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Strict infection control measures do not prevent clonal spread of coagulase negative staphylococci colonizing central venous catheters in neutropenic hemato-oncologic patients
- Source :
- Fems Immunology & Medical Microbiology, 38, 153-158. Oxford University Press
- Publication Year :
- 2003
- Publisher :
- Oxford University Press, 2003.
-
Abstract
- Coagulase negative staphylococci (CoNS) are a main cause of catheter related infections (CRI). Earlier studies (1994-1996) revealed a high incidence of CRI (6 per 1000 catheter days) among neutropenic hemato-oncologic patients in the Erasmus MC Hematology Department (Rotterdam, The Netherlands). This was mainly explained by expansion of two methicillin resistant Staphylococcus epidermidis (MRSE) clones (Nouwen et al., J. Clin. Microbiol. 36 (1998) 2696-2702). In a new, 16-bed unit in the same institution, we investigated the effect of strict clinical isolation measures on the incidence of CRI. During two 6-month screening periods (period I: April 1998-December 1998 and period II: April 1999-October 1999) all patients receiving a central venous catheter were prospectively monitored for the development of CRI. During period I every visitor of the cubicles had to wear hair caps, masks, gowns and gloves. During period II these procedures were abolished, but hands were cleansed using alcohol and masks were worn during both periods in case of coughing and sneezing. All CoNS strains isolated from blood cultures were genetically classifies by pulsed field gel electrophoresis (PFGE). The incidence of CRI during period I was 13.0 per 1000 catheter days, in comparison to 9.6 in period II (P=0.84). During this latter period, 19 CRI were diagnosed, 14 catheter related bacteremia episodes (CRB) and five local infections. Seventy-two percent (n=9) of CRB were due to a CoNS. The mean catheter survival until appearance of a CRI increased from 43 days during period I to 78 days in period II (P=0.39). The mean catheter survival until infection related removal was increased from 43 days to 133 days (P=0.12). During period I less experienced intervention radiologists introduced the catheters, which may have limited the efficacy of the strict hygiene measures. Thus, abolishing strict isolation precautions had no negative effect on the incidence of CRI. After genotyping of 38 MRSE strains isolated from blood and central venous catheter cultures of 12 patients in period II, eight PFGE types were found. Three types were found in more than one patient, but based on epidemiological data patient-to-patient spread could not be proven. No genotypic identity between patient and personnel CoNS isolates was shown and the two major clonal types that were present between 1994 and 1996 were not encountered. However, from December 1998 onwards new MRSE clones could be identified (types E and J). In conclusion, despite a constant rate of CRI and implementation of optimal patient care, clonal spread of MRSE strains was not prevented by strict hygiene measures.
- Subjects :
- Coagulase
Microbiology (medical)
Catheterization, Central Venous
medicine.medical_specialty
Neutropenia
Genotype
Staphylococcus
medicine.medical_treatment
Immunology
Microbial Sensitivity Tests
medicine.disease_cause
Microbiology
Catheters, Indwelling
Internal medicine
medicine
Humans
Immunology and Allergy
Blood culture
Infection Control
medicine.diagnostic_test
business.industry
Incidence
Incidence (epidemiology)
Methicillin-resistant Staphylococcus epidermidis
General Medicine
Staphylococcal Infections
medicine.disease
Methicillin-resistant Staphylococcus aureus
Culture Media
Electrophoresis, Gel, Pulsed-Field
Surgery
Catheter
Infectious Diseases
Hematologic Neoplasms
Bacteremia
Equipment Contamination
business
Central venous catheter
Subjects
Details
- ISSN :
- 1574695X, 2049632X, and 09288244
- Volume :
- 38
- Database :
- OpenAIRE
- Journal :
- Pathogens and Disease
- Accession number :
- edsair.doi.dedup.....ec116874c326d9922344a9c2ed0bdc79