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The Prevalence of Morality in Patients Due to Central Venous CRBSI is Higher in Patients with Catheters Removed in Less than 7 Days
 

The Prevalence of Morality in Patients Due to Central Venous CRBSI is Higher in Patients with Catheters Removed in Less than 7 Days

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    The Prevalence of Morality in Patients Due to Central Venous CRBSI is Higher in Patients with Catheters Removed in Less than 7 Days The Prevalence of Morality in Patients Due to Central Venous CRBSI is Higher in Patients with Catheters Removed in Less than 7 Days Presentation Transcript

    • The Prevalence of Mortality in Patients Due to Central Venous Catheter Related Catheter-Related Bloodstream Infection is Higher in Patients with Catheters’ Removal Less than 7 DaysINTENSIVE CARE UNIT OF THE CENTRAL MILITARY HOSPITAL “Cir My Dr Cosme Argerich”, Cir Argerich Buenos Aires, ARGENTINA GAMBINO, J., MARGALEJO, S., BALBI, A.;UGO, BALBI A UGO K
    • About the StudyCritical C M di i i the branch of medicine th t h more challenges fi di thC iti l Care Medicine is th b h f di i that has h ll finding theright therapy to assure each patient the best outcome and recovery from illness whenadmitted to the Intensive Care Unit (ICU).Objective:Obj tiTo demonstrate higher prevalance of mortality among patients who had a centralvenous catheter for less than 7 days while admitted in ICU.Materials and Methods:Prospective study that includes 95 patients admitted in the Intensive Care Unit of theCentral Military Hospital with the diagnosis of Central Venous Catheter-RelatedBloodstream Infection.In each patient, age, time of removal of central venous catheter, results of the culturesamples, requirement of invasive mechanical ventilation, and the outcome were takeninto account. First of all, it is defined as a central venous catheter related-bloodstreaminfection (CVC-BSI) is a bloodstream infection most likely caused by the presence of acentral venous catheter determined by the need of invasive mechanical ventilation (IMV)and time of connection to IMV and the acq isition of positive c lt res All data is tested acquisition positi e cultures.using logistic regression and a p value less than 0,05 is considered significant.
    • Results• 40 (42%) patients h d th i catheter f more th 6 d ti t had their th t for than days b t no more th 10 d but than days and d 13 of them had positive culture results. 4 of these patients died. Among the 27 patients without an isolation of germ in the tip culture, 7 patients passed away.• 18 patients of the 55 who had their central vein catheter changed within 5 days required invasive mechanical ventilation.• 17 patients of the 40 who had their catheter removed within 7 days were connected to invasive mechanical ventilation for more than 7 days. Among them 4 p y g patients p passed away. y• Among the 95 patients recruited in this study, 29 (30,5%) died but 22 of them had no positive results in the cultures of the central vein catheter and 18 patients had their catheters removed within the first five days of being positioned.• Graph 2 prevalence of mortality taking into 11 37 account days of central vein catheter. 29 According to these two graphs there is only a 18 different trend in the days of stay at the ICU among those whose central vein catheter was removed after five days of being positioned. There is no difference in the trend related to length of invasive mechanical ventilation among LESS THAN 5 DAYS ALIVE LESS THAN 5 DAYS DEAD the two groups of patients. MORE THAN 5 DAYS ALIVE MORE THAN FIVE DAYS DEAD
    • ResultsAmong the 95 samples of centrall venous catheters:A th l f t th t• 65 (68%) were negative, or in other words, no germ could be isolated.• 30 (32%) were positive and the germs found were acinetobacter baumanii, staphylococcus aureus, aureus klebsiella pneumonia meticillin resistant staphylococcus. pneumonia, staphylococcus• The mean age of the patients was 55 years old, 55 (58%) patients had their catheter removed in the 5th day and 17 of them had positive culture results. 3 of these patients died. Among the 38 patients without an isolation of germ in the tip culture ,15 patients died. g p g p , p 90 80 70 60 50 40 30 20 10 0 CVC less 5 days < 55 years CVC less 5 days > 56 years 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 CVC more 6 days < 55 years age with CVC less 5 days age with CVC > 5 days Graph 1 Trend of age among the p p g g patients There is no difference among the g included in each group with central vein two groups of patients related to age. catheter removed before and after 5 days
    • Results Graph 3 Trend of length of stay at the ICU comparing those patients with central vein catheter removed before and after 5 days 100 80 60 40 0 20 0 CVC less 5 days <37 days at ICU 1 5 9 13 17 21 25 29 33 37 41 45 49 53 CVC less 5 days >37 days at ICU CVC more 6 days < 37 days at ICU stay at ICU with CVC < 5 days CVC more 6 days >37 days at ICU stay at ICU with CVC > 6 daysGraph 4 Trend of length in days connected to invasive mechanical ventilation (IMV) at the ICU comparing those patientswith central vein catheter removed before and after 5 days 100 80 60 40 CVC less 5 days with NE 20 CVC less 5 days without NE 0 CVC more 6 days with NE 1 5 9 13 17 21 25 29 33 37 41 45 49 53 days of IMV with CVC < 5 days days of IMC with CVC > 6 daysAccording to these two graphs there is only a different trend in the days of stay at the ICU among thosewhose central vein catheter was removed after five days of being positioned. There is no difference in thetrend related to length of invasive mechanical ventilation among the two groups of patients.
    • Results Table 1 Outcome of the patients Days of  Need of  ALIVE DEAD TOTAL P taking into account the need of central vein  norepine Norepinephirine and the length of catheter phrine the th centrall vein catheter b f t i th t before Less than 5  Yes NE 29  18  47  <0.05 removal. days (53%) (33%) (85.5%) N=55 NO NE NO NE 8 8  8 8   <0 05 <0.05 (14.5%) (14.5%) More than  Yes NE 29     11  40   <0,05 6 days (72.5%) (27.5%) (100%) N=40 No NE 0 0 0 <0,05CVC less 5 days with NE CVC less 5 days without NECVC more 6 days with NE CVC more 6 days without NE
    • Graphs 5-6-7 Percentage of patients who required norepinephrine takinginto account the days of central vein catheter dividing the patients into twogroups, one of the alive ones and the second of the dead onesGroup of alive patients Group of dead patients CVC less 5 days with NE CVC less 5 days without NE CVC less 5 days with NE CVC less 5 days without NE CVC more 6 days with NE CVC more 6 days with NE CVC more 6 days without NE
    • Conclusion and AcknowledgementsConclusionThe prevalence of mortality was higher among the patients admitted in theICU with Central Venous Catheter-Related Bloodstream Infection whose CU C Ccentral vein catheter was removed within the first days after being properlypositioned.The mortality among these patients is 4,3% higher than the mortality among thepatients whose catheter was changed after six days, although there is no differenceof requirement of mechanical ventilationcompared with the two types of patients.AcknowledgementsAll the personnel of the ICU and theDepartment of Biochemistry fof the Central Military Hospitalfor their effort and tiredless work.