisi olan hastaların %90’ında intravasküler kateter öyküsü olduğu saptanmıştır. Biyofilm; su, protein, karbonhidrat içeren hücre dışı bir yapıdır ve mikroorganizmanın konak hücre ve yapay yüzeylere istenmeyen yapışmasından sorumludur. Biyofilm mekanizması, malzeme yüzeyi ve bakteri yüzeyi arasındaki etkileşimlere bağlı olarak değiştirilebilir. Çalışmamızda uygun monomer seçimi ile modifiye edilmiş yüzeylerde mikroorganizma biyofilm oluşumunun ve buna bağlı olarak biyofilm ilişkili infeksiyon risklerinin azaltılabilme potansiyelini gösteren in vitro sonuçlar elde edilmiştir.

Supplemental Digital Content is available in the text, Nursing staff play a crucial role in maintaining a functional port. Nursing guidelines recommend standard maintenance with 10 ml irrigation without consideration for variations among patients and individual nursing staff. The aim of this study is to identify the efficacy of the current maintenance strategy and analyze the correlation between complications and actual port presentations, based on disassembled intravenous ports after removal from patients. We attempt to organize the information and propose a definite maintenance strategy. After treatment completion, or due to complications, 434 implanted intravenous ports were removed from patients. All ports were deconstructed to observe their actual presentations and were then analyzed in conjunction with medical records. The correlation between complications and actual presentations was analyzed. From March 2012 to December 2017, 434 implanted intravenous ports were removed from oncology patients after completion of treatment or catheter related complications. From the view of maintenance related presentations, injection chamber blood clot was highly correlated with chemotherapy completion (P

Catheter-associated bloodstream infections (CABSIs) are common complications encountered with cancer treatment. The aims of this study were to analyze the factors associated with recurrent infection and catheter removal in pediatric hematology-oncology patients. All cases of CABSIs in patients attending the Department of Pediatric Hematology-Oncology between January 2008 and December 2010 were reviewed. A total of 44 episodes of CABSIs, including multiple episodes involving the same catheter, were identified in 31 children with cancer. The overall CABSIs rate was 7.4 infections per 1000 central venous catheter (CVC) days. The most frequent organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in nine (20.4%) episodes. We found that hypotension, persistent bacteremia, Candida infection, exit-side infection, neutropenia, and prolonged duration of neutropenia were the factors for catheter removal. There were 23 (52.2%) episodes of recurrence or reinfection. Mortality rate was found to be 9.6% in children with CABSIs. In this study, we found that CABSIs rate was 7.4 infections per 1000 catheter-days. CABSIs rates in our hematology-oncology patients are comparable to prior reports. Because CONS is the most common isolated microorganism in CABSIs, vancomycin can be considered part of the initial empirical regimen.

Aquest document també està publicat a: 'Cirugía Cardiovascular' http://dx.doi.org/10.1016/j.circv.2016.06.001, The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. Short peripheral catheters have been found to be associated with the risk of nosocomial bacteremia resulting in morbidity and mortality. Staphyloccus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy and Spanish Society of Thoracic-Cardiovascular Surgery and aims at define and establish the norm for management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance and registry, diagnosis and treatment of infection, indications for removal and stresses on continuous education as a driver for quality. Implementation of this norm will allow uniformity in usage thus minimizing the risk of infection and its complications.

SUMMARYWe analysed nosocomial MRSA cases between January 2004 and December 2006 in a retrospective case-control study in a 250-bed tertiary-care teaching hospital. During the study period, 265 nosocomial Staphylococcus aureus infections were identified in 231 patients. There was a significant increase in methicillin resistance in isolates (MRSA) from these infections with frequencies for 2004 of 39/88 (44·3%), 2005 (62/80, 77·5%), and 2006 (75/97, 77·3%) (PPPP=0·023), and male sex (OR 2·000, 95% CI 1·081–3·699, P=0·027). The determination of associated factors for methicillin resistance in nosocomial S. aureus infections in hospitals will play an important role in efforts to reduce MRSA infection rates.

