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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
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Edité par CCSD ; Springer Verlag -
International audience. 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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