Niccolò Buetti1, Olivier Mimoz2, Leonard Mermel3, Stéphane Ruckly1, Nicolas Mongardon4, Claire Dupuis1, Jean-Paul Mira5, Jean-Christophe Lucet1,6, Bruno Mégarbane7, Sébastien Bailly8, Jean-Jacques Parienti9, Jean-François Timsit1,10. 1. University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France. 2. Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, France; Université de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France. 3. Division of Infectious Diseases, Rhode Island Hospital and Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA. 4. Service d'Anesthésie-Réanimation Chirurgicale, Hôpitaux Universitaires Henri Mondor, DMU CARE, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm U955 équipe 3, Faculté de Santé, Université Paris-Est Créteil, Créteil, France. 5. Groupe Hospitalier Paris Centre - Cochin University Hospital - APHP, Paris Descartes University, Paris, France. 6. AP-HP, Infection Control Unit, Bichat- Claude Bernard University Hospital, 46 rue Henri Huchard, Paris Cedex, France. 7. Service de réanimation médicale et toxicologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France. 8. Univ. Grenoble Alpes, INSERM U1042, HP2, 38000 Grenoble, France EFCR laboratory, Grenoble Alpes University Hospital, Grenoble, France. 9. Department of Biostatistics and Clinical Research and Department of Infectious Diseases, Caen University Hospital, Caen, France. 10. Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, Paris Cedex, France.
Abstract
BACKGROUND: Ultrasound (US) guidance is frequently used in critically ill patients for central venous catheter (CVC) insertion. The effect of US on infectious risk remains controversial and randomized-controlled trials (RCTs) assessed mainly non-infectious complications. This study assessed infectious risk associated with catheters inserted with US guidance versus use of anatomical 'landmarks' (AL). METHODS: We used individual data from three large RCTs for which a prospective, high-quality data collection was performed. Adult patients were recruited in various intensive care units (ICU) in France as soon as they required short-term CVC insertion. We applied marginal Cox models with inverse probability weighting to estimate the effect of US-guided insertion on catheter-related bloodstream infections (CRBSI, primary outcome) and major catheter-related infections (MCRI, secondary outcome).We also evaluated insertion site colonization at catheter removal. RESULTS: Our post hoc analysis included 4636 patients and 5502 catheters inserted in 2088 jugular, 1733 femoral and 1681 subclavian veins, respectively, in 19 ICUs. US was used for 2147 catheter insertions. Among jugular and femoral CVCs and after weighting, we found an association between US and CRBSI (HR 2.21, 95% CI 1.17-4.16, p=0.014) and between US and MCRI (HR 1.55, 95% CI 1.01-2.38, p=0.045). Catheter insertion site colonization at removal was more common in the US-guided group (p=0.0045) among jugular and femoral CVCs in situ for ≤7 days (n=606). CONCLUSIONS: In prospectively collected data in which catheters were not randomized to insertion by US or AL, US guidance was associated with increased risk of infection.
BACKGROUND: Ultrasound (US) guidance is frequently used in critically illpatients for central venous catheter (CVC) insertion. The effect of US on infectious risk remains controversial and randomized-controlled trials (RCTs) assessed mainly non-infectious complications. This study assessed infectious risk associated with catheters inserted with US guidance versus use of anatomical 'landmarks' (AL). METHODS: We used individual data from three large RCTs for which a prospective, high-quality data collection was performed. Adult patients were recruited in various intensive care units (ICU) in France as soon as they required short-term CVC insertion. We applied marginal Cox models with inverse probability weighting to estimate the effect of US-guided insertion on catheter-related bloodstream infections (CRBSI, primary outcome) and major catheter-related infections (MCRI, secondary outcome).We also evaluated insertion site colonization at catheter removal. RESULTS: Our post hoc analysis included 4636 patients and 5502 catheters inserted in 2088 jugular, 1733 femoral and 1681 subclavian veins, respectively, in 19 ICUs. US was used for 2147 catheter insertions. Among jugular and femoral CVCs and after weighting, we found an association between US and CRBSI (HR 2.21, 95% CI 1.17-4.16, p=0.014) and between US and MCRI (HR 1.55, 95% CI 1.01-2.38, p=0.045). Catheter insertion site colonization at removal was more common in the US-guided group (p=0.0045) among jugular and femoral CVCs in situ for ≤7 days (n=606). CONCLUSIONS: In prospectively collected data in which catheters were not randomized to insertion by US or AL, US guidance was associated with increased risk of infection.
Authors: Antonia F Demleitner; Andreas W Wolff; Johanna Erber; Friedemann Gebhardt; Erica Westenberg; Andrea S Winkler; Susanne Kolbe-Busch; Iris F Chaberny; Paul Lingor Journal: J Neural Transm (Vienna) Date: 2022-03-04 Impact factor: 3.850
Authors: Niccolò Buetti; Jonas Marschall; Marci Drees; Mohamad G Fakih; Lynn Hadaway; Lisa L Maragakis; Elizabeth Monsees; Shannon Novosad; Naomi P O'Grady; Mark E Rupp; Joshua Wolf; Deborah Yokoe; Leonard A Mermel Journal: Infect Control Hosp Epidemiol Date: 2022-04-19 Impact factor: 6.520