Letter to the Editor
Epidemic outbreak of gram negatives in patients with long-term tunneled hemodialysis catheters: Adverse event on hemodialysis units
Brote de bacteriemia por gramnegativos en pacientes portadores de catéteres tunelizados: evento adverso en las unidades de hemodiálisis
María Dolores Arenas
Fundación Renal Iñigo Alvarez de Toledo, Spain
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"idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Impact of dialysis modality on morbimortality of kidney transplant recipients after allograft failure. Analysis in the presence of competing events" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "200" "paginaFinal" => "209" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto de la modalidad de diálisis sobre la morbimortalidad tras el fracaso del injerto renal: análisis con eventos competitivos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1652 "Ancho" => 1505 "Tamanyo" => 85965 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kaplan–Meier survival curves. They compare crude mortality in the PD group (n = 86, blue line) vs. in the HD group (n = 89, red line). Breslow p = 0.30. The table shows the patients at risk throughout the follow-up.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sandra Beltrán Catalán, Asunción Sancho Calabuig, Pablo Molina, Belén Vizcaíno Castillo, Eva Gavela Martínez, Julia Kanter Berga, Mercedes González Moya, Luis Manuel Pallardó Mateu" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Sandra" "apellidos" => "Beltrán Catalán" ] 1 => array:2 [ "nombre" => "Asunción" "apellidos" => "Sancho Calabuig" ] 2 => array:2 [ "nombre" => "Pablo" "apellidos" => "Molina" ] 3 => array:2 [ "nombre" => "Belén" "apellidos" => "Vizcaíno Castillo" ] 4 => array:2 [ "nombre" => "Eva" "apellidos" => "Gavela Martínez" ] 5 => array:2 [ "nombre" => "Julia" "apellidos" => "Kanter Berga" ] 6 => array:2 [ "nombre" => "Mercedes" "apellidos" => "González Moya" ] 7 => array:2 [ "nombre" => "Luis Manuel" "apellidos" => "Pallardó Mateu" ] 8 => array:1 [ "colaborador" => "Grupo Levante de Diálisis Peritoneal" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699521000138" "doi" => "10.1016/j.nefro.2020.12.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699521000138?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251421000353?idApp=UINPBA000064" "url" => "/20132514/0000004100000002/v1_202106220601/S2013251421000353/v1_202106220601/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Epidemic outbreak of gram negatives in patients with long-term tunneled hemodialysis catheters: Adverse event on hemodialysis units" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "210" "paginaFinal" => "211" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "María Dolores Arenas" "autores" => array:1 [ 0 => array:3 [ "nombre" => "María Dolores" "apellidos" => "Arenas" "email" => array:2 [ 0 => "lola@olemiswebs.com" 1 => "Mdarenas@friat.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Fundación Renal Iñigo Alvarez de Toledo, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Brote de bacteriemia por gramnegativos en pacientes portadores de catéteres tunelizados: evento adverso en las unidades de hemodiálisis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Implementation of a safety culture in haemodialysis (HD) units is key.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, a punitive culture is responsible for limited reporting of adverse events (AEs), creating an obstacle to effective investigation. It is essential to promote a safety culture to establish strategies that ensure the provision of harm-free care. AEs are often linked to system failures, so it is more important to identify existing procedural weaknesses and report them to other units in order to adopt preventive measures, than it is to look for guilty parties.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Infectious complications of vascular access, associated with the growing use of tunnelled catheters (TCs),<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> represent a common AE and correspond to an epidemic outbreak of gram-negative bacteria.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Such a complication should be a sentinel indicator to investigate its origin and route of transmission, which is not always easy.