Top

Published in:

01-12-2008 | Original

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

Authors: Jose Garnacho-Montero, Teresa Aldabó-Pallás, Mercedes Palomar-Martínez, Jordi Vallés, Benito Almirante, Rafael Garcés, Fabrio Grill, Miquel Pujol, Cristina Arenas-Giménez, Eduard Mesalles, Ana Escoresca-Ortega, Marina de Cueto, Carlos Ortiz-Leyba

Published in: Intensive Care Medicine | Issue 12/2008

Abstract

Objective

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.

Patients

All subjects admitted to the participating ICUs from October 2004 to June 2005 with a CVC.

Interventions

None.

Measurement and results

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.

Conclusions

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.

Blot SI, Depuydt P, Annemans L, Benoit D, Hoste E, De Waele JJ, Decruyenaere J, Vogelaers D, Colardyn F, Vandewoude KH (2005) Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 41:1591–1598PubMedCrossRef

Henderson DK (2000) Infections due to percutaneous intravascular devices. In: Mandell GL, Bennet JE, Dolin R (eds) Principles and practice of infectious diseases. Churchill Livingstone, Philadelphia, pp 3005–3020

Moro ML, Vigano EF, Cozzi Lepri A (1994) Risk factors for central venous catheter-related infections in surgical and intensive care units. The Central Venous Catheter-Related Infections Study Group. Infect Control Hosp Epidemiol 15:253–264PubMedCrossRef

Charalambous C, Swodoba SM, Dick J, Perl T, Lipsett PA (1998) Risk factors and clinical impact of central line infections in the surgical intensive care unit. Arch Surg 133:1241–1246PubMedCrossRef

Gowardman JR, Montgomery C, Thirwell S, Shewan J, Idema A, Larsen PD, Havill JH (1998) Central venous catheter-related bloodstream infections: an analysis of incidence and risk factors in a cohort of 400 patients. Intensive Care Med 24:1034–1039PubMedCrossRef

Lorente L, Henry C, Martin MM, Jiménez A, Mora ML (2005) Central venous catheter-related infection in a prospective and observational study of 2, 595 catheters. Crit Care 9:R631–635PubMedCrossRef

Safdar N, Kluger DM, Maki DG (2002) A review of risk factors for catheter-relayed bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters. Medicine 81:466–479PubMedCrossRef

Raad I, Hanna H, Maki DG (2007) Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis 7:645–657PubMedCrossRef

Escoresca AM, Aldabo T, Diaz A, Palomar M, Valles J, Graces R, Baquero F, Pujol M, Bouza E, Garnacho J (2007) National multicenter study: risk factors for bacteremia associated with central venous catheter in Intensive Care Unit. Intensive Care Med 33:S102CrossRef

10.

O’Grady NP, Alexander M, Delliger P Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA; Healthcare Infection Control Practices Advisory Committee (2002) Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 23:759–769

11.

Pittet D, Thiévent B, Wenzel RP, Li N, Gurman G, Suter P (1993) Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients. Intensive Care Med 19:265–272PubMedCrossRef

12.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II, a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRef

13.

Langgartner J, Linde HJ, Lehn N, Reng M, Schölmerich J, Glück T (2004) Combined skin disinfection with chlorhexidine/propanol and aqueous povidone-iodine reduces bacterial colonisation of central venous catheters. Intensive Care Med 30:1081–1088PubMedCrossRef

14.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710PubMedCrossRef

15.

Mermel LA, Farr BM, Sherertz RJ, Raad II, O’Grady N, Harris JS, Craven DE (2001) Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 32:1249–1272PubMedCrossRef

16.

Rothman KJ, Greenland S (1998) Modern epidemiology, 2nd edn. Lippincott Williams & Wilkins, Philadelphia

17.

Maki DG, Kluger DM, Cmich CJ (2006) The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 81:1159–1171PubMed

18.

Lorente L, Villegas J, Martín MM, Jimenez A, Mora ML (2004) Catheter-related infection in critically ill patients. Intensive Care Med 30:1681–1684PubMedCrossRef

19.

Sadfar N, Maki DG (2005) Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 128:489–495CrossRef

20.

Kelbel I, Koch T, Weber A, Schiefer HG, van Ackern K, Neuhof H (1999) Alterations of bacterial clearance induced by propofol. Acta Anaesthesiol Scand 43:71–76PubMedCrossRef

21.

Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, Rigaud JP, Casciani D, Misset B, Bosquet C, Outin H, Brun-Buisson C, Nitenberg G; French Catheter Study Group in Intensive Care (2001) Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 286:700–707

22.

van de Wetering MD, van Woensel JB, Kremer LC, Caron HN (2005) Prophylactic antibiotics for preventing early Gram-positive central venous catheter infections in oncology patients, a Cochrane systematic review. Cancer Treat Rev 31:186–196PubMedCrossRef

23.

