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P. Rivard, S. Luther, C. Christiansen, Shibei Zhao, Susan Loveland, Anne Elixhauser, P. Romano, A. Rosen (2008)
Using Patient Safety Indicators to Estimate the Impact of Potential Adverse Events on OutcomesMedical Care Research and Review, 65
F. Pinelli, E. Cecero, Dario Degl’Innocenti, V. Selmi, R. Giua, G. Villa, C. Chelazzi, S. Romagnoli, M. Pittiruti (2018)
Infection of totally implantable venous access devices: A review of the literatureThe Journal of Vascular Access, 19
M. Ramadan, Gautam Hebbar (2018)
A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of KuwaitMedical Principles and Practice, 27
V. Rebić, Nejra Mašić, Sanela Teskeredžić, M. Aljičević, Amila Abduzaimović, D. Rebić (2018)
The Importance of Acinetobacter Species in the Hospital EnvironmentMedical Archives, 72
F. Rodrigues, F. Luca, A. Cunha, C. Fortaleza (2019)
Season, weather and predictors of healthcare-associated Gram-negative bloodstream infections: a case-only study.The Journal of hospital infection, 101 2
Margaret Dudeck, Jonathan Edwards, K. Allen-Bridson, Cindy Gross, Paul Malpiedi, Kelly Peterson, Daniel Pollock, Lindsey Weiner, Dawn Sievert (2015)
National Healthcare Safety Network report, data summary for 2013, Device-associated Module.American journal of infection control, 43 3
L. Delaney, K. Sainsbury (2016)
CLINICAL ENGAGEMENT MODEL: PROVIDING THE SUPPORT BETWEEN STUDENTS AND THE CLINICAL ENVIRONMENT.Australian nursing & midwifery journal, 24 4
Niu Li-hu (2014)
Results of detection of microorganisms on the 58 venous catheters in 2012-2013
Lin Zhang, Lin Zhang, Nicole Marsh, Nicole Marsh, Debbie Long, Debbie Long, Ming Wei, Mark Morrison, C. Rickard, C. Rickard (2015)
Microbial diversity on intravascular catheters from paediatric patientsEuropean Journal of Clinical Microbiology & Infectious Diseases, 34
Shuiqin Cheng, Shutian Xu, Jinzhou Guo, Qunpeng He, Aijuan Li, Lixuan Huang, Zhihong Liu, Shijun Li (2018)
Risk Factors of Central Venous Catheter-Related Bloodstream Infection for Continuous Renal Replacement Therapy in Kidney Intensive Care Unit PatientsBlood Purification, 48
Pao-Yu Chen, Y. Chuang, Jann-Tay Wang, W. Sheng, Chung-Jen Yu, Chen-Chen Chu, P. Hsueh, Shan-Chwen Chang, Yee-Chun Chen (2014)
Comparison of epidemiology and treatment outcome of patients with candidemia at a teaching hospital in Northern Taiwan, in 2002 and 2010.Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi, 47 2
Franziska Stressmann, E. Couvé-Deacon, D. Chainier, A. Chauhan, Aimee Wessel, S. Durand-Fontanier, M. Escande, I. Kriegel, B. François, M. Ploy, C. Beloin, J. Ghigo (2017)
Comparative Analysis of Bacterial Community Composition and Structure in Clinically Symptomatic and Asymptomatic Central Venous CathetersmSphere, 2
M. Bassetti, L. Taramasso, E. Nicco, M. Molinari, M. Mussap, C. Viscoli (2011)
Epidemiology, Species Distribution, Antifungal Susceptibility and Outcome of Nosocomial Candidemia in a Tertiary Care Hospital in ItalyPLoS ONE, 6
Jean Lee, I. Monk, A. Silva, T. Seemann, K. Chua, A. Kearns, R. Hill, N. Woodford, M. Bartels, B. Strommenger, F. Laurent, M. Dodémont, A. Deplano, Robin Patel, A. Larsen, T. Korman, T. Stinear, B. Howden (2018)
Global spread of three multidrug-resistant lineages of Staphylococcus epidermidisNature Microbiology, 3
M. Pammi, Linda Holland, G. Butler, A. Gácser, J. Bliss (2013)
Candida parapsilosis Is a Significant Neonatal Pathogen: A Systematic Review and Meta-analysisThe Pediatric Infectious Disease Journal, 32
C. Rickard, A. Ullman, Tricia Kleidon, N. Marsh (2017)
TEN TIPS FOR DRESSING AND SECUREMENT OF IV DEVICE WOUNDS.Australian nursing & midwifery journal, 24 10
Han Li-zhong (2013)
Prevalence of pathogens isolated from central venous catheter tip specimens:A retrospective analysis of 4 281 specimensJournal of Diagnostics Concepts & Practice
Yinjuan Guo, Yu Ding, Li Liu, Xiaofei Shen, Zhihao Hao, Jingjing Duan, Ye Jin, Zeng-qiang Chen, F. Yu (2019)
Antimicrobial susceptibility, virulence determinants profiles and molecular characteristics of Staphylococcus epidermidis isolates in Wenzhou, eastern ChinaBMC Microbiology, 19
M. Sohail, Z. Latif (2018)
Molecular analysis, biofilm formation, and susceptibility of methicillin-resistant Staphylococcus aureus strains causing community- and health care-associated infections in central venous catheters.Revista da Sociedade Brasileira de Medicina Tropical, 51 5
B. Alonso, M. Latorre, Raquel Cruces, D. Ampuero, Laura Haces, P. Martín-Rabadán, C. Sánchez-Carrillo, Belén Rodríguez, E. Bouza, P. Muñoz, M. Guembe (2019)
Evaluation of the Alfred™ turbidity monitoring system (Alifax®) following sonication in the diagnosis of central venous catheter colonizationEuropean Journal of Clinical Microbiology & Infectious Diseases, 38
Margaret Dudeck, T. Horan, Kelly Peterson, K. Allen-Bridson, Gloria Morrell, Angela Anttila, D. Pollock, J. Edwards (2013)
National Healthcare Safety Network report, data summary for 2011, device-associated module.American journal of infection control, 41 4
S. Kouni, M. Tsolia, E. Roilides, G. Dimitriou, S. Tsiodras, A. Skoutelis, E. Kourkouni, D. Gkentzi, E. Iosifidis, N. Spyridis, Ioannis Kopsidas, P. Karakosta, G. Tsopela, I. Spyridaki, G. Kourlaba, S. Coffin, E. Zaoutis (2019)
Establishing nationally representative central line-associated bloodstream infection surveillance data for paediatric patients in Greece.The Journal of hospital infection, 101 1
Zeynep Ture, E. Alp (2018)
