***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Fifty-seven patients developed an episode of catheter-related infection ( CRI ) in the bloodstream during their stay in the intensive care unit ( cases ) and were prospect ively observed to establish the attributable mortality , increase in length of stay , and excess costs . Costs were estimated by multiplying the number of excess days of stay by the reimbursement provided . The outcomes for these cases were compared with those for matched control subjects without CRI . Eight cases were excluded as no control was found . Of the 49 cases , 31 were coagulase-negative staphylococci ( CNS ) . The level of severity was similar for both groups ( APACHE II 15.5 + /- 7 . 2 versus 15.2 + /- 7.3 ) . There were no significant differences ( p > 0 . 20 ) in the mortality observed in the hospital for the cases ( 22.4 % , 95 % confidence interval [ CI ] 0.3 % to 34.9 % ) and the control subjects ( 34.7 % , 95 % CI 21.2 % to 40.1 % ) . Among the survivors , the hospital stay was increased by 19.6 d ( 95 % CI -1.1 ; 40.4 ) . This represents an added cost of 3,124 Euros per episode of CRI among the survivors . In conclusion , our cohort study failed to show a difference in attributable mortality due to CRI in intensive care unit patients . Nevertheless , these infections lead to an increase in hospital stay of approximately 20 d. Each episode of CRI represents an additional cost of more than 3,000 Euros BACKGROUND The use of indwelling central venous catheters ( CVCs ) has become commonplace in the management of children undergoing anticancer treatment . Several types of CVC are available , while information on complications observed in children is scarce . We describe the experience of two tertiary care centers in Italy that prospect ively followed up three types of CVC used at both institutions over a 30-month period . PATIENTS AND METHODS Between January 2000 and May 2002 , double-lumen ( DL ) or single-lumen ( SL ) Hickman-Broviac ( HB ) catheters , and single-lumen pressure-activated safety valve ( PASV ) catheters were used and prospect ively evaluated . Four types of possible complication were defined a priori : mechanical , thrombotic , malfunctioning and infectious . RESULTS Four hundred and eighteen CVCs ( 180 SL-HB , 162 DL-HB and 76 PASV ) were inserted in 368 children , for a total of 107 012 catheter days at risk of complication . At least one complication occurred while using 169 of the devices ( 40 % ) : 46 % of the DL-HB , 46 % of the PASV and 33 % of the SL-HB ( P=0.02 ) catheters . Subjects with hematological malignancies or non-malignant diseases had significantly more complications  than those with solid tumors ( P < 0.0001 ) . Overall , 234 complications were documented : 93 infectious [ complication rate per 1000 catheter days at risk (CR)=0.87 ] , 84 malfunctioning ( CR=0.78 ) , 48 mechanical ( CR=0.45 ) and nine thrombotic ( CR=0.08 ) . SL-HB had statistically fewer infectious complications , while PASV had more mechanical complications . In a multivariate regression model , the most significant risk factors for having a CVC complication were hematological disease [ relative risk (RR)=3.0 ; 95 % confidence interval ( CI ) 1.8 - 4.8 ] and age < 6 years at CVC insertion ( RR=2.5 ; 95 % CI 1.5 - 4.1 ) . As for the type of CVC , compared with SL-HB , the DL-HB catheter had a statistically significant two-fold increased risk of any complication ( RR=2.1 ; 95 % CI 1.2 - 3.6 ) , while the PASV catheter had a borderline RR of 1.8 ( 95 % CI 1.0 - 3.6 ) . Analysis by tumor type showed a higher risk of any kind of complication in patients with solid malignancies who had received a DL-HB catheter as compared with an SL-HB catheter ( RR=7.2 ; 95 % CI 2.8 - 18.7 ) . CONCLUSIONS CVCs may cause complications in up to 40 % of patients , with type of CVC , underlying disease and patient age being the three main factors that affect the incidence of CVC-related complications . SL-HB catheters have the best performance Taurolidine has demonstrated inhibition of biofilm formation in vitro . The aim of this study was to compare the effect of catheter locking with taurolidine vs heparin in biofilm formation in central venous catheters . Forty‐eight children with cancer were r and omized to catheter locking by heparin ( n = 22 ) or taurolidine ( n = 26 ) , respectively . After removal , catheters were examined by st and ardized scanning electron microscopy to assess quantitative biofilm formation . Biofilm was present if morphologically typical structures and bacterial cells were identified . Quantitative and semi‐quantitative cultures were also performed . Biofilm was identified in 23 of 26 catheters from the taurolidine group and 21 of 22 catheters from the heparin group . A positive culture was made of six of the catheters locked with taurolidine and heparin , respectively ( p = 0.78 ) . The rate of catheter‐related bloodstream infections ( CRBSI ) was 0.1 per 1000 catheter‐days using taurolidine and 0.9 per 1000 catheter‐days using heparin ( p = 0.03 ) . This r and omized trial confirmed that the use of taurolidine as catheter‐lock compared with heparin reduced the rate of CRBSIs ; this reduction was not related to a reduction in the intraluminal biofilm formation and the rate of bacterial colonization detected by scanning electron microscopy in the two groups HYPOTHESIS Catheter-related bloodstream infection ( CRBSI ) in critically ill surgical patients with prolonged intensive care unit ( ICU ) stays is associated with a significant increase in health care re source use . DESIGN Prospect i ve cohort study . SETTING Surgical ICU at a large tertiary care center . PATIENTS Critically ill surgical patients ( N = 260 ) with projected surgical ICU length of stay greater than 3 days . INTERVENTIONS Central venous catheters were cultured for clinical suspicion of