[Fatal encephalopathy induced by ceftazidime].
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Biomedical subjects
Publications and source records attributed to B Eurin.
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Intravascular embolization of catheter fragments is a severe and rare complication of indwelling intravenous catheters. The estimated rate of incidence is 0,1% of central venous catheter insertions. This report of three cases shows how this complication may occur and suggests preventive measures. Mortality from arrhythmia-related cardiac arrest, septic and thrombo-embolic complications, and the risk of perforation of the heart argue for an immediate extraction of the broken catheter. Surgical removal used to be the only method; a non-surgical technique is now available, in which the embolized fragment is removed by means of a loop snare. No death has been associated with this technique which seems to be safe and reliable.
The accuracy of paired quantitative blood cultures (PQtBCs) collected in pediatric Isolator 1.5-ml tubes compared to central venous catheter (CVC) segment cultures (hub and tip) to diagnose catheter-related bacteremia (CRB) was evaluated in 58 bacteremic adult patients. The second aim of this study was to state precisely whether the tip or the hub (or both) of the infected device was the source of the bacteremia in case of significant results of PQtBC. Fifty-eight bacteremic patients with suspected CRB entered the study. In 52 patients, the diagnosis was obtained before CVC removal by PQtBC and was confirmed by CVC segment cultures: CRB in 30 patients, non-catheter-related bacteremia in 22 patients. Six patients had CRB not found by PQtBC. 1) PQtBC is 83% sensitive, 100% specific (negative predictive values 78%, positive predictive values 100%). 2) Sixteen bacteremic patients had authentic hub-related bacteremia (positive hub culture associated with negative tip cultures). When CRB is suspected in bacteremic patients, a negative tip culture cannot exclude the diagnosis of CRB. In all cases, CVC tip culture must be associated either with PQtBC or with hub cultures.