INTRAVENOUS LINE COLONIZATION IN PATIENTS RECEIVING CYTOTOXIC DRUGS
Hero Ali Hama Rahim a and Sherko A Omer b
a Hewa Hospital, Sulaimani Directorate of Health.
b Department of Microbiology, College of Medicine, University of Sulaimani.
Submitted: 14/2/2017; Accepted: 1/8/2017; Published: 15/8/2017
DOI Link: https://doi.org/10.17656/jsmc.10109
Hospital acquired infections are infections that develop during the hospital stay; they mainly include urinary tract, respiratory tract or blood stream infections.
To investigate microbial colonization of intravenous cannula of cancers patients receiving cytotoxic drugs.
Materials and Methods
Colonization of intravenous cannulas was investigated by cultivation of the device surface and lumen on different culture media under aerobic incubation. The isolates were identified based on cultural, morphological and biochemical activities. The susceptibility of the isolates to antimicrobial drugs was investigated using Bauer-Kirby disk diffusion method and the bacterial isolates were further investigated for their ability to form biofilm.
From 200 cultivated intravenous cannulas, microbial colonization was detected among 26% and 11% of intravenous cannulas from cancer and non-cancer patients respectively; Out of 37 isolates, 34 (91.9 %) were Gram-positive bacteria, 2 (5.4 %) Gram-negative bacteria and one (2.7 %) was a Candida species. The main bacterial isolates were bacteria belonging to different coagulase negative staphylococci species such as Staphylococcus epidermidis, S. hominis and others. Few faecal organisms were isolated including a single isolate of each Klebsiella pneumoniae and Escherichia coli. All bacterial isolates were able to form biofilm and most showed to have biofilm-related icaA and icaD genes.
We detected microbial colonization of intravenous cannulas in 18.5% of all cultivated devices. We observed more colonization in cancer patients (26%) in comparison to the control group (11%). Most of the isolates were species of CoNS that were able to form biofilm.
Intravenous line colonization, Hospital infection, Nosocomial, CoNS, Biofilm.
1. Horan TC, Gaynes RP. Surveillance of Nosocomial Infections. In: Mayhall CG, editor. Hospital Epidemiology and Infection Control. Philadelphia: Lippincott Williams and Wilkins; 2004. p. 1659–702.
2. European Centre for Disease Prevention and Control. Annual Epidemiological Report on Communicable Diseases in Europe. Stockholm, Sweden: ECDC; 2007.
3. Bryers JD. Medical biofilms. Biotechnol Bioeng. 2008;100(1):1-18.
4. Kampf G, Loffler H, Gastmeier P. Hand hygiene for the prevention of nosocomial infections. Dtsch Arztebl Int. 2009;106(40):649-55.
5. Singhai M, Malik A, Shahid M, Malik MA, Goyal R. A study on device-related infections with special reference to biofilm production and antibiotic resistance. J Glob Infect Dis. 2012;4(4):193-8.
6. Parameswaran R, Sherchan JB, Varma DM, Mukhopadhyay C, Vidyasagar S. Intravascular catheter-related infections in an Indian tertiary care hospital. J Infect Dev Ctries. 2011;5(6):452-8.
7. Zias N, Chroneou A, Beamis JF, Carven DE. Vascular Catheter-Related Bloodstream Infections In: O’DONNELL JM, NACUL FE, editors. Surgical Intensive Care Medicine. 2nd ed. USA: Springer; 2011. p. 311-25.
8. Rello J, Ochagavia A, Sabanes E, Roque M, Mariscal D, Reynaga E, et al. Evaluation of outcome of intravenous catheter-related infections in critically ill patients. American journal of respiratory and critical care medicine. 2000;162(3 Pt 1):1027-30.
9. Reed D, Kemmerly SA. Infection control and prevention: a review of hospital-acquired infections and the economic implications. Ochsner J. 2009;9(1):27-31.
10. Rupp ME, Archer GL. Coagulase-negative staphylococci: pathogens associated with medical progress. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 1994;19(2):231-43; quiz 44-5.
11. Lorente L, Villegas J, Martin MM, Jimenez A, Mora ML. Catheter-related infection in critically ill patients. Intensive care medicine. 2004;30(8):1681-4.
12. Klingenberg C, Aarag E, Ronnestad A, Sollid JE, Abrahamsen TG, Kjeldsen G, et al. Coagulase-negative staphylococcal sepsis in neonates. Association between antibiotic resistance, biofilm formation and the host inflammatory response. The Pediatric infectious disease journal. 2005;24(9):817-22.
13. Mack D, Riedewald J, Rohde H, Magnus T, Feucht H, Elsner H, et al. Essential Functional Role of the Polysaccharide Intercellular Adhesin of Staphylococcus epidermidis in Hemagglutination. Infect Immun. 1999;67(2):1004-8.
14. Christensen GD, Simpson WA, Bisno AL, Beachey EH. Adherence of slime-producing strains of Staphylococcus epidermidis to smooth surfaces. Infect Immun. 1982;37(1):318-26.
