Niccolò Buetti1, Stéphane Ruckly1, Jean-Christophe Lucet1,2, Olivier Mimoz3,4,5, Bertrand Souweine6, Jean-François Timsit7,8. 1. University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France. 2. AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France. 3. Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, 86021, Poitiers, France. 4. Université de Poitiers, Poitiers, France. 5. Inserm U1070, Poitiers, France. 6. Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France. 7. University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France. jean-francois.timsit@aphp.fr. 8. Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France. jean-francois.timsit@aphp.fr.
Abstract
PURPOSE: Little is known on catheter-related infections associated with short-term dialysis catheters (DC). Recommendations for infection prevention are mostly derived from those related to central venous catheters (CVC). A comparison of infectious risk of DCs and CVCs would be instrumental for improving infection control prevention strategies. This study aimed to describe differences in infectious risk between DC and CVC. METHODS: We used individual data from 4 multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies regarding colonization, major catheter-related infections (MCRI) and catheter-related bloodstream infections (CR-BSI). We selected only catheters with non-chlorhexidine gluconate impregnated dressings. A marginal Cox model for clustered data was used for the evaluation of the daily hazard rate for catheter-tip colonization, MCRI and CR-BSI. RESULTS: We included 3029 patients and 4148 catheters (31,547 catheter-days) which comprised 1872 DCs and 2276 CVCs. After adjustment on confounders, we identified an increased risk in DC compared to CVC for colonization (HR 1.45, 95% CI 1.03-2.04, p = 0.04) and for MCRI (HR 2.97, 95% CI 1.03-8.51, p = 0.04) in the first 7 days of catheter maintenance. The daily hazard rate for colonization and MCRI was generally higher for DC in the first catheter-days, whereas it was similar between DC and CVC for longer catheterizations. CONCLUSIONS: The daily risk of colonization and MCRI was significantly higher in DC compared to CVC within the first 7 days of catheter maintenance. Targeted prevention strategies for DC should mostly focus on the period following the insertion.
PURPOSE: Little is known on catheter-related infections associated with short-term dialysis catheters (DC). Recommendations for infection prevention are mostly derived from those related to central venous catheters (CVC). A comparison of infectious risk of DCs and CVCs would be instrumental for improving infection control prevention strategies. This study aimed to describe differences in infectious risk between DC and CVC. METHODS: We used individual data from 4 multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies regarding colonization, major catheter-related infections (MCRI) and catheter-related bloodstream infections (CR-BSI). We selected only catheters with non-chlorhexidine gluconate impregnated dressings. A marginal Cox model for clustered data was used for the evaluation of the daily hazard rate for catheter-tip colonization, MCRI and CR-BSI. RESULTS: We included 3029 patients and 4148 catheters (31,547 catheter-days) which comprised 1872 DCs and 2276 CVCs. After adjustment on confounders, we identified an increased risk in DC compared to CVC for colonization (HR 1.45, 95% CI 1.03-2.04, p = 0.04) and for MCRI (HR 2.97, 95% CI 1.03-8.51, p = 0.04) in the first 7 days of catheter maintenance. The daily hazard rate for colonization and MCRI was generally higher for DC in the first catheter-days, whereas it was similar between DC and CVC for longer catheterizations. CONCLUSIONS: The daily risk of colonization and MCRI was significantly higher in DC compared to CVC within the first 7 days of catheter maintenance. Targeted prevention strategies for DC should mostly focus on the period following the insertion.
Entities:
Keywords:
Catheter; Central venous catheter; Colonization; Dialysis catheter; ICU; Infection