Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. 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(11):1591–1598. https://doi.org/10.1086/497833

    Article  PubMed  Google Scholar 

  2. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory C (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52(9):e162–e193. https://doi.org/10.1093/cid/cir257

    Article  PubMed  PubMed Central  Google Scholar 

  3. Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O’Grady NP, Pettis AM, Rupp ME, Sandora T, Maragakis LL, Yokoe DS, Society for Healthcare Epidemiology of America (2014) Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35(7):753–771. https://doi.org/10.1086/676533

    Article  PubMed  Google Scholar 

  4. Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J, Wilcox M (2014) epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 86(Suppl 1):S1–S70. https://doi.org/10.1016/s0195-6701(13)60012-2

    Article  PubMed  Google Scholar 

  5. Bell T, O’Grady NP (2017) Prevention of central line-associated bloodstream infections. Infect Dis Clin North Am 31(3):551–559. https://doi.org/10.1016/j.idc.2017.05.007

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rupp ME, Karnatak R (2018) Intravascular catheter-related bloodstream infections. Infect Dis Clin North Am 32(4):765–787. https://doi.org/10.1016/j.idc.2018.06.002

    Article  PubMed  Google Scholar 

  7. Timsit JF, Rupp M, Bouza E, Chopra V, Karpanen T, Laupland K, Lisboa T, Mermel L, Mimoz O, Parienti JJ, Poulakou G, Souweine B, Zingg W (2018) A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill. Intensive Care Med 44(6):742–759. https://doi.org/10.1007/s00134-018-5212-y

    Article  PubMed  Google Scholar 

  8. Schneider A, Baldwin I, Souweine B (2018) What’s new: prevention of acute dialysis catheter-related infection. Intensive Care Med 44(3):356–358. https://doi.org/10.1007/s00134-017-4833-x

    Article  PubMed  Google Scholar 

  9. Mrozek N, Lautrette A, Timsit JF, Souweine B (2012) How to deal with dialysis catheters in the ICU setting. Ann Intensive Care 2(1):48. https://doi.org/10.1186/2110-5820-2-48

    Article  PubMed  PubMed Central  Google Scholar 

  10. Girardot T, Monard C, Rimmele T (2018) Dialysis catheters in the ICU: selection, insertion and maintenance. Curr Opin Crit Care 24(6):469–475. https://doi.org/10.1097/mcc.0000000000000543

    Article  PubMed  Google Scholar 

  11. Clark EG, Barsuk JH (2014) Temporary hemodialysis catheters: recent advances. Kidney Int 86(5):888–895. https://doi.org/10.1038/ki.2014.162

    Article  PubMed  PubMed Central  Google Scholar 

  12. Souweine B, Traore O, Aublet-Cuvelier B, Badrikian L, Bret L, Sirot J, Gazuy N, Laveran H, Deteix P (1999) Dialysis and central venous catheter infections in critically ill patients: results of a prospective study. Crit Care Med 27(11):2394–2398

    Article  CAS  Google Scholar 

  13. Harb A, Estphan G, Nitenberg G, Chachaty E, Raynard B, Blot F (2005) Indwelling time and risk of infection of dialysis catheters in critically ill cancer patients. Intensive Care Med 31(6):812–817. https://doi.org/10.1007/s00134-005-2621-5

    Article  PubMed  Google Scholar 

  14. Souweine B, Liotier J, Heng AE, Isnard M, Ackoundou-N’Guessan C, Deteix P, Traore O (2006) Catheter colonization in acute renal failure patients: comparison of central venous and dialysis catheters. Am J Kidney Dis 47(5):879–887. https://doi.org/10.1053/j.ajkd.2006.01.023

    Article  PubMed  Google Scholar 

  15. Timsit JF, Schwebel C, Bouadma L, Geffroy A, Garrouste-Orgeas M, Pease S, Herault MC, Haouache H, Calvino-Gunther S, Gestin B, Armand-Lefevre L, Leflon V, Chaplain C, Benali A, Francais A, Adrie C, Zahar JR, Thuong M, Arrault X, Croize J, Lucet JC, Dressing Study Group (2009) Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA 301(12):1231–1241. https://doi.org/10.1001/jama.2009.376

    Article  CAS  PubMed  Google Scholar 

  16. Timsit JF, Mimoz O, Mourvillier B, Souweine B, Garrouste-Orgeas M, Alfandari S, Plantefeve G, Bronchard R, Troche G, Gauzit R, Antona M, Canet E, Bohe J, Lepape A, Vesin A, Arrault X, Schwebel C, Adrie C, Zahar JR, Ruckly S, Tournegros C, Lucet JC (2012) Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med 186(12):1272–1278. https://doi.org/10.1164/rccm.201206-1038OC

    Article  CAS  PubMed  Google Scholar 

  17. Souweine B, Lautrette A, Gruson D, Canet E, Klouche K, Argaud L, Bohe J, Garrouste-Orgeas M, Mariat C, Vincent F, Cayot S, Cointault O, Lepape A, Guelon D, Darmon M, Vesin A, Caillot N, Schwebel C, Boyer A, Azoulay E, Bouadma L, Timsit JF (2015) Ethanol lock and risk of hemodialysis catheter infection in critically ill patients. A randomized controlled trial. Am J Respir Crit Care Med 191(9):1024–1032. https://doi.org/10.1164/rccm.201408-1431oc