Infection control measures to prevent hospital transmission of candidaHospital Practice, 46
G. Khalil, M. Azqul (2018)
Risk factors and microbial profile of central venous catheter related blood stream infection in medical cardiac care units, National Heart Institute, EgyptThe Egyptian Heart Journal, 70
John Millar (1992)
Evaluation of thePhysical review. B, Condensed matter, 45 24
Songlin Peng, Yan Lu (2013)
Clinical epidemiology of central venous catheter-related bloodstream infections in an intensive care unit in China.Journal of critical care, 28 3
Xiaoxia Li, Xiangyu Ding, P. Shi, Yiqing Zhu, Yidie Huang, Qin Li, Jinmiao Lu, Zhiping Li, Lin Zhu (2019)
Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital, 2013 to 2017Medicine, 98
Yan-Jun Zheng, T. Xie, Lin Wu, Xiao-ying Liu, Ling Zhu, Ying Chen, E. Mao, Lina Han, E. Chen, Zhitao Yang (2014)
Epidemiology, species distribution and outcome of nosocomial Candida spp. bloodstream infection in ShanghaiBMC Infectious Diseases, 14
Li Zhang, J. Gowardman, Mark Morrison, Lutz Krause, E. Playford, C. Rickard, C. Rickard (2014)
Molecular investigation of bacterial communities on intravascular catheters: no longer just StaphylococcusEuropean Journal of Clinical Microbiology & Infectious Diseases, 33
W. Kamolvit, H. Sidjabat, D. Paterson (2015)
Molecular Epidemiology and Mechanisms of Carbapenem Resistance of Acinetobacter spp. in Asia and Oceania.Microbial drug resistance, 21 4
R. Sagana, R. Hyzy (2013)
Achieving zero central line-associated bloodstream infection rates in your intensive care unit.Critical care clinics, 29 1
T. Kitano, Kumiko Takagi, I. Arai, Hajime Yasuhara, Reiko Ebisu, Ayako Ohgitani, D. Kitagawa, Miyako Oka, Kazue Masuo, H. Minowa (2018)
Efficacy of routine catheter tip culture in a neonatal intensive care unitPediatrics International, 60
H. Canela, Bárbara Cardoso, L. Vitali, H. Coelho, R. Martinez, M. Ferreira (2018)
Prevalence, virulence factors and antifungal susceptibility of Candida spp. isolated from bloodstream infections in a tertiary care hospital in BrazilMycoses, 61
S. Percival, C. Emanuel, K. Cutting, D. Williams (2012)
Microbiology of the skin and the role of biofilms in infectionInternational Wound Journal, 9
J. Pozo (2018)
Biofilm-related disease.Expert Review of Anti-infective Therapy, 16
Silvia Günther, C. Schwebel, R. Hamidfar-Roy, A. Bonadona, M. Lugosi, C. Ara-Somohano, C. Minet, L. Potton, J. Cartier, A. Vésin, M. Chautemps, Lenka Styfalova, S. Ruckly, J. Timsit (2016)
Complications of intravascular catheters in ICU: definitions, incidence and severity. A randomized controlled trial comparing usual transparent dressings versus new-generation dressings (the ADVANCED study)Intensive Care Medicine, 42
J. Timsit, M. Rupp, E. Bouza, V. Chopra, T. Kärpänen, K. Laupland, T. Lisboa, L. Mermel, O. Mimoz, J. Parienti, G. Poulakou, B. Souweine, W. Zingg (2018)
A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically illIntensive Care Medicine, 44
J. M. Zhou N. J. Si (2018)
Pathogen characteristics and objective.monitoring of catheter-related hospital infections in patients in intensive care unit (ICU) China,Chinese Journal of Nosocomiology, 28
Hindawi Journal of Healthcare Engineering Volume 2019, Article ID 8632701, 7 pages https://doi.org/10.1155/2019/8632701 Research Article Retrospective Analysis of Microbial Colonization Patterns in Central Venous Catheters, 2013–2017 1 2 2 2 3 2 Yu He, Huihan Zhao, Yan Wei, Xiao Gan, Ying Ling, and Yanping Ying Department of Clinical Laboratory, e First Affiliated Hospital of Guangxi Medical University, No. 6., Shuangyong Road, 530021 Nanning, Guangxi, China Department of Nursing, e First Affiliated Hospital of Guangxi Medical University, No. 6., Shuangyong Road, 530021 Nanning, Guangxi, China Department of Medical Oncology, e First Affiliated Hospital of Guangxi Medical University, No. 6., Shuangyong Road, 530021 Nanning, Guangxi, China Correspondence should be addressed to Yanping Ying; yanpingying0116@126.com Received 8 April 2019; Revised 31 July 2019; Accepted 19 August 2019; Published 17 September 2019 Academic Editor: Feng-Huei Lin Copyright © 2019 Yu He et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. *is study was performed to provide epidemiological information on microbial colonization in central venous catheters (CVCs). Methods. CVCs submitted to Medical Microbiology Laboratory from January 1, 2013, through October 1, 2017, which met our criteria would be included for analysis. Quantitative culture was used for CVCs. *e results of culture and related information on CVCs were collected and recorded in detail. *e prevalence was calculated, and related factors were analyzed statistically. Results. A total of 2020 CVCs were submitted for culture and eligible for analysis. Positive microbial culture occurred in 379 catheters with 18.7% (379 of 2020) prevalence of colonization. *ere were 23 microbial genera and 45 organisms detected. Among the isolated organisms, there were 39 kinds of isolated bacteria and 6 kinds of isolated fungi. Acinetobacter (19.8%) predominated in total isolated microorganisms, followed by Staphylococcus epidermidis (11.3%) and Candida albicans (10.3%). *ere were no significant differences in isolated organisms and fungal species between different sexes (X = 2.365, P � 0.50). Conversely, there were significant differences in isolated bacterial and fungal species between different wards and years 2 2 (X = 124.046, P � 0.000; X = 77.064, P � 0.000). A total of 107 (5.3%, 107/2020) CVCs were associated with a