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Current Pharmaceutical Biotechnology

Author(s): Benedetto Caroleo, Pasquale Malandrino, Aldo Liberto, Dario Condorelli, Federico Patanè, Aniello Maiese, Filomena Casella, Diego Geraci, Pietrantonio Ricci and Giulio Di Mizio*

DOI: 10.2174/1389201020666190405182025

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Catheter-related Bloodstream Infections: A Root Cause Analysis in a Series of Simultaneous Ochrobactrum anthropi Infections

Page: [609 - 614] Pages: 6

  • * (Excluding Mailing and Handling)

Abstract

Objective: Catheter-related bloodstream infections (CRBSIs) pathogenesis is complex and multifactorial mostly due to cutaneous microorganisms migration through the catheter insertion site and catheter tip colonization. Ochrobactrum anthropi is a gram-negative bacterium belonging to the Brucellaceae and related infections are especially observed in immunocompromised patients.

Methods: Therefore, O. anthropi infection prevention and surveillance are relevant issues for healthcare system and risk management, in order to improve healthcare quality and patient safety. Four cases of anthropi-related CRBSIs occurring in immunodepressed patients under chemotherapy treatment are reported and the possible prevention and surveillance strategies are analyzed.

Results: In the reported cases, all infections occurred almost simultaneously in the Oncology Unit, leading to hypothesize an identical infection source. Subsequently, a clinical audit was performed in order to investigate infection origin and implement prevention and control strategies. Clinical audit allowed to identify the hand hygiene defects as the primary source of the infections, responsible for catheter flushing solution contamination.

Conclusion: The aim of this study is to reveal how through correct root cause analysis and clinical audit, several measures could be undertaken in order to promote the prevention of the CRBSIs risk.

Keywords: Catheter-related infection, root cause analysis process, Ochrobactrum anthropi, hospital-acquired infections (HAIs), prevention, clinical risk management, chemotherapy treatment immunocompromised patients.

