Obesity and risk of catheter-related infections in the ICU. A post hoc analysis of four large randomized controlled trials.
BMI
Catheter-related bloodstream infections
Catheter-related infections
Intravascular catheter infections
Obesity
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
16
10
2020
accepted:
10
12
2020
pubmed:
2
2
2021
medline:
1
6
2021
entrez:
1
2
2021
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 33521871
doi: 10.1007/s00134-020-06336-4
pii: 10.1007/s00134-020-06336-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
435-443Subventions
Organisme : Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (CH)
ID : P400PM_183865
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Références
WHO (2020) Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight . Last accessed 8 Sept 2020
Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, Romundstad P, Vatten LJ (2016) BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 353:2156. https://doi.org/10.1136/bmj.i2156
doi: 10.1136/bmj.i2156
Falagas ME, Kompoti M (2006) Obesity and infection. Lancet Infect Dis 6(7):438–446. https://doi.org/10.1016/S1473-3099(06)70523-0
doi: 10.1016/S1473-3099(06)70523-0
pubmed: 16790384
Tsai AG, Wadden TA (2013) In the clinic: obesity. Ann Intern Med 159(5):ITC3-1-ITC3-15. https://doi.org/10.7326/0003-4819-159-5-201309030-01003
doi: 10.7326/0003-4819-159-5-201309030-01003
Waisbren E, Rosen H, Bader AM, Lipsitz SR, Rogers SO Jr, Eriksson E (2010) Percent body fat and prediction of surgical site infection. J Am Coll Surg 210(4):381–389. https://doi.org/10.1016/j.jamcollsurg.2010.01.004
doi: 10.1016/j.jamcollsurg.2010.01.004
pubmed: 20347729
Serrano PE, Khuder SA, Fath JJ (2010) Obesity as a risk factor for nosocomial infections in trauma patients. J Am Coll Surg 211(1):61–67. https://doi.org/10.1016/j.jamcollsurg.2010.03.002
doi: 10.1016/j.jamcollsurg.2010.03.002
pubmed: 20610250
Kaye KS, Marchaim D, Chen TY, Chopra T, Anderson DJ, Choi Y, Sloane R, Schmader KE (2011) Predictors of nosocomial bloodstream infections in older adults. J Am Geriatr Soc 59(4):622–627. https://doi.org/10.1111/j.1532-5415.2010.03289.x
doi: 10.1111/j.1532-5415.2010.03289.x
pubmed: 21366545
Bochicchio GV, Joshi M, Bochicchio K, Nehman S, Tracy JK, Scalea TM (2006) Impact of obesity in the critically ill trauma patient: a prospective study. J Am Coll Surg 203(4):533–538. https://doi.org/10.1016/j.jamcollsurg.2006.07.001
doi: 10.1016/j.jamcollsurg.2006.07.001
pubmed: 17000398
Pepin JL, Timsit JF, Tamisier R, Borel JC, Levy P, Jaber S (2016) Prevention and care of respiratory failure in obese patients. Lancet Respir Med 4(5):407–418. https://doi.org/10.1016/S2213-2600(16)00054-0
doi: 10.1016/S2213-2600(16)00054-0
pubmed: 27304558
Dossett LA, Dageforde LA, Swenson BR, Metzger R, Bonatti H, Sawyer RG, May AK (2009) Obesity and site-specific nosocomial infection risk in the intensive care unit. Surg Infect 10(2):137–142. https://doi.org/10.1089/sur.2008.028
doi: 10.1089/sur.2008.028
Tsolakoglou I, Intas G, Stergiannis P, Sakkou A, Chalari E, Tsoumakas K, Elefsiniotis I, Fildissis G (2020) Central-line-associated bloodstream infections (CLABSIs) incidence and the role of obesity: a prospective, observational study in Greece. Adv Exp Med Biol 1196:11–18. https://doi.org/10.1007/978-3-030-32637-1_2
doi: 10.1007/978-3-030-32637-1_2
pubmed: 32468303
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
doi: 10.1164/rccm.201206-1038OC
pubmed: 23043083
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
doi: 10.1164/rccm.201408-1431OC
pubmed: 25668557
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, CLEAN trial investigators (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
doi: 10.1016/S0140-6736(15)00244-5
pubmed: 26388532
Parienti JJ, Mongardon N, Megarbane B, Mira JP, Kalfon P, Gros A, Marque S, Thuong M, Pottier V, Ramakers M, Savary B, Seguin A, Valette X, Terzi N, Sauneuf B, Cattoir V, Mermel LA, du Cheyron D, 3SITES Study Group (2015) Intravascular complications of central venous catheterization by insertion site. N Eng J Med 373(13):1220–1229. https://doi.org/10.1056/NEJMoa1500964
doi: 10.1056/NEJMoa1500964
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 Committee (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis Off Publ Infect Dis Soc Am 52(9):e162-193. https://doi.org/10.1093/cid/cir257
doi: 10.1093/cid/cir257
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
doi: 10.1016/j.annfar.2004.12.022
pubmed: 15792575
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
doi: 10.1086/599376
pubmed: 19489710
pmcid: 4039170
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
doi: 10.1001/archinte.1987.00370050069012
de Grooth HJ, Timsit JF, Mermel L, Mimoz O, Buetti N, du Cheyron D, Oudemans-van Straaten HM, Parienti JJ, Sites C, Groups D (2020) Validity of surrogate endpoints assessing central venous catheter-related infection: evidence from individual- and study-level analyses. Clin Microbiol Infect Off Publi Eur Soc Clin Microbiol Infect Dis 26(5):563–571. https://doi.org/10.1016/j.cmi.2019.09.022
doi: 10.1016/j.cmi.2019.09.022
Lee E, Wei L, Amato D (1992) Cox-type regression analysis for large numbers of small groups of correlated failure time observations. In: Klein J, Goel PK (eds) Survival analysis: state of the art: Nato asi series. Kluwer Academic, The Netherlands, pp 237–247
doi: 10.1007/978-94-015-7983-4_14
Lawrence VJ, Kopelman PG (2004) Medical consequences of obesity. Clin Dermatol 22(4):296–302. https://doi.org/10.1016/j.clindermatol.2004.01.012
doi: 10.1016/j.clindermatol.2004.01.012
pubmed: 15475229
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
doi: 10.1097/CCM.0b013e31824e0d46
pubmed: 22488003
pmcid: 22488003
Buetti N, Ruckly S, Lucet JC, Mimoz O, Souweine B, Timsit JF (2019) 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(12):1774–1782. https://doi.org/10.1007/s00134-019-05812-w
doi: 10.1007/s00134-019-05812-w
pubmed: 31624854
Buetti N, Ruckly S, Schwebel C, Mimoz O, Souweine B, Lucet JC, Timsit JF (2020) Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for short-term intravascular catheters: which one is better? Crit Care 24(1):458. https://doi.org/10.1186/s13054-020-03174-0
doi: 10.1186/s13054-020-03174-0
pubmed: 32703235
pmcid: 7376730
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 A (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
doi: 10.1086/676533
pubmed: 24915204
Buetti N, Tabah A, Timsit JF, Zingg W (2020) What is new in catheter use and catheter infection prevention in the ICU. Curr Opin Crit Care 26(5):459–465. https://doi.org/10.1097/MCC.0000000000000754
doi: 10.1097/MCC.0000000000000754
pubmed: 32773616