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• W2049204040 abstract "To the Editor:Percutaneously inserted central venous catheters (CVCs) are widely used in both adults and neonates and are a major cause of bloodstream infection (BSIs) in hospitals. There are 2 major sources of intravascular device-related BSI: colonization of the device and contamination of the fluid administered through the device.1Safdar N. Maki D.G. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters.Intensive Care Med. 2004; 30: 62-77Crossref PubMed Scopus (250) Google Scholar In short-term catheters (in place ≤8 days), the most common catheter colonization results from skin microorganisms from the insertion site, which gain access to the catheter tip extraluminally. For long-term catheters (in place >8 days), the source of colonization is most commonly the hub, and intraluminal dissemination appears to be the major mechanism.2Sherertz R.J. Ely E.W. Westbrook D.M. Gledhill K.S. Streed S.A. Kiger B. et al.Education of physicians in training can decrease the risk for vascular catheter infection.Ann Intern Med. 2000; 132: 641-647Crossref PubMed Scopus (301) Google ScholarStudies about the pathogenesis of catheter-related BSI have been limited in critically ill neonates. Garland et al (2008)3Garland J.S. Alex C.P. Sevallius J.M. Murphy D.M. Good M.J. Volberding A.M. et al.Cohort study of the pathogenesis and molecular epidemiology of catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters.Infect Control Hosp Epidemiol. 2008; 29: 243-249Crossref PubMed Scopus (104) Google Scholar reported that the pathogenesis of catheter-related BSI in neonates with peripherally inserted CVCs was intraluminally acquired in 67% of patients, whereas extraluminally acquired catheter-related BSI occurred in 20%, and indeterminate in only 13%, as reported for adults with CVCs in place for long periods. In a study with 318 patients hospitalized in a neonatal intensive care unit of Uberlandia University Medical School, we have showed the rate of CVC-related BSI of only 2.1 per 1000 CVC-days with 18% of catheter tip colonized. From a total of 63 neonates with BSIs without an identified source, we observed definite catheter-related BSI in just 10 neonates (15.9%), with low concordance among isolates recovered from the skin surrounding the catheter, peripheral blood sample, catheter tip, and from the catheter hub for both extra- (20%) and intraluminally (10%) acquired BSI (Table 1).Table 1Results of cultures associated with catheter-related bloodstream infection from 10 neonatesPatient numberSitesBloodCVC tipCVC typeCatheterization time (days)Route of acquisitionNostrilSkinHub1S aureusS aureus-S aureusS aureusUmbilical5Extraluminal2---CoNSCoNSPhlebotomy7ND3CoNS--CoNSCoNSPhlebotomy6ND4CoNS-CoNSCoNSCoNSPICC23Intraluminal5---CoNSCoNSPICC10ND6---E faecalisE faecalisUmbilical5ND7---CoNSCoNSUmbilical8ND8---CoNSCoNSPhlebotomy11ND9-S aureus-S aureusS aureusUmbilical9Extraluminal10---S aureusS aureusUmbilical6NDCoNS, coagulase-negative Staphylococcus; E faecalis, Enterococcus faecalis; ND, not determined; PICC, peripherally inserted central venous catheters; S aureus, Staphylococcus aureus. Open table in a new tab Coagulase-negative Staphylococcus (CoNS) was the main etiologic agent (60%) of catheter-related BSIs. These microorganisms colonize mucosal sites including gut, nares, and throat and may well translocate from mucosal sites to the bloodstream. These data were supported by epidemiologic, experimental, clinical, and molecular related studies. Donnell et al (2002)4Donnel S.C. Taylor N. van Saene H.K.F. Magnall V.L. Pierro A. Lloyd D.A. Infection rates in surgical neonates and infants receiving parenteral nutrition: a five-year prospective study.J Hosp Infect. 2002; 52: 273-280Abstract Full Text PDF PubMed Scopus (49) Google Scholar reported that microbial translocation was responsible for 84% of sepsis episodes in 76% of surgical neonates and that the predominant microorganisms (86%) were CoNS.In conclusion, in our study, for the majority (70%) of catheter-related BSI that occurred in neonates with CVCs, the route of acquisition was not determinate, suggesting other bacterial sources besides skin and CVC hub. Currently, mucosal sites, mainly gut mucosal atrophy, cannot be ruled out as an important source of neonatal bacteremia as well as critically ill adult patient. The highest level protection strategies designed to prevent both extra- and intraluminally acquired BSI should be combined with strategies to prevent microorganism infection deriving from the gut tract. To the Editor: Percutaneously inserted central venous catheters (CVCs) are widely used in both adults and neonates and are a major cause of bloodstream infection (BSIs) in hospitals. There are 2 major sources of intravascular device-related BSI: colonization of the device and contamination of the fluid administered through the device.1Safdar N. Maki D.G. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters.Intensive Care Med. 2004; 30: 62-77Crossref PubMed Scopus (250) Google Scholar In short-term catheters (in place ≤8 days), the most common catheter colonization results from skin microorganisms from the insertion site, which gain access to the catheter tip extraluminally. For long-term catheters (in place >8 days), the source of colonization is most commonly the hub, and intraluminal dissemination appears to be the major mechanism.2Sherertz R.J. Ely E.W. Westbrook D.M. Gledhill K.S. Streed S.A. Kiger B. et al.Education of physicians in training can decrease the risk for vascular catheter infection.Ann Intern Med. 2000; 132: 641-647Crossref PubMed Scopus (301) Google Scholar Studies about the pathogenesis of catheter-related BSI have been limited in critically ill neonates. Garland et al (2008)3Garland J.S. Alex C.P. Sevallius J.M. Murphy D.M. Good M.J. Volberding A.M. et al.Cohort study of the pathogenesis and molecular epidemiology of catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters.Infect Control Hosp Epidemiol. 2008; 29: 243-249Crossref PubMed Scopus (104) Google Scholar reported that the pathogenesis of catheter-related BSI in neonates with peripherally inserted CVCs was intraluminally acquired in 67% of patients, whereas extraluminally acquired catheter-related BSI occurred in 20%, and indeterminate in only 13%, as reported for adults with CVCs in place for long periods. In a study with 318 patients hospitalized in a neonatal intensive care unit of Uberlandia University Medical School, we have showed the rate of CVC-related BSI of only 2.1 per 1000 CVC-days with 18% of catheter tip colonized. From a total of 63 neonates with BSIs without an identified source, we observed definite catheter-related BSI in just 10 neonates (15.9%), with low concordance among isolates recovered from the skin surrounding the catheter, peripheral blood sample, catheter tip, and from the catheter hub for both extra- (20%) and intraluminally (10%) acquired BSI (Table 1). CoNS, coagulase-negative Staphylococcus; E faecalis, Enterococcus faecalis; ND, not determined; PICC, peripherally inserted central venous catheters; S aureus, Staphylococcus aureus. Coagulase-negative Staphylococcus (CoNS) was the main etiologic agent (60%) of catheter-related BSIs. These microorganisms colonize mucosal sites including gut, nares, and throat and may well translocate from mucosal sites to the bloodstream. These data were supported by epidemiologic, experimental, clinical, and molecular related studies. Donnell et al (2002)4Donnel S.C. Taylor N. van Saene H.K.F. Magnall V.L. Pierro A. Lloyd D.A. Infection rates in surgical neonates and infants receiving parenteral nutrition: a five-year prospective study.J Hosp Infect. 2002; 52: 273-280Abstract Full Text PDF PubMed Scopus (49) Google Scholar reported that microbial translocation was responsible for 84% of sepsis episodes in 76% of surgical neonates and that the predominant microorganisms (86%) were CoNS. In conclusion, in our study, for the majority (70%) of catheter-related BSI that occurred in neonates with CVCs, the route of acquisition was not determinate, suggesting other bacterial sources besides skin and CVC hub. Currently, mucosal sites, mainly gut mucosal atrophy, cannot be ruled out as an important source of neonatal bacteremia as well as critically ill adult patient. The highest level protection strategies designed to prevent both extra- and intraluminally acquired BSI should be combined with strategies to prevent microorganism infection deriving from the gut tract." @default.
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• W2049204040 title "Are there any differences among pathogenesis of catheter-related primary bloodstream infection in adults and neonates patients?" @default.
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