Summary Background Patients on long-term hemodialysis are at a significantly higher risk for catheter-related bloodstream infections (BSI) than the general population. These infections are generally caused by Gram-positive organisms, especially Staphylococcus aureus . In the present study, we evaluated the antimicrobial susceptibility patterns of S. aureus causing BSI in dialysis patients compared to those causing BSI in other patient populations. Methods The potencies of daptomycin and various comparator agents were evaluated by reference broth microdilution methods for S. aureus bloodstream isolates from dialysis patients (606 strains) in 43 hospitals in North America and Europe. Susceptibility patterns for the dialysis isolate set were compared to those S. aureus causing BSI in other patient populations in the same hospitals and time period. Results Daptomycin was highly potent against S. aureus causing bacteremia in dialysis patients (MIC 50 /MIC 90 , 0.25/0.5 μg/ml). Vancomycin (MIC 50 /MIC 90 , 1/1 μg/ml) and linezolid (MIC 50 /MIC 90 , 2/2 μg/ml) showed similar potency, and overall susceptibility rates for the three antibiotics were 99.8–100.0% susceptible. Linezolid and vancomycin were four- to eight-fold less potent than daptomycin. Conclusions The overall susceptibility patterns of S. aureus strains from dialysis patients were very similar to those of non-dialysis patients.

Background. Microbial infections are the most serious complications associated with indwelling central venous catheters. A catheter lock solution that is both antibacterial and antithrombotic is needed. The goal of this study was to determine whether a new catheter lock solution containing citrate, methylene blue and parabens has antimicrobial properties against planktonic bacteria and against sessile bacteria within a biofilm. These effects were compared to the antimicrobial properties of heparin at 2500 units/ml. Methods. The tested solution (C/MB/P comprising 7% sodium citrate, 0.05% methylene blue and 0.165% parabens) and individual components were challenged against gram-positive and gram-negative organisms and fungi. Control solutions were heparin with preservatives. Studies included evaluation of eradication of planktonic bacteria and sessile organisms in a biofilm grown on polymeric and glass coupons. Biofilm samples were inspected by scanning electron microscopy, atomic force microscopy and vital stains. Results. The C/MB/P solution, contrary to heparin, kills most tested planktonic microorganisms within 1 h of incubation. All tested organisms have an MIC of 25% or less of the original concentration of a new catheter lock. Bacteria strains did not develop resistance over more than 40 passages of culture suspensions. The C/MB/P solution is able to kill nearly all sessile bacteria in biofilm growth on plastic or glass discs in 1 h. Microscopic methods demonstrated extensive physical elimination of biofilm deposits from treated coupons. In contrast, heparin had a minimal effect on planktonic or biofilm organisms. Conclusions. The new multicomponent lock solution has strong antimicrobial properties against both planktonic and sessile microorganisms. By comparison, heparin with preservative has weak antibacterial properties against planktonic and biofilm bacteria. The tested catheter lock may have usefulness in preventing bacterial colonization of haemodialysis catheters and diminishing the incidence of catheter-related bacteraemia.

This study was conducted to evaluate the impact of central venous catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients. One hundred and thirty-three patients requiring central venous catheterization were chosen at random to receive either an antiseptic-impregnated triple-lumen catheter (N = 64) or a standard triple-lumen catheter (N = 69). The mean (SD) durations of catheterization for the antiseptic and standard catheters were 11.7 (5.8) days (median 10; range 3-29) and 8.9 (4.6) days (median 8.0; range 3-20), respectively (P = 0.006). Fourteen (21.9%) of the antiseptic catheters and 14 (20.3%) of the standard catheters had been colonized at the time of removal. (P = 0.834). Four cases (6.3%) of catheter-related bloodstream infection were associated with antiseptic catheters and one case (1.4%) was associated with a standard catheter (P = 0.195). The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the standard catheter group (P = 0.640). The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the standard catheter group (P = 0.452). In conclusion, our results indicate that the use of antiseptic-impregnated central venous catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients.

There is increasing concern over multiresistant staphylococcci in catheter-associated infections. Local infections due to coagulase-negative staphylococci are usually resolved by removal of the intravascular catheter. However, if the device should remain for a certain period of time, e.g. to complete a course of chemotherapy, the antibiotic lock technique with a glycopeptide should be considered. In case of septic embolism to the lung caused by a multiresistant Staphylococccus aureus or Enterococcus faecium, systemic therapy with glycopeptides, streptogramins or linezolid must be employed.

