Our patients: n= 105
BC HPN PROGRAM - ADULT DIVISION – ACTIVE PATIENT SUMMARY
2013/2014
P13
2014/2015
P13
2015/2016 P13
(on Mar
31/14)
(on Mar
31/15)
(on Mar 31/16)
PATIENTS
Male
27 (36%) 31 (38%)
34 (38%)
Female
47 (64%) 50 (62%)
56 (62%)
Total
74
81
90
AGE
Average (y)
58
56
57
Range (y)
30-83
18-84
19-84
DURATION ON
HPN
Average (y)
8
8
7
Patient diagnoses
BC HPN PROGRAM - ADULT DIVISION – ACTIVE PATIENT SUMMARY
PRIMARY DIAGNOSIS FOR HPN
2013/2014 P13
2014/2015 P13
2015/2016 P13
(on Mar 31/14)
(on Mar 31/15)
(on Mar 31/16)
Biofilm – the matrix
2,9,10
New strategy
Tetrasodium EDTA 4%
•
Current patients: History of 2 or more CLABSIs while on home
TPN (“high risk”)
CVAD Lock Solutions
1-4,7-11
Product
Anticoagulant
Antimicrobial
Antibiofilm
Support in the literature
2,9
JVA
ISSN 1129-7298
chti u l sh n J Vasc Access 2016; 17 (6): 453-464REVIEW
Introduction
There is a wide consensus that a central venous line – if
use scontinuousl shoul e er o call ushe th
nor al sal ne so to re ove traces of the rev ousl nfuse
solutions also as the l ne s close t shoul e lle th a
lock solution h ch a have anticoa ulant action an or
an anti acter al action or as n the case of nor al sal ne
no s ec c action at all
va
Evidence-based criteria for the choice and the clinical
use of the most appropriate lock solutions for central
venous catheters (excluding dialysis catheters):
a GAVeCeLT consensus
Mauro Pittiruti
1, Sergio Bertoglio
2, Giancarlo Scoppettuolo
1, Roberto Biffi
3, Massimo Lamperti
4, Alberto Dal Molin
5,
Nicola Panocchia
1, Nicola Petrosillo
6, Mario Venditti
7, Carla Rigo
8, Enrico DeLutio
91 on a one ol cl n co n vers tar o e ell o e tal 2 e art ent of ur cal c ences n vers t e l tu enova tal 3 stituto uro eo ncolo a lan tal
4 Clevelan Cl n c os tal u ha n te ra rates 5 n vers t el e onte r entale ella tal
6 stituto a onale ala e nfe ve allan an o e tal 7 n vers t a a en a o e tal
8 en a s e al era n vers tar a a ore ella Car t ovara tal 9 ascular ccess ec al st o e tal
ABSTRACT
Background: he ost a ro r ate lock solution for central venous access ev ces s still to e e ne
eCe the tal an rou for venous access ev ces has evelo e a consensus on the ev ence ase
cr ter a for the cho ce an the cl n cal use of the ost a ro r ate lock solution for central venous catheters
e clu n al s s catheters
Method: er the constitution of a anel of e erts a s ste atic collection an rev e of the l terature has een
erfor e focus n on cl n cal stu es eal n th lock solutions use for revention of occlus on he ar n c
-trate urok nase reco
nant tissue las no en activator r
nor al sal ne or for revention of nfection
c trate ethanol taurol ne eth lene a ne tetra acetic ac
vanco c n l ne ol an other anti
ot-cs n oth a ults an n e atr c atients tu es on central l nes use for al s s or heres s on er heral
venous l nes an on arter al l nes ere e clu e fro th s anal s s tu es on lock solutions use for treat ent
of o struction or nfection ere not cons ere he consensus has een carr e out accor n to the el h
etho
Results: he anel has conclu e that a there s no ev ence su ortin the he ar n lock the revention of
occlus on s ase on the ro er ush n an lock n techn ue th nor al sal ne c the ost a ro r ate lock
solution for nfection revention shoul nclu e c trate an or taurol ne h ch have oth anti acter al an
anti o l activ t th ne l
le un es re e ects f co
are to anti otics the atient o ulations ost
l kel to ene t fro c trate taurol ne lock are et to e e ne
Conclusions: he actual value of he ar n ation for non al s s catheters shoul e recons ere lso the use
of lock th su stances th anti acter al an anti o l activ t such as c trate or taurol ne shoul e taken
nto cons eration n selecte o ulations of atients
Keywords: Central venous catheters C trate lush n e ar n ock solution aurol ne
Accepted: a Published online: u ust Corresponding author:
Mauro Pittiruti, MD
Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario ‘A. Gemelli’ Largo Francesco Vito 1
00168 Roma, Italy
mauro.pittiruti@policlinicogemelli.it
Review Article
Central venous catheters and biofilms: where do we
stand in 2017?
