Risk factors and prognosis of catheter-related bloodstream infection in critically ill patients: a multicenter study. Intensive Care Med

Intensive Care Unit, Hospital Virgen del Rocio, Sevilla, Spain.
Intensive Care Medicine (Impact Factor: 7.21). 08/2008; 34(12):2185-93. DOI: 10.1007/s00134-008-1204-7
Source: PubMed


To assess the risk factors associated with CR-BSI development in critically ill patients with non-tunneled, non-cuffed central venous catheters (CVC) and the prognosis of the episodes of CR-BSI. Design and setting; prospective, observational, multicenter study in nine Spanish Hospitals.
All subjects admitted to the participating ICUs from October 2004 to June 2005 with a CVC.
Overall, 1,366 patients were enrolled and 2,101 catheters were analyzed. Sixty-six episodes of CR-BSI were diagnosed. The incidence of CR-BSI was significantly higher in CVC compared with peripherically inserted central venous catheters (PICVC) without significant differences among the three locations of CVC. In the multivariate analysis, duration of catheterization and change over a guidewire were the independent variables associated with the development of CR-BSI whereas the use of a PICVC was a protective factor. Excluding PICVC, 1,598 conventional CVC were analyzed. In this subset, duration of catheterization, tracheostomy and change over a guidewire were independent risk factors for CR-BSI. A multivariate analysis of predictors for mortality among 66 patients with CRSI showed that early removal of the catheter was a protective factor and APACHE II score at the admission was a strong determinant of in-hospital mortality.
Peripherically inserted central venous catheters is associated with a lower incidence of CR-BSI in critically ill patients. Exchange over a guidewire of CVC and duration of catheterization are strong contributors to CR-BSI. Our results reinforce the importance of early catheter removal in critically ill patients with CR-BSI.

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Available from: Miquel Pujol, Dec 28, 2014
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    • "No information was provided on the technique of GWX. The other found that GWX was associated with an increased risk of catheter-related bacteraemia [35]. However, this latter study only assessed 76 CVCs inserted by GWX, with only half being triple lumen CVCs. "
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    ABSTRACT: The management of suspected central venous catheter (CVC)-related sepsis by guide wire exchange (GWX) is not recommended. However, GWX for new antimicrobial surface treated (AST) triple lumen CVC's has never been studied. We aimed to compare the microbiological outcome of triple lumen AST CVC's inserted by GWX (GWX-CVC's) with newly inserted triple lumen AST CVC's (NI-CVC's). We studied a cohort of 145 consecutive patients with GWX-CVC's and contemporaneous site-matched control cohort of 163 patients with a NI-CVC's in a tertiary intensive care unit (ICU). GWX-CVC and NI-CVC patients were similar for mean age (58.7 vs. 62.2 years), gender (88 (60.7%) vs. 98 (60.5%) male) and illness severity on admission (mean APACHE III: 71.3 vs. 72.2). However, GWX patients had longer median ICU length of stay (12.2 vs. 4.4 days; P<0.001) and median hospital length of stay (30.7 vs. 18.0 days; P <0.001). There was no significant difference with regard to the number of CVC tips with bacterial or fungal pathogen colonization among GWX-CVC's vs. NI-CVC's [5 (2.5%) vs. 6 (7.4%); P = 0.90]. Catheter-associated blood stream infection (CA-BSI) occurred in 2 (1.4%) GWX patients compared with 3 (1.8%) NI-CVC patients (p=0.75). There was no significant difference in hospital mortality [35 (24.1%) vs. 48 (29.4%); P= 0.29]. GWX-CVC's and NI-CVC's had similar rates of tip colonization at removal, CA-BSI and mortality. If the CVC removed by GWX is colonized, a new CVC must then be inserted at another site. In selected ICU patients at higher central vein puncture risk receiving AST CVC's GWX may be an acceptable initial approach to line insertion.
    Full-text · Article · Sep 2013 · Critical care (London, England)
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    • "Care process duration for empiric antibiotics and central venous catheters was categorized into 1–3days (Category 1), 4–6days (Category 2), and ≥7days (Category 3). A 72 hour cutoff for Category 1 was chosen because this interval is shorter than the threshold of increased risk of ventilator-associated pneumonia, central line-associated bloodstream infection, and urinary catheter-related infection [20-22]; approximately the time point at which de-escalation of empiric antibiotics is considered [23]; and approximately when final bacterial culture results become available in our laboratory. To test whether our findings were sensitive to the empiric antibiotic categories we chose, we performed an additional analysis with empiric antibiotic duration categories of 1–3days, 4–5days, and ≥6days. "
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    ABSTRACT: Checklists are clinical decision support tools that improve process of care and patient outcomes. We previously demonstrated that prompting critical care physicians to address issues on a daily rounding checklist that were being overlooked reduced utilization of empiric antibiotics and mechanical ventilation, and reduced risk-adjusted mortality and length of stay. We sought to examine the degree to which these process of care improvements explained the observed difference in hospital mortality between the group that received prompting and an unprompted control group. In the medical intensive care unit (MICU) of a tertiary care hospital, we conducted face-to-face prompting of critical care physicians if processes of care on a checklist were being overlooked. A control MICU team used the checklist without prompting. We performed exploratory analyses of the mediating effect of empiric antibiotic, mechanical ventilation, and central venous catheter (CVC)duration on risk-adjusted mortality. One hundred forty prompted group and 125 control group patients were included. One hundred eighty-three patients were exposed to at least one day of empiric antibiotics during MICU admission. Hospital mortality increased as empiric antibiotic duration increased (P<0.001). Prompting was associated with shorter empiric antibiotic duration and lower risk-adjusted mortality in patients receiving empiric antibiotics (OR 0.41, 95% CI 0.18-0.92, P=0.032). When empiric antibiotic duration was added to mortality models, the adjusted OR for the intervention was attenuated from 0.41 to 0.50, suggesting that shorter duration of empiric antibiotics explained 15.2% of the overall benefit of prompting. Evaluation of mechanical ventilation was limited by study size. Accounting for CVC duration changed the intervention effect slightly. In this analysis, some improvement in mortality associated with prompting was explained by shorter empiric antibiotic duration. However, most of the mortality benefit of prompting was unexplained.
    Full-text · Article · Jul 2012 · BMC Health Services Research
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    • "This lower infection rate has also been shown in ICU patients. In a 2008 multicenter study including eight Spanish ICUs, the CRBSI rate of PICCs was significantly lower than that of CVCs (1.08 episodes vs. 3.83 episodes for 1,000 catheter-days), although ultrasound guided insertion was not used [22]. In a recent study carried out regarding 37 PICCs in a burn unit [23] the incidence of PICC-related bloodstream infection was 0 episodes, as compared with 6.6 episodes of CVC-related bloodstream infection for 1000 catheter-days. "
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    ABSTRACT: In the ICU, peripherally inserted central catheters (PICCs) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome with the use of power-injectable catheters. We retrospectively reviewed all of the power-injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. We collected 89 power-injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related bloodstream infection. Non-infective complications during management were not clinically significant. There was one episode of symptomatic thrombosis during the stay in the ICU and one episode after transfer of a patient to a non-intensive ward. Power-injectable PICCs have many advantages in the ICU: they can be used as multipurpose central lines for any type of infusion including high-flow infusion, for hemodynamic monitoring, and for high-pressure injection of contrast media during radiological procedures. Their insertion is successful in 100% of cases and is not associated with significant risks, even in patients with coagulation disorders. Their maintenance is associated with an extremely low rate of infective and non-infective complications.
    Full-text · Article · Feb 2012 · Critical care (London, England)
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