infection . MAIN OUTCOME MEASURES Increases in total hospital cost , ICU cost , hospital days , and ICU days attributable to CRBSI were estimated using multiple linear regression after adjusting for demographic factors and severity of illness ( APACHE III [ Apache Physiology and Chronic Health Evaluation III ] score ) . RESULTS The incidence of CRBSI per 1000 catheter-days was 3.6 episodes ( 95 % confidence interval [ CI ] , 2.1 - 5.8 episodes ) . Microbiologic isolates were Gram-positive bacteria in 75 % , Gram-negative bacteria in 20 % , and yeast in 5 % . After adjusting for demographic factors and severity of disease , CRBSI was associated with an increase of $ 56 167 ( 95 % CI , $ 11 523-$165 735 ; P = .001 ) ( in 1998 dollars ) in total hospital cost , an increase of $ 71 443 ( 95 % CI , $ 11 960-$195 628 ; P<.001 ) in ICU cost , a 22-day increase in hospital length of stay , and a 20-day increase in ICU length of stay . CONCLUSIONS For critically ill surgical patients , CRBSI is associated with a profound increase in re source use . Prevention , early diagnosis , and intervention for CRBSI might result in cost savings in this high-risk population Background Taurolidin/Citrate ( TauroLock ™ ) , a lock solution with broad spectrum antimicrobial activity , may prevent bloodstream infection ( BSI ) due to coagulase-negative staphylococci ( CoNS or ' MRSE ' in case of methicillin-resistant isolates ) in pediatric cancer patients with a long term central venous access device ( CVAD , Port- or/Broviac-/Hickman-catheter type ) . Methods In a single center prospect i ve 48-months cohort study we compared all patients receiving anticancer chemotherapy from April 2003 to March 2005 ( group 1 , heparin lock with 200 IU/ml sterile normal saline 0.9 % ; Canusal ® Wockhardt UK Ltd , Wrexham , Wales ) and all patients from April 2005 to March 2007 ( group 2 ; taurolidine 1.35%/Sodium Citrate 4 % ; TauroLock ™ , Tauropharm , Waldbüttelbrunn , Germany ) . Results In group 1 ( heparin ) , 90 patients had 98 CVAD in use during the surveillance period . 14 of 30 ( 47 % ) BSI were ' primary Gram positive BSI due to CoNS ( n = 4 ) or MRSE ( n = 10 ) ' [ incidence density ( ID ) ; 2.30 per 1000 inpatient CVAD-utilization days].In group 2 ( TauroLock ™ ) , 89 patients had 95 CVAD in use during the surveillance period . 3 of 25 ( 12 % ) BSI were caused by CoNS . ( ID , 0.45 ) . The difference in the ID between the two groups was statistically significant ( P = 0.004 ) . Conclusion The use of Taurolidin/Citrate ( TauroLock ™ ) significantly reduced the number and incidence density of primary catheter-associated BSI due to CoNS and MRSE in pediatric cancer patients Abstract Objective . To prevent catheter occlusion , intermittently used central venous catheters are frequently sealed with vitamin C solution or heparin solution between use . The present study was design ed to test the effectiveness of this approach and to compare the efficiency of sealing solutions . Design and setting . Prospect i ve r and omized study performed on a 9-bed medical ICU and on medical wards of an academic tertiary care center . Participants . Ninety-nine central venous line placements were prospect ively included in the study and r and omized into three treatment groups : sodium chloride 0.9 % , vitamin C ( 200 mg/ml ) and heparin ( 5000 IU/ml ) sealing solutions . Interventions and measurements . Catheters were filled with the respective sealing solution and patency was tested once every 2 days using a st and ardized routine . Catheter patency was compared among the three groups using Kaplan-Meier statistics and log-rank testing . Results . There was a significant difference in catheter patency between the three groups ( p<0.03 , log-rank test ) . A comparison of catheter survival between the catheters filled with heparin and those filled with sodium chloride , but not between those filled with vitamin C solution and with sodium chloride solution , exhibited significant differences in catheter patency ( p<0.04 , log-rank test ) . Conclusions . Local anticoagulation of intermittently used central venous catheters prolongs catheter patency . High-dose ( 5000 IU/ml ) heparin solution is a useful anticoagulant for this purpose , while vitamin C solution does not prolong catheter patency BACKGROUND Bacteremia is a major cause of morbidity in patients using intravascular catheters . Interdialytic locking with antibiotics decreases the incidence of bacteremia , but risks antibiotic resistance . Taurolidine is a nontoxic broad-spectrum antimicrobial agent that has not been associated with resistance . Preliminary evidence suggests that taurolidine-citrate locks decrease bacteremia , but cause flow problems in established catheters . STUDY DESIGN Double-blind r and omized controlled trial . INTERVENTION Interdialytic locking with taurolidine and citrate ( 1.35 % taurolidine and 4 % citrate ) compared with heparin ( 5,000 U/mL ) started at catheter insertion . SETTING & PARTICIPANTS 110 adult hemodialysis patients with tunneled cuffed intravascular catheters inserted at 3 centers in Northwest Engl and . OUTCOMES & MEASUREMENTS Primary end points were time to first bacteremia episode from any cause and time to first use of thrombolytic therapy . RESULTS There were 11 bacteremic episodes in the taurolidine-citrate group and 23 in the heparin group ( 1.4 and 2.4 episodes/1,000 patient-days , respectively ; P = 0.1 ) . There was no significant benefit of taurolidine-citrate versus heparin for time to first bacteremia ( hazard ratio , 0.66 ; 95 % CI , 0.2 - 1.6 : P = 0.4 ) . Taurolidine-citrate was associated with fewer infections caused by Gram-negative organisms than heparin ( 0.2 vs 1.1 infections/1,000 patient-days ; P = 0.02 ) 
    Output:
    
Conclusions : Catheter locking with TCLS reduced the risk of CRB and Gram-negative bacterial infection .