Central venous catheter-related infection: does insertion site still matter? A French multicentric cohort study,Intensive Care Medicine

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Central venous catheter-related infection: does insertion site still matter? A French multicentric cohort study
Intensive Care Medicine ( IF 27.1 ) Pub Date : 2024-09-17 , DOI: 10.1007/s00134-024-07615-0
Vincent Cosme ₁ , Nicolas Massart ₁ , Florian Reizine ₂ , Anaïs Machut ₃ , Charles-Hervé Vacheron _{3,

4,

5} , Anne Savey _{3,

5} , Arnaud Friggeri _{3,

4,

5} , Alain Lepape _{3,

4,

5} ,

Affiliation

Purpose

We aim to evaluate the association between central venous catheter (CVC) insertion site and microbiological CVC complications in a nationwide cohort.

Methods

This study was conducted using the healthcare-associated infection surveillance cohort “REA-REZO” involving 193 intensive care units (ICUs). All CVC inserted and removed during the same ICU stay between January 1st 2018 and December 31st 2022 were eligible but only those whose tips were sent for microbiological analysis were included. Primary objective was to describe CVC insertion sites and subsequent catheter-related bloodstream infection (CRBSI).

Results

Out of 126,997 CVCs, 71,314 were not sent for tip culture, and only 55,663 CVCs were included, (30,548 in internal jugular [IJ], 14,423 in femoral and 10,692 in subclavian [SC] sites). The incidence of CRBSI was 0.7 [0.6–0.8] in the IJ site, 0.7 [0.6–0.9] in the femoral site, and 0.6 [0.4–0.7] CRBSI per 1000 CVC days in the SC site (p = 0.248). The multivariable Poisson regression model showed no differences of CRBSI incidence rates between the three insertion sites. Microorganisms observed in CRBSI were coagulase-negative Staphylococci (27.9%), Enterobacterales (27.5%), non-fermenting Gram-negative Bacilli (10.4%), Candida sp. (16.9%), and Staphylococcus aureus (16.9%).

Conclusion

Low CRBSI incidence rates were reported. CRBSI incidences rates were similar in the three insertion sites. Uncertainty remains due to potential selection bias since many CVCs had to be excluded.

中文翻译：

中心静脉导管相关感染：插入部位仍然重要吗？一项法国多中心队列研究

目的

我们旨在评估全国队列中中心静脉导管（CVC）插入部位与微生物学 CVC 并发症之间的关联。

方法

本研究是使用涉及 193 个重症监护病房（ICU）的医疗保健相关感染监测队列 “REA-REZO” 进行的。在 2018 年 1 月 1 日至 2022 年 12 月 31 日期间，在同一 ICU 住院期间插入和移除的所有 CVC 均符合条件，但仅包括那些尖端被送去进行微生物分析的 CVC。主要目的是描述 CVC 插入部位和随后的导管相关血流感染（CRBSI）。

结果

在 126,997 例 CVC 中，71,314 例未送去进行尖端培养，仅包括 55,663 例 CVC（颈内静脉 [IJ] 30,548 例，股骨 14,423 例和锁骨下 [SC] 部位 10,692 例）。IJ 部位的 CRBSI 发生率为 0.7 [0.6-0.8]，股骨部位为 0.7 [0.6-0.9]，SC 部位每 1000 个 CVC 天 0.6 [0.4-0.7] CRBSI （p = 0.248）。多变量泊松回归模型显示 3 个插入部位之间的 CRBSI 发生率没有差异。在 CRBSI 中观察到的微生物是凝固酶阴性葡萄球菌（27.9%）、肠杆菌属（27.5%）、非发酵革兰阴性杆菌（10.4%）、念珠菌属（16.9%）和金黄色葡萄球菌 （16.9%）。