Graphical Abstract

[1]
Cornejo-Juárez, P.; Vilar-Compte, D.; García-Horton, A.; López-Velázquez, M.; Ñamendys-Silva, S.; Volkow-Fernández, P. Hospital-acquired infections at an oncological intensive care cancer unit: differences between solid and hematological cancer patients. BMC Infect. Dis., 2016, 16(1), 274.
[2]
Vitrat, V.; Hautefeuille, S.; Janssen, C.; Bougon, D.; Sirodot, M.; Pagani, L. Optimizing antimicrobial therapy in critically ill patients. Infect. Drug Resist., 2014, 7, 261-271.
[3]
Mirabile, A.; Vismara, C.; Crippa, F.; Bossi, P.; Locati, L.; Bergamini, C.; Granata, R.; Resteghini, C.; Conte, E.; Morelli, D.; Scarpellini, P.; Licitra, L. Health care-associated infections in patients with head and neck cancer treated with chemotherapy and/or radiotherapy. Head Neck, 2016, 38(S1), E1009-E1013.
[4]
Montassier, E.; Batard, E.; Gastinne, T.; Potel, G.; de La Cochetière, M.F. Recent changes in bacteremia in patients with cancer: A systematic review of epidemiology and antibiotic resistance. Eur. J. Clin. Microbiol. Infect. Dis., 2013, 32(7), 841-850.
[5]
Freifeld, A.G.; Bow, E.J.; Sepkowitz, K.A.; Boeckh, M.J.; Ito, J.I.; Mullen, C.A.; Raad, I.I.; Roldton, K.V.; Young, J.H.; Wingard, J.R. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin. Infect. Dis., 2011, 52(4), e56-e93.
[6]
Ramphal, R. Changes in the etiology of bacteremia in febrile neutropenic patients and the susceptibilities of the currently isolated pathogens. Clin. Infect. Dis., 2004, 39(S1), S25-S31.
[7]
Wisplinghoff, H.; Seifert, H.; Wenzel, R.P.; Edmond, M.B. Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin. Infect. Dis., 2003, 36(9), 1103-1110.
[8]
Hagiya, H.; Ohnishi, K.; Maki, M.; Watanabe, N.; Murase, T. Clinical characteristics of Ochrobactrum anthropi bacteremia. J. Clin. Microbiol., 2013, 51(4), 1330-1333.
[9]
European Centre for Disease Prevention and Control. Surveillance of healthcare-associated infections and prevention indicators in European intensive care units.Stockholm: ECDC,; , 2017.
[10]
Kanjee, R.; Koreishi, A.F.; Tanna, A.P.; Goldstein, D.A. Chronic postoperative endophthalmitis after cataract surgery secondary to vancomycin-resistant Ochrobactrum anthropi: Case report and literature review. J. Ophthalmic Inflamm. Infect., 2016, 6(1), 25.
[11]
Gomez, M.R.; Esteban, A.P.; Daza, J.S.; Nieto, J.S.; Alvarez, D.; Garcia, P.P. Prosthetic mitral valve endocarditis due to Ochrobactrum anthropi: Case report. J. Clin. Microbiol., 2004, 42(7), 3371-3373.
[12]
Appelbaum, P.C.; Campbell, D.B. Pancreatic abscess associated with Achromobacter group Vd biovar 1. J. Clin. Microbiol., 1980, 12(2), 282-283.
[13]
Jelveh, N.; Cunha, B.A. Ochrobactrum anthropi bacteremia. Heart Lung, 1999, 28(2), 145-146.
[14]
Pomara, C.; Riezzo, I.; Bello, S.; De Carlo, D.; Neri, M.; Turillazzi, E. A pathophysiological insight into sepsis and its correlation with postmortem diagnosis. Mediators Inflamm., 2016, 20164062829
[15]
Kern, W.V.; Oethinger, M.; Marre, R.; Kaufhold, A.; Rozdzinski, E. Ochrobactrum anthropi bacteremia: Report of four cases and short review. Infection, 1993, 21(5), 306-310.
[16]
Nadjar, D.; Labia, R.; Cerceau, C.; Bizet, C.; Philippon, A.; Arlet, G. Molecular characterization of chromosomal class C beta-lactamase and its regulatory gene in Ochrobactrum anthropi. Antimicrob. Agents Chemother., 2001, 45(8), 2324-2330.
[17]
Deliere, E.; Vu-Thien, H.; Levy, V.; Barquins, S.; Schlegel, L.; Bouvet, A. Epidemiological investigation of Ochrobactrum anthropi strains isolated from a haematology unit. J. Hosp. Infect., 2000, 44(3), 173-178.
[18]
Holmes, B.; Popoff, M.; Kiredjian, M.; Kersters, K. Ochrobactrum anthropi gen. nov., sp. nov. from human clinical specimens and previously known as group Vd. Int. J. Syst. Bacteriol., 1988, 38(4), 406-416.
[19]
Earhart, K.C.; Boyce, K.; Bone, W.D.; Wallace, M.R. Ochrobactrum anthropi infection of retained pacemaker leads. Clin. Infect. Dis., 1997, 24, 281-282.
[20]
Naik, C.; Kulkarni, H.; Darabi, A.; Bhanot, N. Ochrobactrum anthropi: A rare cause of pneumonia. J. Infect. Chemother., 2013, 19(1), 162-165.
[21]
