Short-term dialysis catheter versus central venous catheter infections in ICU patients: a post hoc analysis of individual data of 4 multi-centric randomized trials

Abstract

Purpose

Little is known on catheter-related infections associated with short-term dialysis catheters (DC). Recommendations for infection prevention are mostly derived from those related to central venous catheters (CVC). A comparison of infectious risk of DCs and CVCs would be instrumental for improving infection control prevention strategies. This study aimed to describe differences in infectious risk between DC and CVC.

Methods

We used individual data from 4 multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies regarding colonization, major catheter-related infections (MCRI) and catheter-related bloodstream infections (CR-BSI). We selected only catheters with non-chlorhexidine gluconate impregnated dressings. A marginal Cox model for clustered data was used for the evaluation of the daily hazard rate for catheter-tip colonization, MCRI and CR-BSI.

Results

We included 3029 patients and 4148 catheters (31,547 catheter-days) which comprised 1872 DCs and 2276 CVCs. After adjustment on confounders, we identified an increased risk in DC compared to CVC for colonization (HR 1.45, 95% CI 1.03–2.04, p = 0.04) and for MCRI (HR 2.97, 95% CI 1.03–8.51, p = 0.04) in the first 7 days of catheter maintenance. The daily hazard rate for colonization and MCRI was generally higher for DC in the first catheter-days, whereas it was similar between DC and CVC for longer catheterizations.

Conclusions

The daily risk of colonization and MCRI was significantly higher in DC compared to CVC within the first 7 days of catheter maintenance. Targeted prevention strategies for DC should mostly focus on the period following the insertion.

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Acknowledgements

The authors thank Céline Féger, M.D., (EMIBiotech) for her editorial support.

Funding

Funnded by Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (CH), Grant number P400PM_183865.

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Authors

Contributions

All authors contributed to the study conception and design. Material preparation and analysis were performed by NB, SR and J-FT. The first draft of the manuscript was written by NB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jean-François Timsit.

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Conflicts of interest

The authors have disclosed that they do not have conflict of interest. JFT received fees for lectures to 3M, MSD, Pfizer, and Biomerieux. JFT received research grants from Astellas, 3M, MSD, and Pfizer. JFT participated to advisory boards of 3M, MSD, Bayer Pharma, Nabriva, and Pfizer. NB is currently receiving a Post.doc Mobility grant from the Swiss National Science Foundation (Grant Number: P400PM_183865) and a grant from the Bangerter-Rhyner Foundation. JCL received fees for lectures for 3M, Pfizer MSD, and research grants from Anios. OM received fees for lectures for 3M and BD. OM received research grants from BD.

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Buetti, N., Ruckly, S., Lucet, JC. et al. Short-term dialysis catheter versus central venous catheter infections in ICU patients: a post hoc analysis of individual data of 4 multi-centric randomized trials. Intensive Care Med 45, 1774–1782 (2019). https://doi.org/10.1007/s00134-019-05812-w

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Keywords

  • Catheter
  • Dialysis catheter
  • Central venous catheter
  • ICU
  • Infection
  • Colonization