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We report an epidemic outbreak of bacteraemia due to <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> (Psa) that occurred at an HD unit in Alicante, Spain, with 164 patients, in which 11 episodes of bacteraemia were detected in two months (10 gram-negative bacteria; 9 Psa). The alert was issued after the first two cases. Various points were cultured (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Massive growth of Psa was detected in the drain of a wash basin and in a Hansen coupling. This Psa was genotypically identical to the Psa detected in the patients, suggesting that it was the source of infection and presumably reached the catheter via staff. Taps can be reservoirs for Psa infection in hospitalised patients,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> as can other sites that are not always suspected (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">All cases of bacteraemia occurred in patients with TCs (33 patients: 0.18 cases of bacteraemia/TC/months of risk). Haemodynamic instability preceded bacteraemia by a week. The first three patients received empirical vancomycin and IV tobramycin and required catheter removal. All the other patients received specific treatment from the start and responded favourably. Following disinfection of water drains and the use of a disinfectant alcohol solution before and after contact with each patient,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> no new cases appeared after 12 months.</p><p id="par0020" class="elsevierStylePara elsevierViewall">These outbreaks highlight the importance of active surveillance of AEs in HD, strengthening safety policies, early risk assessment and the importance of case reporting.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arenas MD. Brote de bacteriemia por gramnegativos en pacientes portadores de catéteres tunelizados: evento adverso en las unidades de hemodiálisis. Nefrologia. 2021;41:210–211.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">HD: haemodialysis.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Disinfectant solutions (aqueous chlorhexidine)<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. Infusion fluids (saline solution) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3. Heparins \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4. Running water \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5. Wash basin drain in the rooms \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6. Treated water<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7. Acidic HD concentrates \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8. Dialysis fluid at the inlet and outlet of the dialyser<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9. Hansen couplings \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10. Arterial and venous blood lines \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11. Monitor drainage tubes<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12. Hands of staff involved in patient care<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13. Hand disinfectant solutions<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2628814.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Points from which samples were drawn for culture, liable to be contaminated based on scientific evidence.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety on haemodialysis: team work paradigm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.D. Arenas Jiménez" 1 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 8 | 16 |
| 2024 October | 39 | 54 | 93 |
| 2024 September | 48 | 32 | 80 |
| 2024 August | 62 | 71 | 133 |
| 2024 July | 33 | 40 | 73 |
| 2024 June | 41 | 46 | 87 |
| 2024 May | 39 | 46 | 85 |
| 2024 April | 42 | 32 | 74 |
| 2024 March | 45 | 22 | 67 |
| 2024 February | 42 | 39 | 81 |
| 2024 January | 28 | 34 | 62 |
| 2023 December | 16 | 28 | 44 |
| 2023 November | 46 | 36 | 82 |
| 2023 October | 75 | 33 | 108 |
| 2023 September | 33 | 29 | 62 |
| 2023 August | 34 | 38 | 72 |
| 2023 July | 29 | 32 | 61 |
| 2023 June | 36 | 17 | 53 |
| 2023 May | 43 | 26 | 69 |
| 2023 April | 30 | 17 | 47 |
| 2023 March | 60 | 21 | 81 |
| 2023 February | 41 | 13 | 54 |
| 2023 January | 29 | 31 | 60 |
| 2022 December | 59 | 32 | 91 |
| 2022 November | 50 | 50 | 100 |
| 2022 October | 75 | 50 | 125 |
| 2022 September | 46 | 49 | 95 |
| 2022 August | 41 | 44 | 85 |
| 2022 July | 48 | 61 | 109 |
| 2022 June | 53 | 52 | 105 |
| 2022 May | 50 | 34 | 84 |
| 2022 April | 47 | 44 | 91 |
| 2022 March | 50 | 63 | 113 |
| 2022 February | 55 | 49 | 104 |
| 2022 January | 44 | 57 | 101 |
| 2021 December | 28 | 42 | 70 |
| 2021 November | 38 | 33 | 71 |
| 2021 October | 58 | 58 | 116 |
| 2021 September | 42 | 73 | 115 |
| 2021 August | 35 | 48 | 83 |
| 2021 July | 47 | 51 | 98 |
| 2021 June | 35 | 23 | 58 |
| 2021 May | 28 | 21 | 49 |
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