diagnosis of central line-associated bloodstream infection (CLABSI). *e most common organisms in causing CLABSI were Acinetobacter (23.4%), S. aureus (13.1%), and Candida albicans (12.1%). Conclusion. *e prevalence of microbial colonization in CVCs is still significant and even has gradually changed over time. *e study provides a new view of microbial colonization pattern in CVCs and a prevalence of CLABSI, which will facilitate catheter-related infection prevention and control in clinic. carry unintended complications, such as infection and 1. Introduction thrombosis, which are not rare. Infectious complications, Intravascular catheters (IVCs) as medical devices are especially central line-associated bloodstream infection (CLABSI), are potentially associated with poor patient ubiquitous in health care setting. Most hospitalized patients benefit from intravascular catheters used to monitor hae- outcomes, high morbidity and mortality, increasing hos- modynamic status and administer drug, fluids, and paren- pitalization, and hospital costs [2]. teral nutrition. More than two billion intravascular devices *e mean rate of CLABSIs in acute-care hospital units in are inserted globally each year [1]. Central venous catheter the United States ranges from zero to 2.9/1000 CVC days (CVC) as a common type of IVC and crucial device has been depending on the type of unit [3]. Gunther ¨ et al. reported widely used in critical patients and oncology patients. CVC that overall infectious complication’s incidence rate was indwell promotes effective treatment and avoids the pain of 14.5/1000 catheter days; in addition, catheter-tip coloniza- repeated punctures for patients. Unfortunately, CVCs also tion (14.2/1000 catheter days) was the most common [4]. 2 Journal of Healthcare Engineering CVC insertion allows an entrance for colonization of and labeled sterile container and then transported to the pathogenic bacteria. Pathogenic bacteria adhere successfully Medical Microbiology Laboratory in 2 hours for examina- tion. All catheters tips planned to culture were cultured by on the surface of the device in 24 hours, and host tissue cells and pathogenic bacteria compete to present on the surface of the roll-plate culture method. *e catheter tips were re- device. If the bacteria adhere successfully, biofilm formation moved carefully using sterile forceps and then directly used would be initiated. *e biofilm formation makes resistance to inoculate onto chocolate agar with 5% sheep blood agar in to common antibiotics [5, 6] and evacuates adhered bacteria the laboratory. *e catheter tip was rolled across the plate 2- difficultly. So it becomes a major source of catheter-related 3 times. *e plates containing the catheter were incubated in blood infection and causes critical challenge for health care. 5% CO at 35–37 C for 18–24 hours, after which the number In the United States, CLABSI accounts for an estimated of organisms in the plates were evaluated quantitatively. A 28,000 deaths and up to $2.3 billion annually [3, 7]. In China, minimum of 15 colony-forming units (CFU) in each plate the average economic loss per case of CLABSI is about was considered as a positive catheter-tip culture, after which ¥30713 [8], which makes it become the most costly form of bacterial and fungal identification was performed using health care-associated infections. biochemical systems (VITEK 2 Compact, bioMerieux, With a wide application of CVCs, the characteristics of France). microorganisms present diversity. 8 microbial phyla were reported, and 136 diverse microbial genera were detected on the IVC surfaces in children. Staphylococcus and Strepto- 2.2. Blood Culture. During the 5 years, the blood culture results were reviewed and analyzed for each case from whom coccus were the most common [9]. However, a study form a CVC was collected and cultured as to analyze any re- Spain showed Gram-positive cocci (68.4%) accounted for lationship between the two types of culture. Blood culture most episodes, followed by yeasts (26.3%) and Gram-neg- was carried out by BacT-ALERT 3D120. ative bacilli (5.3%) in colonized catheters [10]. *ere were also studies, respectively, reporting that the predominant positive microorganisms were coagulase-negative staphylo- 2.3. Data Collection. Some factors such as patient’s socio- cocci [11] and S. aureus [12]. *us, the prevalence of mi- demographic characteristics, different wards, types of CVCs, crobial colonization in CVCs in different studies varies positive blood culture results, and diagnosis of CLABSI were widely. Moreover, with the appearance of multidrug-re- collected through the electronic medical record system. sistant pathogens, the treatment of catheter-related infection and choice of antibiotics become more difficult. So char- acteristics and distribution of colonization of microorgan- 2.4. Data Analysis. SPSS version 17.0 software package isms on the catheters’ surface need to be timely and (Chicago, IL, USA) was used to input and analyze the data. accurately understood and updated as to guide clinical Positive catheter tip, blood culture rates, and cultured fungal practice. Our study based on clinic presented distribution and bacterial epidemiological characteristics were evaluated. characteristics of microorganisms on the CVC surface, as to Fisher’s exact test or chi-square test was used to test if provide a reference for prevention and treatment of cath- differences existed between different related factors. P< 0.05 eter-related infection in clinic. was considered significant. 