Niccolò Buetti1,2, Bertrand Souweine3, Leonard Mermel4, Olivier Mimoz5,6, Stéphane Ruckly1, Ambre Loiodice7, Nicolas Mongardon8, Jean-Christophe Lucet1,9, Jean-Jacques Parienti10,11, Jean-François Timsit12,13. 1. University of Paris, INSERM, IAME, 75006, Paris, France. 2. Infection Control Program and World Health Organization Collaborating Centre On Patient Safety, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland. 3. Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France. 4. Division of Infectious Diseases, Department of Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA. 5. Services Des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, 86021, Poitiers, France. 6. Université de Poitiers, Inserm U1070, Poitiers, France. 7. ICURESEARCH, 6B Avenue de Romans, Saint Marcellin, France. 8. 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. 9. AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75877, Paris Cedex, France. 10. Department of Biostatistics and Clinical Research, Caen University Hospital, 14000, Caen, France. 11. GRAM 2.0, EA2656, UNICAEN, Normandie University Hospital, Caen, France. 12. University of Paris, INSERM, IAME, 75006, Paris, France. jean-francois.timsit@aphp.fr. 13. AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018, Paris, France. jean-francois.timsit@aphp.fr.
Abstract
PURPOSE: Obesity increases the risk of nosocomial infection, but data regarding the role of body mass index (BMI) in catheter related infections are scarce. We used the data gathered from four randomized, controlled trials (RCTs) to investigate the association between body mass index (BMI) and intravascular catheter infections in critically ill obese patients. METHODS: Adult obese patients who required short-term central venous, arterial or dialysis catheter insertion in the intensive care unit (ICU) were analyzed. The association between BMI and major catheter-related infection (MCRI), catheter-related bloodstream infection (CRBSI) and catheter tip colonization was estimated using univariate and multivariate marginal Cox models. Exploratory analysis using dressing disruptions was added. RESULTS: A total of 2282 obese patients and 4275 catheters from 32 centers were included in this post-hoc analysis. Overall, 66 (1.5%) MCRI, 43 (1%) CRBSI and 399 (9.3%) catheter colonizations were identified. The hazard ratio (HR) for MCRI, CRBSI and colonization increased with BMI. After adjustment for well-known infection risk factors, the BMI ≥ 40 group had an increased risk for MCRI (HR 1.88, 95% CI 1.13-3.12, p = 0.015), CRBSI (HR 2.19, 95% CI 1.19-4.04, p = 0.012) and colonization (HR 1.44, 95% CI 1.12-1.84, p = 0.0038) compared to the BMI < 40 group. The mean dressing disruption per catheter was increased in the BMI ≥ 40 group (2.03 versus 1.68 in the BMI < 40 group, p = 0.05). CONCLUSIONS: Using the largest dataset ever collected from large multicentric RCTs, we showed that patients with BMI ≥ 40 had an increased risk for intravascular catheter infections. Targeted prevention measures should focus on this population with a particular attention to catheter care and dressing disruption.
PURPOSE:Obesity increases the risk of nosocomial infection, but data regarding the role of body mass index (BMI) in catheter related infections are scarce. We used the data gathered from four randomized, controlled trials (RCTs) to investigate the association between body mass index (BMI) and intravascular catheter infections in critically ill obesepatients. METHODS: Adult obesepatients who required short-term central venous, arterial or dialysis catheter insertion in the intensive care unit (ICU) were analyzed. The association between BMI and major catheter-related infection (MCRI), catheter-related bloodstream infection (CRBSI) and catheter tip colonization was estimated using univariate and multivariate marginal Cox models. Exploratory analysis using dressing disruptions was added. RESULTS: A total of 2282 obesepatients and 4275 catheters from 32 centers were included in this post-hoc analysis. Overall, 66 (1.5%) MCRI, 43 (1%) CRBSI and 399 (9.3%) catheter colonizations were identified. The hazard ratio (HR) for MCRI, CRBSI and colonization increased with BMI. After adjustment for well-known infection risk factors, the BMI ≥ 40 group had an increased risk for MCRI (HR 1.88, 95% CI 1.13-3.12, p = 0.015), CRBSI (HR 2.19, 95% CI 1.19-4.04, p = 0.012) and colonization (HR 1.44, 95% CI 1.12-1.84, p = 0.0038) compared to the BMI < 40 group. The mean dressing disruption per catheter was increased in the BMI ≥ 40 group (2.03 versus 1.68 in the BMI < 40 group, p = 0.05). CONCLUSIONS: Using the largest dataset ever collected from large multicentric RCTs, we showed that patients with BMI ≥ 40 had an increased risk for intravascular catheter infections. Targeted prevention measures should focus on this population with a particular attention to catheter care and dressing disruption.
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