15. Freeman DJ, Falkiner FR, Keane CT. New method for detecting slime production by coagulase negative staphylococci. J Clin Pathol. 1989;42(8):872-4.
16. Christensen G, Simpson W, Younger J, Baddour L, Barrett F, Melton D, et al. Adherence of coagulase-negative staphylococci to plastic tissue culture plates: a quantitative model for the adherence of staphylococci to medical devices. J Clin Microbiol. 1985;22(6):996-1006.
17. Gad GF, El-Feky MA, El-Rehewy MS, Hassan MA, Abolella H, El-Baky RM. Detection of icaA, icaD genes and biofilm production by Staphylococcus aureus and Staphylococcus epidermidis isolated from urinary tract catheterized patients. J Infect Dev Ctries. 2009;3(5):342-51.
18. Gotz F. Staphylococcus and biofilms. Mol Microbiol. 2002;43(6):1367-78.
19. Arciola C, Baldassarri L, Montanaro L. Presence of icaA and icaD Genes and Slime Production in a Collection of Staphylococcal Strains from Catheter-Associated Infections. Journal of Clinical Microbiology. 2001;39(6):2151-6.
20. Maki D, Weise C, Sarafin H. A Semiquantitative Culture Method for Identifying Intravenous-Catheter-Related Infection. N Engl J Med. 1977;296(23):1305-9.
21. Cleri DJ, Corrado ML, Seligman SJ. Quantitative culture of intravenous catheters and other intravascular inserts. J Infect Dis. 1980;141(6):781-6.
22. Colaninno PM. Identification of Gram-Positive Organisms. In: Goldman E, H. GL, editors. Practical Handbook of Microbiology. Second ed. Boca Raton CRC Press; 2009. p. 53-66.
23. Donna J. Kohlerschmidt, Kimberlee A. Musser, Dumas NB. Identification of Gram-Positive Organisms. In: Goldman E, H. GL, editors. Practical Handbook of Microbiology. Boca Raton: CRC Press; 2009. p. 67-79.
24. Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. American journal of clinical pathology. 1966;45(4):493-6.
25. CLSI. Performance Standards for Antimicrobial Disk Susceptibility Tests: Twenty Third Informational Supplement. Wayne, PA2013.
26. Atshan SS, Nor Shamsudin M, Sekawi Z, Lung LT, Hamat RA, Karunanidhi A, et al. Prevalence of adhesion and regulation of biofilm-related genes in different clones of Staphylococcus aureus. Journal of biomedicine & biotechnology. 2012;2012:976972.
27. Mathur T, Singhal S, Khan S, Upadhyay DJ, Fatma T, Rattan A. Detection of biofilm formation among the clinical isolates of Staphylococci: an evaluation of three different screening methods. Indian journal of medical microbiology. 2006;24(1):25-9.
28. Ghotaslou R, Negargar S, Hashemzade K, Mahmoodpoor A, Safarpour M. Intravascular Catheter Colonization and Related Bloodstream Infection in Madani Cardiac Surgery Center. Journal of Cardiovascular and Thoracic Research 2009:13-6.
29. Samsoondar W, Freeman JB. Colonization of intravascular monitoring devices. Critical care medicine. 1985;13(9):753-5.
30. Moro ML, Vigano EF, Cozzi Lepri A. Risk factors for central venous catheter-related infections in surgical and intensive care units. The Central Venous Catheter-Related Infections Study Group. Infection control and hospital epidemiology. 1994;15(4 Pt 1):253-64.
31. Charalambous C, Swoboda SM, Dick J, Perl T, Lipsett PA. Risk factors and clinical impact of central line infections in the surgical intensive care unit. Archives of surgery (Chicago, Ill : 1960). 1998;133(11):1241-6.
32. Tomanovic B, Mirovic V. [Frequency and colonization rate of intravascular catheters]. Vojnosanitetski pregled. 2004;61(3):255-8.
33. Mozaffari K, Bakhshandeh H, Khalaj H, Soudi H. Incidence of catheter-related infections in hospitalized cardiovascular patients. Research in cardiovascular medicine. 2013;2(2):99-103.
34. Dimick JB, Pelz RK, Consunji R, Swoboda SM, Hendrix CW, Lipsett PA. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Archives of surgery (Chicago, Ill : 1960). 2001;136(2):229-34.
35. Safdar N, Kluger DM, Maki DG. 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):466-79.
36. Diener JR, Coutinho MS, Zoccoli CM. [Central venous catheter-related infections in critically ill patients]. Revista da Associacao Medica Brasileira (1992). 1996;42(4):205-14.
37. Mermel LA. Prevention of intravascular catheter-related infections. Annals of internal medicine. 2000;132(5):391-402.
38. Dobbins BM, Kite P, Kindon A, McMahon MJ, Wilcox MH. DNA fingerprinting analysis of coagulase negative staphylococci implicated in catheter related bloodstream infections. J Clin Pathol. 2002;55(11):824-8.
