Rough Draft Quantitative Research Critique and Ethical Considerations

Maria Tran

Grand Canyon University

NRS 433V

In the wake of increased central-line associated bloodstream infections, much studies have been done to eradicate or decrease these costly incidents.Once a central-line catheter is believed to be infected, many physicians believed that removal of the catheter is the best option for managing an CLABSIs. However, catheter salvage could be an option especially for situations where venous access is poor and incidence of infection is high (Vassallo, Dunais& Roger, 2015). Examples of increased infection rate are catheters that used for hemodialysis, parental nutrition and those used for onco-hematoligy therapy. In situations where Staphylococcus aureus and fungi are present, removal of the catheter is the best treatment option. Central line associated bloodstream infections are linked to morbidity, mortality, longer hospital stays and high costs. Antimicrobial lock therapy (ALT) seems to be a promising approach for the treatment of central line associated bloodstream infections (CLABSI) (Vassallo, Dunais& Roger, 2015). The treatment is easy and requires instilling an antibiotic solution into the hub of the central venous catheter when not in use. Antimicrobial and antifungal molecules have shown increased efficacy against CLABSI alone or in combination with other antibiotics.

Method of Study

Articles from[MR3] Pummed database using the broad search term such as “central-line infection” and lock therapy” were obtained. Case-control studies evaluating two or more drugs as ALT in central venous catheter infections were included (Vassallo, Dunais& Roger, 2015). Some experimental models and in vivo studies on humans were considered. The research was conducted in April 2014 and updated in December 2014. Two hundred and twenty-one articles were selected. Two hundred seventeen were abstract, 204 were written in English, and 103 focused on the research topic. From 103 papers, 54 were used for their [MR4] context concerning ALT.

Results of the Study

In the United States, approximately 80,000 cases of CLABSI occur among 3 million central venous catheters (Vassallo, Dunais& Roger, 2015). While, the numbers seem staggering, in recent CDC reports reveal a 58% decrease of CLABSIs in ICU from 2001 to 2009.The measured incidence trend in pathogenic-specific CLABSI in ICU began to dramatically reduce in 2006. The CLABSI ratios lies between 1.9 and 6.8 episodes per 1,000 catheter-days, with a median of 2.75. The odds ratiofor in-hospital death related to CLABSI was 2.75, decreasing to 1.51.

Microorganisms found on the skin or in the catheter hub are the main cause of CLABSIs. The leading pathogen is Staphylococcus aureusand coagulase negative staphylococci (CoNS). Other microorganisms include Enterobacteriaceae, Pseudomonas and fungi. The use of aminoglycosides revealed thatgentamicin lock therapy is active against S. aureusand CoNS. Also, amikacin locked for 12 hours resulted in 90% successful treatment of CLABSI (Vassallo, Dunais& Roger, 2015). Candida albicans is the most common fungal associated with CLABSIs. Although guidelines suggest removing the central venous catheter as the best treatment, there are reports of effective ALT. Lipid Amphotericin formulations, echinocandis and 25% ethanol proved to have good success rates in salvaging catheters with CLABSIs. Vancomycin lock therapy is active against gram positive bacteria such as methicillin- resistant staphylococci. Vancomycin ALT alone or in combination with an aminoglycoside agent or ethanol proved successful and avoided catheter removal. Daptomycin(DPT)is a cyclic lipopeptide antibiotic, which a rapid, concentration-dependent bactericidal activity against most clinically importantgram-positive bacteria, including methicillin resistant Staphylococcus aureus (MRSA), CoNS, vancomycin resistant enterococci and penicillin resistant Streptococcus pneumoniae. DPT is a calcium dependent antibacterial agent and is being studied with Lactated Ringer’s solution for its capacity to work with free calcium ions. Ethanol lock therapy alone or in combination was effective as lock therapy against Strenotrophomonasmaltophilia.Broad spectrum antibiotics like aminoglycosides, fluoroquinolones and tigecycline and their potential for antimicrobial lock therapy is limited by the lack of studies of these molecules.[MR5]

Conclusion

Studies evaluating the efficacy of antimicrobial lock therapy for central line associated bloodstream infections vary according to the type of antibiotic used. The causative agent determines on the type of antimicrobial lock therapy that needs to be used.The most promising indication for treating CLABSI with ALT appears to be CoNS related infection, where systemic signs of infection are generally less severe and the introduction of molecules, such a DPT, improve the potential to cure without catheter removal (Vassallo, Dunais& Roger, 2015).

Overall, antimicrobial lock therapy proves to be effective against CLABSI. It proves to decrease morbidity, mortality and decrease costs. While more research is needed to evaluate the efficacy of other broad-spectrum antibiotics used in ALT, the already in use have decreased the CLABSI incident in ICU patients. These studies have shown that central venous catheters can be salvaged, thus reducing CLABSI re-infections.

References

Vallaso, M., Dunais, B., & Roger, P. (2015). Antimicrobial Lock Therapy in central-Line Associated Bloodstream Infections: A Systematic Review. Infection 43, no. 4: 389-398.

CINHAL Complete, EBSCOhost (accessed September 16, 2018).

[MR1]The title in your running head should be in all capital letters

[MR2]Title of you paper should come first

[MR3]From the

[MR4]Can you make this a bit clearer as to what the method was-I am gathering that it was a retrospective study of looking at research articles?? Please make this more clearer thank you

[MR5]Don’t forget to address ethical considerations