University of Paris, INSERM, IAME, 75006, Paris, France.
Infection Control Program and World Health Organization Collaborating Centre On Patient Safety, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Intensive Care Med. 2021 Apr;47(4):435-443. doi: 10.1007/s00134-020-06336-4. Epub 2021 Feb 1.
Obesity increases the risk of nosocomial infection, but data regarding the role of body mass index (BMI) in catheter related infections are scarce. We used the data gathered from four randomized, controlled trials (RCTs) to investigate the association between body mass index (BMI) and intravascular catheter infections in critically ill obese patients.
Adult obese patients who required short-term central venous, arterial or dialysis catheter insertion in the intensive care unit (ICU) were analyzed. The association between BMI and major catheter-related infection (MCRI), catheter-related bloodstream infection (CRBSI) and catheter tip colonization was estimated using univariate and multivariate marginal Cox models. Exploratory analysis using dressing disruptions was added.
A total of 2282 obese patients and 4275 catheters from 32 centers were included in this post-hoc analysis. Overall, 66 (1.5%) MCRI, 43 (1%) CRBSI and 399 (9.3%) catheter colonizations were identified. The hazard ratio (HR) for MCRI, CRBSI and colonization increased with BMI. After adjustment for well-known infection risk factors, the BMI ≥ 40 group had an increased risk for MCRI (HR 1.88, 95% CI 1.13-3.12, p = 0.015), CRBSI (HR 2.19, 95% CI 1.19-4.04, p = 0.012) and colonization (HR 1.44, 95% CI 1.12-1.84, p = 0.0038) compared to the BMI < 40 group. The mean dressing disruption per catheter was increased in the BMI ≥ 40 group (2.03 versus 1.68 in the BMI < 40 group, p = 0.05).
Using the largest dataset ever collected from large multicentric RCTs, we showed that patients with BMI ≥ 40 had an increased risk for intravascular catheter infections. Targeted prevention measures should focus on this population with a particular attention to catheter care and dressing disruption.
肥胖会增加医院感染的风险，但关于体重指数（BMI）在导管相关感染中的作用的数据却很少。我们使用来自四项随机对照试验（RCT）的数据来研究体重指数（BMI）与重症肥胖患者血管内导管感染之间的关系。
分析了在重症监护病房（ICU）需要短期中心静脉、动脉或透析导管插入的成年肥胖患者。使用单变量和多变量边际 Cox 模型估计 BMI 与主要导管相关感染（MCRI）、导管相关血流感染（CRBSI）和导管尖端定植之间的关系。使用敷料破损进行了探索性分析。
这项事后分析共纳入了来自 32 个中心的 2282 名肥胖患者和 4275 根导管。总的来说，确定了 66 例（1.5%）MCRI、43 例（1%）CRBSI 和 399 例（9.3%）导管定植。MCRI、CRBSI 和定植的风险比（HR）随 BMI 增加而增加。在调整了已知的感染危险因素后，BMI≥40 组发生 MCRI（HR 1.88，95%CI 1.13-3.12，p=0.015）、CRBSI（HR 2.19，95%CI 1.19-4.04，p=0.012）和定植（HR 1.44，95%CI 1.12-1.84，p=0.0038）的风险高于 BMI<40 组。BMI≥40 组的平均每根导管敷料破损次数增加（BMI<40 组为 2.03 次，BMI≥40 组为 2.03 次，p=0.05）。
使用来自大型多中心 RCT 的最大数据集，我们表明 BMI≥40 的患者血管内导管感染风险增加。有针对性的预防措施应针对这一人群，特别注意导管护理和敷料破损。