2. Materials and Methods 3. Results A retrospective study over near 5 years (from January 2013 A total of 2020 CVCs were submitted for culture and eligible through October 2017) was carried out in a tertiary, general for analysis. *ere was no CVC excluded. *e basic char- hospital in Guangxi, China. CVCs submitted to the clinical acteristics of patients with the CVCs are shown in Table 1. laboratory for culture during the period were objects of the Positive microbial culture occurred in 379 catheters with study. Each catheter is an independent subject. *e methods prevalence of microbial colonization of 18.7% (379 of 2020). of catheter insertion did not standardize. All removed CVCs *ere were 23 microbial genera and 45 organisms detected. were not mandatory to submit for culture. Clinicians de- Among the 45 isolated organisms, there were 39 isolated cided whether to culture the CVCs based on individual and bacteria and 6 isolated fungi. Gram-negative bacteria with clinical conditions. As we were only interested in the culture 44.4% predominated among the isolated bacteria. *e most results of all submitted CVCs, all submitted CVC samples common Gram-negative bacteria were Acinetobacter for culture in the laboratory were included. However, CVCs (19.8%) followed by Pseudomonas (9.8%). Of Gram-positive with incomplete culture information were excluded. bacteria (40.1%), S. epidermidis (11.3%) and S. haemolyticus (9.2%) were the most common. In fungi, Candida albicans 2.1. Catheter Tip Culture. Catheter removal and transport to with 10.3% was predominate. A total of 107 (5.3%, 107/2020) the laboratory were standardized. All cultured catheters were CVCs were associated with a diagnosis of CLABSI. *e most removed using sterile gloves after the insertion site had been common organisms in causing CLABSI were Acinetobacter thoroughly cleaned with 2% povidone-iodine which are (23.4%), S. aureus (13.1%), and Candida albicans (12.1%). under aseptic conditions. *e distal 2-3 cm of the catheter tip *e compositions of isolated organisms from CVCs and was cut with a sterile surgical scissors and put into a separate blood cultures are listed in Table 2. Journal of Healthcare Engineering 3 Table 1: Basic characteristics of CVC sources (patients). species) isolated is shown. From this study, Acinetobacter predominated in total isolated microorganisms, followed by Items Frequency, N � 2020 Percentages (%) S. epidermidis and Candida albicans. Comparing the prev- Age mean (range) 39.6 (0.01–94.00) alence of microbial colonization of 18.4%, several studies Sex using molecular analysis has showed a higher colonization Male 1356 67.1 rate, and even almost all implanted venous access devices Female 664 32.9 were colonized in recent years [12–14], which may be at- Medical wards tributed to different analysis techniques. Molecular analysis Pediatric ward 107 5.3 ICU ward 1177 58.3 with a higher detection rate should be developed and applied Transplant ward 202 10.0 in clinic. In addition, it is similar with a study including 4281 Other wards 534 26.4 CVCs in China which reported Acinetobacter baumannii CVC, central venous catheter. was the most common isolate and followed by S. epidermidis [15]. But a recently study reported Gram-positive bacteria (64%) accounted for most episodes, followed by Gram- Table 2: Etiology of the CVC colonization and CALBSI episodes. negative bacteria (26%) and Candida (10%) [12]. Another Colonization CALBSI study reported the distribution of microorganisms’ colo- Microorganism (n � 379) (n � 107) nization on CVCs in Spain was as follows: Gram-positive, Gram-positive bacteria, n (%) 68.4%; yeasts, 26.3%, Gram-negative, 5.3%; and with S. S. aureus 25 (6.6) 14 (13.1) epidermidis predominately [10]. In addition, a study from S. epidermidis 43 (11.3) 7 (6.5) Australia found that there were 136 diverse microbial genera S. haemolyticus 35 (9.2) 7 (6.5) detected on the IVC surfaces in children, and Staphylo- Other CoNS 31 (8.2) 7 (6.5) coccus, Streptococcus, and Bacillus predominate in the mi- Enterococcus 8 (2.1) 2 (1.9) Corynebacterium 6 (1.6) 1 (0.9) croorganisms [9]. *erefore, there are still some differences Others 4 (1.1) 1 (0.9) in epidemiology of microbial colonization presented in Gram-negative bacteria, n (%) different studies. *ese differences may be attributed to Acinetobacter 75 (19.8) 25 (23.4) different regions with different climates and different hos- Pseudomonas 37 (9.8) 12 (11.2) pital environments which are directly related to bacterial species colonization [16, 17]. Another possibility is that microbial Klebsiella species 14 (3.7) 3 (2.8) flora has quietly changed and become diversity, no longer Colibacter 12 (3.2) 3 (2.8) Enterobacter spp. 11 (2.9) 5 (4.7) just Staphylococcus. Microbial diversity on the CVC surface Others 19 (5.0) — should be focused, which needs us to pay more attention, Fungi, n (%) strengthen monitoring, and even update epidemiological Candida albicans 39 (10.3) 13 (12.1) data. Candida 9 (2.4) 5 (4.7) *e result of our study indicated that Acinetobacter, parapsilosis S. epidermidis, and Candida albicans were the most common Candida glabrata 6 (1.6) 1 (0.9) Others 5 (1.3) 1 (0.9) colonies in CVCs. Acinetobacter spp. belongs to Gram-neg- ative opportunistic pathogen and is an important nosocomial CVC, central venous catheter; CLABSI, central line-associated bloodstream infection; CoNS, coagulase-negative staphylococci. *e data in the table are pathogen. Acinetobacter can be