Local signs at insertion site and catheter-related bloodstream infections: an observational post hoc analysis using individual data of four RCTs

Critical Care

Bertrand Souweine¹  Carole Schwebel²  Olivier Mimoz³  Stéphane Ruckly⁴  Jean-François Timsit⁴  Maité Garrouste-Orgeas⁴  Jean-Christophe Lucet⁴  Niccolò Buetti⁴  Lila Bouadma⁴ 

[1] Medical ICU, Gabriel-Montpied University Hospital;Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University;Services Des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers;University of Paris, INSERM, IAME;

关键词: Insertion site;    Exit-site;    Intravascular catheter;    Intravascular catheter infection;    Catheter-related bloodstream infection;    Local sign;   

DOI  :  10.1186/s13054-020-03425-0

来源: DOAJ

【 摘 要 】

Abstract Background Little is known on the association between local signs and intravascular catheter infections. This study aimed to evaluate the association between local signs at removal and catheter-related bloodstream infections (CRBSI), and which clinical conditions may predict CRBSIs if inflammation at insertion site is present. Methods We used individual data from four multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies for arterial and central venous catheters. We used multivariate logistic regressions in order to evaluate the association between ≥ 1 local sign, redness, pain, non-purulent discharge and purulent discharge, and CRBSI. Moreover, we assessed the probability for each local sign to observe CRBSI in subgroups of clinically relevant conditions. Results A total of 6976 patients and 14,590 catheters (101,182 catheter-days) and 114 CRBSI from 25 ICUs with described local signs were included. More than one local sign, redness, pain, non-purulent discharge, and purulent discharge at removal were observed in 1938 (13.3%), 1633 (11.2%), 59 (0.4%), 251 (1.7%), and 102 (0.7%) episodes, respectively. After adjusting on confounders, ≥ 1 local sign, redness, non-purulent discharge, and purulent discharge were associated with CRBSI. The presence of ≥ 1 local sign increased the probability to observe CRBSI in the first 7 days of catheter maintenance (OR 6.30 vs. 2.61 [> 7 catheter-days], pheterogeneity = 0.02). Conclusions Local signs were significantly associated with CRBSI in the ICU. In the first 7 days of catheter maintenance, local signs increased the probability to observe CRBSI.

【 授权许可】

Unknown