Abstract
BackgroundLittle 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.MethodsWe 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.ResultsA 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).ConclusionsLocal 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.
Highlights
Little is known on the association between local signs and intravascular catheter infections
Description of patients and catheters A total of 6976 patients and 14,590 catheters (101,182 catheter-days) from 25 intensive care unit (ICU) with described local signs were included in this study: 2033 (29.1%) from the CLEAN study, 1460 (20.9%) from ELVIS, 1614 (23.1%) from DRESSING1 and 1869 (26.8%) from DRESSING2
13.9% (2034) catheters were removed for suspected infection, whereas pathological body temperature was present in 54.7% (7979) of catheters at removal
Summary
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. Buetti et al Crit Care (2020) 24:694 recently changed the landscape of the risk factors [11] and, probably, of the clinical predictors for intravascular catheter infections. Recent studies suggested that the epidemiology of intravascular catheter-related infections is changing [12, 13]. Our primary objective was to determine whether local symptoms and signs at insertion site were associated with CRBSI using data from four randomized controlled trials (RCTs). The secondary objective was to determine which clinical conditions increase the probability to observe CRBSI if inflammation at insertion site is present
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