MARIE GOMINET,1,2FABRICE COMPAIN,2,3CHRISTOPHE BELOIN4and DAVID LEBEAUX1,2
1Service de Microbiologie, Unit!e Mobile de Microbiologie Clinique, Assistance Publique-H^opitaux de Paris,
H^opital Europ!een Georges Pompidou, Paris;2Universit!e Paris Descartes, Paris;3Service de Microbiologie,
Assistance Publique-H^opitaux de Paris, H^opital Europ!een Georges Pompidou, Paris; and4Unit!e de
G!en!etique des Biofilms, D!epartement de Microbiologie, Institut Pasteur, Paris, France
Gominet M, Compain F, Beloin C, Lebeaux D. Central venous catheters and biofilms: where do we stand in 2017? APMIS 2017; 125: 365–375.
The use of central venous catheters (CVC) is associated with a risk of microbial colonization and subsequent poten-tially severe infection. Microbial contamination of the catheter leads to the development of a microbial consortia asso-ciated with the CVC surface and embedded in an extracellular matrix, named biofilm. This biofilm provides bacterial cells the ability to survive antimicrobial agents and the host immune system and to disseminate to other sites of the body. The best preventive strategy is to avoid any unnecessary catheterization or to reduce indwelling duration when a CVC is required. Beside aseptic care and antibiotic-impregnated catheters (like minocycline/rifampin), preventive locks can be proposed in some cases, whereas non-biocidal approaches are under active research like anti-adhesive or com-petitive interactions strategies. When the diagnosis of catheter-related bloodstream infection (CRBSI) is suspected on clinical symptoms, it requires a microbiological confirmation by paired blood cultures in order to avoid unnecessary catheter removal. The treatment of CRBSI relies on catheter removal and systemic antimicrobials. However, antibiotic lock technique (ALT) can be used as an attempt to eradicate biofilm formed on the inside lumen of the catheter in case of uncomplicated long-term catheter-related BSI caused by coagulase-negative staphylococci (CoNS) or Enterobacteri-aceae. Recently, promising strategies have been developed to improve biofilm eradication; they rely on matrix degrada-tion or destabilizadegrada-tion or the development of anti-persister compounds, targeting the most tolerant bacterial cells inside the biofilm. Understanding biofilm formation at the molecular level may help us to develop new approaches to prevent or treat these frequent infections.
Key words: Catheter-related bloodstream infections; antimicrobial lock therapy; persisters; skin antisepsis.
David Lebeaux, Service de Microbiologie, H^opital Europ!een Georges POMPIDOU, 20 rue Leblanc, 75015 Paris, France. e-mail: david.lebeaux@aphp.fr
A central venous catheter (CVC) is a device
inserted in a large vein, used to inject parenteral
nutrition, blood products or fluids that would harm
a smaller peripheral vein, such as antineoplastic
chemotherapy. CVC can also be used to perform
haemodialysis, obtain blood tests (specifically the
“central venous oxygen saturation”) and measure
central venous pressure. Main types of CVC include
non-tunnelled
and
tunnelled
catheters,
totally
implantable venous access ports (TIVAP) and
PICC-lines (peripherally inserted central catheters).
As they improve patients’ care, the use of CVC and
other implanted devices is constantly increasing in
modern medicine. In the United States, 15 million
CVC-days (i.e. the total number of days of
expo-sure to CVCs for all patients in the selected
popula-tion during the selected time period) are recorded
in intensive care units (ICUs) each year (1).
The use of CVC is associated with a risk of
colo-nization and subsequent infection (2). In a French
nationwide study led in 2012 by the Institut
National de Veille Sanitaire (INVS), bloodstream
infections (BSIs) were the fourth cause of
hospital-acquired infections, and 33% of them were related
to a CVC (3). With an average incidence of
CVC-associated BSIs in the United States of 5.3 per 1000
catheter-days in the ICU, approximately 80 000
CVC-related BSIs occur in ICUs each year in the
Received 29 August 2016. Accepted 29 December 2016