isolated from multiple parts of presented as n (%), which refer to the number of isolated organism (n) and the health human body [18] and reused medical devices. It could percentage of different isolated organisms (%), respectively. *e total number be found in many health care environment and causes human of isolated organisms was 379 (18.7%). Gram-negative bacteria with 44.4% colonizer in hospitals, especially in patients with mechanical were predominate among the total colonization bacteria on the CVC surfaces, ventilation in intensive care units and indwelling catheters followed by Gram-positive bacteria (40.1%) and fungi (15.6%). A total of 107 (5.3%) isolated organisms from CVCs were associated with a diagnosis of [19]. A retrospective study in an adult ICU in a tertiary care CLABSI. *e most common organisms in causing CLABSI were Acineto- hospital has showed that most frequently isolated organism bacter (23.4%), S. aureus (13.1%), and Candida albicans (12.1%). was Acinetobacter baumannii [20]. Acinetobacter spp. has become a global public health threat because of its increasing *ere were no significant differences in isolated or- resistance to carbapenems and most other antimicrobial ganisms and fungal species that were compared between compounds [2]. Acinetobacter colonization in CVCs is the different sexes (X � 2.365, P � 0.50). Conversely, there were predominant microorganism in the study, which also may be significant differences in isolated organisms and fungal related to the higher proportion of patients with CVCs from species between different wards and years (X �124.046, ICU in this study. P � 0.000; X � 77.064, P � 0.000). *e information on S. epidermidis is the second common isolated organism bacterial and fungal species isolated in different years and on CVCs in the study. S. epidermidis as symbiotic bacterium wards is listed in Table 3 and Figure 1. in human body is a parasite on the skin surface of human body [21]. S. epidermidis can be an opportunistic pathogen attaching to surfaces of medical implants and forms biofilm 4. Discussion over indwelling catheters [22]. A small number of skin and mucosal bacteria contaminate the implanted catheters In the study, positive microbiologic culture in 18.4% and 45 types of microorganisms (39 bacterial and 6 fungal during surgical operation, which may also lead to bacterial 4 Journal of Healthcare Engineering Table 3: *e prevalence of isolated organisms in different wards of catheters. Wards (different sources of catheters) Total Species Pediatric ward Transplant ward Other wards (N � 2020) (%) ICU (N � 1177) (%) (N � 107) (%) (N � 202) (%) (N � 534) (%) Gram-positive bacteria 7.5 19.6 6.3 3.0 9.4 S. aureus 1.2 0.9 — — 4.5 S. epidermidis 2.1 13.1 1.7 1.0 1.3 S. haemolyticus 1.7 1.9 2.1 — 1.5 Other CoNS 1.5 3.7 1.7 0.5 1.1 Enterococcus 0.4 — 0.6 — 0.2 Corynebacterium 0.3 — 0.2 — 0.6 Others 0.2 — — 1.5 0.2 Gram-negative bacteria 8.3 1.9 5.9 2.5 17.2 Acinetobacter 3.7 1.9 2.3 1.0 8.2 Pseudomonas species 1.8 — 1.5 — 3.6 Klebsiella species 0.7 — 0.8 — 0.9 Colibacter 0.6 — 0.3 — 1.7 Enterobacter spp. 0.5 — 0.2 — 1.7 Others 0.9 — 0.8 1.5 1.1 Fungi 2.9 2.8 3.5 — 2.8 Candida albicans 1.9 1.9 2.4 — 1.7 Candida parapsilosis 0.4 — 0.5 — 0.6 Candida glabrata 0.3 — 0.4 — 0.2 Others 0.2 0.9 0.2 — 0.4 CVC, central venous catheter; PICC, peripherally inserted central catheter; ICU, intensive care unit; CoNS, coagulase-negative staphylococci. *e data in the table presented refer to the prevalence of isolated organisms from CVCs. “N” refers to the total number of cultured catheters in different wards. If there were no isolated organisms after microbial culture, “—” is filled in the spaces. *ere were significant differences in isolated organisms on catheter surface from different wards (X �124.046, P≤ 0.001). 100 100 80 80 60 60 % % 2013 2014 2015 2016 2017 2013–2017 Years Years S. aureus Klebsiella species S. aureus Klebsiella species S. epidermidis Colibacter S. epidermidis Colibacter S. haemolyticus Enterobacter spp. S. haemolyticus Enterobacter spp. Other CoNS Other Gram- Other CoNS Other Gram- negative bacteria negative bacteria Enterococcus Enterococcus Candida albicans Candida albicans Corynebacterium Corynebacterium Candida parapsilosis Candida parapsilosis Other Gram- Other Gram- Candida glabrata positive bacteria Candida glabrata positive bacteria Acinetobacter Acinetobacter Other fungi Other fungi Pseudomonas Pseudomonas species species (a) (b) Figure 1: Bacterial and fungal species isolated from 2020 CVCs in different years. CVC, central venous catheter; CoNS, coagulase-negative staphylococci (a) *e total composition of isolated organisms on 2020 CVCs surfaces; (b) the composition of isolated organisms on CVC surface in different years. *e changes of proportion of color block in (b) indicate the proportion of Gram-negative bacteria decreased gradually from 2013 to 2017 and fungus with diversified internal composition was presented accompanied by the proportion of non- Candida albicans increasing in 2017. Journal of Healthcare Engineering 5 to catheter microbial colonization, but also identification of colonization on the catheter surface. *erefore, CVC in- sertion provides a favorable entry and environment for the catheter-related blood-borne infections, and their correla- tion may be different in disease progression. symbiotic bacterium on the skin surface. *erefore, health care providers should pay more attention and standardize *ere were also significant differences in the internal