Local signs at insertion site and catheter-related bloodstream infections: an observational post hoc analysis using indi
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RESEARCH
Local signs at insertion site and catheter‑related bloodstream infections: an observational post hoc analysis using individual data of four RCTs Niccolò Buetti1,10* , Stéphane Ruckly1, Jean‑Christophe Lucet1,2, Lila Bouadma1,3, Maité Garrouste‑Orgeas1,4, Carole Schwebel5,11, Olivier Mimoz6,7,8, Bertrand Souweine9 and Jean‑François Timsit1,3
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 sub‑ groups 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 mainte‑ nance, local signs increased the probability to observe CRBSI. Keywords: Insertion site, Exit-site, Intravascular catheter, Intravascular catheter infection, Catheter-related bloodstream infection, Local sign Background Infections due to central venous catheters and arterial catheters significantly increase hospitalization duration, hospital costs, patient morbidity and mortality in critically ill adult patients [1–3]. Moreover, intravascular *Correspondence: [email protected] 1 University of Paris, INSERM, IAME, 75006 Paris, France Full list of author information is available at the end of the article
catheter-related bloodstream infections are frequent events in the intensive care unit (ICU) setting [4]. Numerous risk factors associated with catheter-related bloodstream infections (CRBSIs) have been identified in several studies [5–8]. More specifically, in the last 20 years, only one old study assessed the exit-site signs as a predictor for intravascular catheter infections [9]. These data reflect practices from an arguably bygone era [10].
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