Quirino, A.; Pulcrano, G.; Rametti, L.; Puccio, R.; Marascio, N.; Catania, M.R.; Matera, G.; Liberto, M.C.; Focà, A. Typing of Ochrobactrum anthropi clinical isolates using automated repetitive extragenic palindromic-polymerase chain reaction DNA fingerprinting and matrix-assisted laser desorption/ionization–time-of-flight mass spectrometry. BMC Microbiol., 2014, 14(1), 74.
[22]
Varano, M.; Gaspari, M.; Quirino, A.; Cuda, G.; Liberto, M.C.; Focà, A. Temperature‐dependent regulation of the Ochrobactrum anthropi proteome. Proteomics, 2016, 16(23), 3019-3024.
[23]
Daxboeck, F.; Zitta, S.; Assadian, O.; Krause, R.; Wenisch, C.; Kovarik, J. Ochrobactrum anthropi bloodstream infection complicating hemodialysis. Am. J. Kidney Dis., 2002, 40(4)e17
[24]
Gill, M.V.; Ly, H.; Mueenuddin, M.; Schoch, P.E.; Cunha, B.A. Intravenous line infection due to Ochrobactrum anthropi (CDC group Vd) in a normal host. Heart Lung, 1997, 26(4), 335-336.
[25]
Miller, D.L.; O’Grady, N.P. Guidelines for the prevention of intravascular catheter-related infections: Recommendations relevant to interventional radiology for venous catheter placement and maintenance. J. Vasc. Interv. Radiol., 2012, 23(8), 997-1007.
[26]
Gahlot, R.; Nigam, C.; Kumar, V.; Yadav, G.; Anupurba, S. Catheter-related bloodstream infections. Int. J. Crit. Illn. Inj. Sci., 2014, 4(2), 162-167.
[27]
Bell, T.; O’Grady, N.P. Prevention of central line–associated bloodstream infections. Infect. Dis. Clin., 2017, 31(3), 551-559.
[28]
Mermel, L.A. Correction: Catheter related bloodstream-infections. Ann. Intern. Med., 2000, 133(5), 395.
[29]
Thom, K.A.; Kleinberg, M.; Roghmann, M.C. Infection prevention in the cancer center. Clin. Infect. Dis., 2013, 57(4), 579-585.
[30]
Friedman, N.D.; Kaye, K.S.; Stout, J.E.; McGarry, S.A.; Trivette, S.L.; Briggs, J.P.; Lamm, W.; Clark, C.; MacFarquhar, J.; Walton, A.L.; Reller, L.B.; Sexton, D.J. Health care-associated bloodstream infections in adults: A reason to change the accepted definition of community-acquired infections. Ann. Intern. Med., 2002, 137(10), 791-797.
[31]
Al-Tawfiq, J.A.; Tambyah, P.A. Healthcare associated infections (HAI) perspectives. J. Infect. Public Health, 2014, 7(4), 339-344.
[32]
Kettaneh, A.; Weill, F.X.; Poilane, I.; Fain, O.; Thomas, M.; Herrmann, J.L.; Hocqueloux, L. Septic shock caused by Ochrobactrum anthropi in an Otherwise Healthy Host. J. Clin. Microbiol., 2003, 41(3), 1339-1341.
[33]
Wu, A.W.; Lipshutz, A.K.; Pronovost, P.J. Effectiveness and efficiency of root cause analysis in medicine. JAMA, 2008, 299(6), 685-687.
[34]
Safdar, N.; Kluger, D.M.; Maki, D.G. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: Implications for preventive strategies. Medicine , 2002, 81(6), 466-479.
[35]
Dang, V.M.; Francois, P.; Batailler, P.; Seigneurin, A.; Vittoz, J.P.; Sellier, E.; Labarère, J. Medical record-keeping and patient perception of hospital care quality. Int. J. Health Care Qual. Assur., 2014, 27(6), 531-543.
[36]
Pomara, C.; D’Errico, S.; Neri, M.; Riezzo, I.; Telesforo, F.; Martelloni, M. Quality of the medical record as a medical - legal indicator of appropriateness and instrument for clinical risk management. First Pugliese experience in private healthcare - verification and analysis of the results of a study on 2000 medical records. Profession - Culture Prac. Doctor D’Oggi, 2009, 8, 24-30.
[37]
Pronovost, P.; Needham, D.; Berenholtz, S.; Sinopoli, D.; Chu, H.; Cosgrove, S.; Sexton, B.; Hyzy, R.; Welsh, R.; Roth, G.; Bander, J.; Kepros, J.; Goeschel, C. An intervention to decrease catheter-related bloodstream infections in the ICU. N. Engl. J. Med., 2006, 355(26), 2725-2732.
[38]
O’grady, N.P.; Alexander, M.; Burns, L.A.; Dellinger, E.P.; Garland, J.; Heard, S.O.; Masur, H.; Mermel, L.A.; Pearson, M.L.; Raad, I.I.; Randolph, A.G.; Rupp, M.E.; Saint, S. Guidelines for the prevention of intravascular catheter-related infections. Clin. Infect. Dis., 2011, 52(9), e162-e193.
[39]
Allegranzi, B.; Nejad, S.B.; Combescure, C.; Graafmans, W.; Attar, H.; Donaldson, L.; Pittet, D. Burden of endemic health-care-associated infection in developing countries: Systematic review and meta-analysis. Lancet, 2011, 377(9761), 228-241.
[40]
Maki, D.G.; Stolz, S.M.; Wheeler, S.; Mermel, L.A. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial. Ann. Intern. Med., 1997, 127(4), 257-266.