Durbec O, Vivand X, Potie F, Vialet R, Albanese J, Martin C (1997) A prospective evaluation of the use of femoral venous catheters in critically ill adults. Crit Care Med 25:1986–1989PubMedCrossRef

24.

Goetz AM, Wagner MM, Miller JM, Muder RR (1998) Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infect Control Hosp Epidemiol 19:842–845PubMed

25.

Deshpande KS, Hatem C, Ulrich HL, Currie BP, Aldrich TK, Bryan-Brown CW, Kvetan V (2005) The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 33:13–20PubMedCrossRef

26.

Gowardman JR, Robertson IK, Parkes S, Rickard CM. (2008) Influence of insertion site on central venous catheter colonization and bloodstream infection rates. Intensive Care Med 10.1007/s00134-008-1046-3. Access May 22.

27.

Maki DG, Ringer M, Alvarado CJ (1991) Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 338:339–343PubMedCrossRef

28.

Mimoz O, Pieroni L, Lawrence C, Edouard A, Costa Y, Samii K, Brun-Buisson C (1996) Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Crit Care Med 24:1818–1823PubMedCrossRef

29.

Hammarskjölf F, Wallén G, Malmvald BE (2006) Central venous catheter infections at a county hospital in Sweden: a prospective analysis of colonization, incidence of infection and risk factors. Acta Anaesthesiol Scand 50:451–460CrossRef

30.

Van der Kooi TI, de Boer AS, Manniën J, Wille JC, Beaumont MT, Mooi BW, van den Hof S (2007) Incidence and risk factors of device-associated infections and associated mortality at the intensive care in the Dutch surveillance system. Intensive Care Med 33:271–278PubMedCrossRef

31.

Yilmaz G, Koksal J, Aydin K, Caylan R, Sucu N, Aksoy F (2007) Risk factors of catheter-related bloodstream infections in parenteral nutrition catheterization. JPEN 31:284–287

32.

Cook D, Randolph A, Kemerman P, Cupido C, King D, Soukup C, Brun-Buisson C (1997) Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med 25:1417–1424PubMedCrossRef

33.

Almuneef MA, Menish ZA, Balkhy HH, HH, Hijazi O, Cunningham G, Francis C (2006) Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect 62:207–213

34.

Garcia-Teresa MA, Casado-Flores J, Delgado-Dominguez MA, Roqueta-Mas J, Cambra-Lasaosa F, Concha-Torre A, Fernández-Pérez C; Spanish Central Venous Catheter Pediatric Study Group (2007) Infectious complications of percutaneous central venous catheterization in pediatric patients: a Spanish multicenter study. Intensive Care Med 33:466–476

35.

Hagly MT, Martin B, Gast P, Traeger SM (1992) Infectious and mechanical complications of central venous catheters placed by percutaneous venipuncture and over guidewires. Crit Care Med 20:1426–1430CrossRef

36.

O’Mara MS, Reed NL, Palmieri TL, Greenhalgh DG (2007) Central venous catheter infections in burn patients with scheduled catheter exchange and replacement. J Surg Res 142:341–350PubMedCrossRef

37.

Michel L, McMilian JC, Bachy JL (1979) Tracheostomy and indwelling central venous line: a hazaradous combination? Intensive Care Med 5:83–86PubMedCrossRef

38.

Rijnders BJ, Peetermans WE, Verwaest C, Wilmer A, Van Wijngaerden E (2004) Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial. Intensive Care Med 30:1073–1080PubMedCrossRef

39.

Falagas ME, Fragoulis K, Bliziotis JA, Chatzinikolau I (2007) Rifampicin-impregnated central venous catheters: a meta-analysis of randomized controlled trials. J Antimicrob Chemother 59:359–369PubMedCrossRef

Title: Risk factors and prognosis of catheter-related bloodstream infection in critically ill patients: a multicenter study
Authors: Jose Garnacho-Montero
Teresa Aldabó-Pallás
Mercedes Palomar-Martínez
Jordi Vallés
Benito Almirante
Rafael Garcés
Fabrio Grill
Miquel Pujol
Cristina Arenas-Giménez
Eduard Mesalles
Ana Escoresca-Ortega
Marina de Cueto
Carlos Ortiz-Leyba
Publication date: 01-12-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 12/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1204-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objective

Patients

Interventions

Measurement and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Patients

Interventions

Measurement and results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2008

Herpes simplex virus load in bronchoalveolar lavage fluid is related to poor outcome in critically ill patients

Enhanced fluid management with continuous venovenous hemofiltration in pediatric respiratory failure patients receiving extracorporeal membrane oxygenation support

Measurement of end-expiratory lung volume by oxygen washin–washout in controlled and assisted mechanically ventilated patients

End-of-life care in Spain: legal framework

Nontuberculous mycobacteria pulmonary infection in medical intensive care unit: the incidence, patient characteristics, and clinical significance

Response to Dr. Tehrani