    Article  PubMed  Google Scholar 

  18. Mimoz O, Lucet JC, Kerforne T, Pascal J, Souweine B, Goudet V, Mercat A, Bouadma L, Lasocki S, Alfandari S, Friggeri A, Wallet F, Allou N, Ruckly S, Balayn D, Lepape A, Timsit JF (2015) Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet 386(10008):2069–2077. https://doi.org/10.1016/s0140-6736(15)00244-5

    Article  CAS  PubMed  Google Scholar 

  19. Brun-Buisson C, Abrouk F, Legrand P, Huet Y, Larabi S, Rapin M (1987) Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med 147(5):873–877

    Article  CAS  Google Scholar 

  20. Sherertz RJ, Heard SO, Raad II (1997) Diagnosis of triple-lumen catheter infection: comparison of roll plate, sonication, and flushing methodologies. J Clin Microbiol 35(3):641–646

    Article  CAS  Google Scholar 

  21. Timsit JF (2005) Updating of the 12th consensus conference of the Societe de Reanimation de langue francaise (SRLF): catheter related infections in the intensive care unit. Ann Fr Anesth Reanim 24(3):315–322. https://doi.org/10.1016/j.annfar.2004.12.022

    Article  PubMed  Google Scholar 

  22. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 49(1):1–45. https://doi.org/10.1086/599376

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Blot F, Nitenberg G, Chachaty E, Raynard B, Germann N, Antoun S, Laplanche A, Brun-Buisson C, Tancrede C (1999) Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet 354(9184):1071–1077. https://doi.org/10.1016/s0140-6736(98)11134-0

    Article  CAS  PubMed  Google Scholar 

  24. Muller HG, Wang JL (1994) Hazard rate estimation under random censoring with varying kernels and bandwidths. Biometrics 50(1):61–76

    Article  CAS  Google Scholar 

  25. Maki DG, Kluger DM, Crnich 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(9):1159–1171. https://doi.org/10.4065/81.9.1159

    Article  PubMed  Google Scholar 

  26. Mermel LA (2011) What is the predominant source of intravascular catheter infections? Clin Infect Dis 52(2):211–212. https://doi.org/10.1093/cid/ciq108

    Article  PubMed  Google Scholar 

  27. 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(4 Pt 1):253–264

    Article  CAS  Google Scholar 

  28. Bouza E, Munoz P, Burillo A, Lopez-Rodriguez J, Fernandez-Perez C, Perez MJ, Rincon C, Cardiovascular Infection Study Group (2005) The challenge of anticipating catheter tip colonization in major heart surgery patients in the intensive care unit: are surface cultures useful? Critical Care Med 33(9):1953–1960

    Article  Google Scholar 

  29. Timsit JF, Bouadma L, Ruckly S, Schwebel C, Garrouste-Orgeas M, Bronchard R, Calvino-Gunther S, Laupland K, Adrie C, Thuong M, Herault MC, Pease S, Arrault X, Lucet JC (2012) Dressing disruption is a major risk factor for catheter-related infections. Crit Care Med 40(6):1707–1714. https://doi.org/10.1097/ccm.0b013e31824e0d46

    Article  PubMed  Google Scholar 

  30. Perez-Granda MJ, Barrio JM, Munoz P, Hortal J, Rincon C, Rabadan PM, Pernia MS, Bouza E (2014) Ethanol lock therapy (E-Lock) in the prevention of catheter-related bloodstream infections (CR-BSI) after major heart surgery (MHS): a randomized clinical trial. PLoS One 9(3):e91838. https://doi.org/10.1371/journal.pone.0091838

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Hermite L, Quenot JP, Nadji A, Barbar SD, Charles PE, Hamet M, Jacquiot N, Ghiringhelli F, Freysz M (2012) Sodium citrate versus saline catheter locks for non-tunneled hemodialysis central venous catheters in critically ill adults: a randomized controlled trial. Intensive Care Med 38(2):279–285. https://doi.org/10.1007/s00134-011-2422-y

    Article  CAS  PubMed  Google Scholar 

  32. Parienti JJ, Deryckere S, Megarbane B, Valette X, Seguin A, Sauneuf B, Mira JP, Souweine B, Cattoir V, Daubin C, du Cheyron D, Cathedia Study G (2014) Quasi-experimental study of sodium citrate locks and the risk of acute hemodialysis catheter infection among critically ill patients. Antimicrob Agents Chemother 58(10):5666–5672. https://doi.org/10.1128/aac.03079-14

    Article  PubMed  PubMed Central  Google Scholar 

  33. Rijnders BJ, Van Wijngaerden E, Peetermans WE (2002) Catheter-tip colonization as a surrogate end point in clinical studies on catheter-related bloodstream infection: how strong is the evidence? Clin Infect Dis 35(9):1053–1058. https://doi.org/10.1086/342905

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France

    Niccolò Buetti, Stéphane Ruckly, Jean-Christophe Lucet & Jean-François Timsit

  2. AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France

    Jean-Christophe Lucet

  3. Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, 86021, Poitiers, France

    Olivier Mimoz

  4. Université de Poitiers, Poitiers, France

    Olivier Mimoz

  5. Inserm U1070, Poitiers, France

    Olivier Mimoz

  6. Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France

    Bertrand Souweine

  7. Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France

    Jean-François Timsit

Authors
  1. Niccolò Buetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stéphane Ruckly
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean-Christophe Lucet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivier Mimoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bertrand Souweine
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean-François Timsit
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Ethics declarations

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.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study and whose decision-making capacity was intact.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 247 kb)

Supplementary material 2 (DOCX 29 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-019-05812-w

Keywords

Search

Navigation