39. Banerjee A, GoswamiM A, Mukherjee P, Bhattacharya C. Bacterial colonization of intravascular cannulae in cardiac surgery. Indian J Anaesth. 2003;47 (3):190-3.
40. Patel R. Biofilms and antimicrobial resistance. Clinical orthopaedics and related research. 2005(437):41-7.
41. Speziale P, Visai L, Rindi S, Pietrocola G, Provenza G, Provenzano M. Prevention and treatment of Staphylococcus biofilms. Current medicinal chemistry. 2008;15(30):3185-95.
42. Omer S. Bacterial Isolates From Pediatric Blood Culture and Their Response to Antimicrobial Agents. JSMC. 2015;5(1):51-61.
43. Mohammad M, Omer S, Rashid B, Hamawandi A. Enteric Fever in Sulaimani Pediatric Teaching Hospital: Risk factors, Presentation, and Drug Susceptibility. JSMC. 2014;4(1):55-62.
44. Slobbe L, El Barzouhi A, Boersma E, Rijnders BJ. Comparison of the roll plate method to the sonication method to diagnose catheter colonization and bacteremia in patients with long-term tunnelled catheters: a randomized prospective study. J Clin Microbiol. 2009;47(4):885-8.
45. Koksal F, Yasar H, Samasti M. Antibiotic resistance patterns of coagulase-negative staphylococcus strains isolated from blood cultures of septicemic patients in Turkey. Microbiological research. 2009;164(4):404-10.
46. Rogers KL, Fey PD, Rupp ME. Coagulase-negative staphylococcal infections. Infectious disease clinics of North America. 2009;23(1):73-98.
47. Piette A, Verschraegen G. Role of coagulase-negative staphylococci in human disease. Veterinary microbiology. 2009;134(1-2):45-54.
48. Huebner J, Goldmann DA. Coagulase-negative staphylococci: role as pathogens. Annual review of medicine. 1999;50:223-36.
49. Otto M. Staphylococcal Biofilms. Curr Top Microbiol Immunol. 2008;322:207-28.
50. Coullioud D, Van der Auwera P, Viot M, Lasset C. Prospective multicentric study of the etiology of 1051 bacteremic episodes in 782 cancer patients. CEMIC (French-Belgian Study Club of Infectious Diseases in Cancer). Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 1993;1(1):34-46.
51. Horvath R, Collignon P. Controlling intravascular catheter infections. Aust Prescr. 2003;26:41-3.
52. Hota B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2004;39(8):1182-9.
53. Altuntas F, Yildiz O, Eser B, Gundogan K, Sumerkan B, Cetin M. Catheter-related bacteremia due to Kocuria rosea in a patient undergoing peripheral blood stem cell transplantation. BMC infectious diseases. 2004;4(1):62.
54. Ahmed NH, Biswal I, Roy P, Grover RK. Kocuria kristinae, an unusual pathogen causing opportunistic infections in patients with malignancy. Indian journal of medical microbiology. 2014;32(4):456-8.
55. Krol JE, Nguyen HD, Rogers LM, Beyenal H, Krone SM, Top EM. Increased transfer of a multidrug resistance plasmid in Escherichia coli biofilms at the air-liquid interface. Applied and environmental microbiology. 2011;77(15):5079-88.
56. May L, Klein E, Rothman R, Laxminarayan R. Trends in antibiotic resistance in coagulase-negative staphylococci in the United States, 1999 to 2012. Antimicrob Agents Chemother. 2014;58(3):1404-9.
57. Olsen I. Biofilm-specific antibiotic tolerance and resistance. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2015;34(5):877-86.
58. Huddleston J. Horizontal gene transfer in the human gastrointestinal tract: potential spread of antibiotic resistance genes. Infect Drug Resist. 2014;7:167-76.
59. Burke JP. Infection control - a problem for patient safety. The New England journal of medicine. 2003;348(7):651-6.
60. Oliveira A, Cunha M. Bacterial biofilms with emphasis on coagulase-negative staphylococci. J Venom Anim Toxins incl Trop Dis. 2008;14:572-96.
61. Oliveira A, Cunha M. Comparison of methods for the detection of biofilm production in coagulase-negative staphylococci. BMC Res Notes. 2010;3:260-.
62. Cafiso V, Bertuccio T, Santagati M, Campanile F, Amicosante G, Perilli MG, et al. Presence of the ica operon in clinical isolates of Staphylococcus epidermidis and its role in biofilm production. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2004;10(12):1081-8.
63. Hall-Stoodley L, Costerton JW, Stoodley P. Bacterial biofilms: from the natural environment to infectious diseases. Nature reviews Microbiology. 2004;2(2):95-108.
64. Costerton JW, Montanaro L, Arciola CR. Biofilm in implant infections: its production and regulation. The International journal of artificial organs. 2005;28(11):1062-8.
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.