insertion and maintenances of CVCs, which is a critical composition of isolated organisms on the catheter surface factor of CVC colonization. from different wards. *e catheters from the pediatric ward In our study, Candida with 15.6% (59/379) was the with the highest rate of isolated organisms presented third common organism and higher than that reported in S. epidermidis predominately. *is is consistent with Zhang’s the studies from Liu et al. [23] and Si et al. [24] and a similar report [13], and their data show that the bacterial com- munity of endovascular catheter in children was mainly recent study which reported Candida spp. with 15.5% [25]. Candida spp. has become the second and third frequent Staphylococcus. Moreover, pediatric patients with imperfect immune system are more vulnerable to colonization of isolated species due to colonization on the CVC surface [10, 26], caused infection predominately among opportu- opportunistic pathogens from the skin surface. *e positive rate of isolated organisms in the transplant ward was low, nistic fungal infections worldwide, and associated with high mortality rates [27]. Although there are differences in and no fungus was found, which may be related to high yeasts prevalence according to geographical differences, standard environment of ward and strict requirements of overall level worldwide is still growing [28, 29]. Further- various medical techniques. Accordingly, iatrogenic factors more, repeated exposure to broad-spectrum antibiotics, may affect catheter microbial colonization and catheter- complex surgical procedures, long-term use of CVCs, related infections to a large extent. Hospital managers need hemodialysis catheters, corticosteroids, and toxic chemo- to strengthen environmental and personnel monitoring as to control iatrogenic factors and facilitate nosocomial infection therapeutic agents will increase the risk of fungal in- fections, especially Candida. From this, one knows that control. We also found isolated organisms with significant dif- Candida colonization of CVCs with significant prevalence may continue to increase. However, whether they are the ferences were existed in different years. *e positive rate of catheter culture decreased, and the proportion of Gram- main microorganism causing catheter-related bloodstream infections needs further study. negative bacteria decreased gradually from 2013 to 2017. We also found 107 (5.3%, 107/2020) CVCs were asso- Besides, the trend of Pseudomonas proportion shows a ciated with a diagnosis of CLABSI. *e most common or- gradual decrease among Gram-negative bacteria. However, ganisms in causing CLABSI were Acinetobacter (23.4%), similar studies analyzing Pseudomonas changing with years S. aureus (13.1%), and Candida albicans (12.1%). It is have not been reported. We guess that these trends may be consistent with a study which reported the incidence rate of related to the effectiveness of clinical prevention. As regards staphylococci, an increase in S. aureus colonization in 2015 CLABSI is 4.3%–26% of placed catheters and 0.46–30 per 1000 catheter days but lower than results from Alonso et al. was presented in the study but in 2016 with S. epidermidis predominantly. It may be due to CVCs from different wards [10] and Khalil and Azqul et al. [30] presenting the CLABSI rate of 12.6% and 9.9%, respectively, and higher than a (X � 3.939, P � 0.047). Most of the positive-cultured CVCs report with 3.9% rate of CRBSI from Cheng et al. who also with staphylococci were from general adult wards in 2015 reported S. aureus was the most common pathogens causing and presented S. aureus predominantly. Conversely, in 2016, CLABIS [31]. However, a study carried out in China also the positive-cultured CVCs with staphylococci were pri- found Acinetobacter baumannii (18.75%) was most common marily from the intensive care unit, and neonatal unit pathogen on intravascular catheters in ICU patients with presented S. epidermidis predominantly. A study from China catheter-related infection and followed by S. epidermidis has displayed S. epidermidis was the principal organism and [24]. Another study about pediatric patients found the most responsible for neonatal sepsis [33]. S. epidermidis is one of common pathogens of CLABIS were Enterobacteriaceae the common biofilm-producing bacteria affiliating coloni- (36%), followed by Gram-positive cocci (29%), non- zation on indwelling or implanted foreign bodies [34]. *e fermenting Gram-negative bacteria (16%), and fungi (16%) proportion of other fungus except Candida albicans in- [25]. *is variability is likely related to different variables as creased in 2017 (Figure 1). Although Candida albicans is the the characteristics of the patient population, the type of most common isolate of candidemia that has been recorded intravenous treatment (i.e., PN vs chemotherapy), and the in study, this year’s study also showed that these isolated nature of the environmental microflora [32]. In our study, S. fungus changed towards non-albicans Candida spp., such as epidermidis was the second common colonization bacteria near-smooth Candida and smooth Candida [29, 35]. With on the CVC surfaces, causing CLABSI is less than S. aureus. the widespread use of antibiotics, unfortunately, some of It can be seen that the catheter colonization bacteria may be these species are naturally resistant to first-line antifungals not necessarily related to CLABSI. Acinetobacter and which also make the prevalence of fungal infections to in- S. aureus are common causative agent of infection on crease. More attention has been paid to non-Candida biomedical devices and harbor a variety of pathogenic tools albicans fungal infections, and these fungal infections make with rapidly acquired resistance and mutation development treatment become more difficult [36]. It can be seen that the which greatly increase mortality, morbidity, costs of treat- characteristics of microbial colonization of the central ve- ment, and hospital stays. *erefore, catheter-related in- nous catheter change gradually, which needs health care fections prevention and control not only requires attention providers pay more attention. 