WOS: 000346433300001, PubMed ID: 25403704, Background: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012. Methods: A DA-HAI surveillance study in 63 adult, paediatric ICUs and neonatal ICUs (NICUs) from 29 hospitals, in 19 cities using the methods and definitions of the U.S. NHSN and INICC methods. Results: We collected prospective data from 94,498 ICU patients for 647,316 bed days. Pooled DA-HAI rates for adult and paediatric ICUs were 11.1 central line-associated bloodstream infections (CLABSIs) per 1000 central line (CL)-days, 21.4 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator (MV)-days and 7.5 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. Pooled DA-HAI rates for NICUs were 30 CLABSIs per 1000 CL-days, and 15.8 VAPs per 1000 MV-days. Extra length of stay (LOS) in adult and paediatric ICUs was 19.4 for CLABSI, 8.7 for VAP and 10.1 for CAUTI. Extra LOS in NICUs was 13.1 for patients with CLABSI and 16.2 for patients with VAP. Extra crude mortality was 12% for CLABSI, 19.4% for VAP and 10.5% for CAUTI in ICUs, and 15.4% for CLABSI and 10.5% for VAP in NICUs. Pooled device use (DU) ratios for adult and paediatric ICUs were 0.54 for MV, 0.65 for CL and 0.88 for UC, and 0.12 for MV, and 0.09 for CL in NICUs. The CLABSI rate was 8.5 per 1,000 CL days in the Medical Surgical ICUs included in this study, which is higher than the INICC report rate of 4.9, and more than eight times higher than the NHSN rate of 0.9. Similarly, the VAP and CAUTI rates were higher compared with U. S. NHSN (22.3 vs. 1.1 for VAP; 7.9 vs. 1.2 for CAUTI) and with the INICC report (22.3 vs. 16.5 in VAP; 7.9 vs. 5.3 in CAUTI). Conclusions: DA-HAI rates and DU ratios in our ICUs were higher than those reported in the INICC global report and in the US NHSN report., Foundation to Fight against Nosocomial Infections, The funding for the activities carried out at INICC head quarters were provided by the corresponding author, Victor D. Rosenthal, and Foundation to Fight against Nosocomial Infections.

Background: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012. Methods: A DA-HAI surveillance study in 63 adult, paediatric ICUs and neonatal ICUs (NICUs) from 29 hospitals, in 19 cities using the methods and definitions of the U.S. NHSN and INICC methods. Results: We collected prospective data from 94,498 ICU patients for 647,316 bed days. Pooled DA-HAI rates for adult and paediatric ICUs were 11.1 central line-associated bloodstream infections (CLABSIs) per 1000 central line (CL)-days, 21.4 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator (MV)-days and 7.5 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. Pooled DA-HAI rates for NICUs were 30 CLABSIs per 1000 CL-days, and 15.8 VAPs per 1000 MV-days. Extra length of stay (LOS) in adult and paediatric ICUs was 19.4 for CLABSI, 8.7 for VAP and 10.1 for CAUTI. Extra LOS in NICUs was 13.1 for patients with CLABSI and 16.2 for patients with VAP. Extra crude mortality was 12% for CLABSI, 19.4% for VAP and 10.5% for CAUTI in ICUs, and 15.4% for CLABSI and 10.5% for VAP in NICUs. Pooled device use (DU) ratios for adult and paediatric ICUs were 0.54 for MV, 0.65 for CL and 0.88 for UC, and 0.12 for MV, and 0.09 for CL in NICUs. The CLABSI rate was 8.5 per 1,000 CL days in the Medical Surgical ICUs included in this study, which is higher than the INICC report rate of 4.9, and more than eight times higher than the NHSN rate of 0.9. Similarly, the VAP and CAUTI rates were higher compared with U.S. NHSN (22.3 vs. 1.1 for VAP; 7.9 vs. 1.2 for CAUTI) and with the INICC report (22.3 vs. 16.5 in VAP; 7.9 vs. 5.3 in CAUTI). Conclusions: DA-HAI rates and DU ratios in our ICUs were higher than those reported in the INICC global report and in the US NHSN report. © 2014 Leblebicioglu et al.

