IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France; Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland.
IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
Clin Microbiol Infect. 2023 Sep;29(9):1200.e1-1200.e5. doi: 10.1016/j.cmi.2023.05.025. Epub 2023 May 26.
We aimed to describe the infectious risk during the dwell time for different catheter types. Furthermore, we wanted to identify risk factors for infections from catheters in place for >10 days.
We performed a post hoc analysis using prospectively collected data from four randomized controlled trials. First, we evaluated the infectious risk after 10 days of analysing the significance of the interaction between dwell time and catheter type in a Cox model. Second, we investigated risk factors for infection in catheters in place for >10 days using multivariable marginal Cox models.
We included 15 036 intravascular catheters from 24 intensive care units. Infections occurred in 46 (0.7%) of 6298 arterial catheters (ACs), 62 (1.0%) of 6036 central venous catheters (CVCs) and 47 (1.7%) of 2702 short-term dialysis catheters (DCs). The interaction between dwell time beyond 10 days and catheter type was significant for CVCs (p 0.008) and DCs (p < 0.001), thus indicating an increased risk of infection after 10 days. The interaction was not significant for ACs (p 0.98). Therefore, we selected 1405 CVCs and 454 DCs in place for >10 days for further analyses. In the multivariable marginal Cox model, we observed an increased hazard ratio (HR) for infection for femoral CVC (HR, 6.33; 95% CI, 1.99-20.09), jugular CVC (HR, 2.82; 95% CI, 1.13-7.07), femoral DC (HR, 4.53; 95% CI, 1.54-13.33) and jugular DC (HR, 4.50; 95% CI, 1.42-14.21) compared with subclavian insertions.
We showed that the risk of catheter infection for CVCs and DCs increased 10 days after insertion, thus suggesting routine replacement for nonsubclavian catheters in situ for >10 days.
我们旨在描述不同类型导管留置期间的感染风险。此外，我们还希望确定导管留置时间超过 10 天时感染的危险因素。
我们使用四项随机对照试验前瞻性收集的数据进行了事后分析。首先，我们通过 Cox 模型分析留置时间和导管类型之间的交互作用，评估第 10 天后的感染风险。其次，我们使用多变量边际 Cox 模型研究导管留置时间超过 10 天时感染的危险因素。
我们纳入了 24 个重症监护病房的 15036 例血管内导管。6298 例动脉导管（AC）中有 46 例（0.7%）发生感染，6036 例中心静脉导管（CVC）中有 62 例（1.0%）发生感染，2702 例短期透析导管（DC）中有 47 例（1.7%）发生感染。留置时间超过 10 天与导管类型之间的交互作用对于 CVC（p=0.008）和 DC（p<0.001）有统计学意义，这表明超过 10 天后感染风险增加。AC 之间的交互作用无统计学意义（p=0.98）。因此，我们选择了留置时间超过 10 天的 1405 例 CVC 和 454 例 DC 进一步分析。在多变量边际 Cox 模型中，我们观察到股静脉 CVC（HR，6.33；95%CI，1.99-20.09）、颈内静脉 CVC（HR，2.82；95%CI，1.13-7.07）、股静脉 DC（HR，4.53；95%CI，1.54-13.33）和颈内静脉 DC（HR，4.50；95%CI，1.42-14.21）的感染风险比均升高。
我们发现，CVC 和 DC 的感染风险在导管插入后 10 天增加，因此建议对留置时间超过 10 天的非锁骨下导管常规更换。
