OBJECTIVE: Despite the lack of evidence to support routine scheduled replacement of dialysis catheters (DCs) this practice continues to be widely used in many intensive care units (ICUs). This study evaluated whether additional risks of catheter-related infection (CRI) are incurred with a conservative attitude in critically ill cancer patients. DESIGN AND SETTING: Prospective, observational study over a 14-month period in a 15-bed medicosurgical unit in a comprehensive cancer center. PATIENTS: Seventy-nine double-lumen DCs were evaluated in 47 patients. Incidence rates of infection per 1000 days of catheter use were examined over 7-day periods. MEASUREMENTS AND RESULTS: The mean indwelling time was 6.9+/-5.5 days. Twelve DCs (15.2%) were removed for suspected CRI. Catheter-tip cultures remained negative in 74 cases (93.7%). Overall, one bacteremic CRI, two colonization episodes, and two contaminations were diagnosed, leading to DC colonization and DC-related bacteremia incidence rates of, respectively, 5.4 and 1.8 per 1000 days. When the catheter colonization rate was examined at 7-day intervals, the incidence rate was similar whatever the indwelling time: 5.8, 4.8, and 6.0 per 1000 days, respectively, for the 49 catheters left in place for 7 days or less, 8-14 days (21 DCs), and more than 14 days (9 DCs). The DC colonization incidence rate was similar to that of the 42 short-term catheters inserted during the same period in the same patients (5.9 per 1000 days). CONCLUSIONS: The stable low risk for DC-related infections over time does not support the rationale for scheduled replacement, even in immunocompromised cancer patients.
OBJECTIVE: Despite the lack of evidence to support routine scheduled replacement of dialysis catheters (DCs) this practice continues to be widely used in many intensive care units (ICUs). This study evaluated whether additional risks of catheter-related infection (CRI) are incurred with a conservative attitude in critically ill cancerpatients. DESIGN AND SETTING: Prospective, observational study over a 14-month period in a 15-bed medicosurgical unit in a comprehensive cancer center. PATIENTS: Seventy-nine double-lumen DCs were evaluated in 47 patients. Incidence rates of infection per 1000 days of catheter use were examined over 7-day periods. MEASUREMENTS AND RESULTS: The mean indwelling time was 6.9+/-5.5 days. Twelve DCs (15.2%) were removed for suspected CRI. Catheter-tip cultures remained negative in 74 cases (93.7%). Overall, one bacteremic CRI, two colonization episodes, and two contaminations were diagnosed, leading to DC colonization and DC-related bacteremia incidence rates of, respectively, 5.4 and 1.8 per 1000 days. When the catheter colonization rate was examined at 7-day intervals, the incidence rate was similar whatever the indwelling time: 5.8, 4.8, and 6.0 per 1000 days, respectively, for the 49 catheters left in place for 7 days or less, 8-14 days (21 DCs), and more than 14 days (9 DCs). The DC colonization incidence rate was similar to that of the 42 short-term catheters inserted during the same period in the same patients (5.9 per 1000 days). CONCLUSIONS: The stable low risk for DC-related infections over time does not support the rationale for scheduled replacement, even in immunocompromised cancerpatients.
Authors: F Blot; G Nitenberg; E Chachaty; B Raynard; N Germann; S Antoun; A Laplanche; C Brun-Buisson; C Tancrède Journal: Lancet Date: 1999-09-25 Impact factor: 79.321
Authors: B Souweine; O Traore; B Aublet-Cuvelier; L Badrikian; L Bret; J Sirot; N Gazuy; H Laveran; P Deteix Journal: Crit Care Med Date: 1999-11 Impact factor: 7.598
Authors: I I Raad; D C Hohn; B J Gilbreath; N Suleiman; L A Hill; P A Bruso; K Marts; P F Mansfield; G P Bodey Journal: Infect Control Hosp Epidemiol Date: 1994-04 Impact factor: 3.254
Authors: Peter Andrews; Elie Azoulay; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Geoffrey Dobb; Jean-Yves Fagon; Herwig Gerlach; Johan Groeneveld; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Jerome Pugin; Michael Pinsky; Peter Radermacher; Christian Richard; Robert Tasker Journal: Intensive Care Med Date: 2006-02-17 Impact factor: 17.440