Articles: sepsis.
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Intensive care medicine · Jan 1988
Sepsis associated with central vein catheters in critically ill patients.
In 440 critically ill patients, the association between different central vein catheter insertion sites, the duration of catheter insertion and catheter-associated sepsis was examined. Of 780 catheter tips studied, 19% were colonized by microorganisms. The incidence of colonization varied with the different insertion sites. ⋯ Catheter colonization was closely related to the development of bacteraemia and was associated with approximately 10% of colonized catheters. Our results suggest that the subclavian site is associated with the lowest infective complication rate. To minimize catheter associated sepsis, catheters at all insertion sites should be used with parsimony and only kept in place for the minimum amount of time that their continuing use is necessary.
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Intensive care medicine · Jan 1988
The microbiologic risk of invasive haemodynamic monitoring in open-heart patients requiring prolonged ICU treatment.
The microbiologic risk of invasive haemodynamic monitoring and support was prospectively studied in 48 patients undergoing open-heart surgery under antibiotic prophylaxis and requiring intensive care for longer than 4 days. A total of 420 catheter tips were cultured of which 12 (2.9%) were positive. The incidence of positive catheter tip cultures was as follows: intravenous 1.8%, central venous 1.2%, arterial 1.8%, pulmonary arterial 5.9%, direct right atrial 2.4%, direct left atrial 0% and intra-aortic balloon pump catheters 7.7%. ⋯ Complicated surgical procedures, a cardiopulmonary bypass time longer than 3.5 h, mechanical ventilation for more than 7 days, intensive care stay longer than 10 days, positive blood cultures and the use of more than 20 catheters were all individually associated with a significantly higher incidence of patients with positive tip cultures. Nevertheless, no patient developed endocarditis nor major morbidity related to the positive catheter tip cultures. Invasive haemodynamic monitoring does not seem to be an important microbiologic risk in open-heart patients requiring intensive care for longer than 4 days.