6 Journal of Healthcare Engineering adverse events on outcomes,” Medical Care Research and 5. Conclusion Review, vol. 65, no. 1, pp. 67–87, 2008. [3] M. A. Dudeck, J. R. Edwards, K. Allen-Bridson et al., “Na- *e study present and update epidemiological characteris- tional healthcare safety network report, data summary for tics of microbial colonization on CVC surfaces and CLABSI. 2013, device-associated module,” American Journal of In- *e prevalence of microbial colonization of CVCs is still fection Control, vol. 43, no. 3, pp. 206–221, 2015. significant which even has gradually changed over time, [4] S. C. Gunther, ¨ C. Schwebel, R. Hamidfar-Roy et al., “Com- which will provide a reference for prevention and control of plications of intravascular catheters in ICU: definitions, in- catheter-related infections in clinic. cidence and severity. A randomized controlled trial comparing usual transparent dressings versus new-generation 6. Limitation dressings (the ADVANCED study),” Intensive Care Medicine, vol. 42, no. 11, pp. 1753–1765, 2016. *e study provides a new view about microbial colonization [5] J. L. Del Pozo, “Biofilm-related disease,” Expert Review of patterns in central venous catheters. However, it still has Anti-Infective erapy, vol. 16, no. 1, pp. 51–65, 2018. some limitations. One limitation was that all data about [6] J.-F. Timsit, M. Rupp, E. Bouza et al., “A state of the art review CVCs culture were derived from a general hospital only. on optimal practices to prevent, recognize, and manage Another limitation was that some information on certain complications associated with intravascular devices in the drugs infusion, antibiotic sensitivities, and indwelling time critically ill,” Intensive Care Medicine, vol. 44, no. 6, of CVCs was not included into the analysis due to the pp. 742–759, 2018. retrospective nature of this analysis and imperfect electronic [7] R. Sagana and R. C. Hyzy, “Achieving zero central line-as- records. In future, it is necessary to improve the record of sociated bloodstream infection rates in your intensive care unit,” Critical Care Clinics, vol. 29, no. 1, pp. 1–9, 2013. laboratory sample information and electronic records in [8] S. Peng and Y. Lu, “Clinical epidemiology of central venous clinic to promote future research in this field. Further studies catheter-related bloodstream infections in an intensive care based on multiple center, larger population, and more unit in China,” Journal of Critical Care, vol. 28, no. 3, various factors of microbial colonization on CVC surfaces pp. 277–283, 2013. and CLABSI should be encouraged to guide clinical practice. [9] L. Zhang, N. Marsh, D. Long, M. Wei, M. Morrison, and C. M. Rickard, “Microbial diversity on intravascular catheters Data Availability from paediatric patients,” European Journal of Clinical Mi- crobiology & Infectious Diseases, vol. 34, no. 12, pp. 2463– *e data used to support the findings of this study are 2470, 2015. available from the corresponding author upon request. [10] B. Alonso, M. C. Latorre, R. Cruces et al., “Evaluation of the Alfred turbidity monitoring system (Alifax ) following Disclosure sonication in the diagnosis of central venous catheter colo- nization,” European Journal of Clinical Microbiology & In- Yu He and Huihan Zhao are the co-first authors. fectious Diseases, vol. 38, no. 9, pp. 1737–1742, 2019. [11] T. Kitano, K. Takagi, I. Arai et al., “Efficacy of routine catheter Conflicts of Interest tip culture in a neonatal intensive care unit,” Pediatrics In- ternational, vol. 60, no. 5, pp. 423–427, 2018. *e authors declare that there are no conflicts of interest. [12] M. Sohail and Z. Latif, “Molecular analysis, biofilm formation, and susceptibility of methicillin-resistant Staphylococcus au- Authors’ Contributions reus strains causing community-and health care-associated infections in central venous catheters,” Revista da Sociedade Yu He and Huihan Zhao contributed equally to this work. Brasileira de Medicina Tropical, vol. 51, no. 5, pp. 603–609, Acknowledgments [13] L. Zhang, J. Gowardman, M. Morrison, L. Krause, E. G. Playford, and C. M. Rickard, “Molecular investigation of *e authors acknowledge teachers from Medical Microbi- bacterial communities on intravascular catheters: no longer ology Laboratory and Medical Records Information Center just Staphylococcus,” European Journal of Clinical Microbi- in the First Affiliated Hospital of Guangxi Medical Uni- ology & Infectious Diseases, vol. 33, no. 7, pp. 1189–1198, 2014. versity for data sharing. *is work was financially supported [14] F. A. Stressmann, E. Couve-Deacon, D. Chainier et al., by the National Natural Science Foundation of China (Grant “Comparative analysis of bacterial community composition no. 81860032), the Guangxi Natural Science Foundation and structure in clinically symptomatic and asymptomatic Project (Grant no. 2018GXNSFAA050081), and Medical central venous catheters,” mSphere, vol. 2, no. 5, 2017. [15] Z. T. Yang, J. Li, H. Q. Sheng et al., “Prevalence of pathogens Self-Funded Plan Projects of Guangxi (Z20170567). isolated from central venous catheter tip specimens: a ret- rospective analysis of 4281 specimens,” Journal of Diagnostics References Concepts & Practice, vol. 12, no. 3, pp. 309–314, 2013. [16] F. S. Rodrigues, F. A. Clemente de Luca, A. Ribeiro da Cunha, [1] C. Rickard, A. Ullman, T. Kleidon, and N. Marsh, “Ten tips for and C. M. C. B. Fortaleza, “Season, weather and predictors of dressing and securement of IV device wounds,” Australian Nursing & Midwifery Journal, vol. 24, no. 10, pp. 32–34, 2017. healthcare-associated Gram-negative bloodstream infections: a case-only study,” Journal of Hospital Infection, vol. 101, no. 2, [2] P. E. Rivard, S. L. Luther, C. L. Christiansen et al., “Using patient safety indicators to estimate the impact of potential pp. 134–141, 2019. Journal of Healthcare Engineering 7 [17] M. A. Ramadan and G. Hebbar, “A retrospective analysis of literature,” e Journal of Vascular Access, vol. 19, no. 3, pp. 230–242, 2018. dialysis events over a 3-year period in an outpatient dialysis unit in the state of Kuwait,” Medical Principles and Practice, [33] X. Li, X. Ding, P. Shi et al., “Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a vol. 27, no. 4, pp. 337–342, 2018. [18] M. A. Dudeck, T. C. Horan, K. D. Peterson et al., “National tertiary children’s hospital, 2013 to 2017,” Medicine, vol. 98, no. 12, article e14686, 2019. healthcare safety network report, data summary for 2011, [34] Y. Guo, Y. Ding, L. Liu et al., “Antimicrobial susceptibility, device-associated module,” American Journal of Infection virulence determinants profiles and molecular characteristics Control, vol. 41, no. 4, pp. 286–300, 2013. of Staphylococcus epidermidis isolates in Wenzhou, Eastern [19] V. Rebic, N. Masic, S. Teskeredzic, M. Aljicevic, China,” BMC Microbiology, vol. 19, no. 1, p. 157, 2019. A. Abduzaimovic, and D. Rebic, “*e importance of acine- [35] M. Bassetti, L. Taramasso, E. Nicco, M. P. Molinari, tobacter species in the hospital environment,” Medical Ar- M. Mussap, and C. Viscoli, “Epidemiology, species distri- chives, vol. 72, no. 5, pp. 330–334, 2018. bution, antifungal susceptibility and outcome of nosocomial [20] W. Kamolvit, H. E. Sidjabat, and D. L. Paterson, “Molecular candidemia in a tertiary care hospital in Italy,” PLoS One, epidemiology and mechanisms of carbapenem resistance of vol. 6, no. 9, Article ID e24198, 2011. acinetobacter spp. in Asia and Oceania,” Microbial Drug [36] Z. T. Yang, L. Wu, X. Y. Liu et al., “Epidemiology, species Resistance, vol. 21, no. 4, pp. 424–434, 2015. distribution and outcome of nosocomial candida spp. [21] S. L. Percival, C. Emanuel, K. F. Cutting, and D. W. Williams, bloodstream infection in Shanghai,” BMC Infectious Diseases, “Microbiology of the skin and the role of biofilms in in- vol. 14, no. 1, 2014. fection,” International Wound Journal, vol. 9, no. 1, pp. 14–32, [22] J. Y. H. Lee, I. R. Monk, A. Gonçalves da Silva et al., “Global spread of three multidrug-resistant lineages of Staphylococcus epidermidis,” Nature Microbiology, vol. 3, no. 10, pp. 1175–1185, 2018. [23] L. H. Liu, H. X. Guo, X. Y. Li et al., “Results of detection of microorganisms on the 58 venous catheters in 2012-2013,” China Tropical Medicine, vol. 14, no. 10, pp. 1237–1239, 2014. [24] N. J. Si, J. M. Zhou, Y. H. Chen et al., “Pathogen characteristics and objective.monitoring of catheter-related hospital in- fections in patients in intensive care unit (ICU) China,” Chinese Journal of Nosocomiology, vol. 28, no. 4, pp. 527–530, [25] S. Kouni, M. Tsolia, E. Roilides et al., “Establishing nationally representative central line-associated bloodstream infection surveillance data for paediatric patients in Greece,” Journal of Hospital Infection, vol. 101, no. 1, pp. 53–59, 2019. [26] M. Pammi, L. Holland, G. Butler, A. Gacser, and J. M. Bliss, “Candida parapsilosis is a significant neonatal pathogen: a systematic review and meta-analysis,” e Pediatric Infectious Disease Journal, vol. 32, no. 5, pp. e206–e216, 2013. [27] H. M. S. Canela, B. Cardoso, L. H. Vitali, H. C. Coelho, R. Martinez, and M. E. d. S. Ferreira, “Prevalence, virulence factors and antifungal susceptibility of candida spp. isolated from bloodstream infections in a tertiary care hospital in Brazil,” Mycoses, vol. 61, no. 1, pp. 11–21, 2018. [28] P.-Y. Chen, Y.-C. Chuang, J.-T. Wang et al., “Comparison of epidemiology and treatment outcome of patients with can- didemia at a teaching hospital in Northern Taiwan, in 2002 and 2010,” Journal of Microbiology, Immunology and In- fection, vol. 47, no. 2, pp. 95–103, 2014. [29] Z. Ture and E. Alp, “Infection control measures to prevent hospital transmission of candida,” Hospital Practice, vol. 46, no. 5, pp. 253–257, 2018. [30] G. M. Khalil and M. M. Azqul, “Risk factors and microbial profile of central venous catheter related blood stream in- fection in medical cardiac care units, National Heart Institute, Egypt,” e Egyptian Heart Journal, vol. 70, no. 4, pp. 361–364, [31] S. Cheng, S. Xu, J. Guo et al., “Risk factors of central venous catheter-related bloodstream infection for continuous renal replacement therapy in kidney intensive care unit patients,” Blood Purification, vol. 48, no. 2, pp. 175–182, 2018. [32] F. Pinelli, E. Cecero, D. 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