To the Editor: Mycobacterium cosmeticum is a rapidly growing nontuberculous mycobacteria species that was first described in November 2004. The first strains were obtained from cultures of a sink drain in a nail salon in Atlanta, Georgia, USA, and from a granulomatous lesion of a female mesotherapy patient in Venezuela (1). Among 3 additional isolates of M. cosmeticum obtained from July 2003 through November 2004, one was obtained from a 77-year-old man who was admitted to Ohio hospital A on September 22, 2004, with fever, exacerbation of chronic obstructive pulmonary disease, and urosepsis. Underlying medical conditions included diabetes, discitis, hyperlipidemia, coronary artery disease, and coal worker’s pneumoconiosis. He had received intravenous antimicrobial agents (rifampin and daptomycin) through a Groshong catheter that had been inserted to treat discitis. A routine blood culture was performed according to standard methods (2), and the catheter was removed. A diagnosis of catheter-associated bacteremia (CAB) was made, but the patient’s overall condition improved without antibacterial drug therapy, and he was discharged 4 days after admission. The culture specimen yielded only mycobacteria and was sent on to ARUP Laboratories, where it was identified as M. cosmeticum by 16S rDNA sequence analysis. The isolate was then sent to the Centers for Disease Control and Prevention (CDC) Mycobacteriology Laboratory Branch (Atlanta, GA, USA) and designated OH1. A 43-year-old woman with a diagnosis of non-Hodgkin lymphoma, who had received regular central venous catheterizations, was admitted to Ohio hospital B on August 20, 2004. A left subclavian catheter was inserted, and a routine blood specimen for culture was subsequently obtained on the day of admission. Before admission, the woman had been receiving acyclovir and cefepime. She received chemotherapeutic agent injections, platelet infusion, and an autologous stem cell transplant 6 days after admission. The blood culture was positive only for rapidly growing mycobacteria, and the final diagnosis was CAB. However, no symptoms of infection were observed, and no antimycobacterial drug therapy was administered. She was discharged without complications after the transplant was received and the catheter removed. The bacterial isolate was forwarded to CDC’s Special Bacteriology Reference Laboratory, where it was identified as M. cosmeticum by 16S rDNA sequence analysis, sent on to the CDC Mycobacteriology Laboratory Branch, and designated OH2. A 36-year-old man with AIDS was admitted to hospital C in Caracas, Venezuela, in June 2003 with dyspnea, fever, and expectoration. A sputum sample was positive by acid-fast bacillus smear and culture, yielding both M. cosmeticum (designated VZ1) and M. scrofulaceum on Middlebrook 7H10 agar (Remel Co., Lenexa, KS, USA). At the time the sputum was obtained, the patient was receiving only trimethoprim-sulfamethoxazole, but he experienced respiratory arrest and died ≈6 weeks later. The 3 isolates were confirmed to be M. cosmeticum by high-performance liquid chromatography mycolate analyses and by PCR restriction analysis of a 440-bp segment of hsp65 (1). The relationship of these isolates to the only documented strains of M. cosmeticum was evaluated by analysis of large restriction fragments with pulsed-field gel electrophoresis (1) and by repetitive element PCR (3). Banding patterns for isolates OH1 and OH2 were different from one another as well as from isolate VZ1 and the 2 control strains. Typing patterns for isolate VZ1, however, matched the control strain from Venezuela (ATCC BAA-878T), which indicates that these 2 isolates are likely a common strain (Figure). Figure Repetitive element (Rep)–PCR (A) and pulsed-field gel electrophoresis (PFGE) (B) patterns of Mycobacterium cosmeticum isolates from 2 patients in Ohio and 1 patient in Venezuela. Rep-PCR was performed by using BOXA1R primer (3), and PFGE was performed ... Of the >125 recognized Mycobacterium species, ≈50 are etiologic agents of human disease (4). The type strain of M. cosmeticum (ATCC BAA-878T) was associated with a soft-tissue infection in which the source was postulated to be environmental contamination of an unknown substance administered to the patient by injection as part of a weight loss regimen. This strain and isolate VZ1 were isolated from clinics in Caracas, Venezuela; both were found to be a common strain, but no other factors suggest that these represent an epidemic cluster. Although the Venezuelan patient from whom isolate VZ1 was obtained exhibited symptoms consistent with mycobacterial pulmonary disease, M. cosmeticum involvement cannot be proven because an additional Mycobacterium species, M. scrofulaceum, was isolated from the patient’s sputum. Because each of these organisms is found in the aqueous environment, they may represent colonization or may have been transiently present in the patient. Nonetheless, additional nontuberculous mycobacteria species have been reported to cause pulmonary disease, and the involvement of M. cosmeticum in this case cannot be excluded. Successful treatment of CAB infections caused by rapidly growing mycobacteria has most often been achieved by removing the catheter with or without the use of antimicrobial drug therapy (4). Criteria to support a true bloodstream infection were met by one of the patients in Ohio. These criteria include the absence of a source for bacteremia alternative to M. cosmeticum OH1 and the resolution of the febrile syndrome after removal of the device. The second patient had no symptoms when the blood culture was obtained; thus, the clinical significance of M. cosmeticum in this case is unclear. When all identified strains of M. cosmeticum are considered, this species is clearly present in diverse geographic regions and in healthcare institutions. These findings suggest that it may be widely distributed in the environment and should be regarded, along with other rapidly growing mycobacteria species, as a potential pathogen.