OBJECTIVE: To find a subset of patients with suspected central venous catheter (CVC)-related infection (CRI) in whom CVC removal is not needed. DESIGN: Randomized controlled trial. SETTING: Thirty-three-bed ICU. PATIENTS AND PARTICIPANTS: One hundred and forty four patients with suspected CRI in which a change of CVCs was planned were evaluated for inclusion. INTERVENTIONS:Hemodynamically stable patients without proven bacteremia, no insertion site infection, and no intravascular foreign body were randomized to a standard-of-care group (SOC, all CVCs were changed as planned) or a watchful waiting group (WW, CVCs changed when bacteremia was subsequently confirmed or hemodynamic instability occurred). MEASUREMENT AND RESULTS: Study groups were compared for incidence of CVC-related bloodstream infection (CR-BSI), resolution of fever, C-reactive protein, SOFA score, duration of ICU stay, and mortality. Of 144 patients with suspected CRI, 80 patients met exclusion criteria. Sixty-four were randomized. Forty-seven of 80 excluded patients were shown to be bacteremic, 20 (25%) of whom had a CR-BSI. Five of 64 (8%) included patients had a CR-BSI during their subsequent ICU stay (two in SOC and three in WW group). All 38 CVCs were changed in the SOC group versus 16 of 42 in the WW group (62% reduction, P<0.01). Resolution of fever, C-reactive protein, SOFA score, duration of ICU stay, and ICU mortality did not differ between SOC and WW group ( P>0.1 for all). CONCLUSIONS: The use of a simple clinical algorithm permits a substantial decrease in the number of unnecessarily removed CVCs without increased morbidity.
RCT Entities:
OBJECTIVE: To find a subset of patients with suspected central venous catheter (CVC)-related infection (CRI) in whom CVC removal is not needed. DESIGN: Randomized controlled trial. SETTING: Thirty-three-bed ICU. PATIENTS AND PARTICIPANTS: One hundred and forty four patients with suspected CRI in which a change of CVCs was planned were evaluated for inclusion. INTERVENTIONS: Hemodynamically stable patients without proven bacteremia, no insertion site infection, and no intravascular foreign body were randomized to a standard-of-care group (SOC, all CVCs were changed as planned) or a watchful waiting group (WW, CVCs changed when bacteremia was subsequently confirmed or hemodynamic instability occurred). MEASUREMENT AND RESULTS: Study groups were compared for incidence of CVC-related bloodstream infection (CR-BSI), resolution of fever, C-reactive protein, SOFA score, duration of ICU stay, and mortality. Of 144 patients with suspected CRI, 80 patients met exclusion criteria. Sixty-four were randomized. Forty-seven of 80 excluded patients were shown to be bacteremic, 20 (25%) of whom had a CR-BSI. Five of 64 (8%) included patients had a CR-BSI during their subsequent ICU stay (two in SOC and three in WW group). All 38 CVCs were changed in the SOC group versus 16 of 42 in the WW group (62% reduction, P<0.01). Resolution of fever, C-reactive protein, SOFA score, duration of ICU stay, and ICU mortality did not differ between SOC and WW group ( P>0.1 for all). CONCLUSIONS: The use of a simple clinical algorithm permits a substantial decrease in the number of unnecessarily removed CVCs without increased morbidity.
Authors: H Richet; B Hubert; G Nitemberg; A Andremont; A Buu-Hoi; P Ourbak; C Galicier; M Veron; A Boisivon; A M Bouvier Journal: J Clin Microbiol Date: 1990-11 Impact factor: 5.948
Authors: B J Rijnders; C Verwaest; W E Peetermans; A Wilmer; S Vandecasteele; J Van Eldere; E Van Wijngaerden Journal: Crit Care Med Date: 2001-07 Impact factor: 7.598
Authors: J L Vincent; A de Mendonça; F Cantraine; R Moreno; J Takala; P M Suter; C L Sprung; F Colardyn; S Blecher Journal: Crit Care Med Date: 1998-11 Impact factor: 7.598
Authors: Cristóbal León; Francisco Alvarez-Lerma; Sergio Ruiz-Santana; Víctor González; María-Victoria de la Torre; Rafael Sierra; Miguel León; Juan-José Rodrigo Journal: Crit Care Med Date: 2003-05 Impact factor: 7.598
Authors: Marco Ranucci; Giuseppe Isgrò; Pier Paolo Giomarelli; Marco Pavesi; Aldo Luzzani; Iolter Cattabriga; Manuela Carli; Paolo Giomi; Antonio Compostella; Antonio Digito; Valerio Mangani; Vito Silvestri; Enzo Mondelli Journal: Crit Care Med Date: 2003-01 Impact factor: 7.598
Authors: Leonard A Mermel; Michael Allon; Emilio Bouza; Donald E Craven; Patricia Flynn; Naomi P O'Grady; Issam I Raad; Bart J A Rijnders; Robert J Sherertz; David K Warren Journal: Clin Infect Dis Date: 2009-07-01 Impact factor: 9.079
Authors: John R Gowardman; Paula Jeffries; Melissa Lassig-Smith; Janine Stuart; Paul Jarrett; Renae Deans; Matthew McGrail; Narelle M George; Graeme R Nimmo; Claire M Rickard Journal: Intensive Care Med Date: 2012-09-26 Impact factor: 17.440
Authors: Abbas Harb; Georges Estphan; Gérard Nitenberg; Elisabeth Chachaty; Bruno Raynard; François Blot Journal: Intensive Care Med Date: 2005-04-16 Impact factor: 17.440
Authors: Michèle Tanguy; Philippe Seguin; Bruno Laviolle; Laurent Desbordes; Yannick Mallédant Journal: Intensive Care Med Date: 2005-03-15 Impact factor: 17.440
Authors: Jose Garnacho-Montero; Teresa Aldabó-Pallás; Mercedes Palomar-Martínez; Jordi Vallés; Benito Almirante; Rafael Garcés; Fabrio Grill; Miquel Pujol; Cristina Arenas-Giménez; Eduard Mesalles; Ana Escoresca-Ortega; Marina de Cueto; Carlos Ortiz-Leyba Journal: Intensive Care Med Date: 2008-07-12 Impact factor: 17.440
Authors: K W Jauch; W Schregel; Z Stanga; S C Bischoff; P Brass; W Hartl; S Muehlebach; E Pscheidl; P Thul; O Volk Journal: Ger Med Sci Date: 2009-11-18