Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials.

Catheter-Related Infections / epidemiology Catheterization, Central Venous / adverse effects Central Venous Catheters / adverse effects Cohort Studies Humans Prospective Studies Randomized Controlled Trials as Topic Renal Dialysis Retrospective Studies
Catheter-related infection Catheter-tip colonization Central Venous catheters Intensive care unit Predictive score

Journal

Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902

Informations de publication

Date de publication:
07 07 2022
Historique:
received: 16 05 2022
accepted: 30 06 2022
entrez: 7 7 2022
pubmed: 8 7 2022
medline: 12 7 2022
Statut: epublish

Résumé

The majority of central venous catheters (CVC) removed in the ICU are not colonized, including when a catheter-related infection (CRI) is suspected. We developed and validated a predictive score to reduce unnecessary CVC removal. We conducted a retrospective cohort study from five multicenter randomized controlled trials with systematic catheter-tip culture of consecutive CVCs. Colonization was defined as growth of ≥10 In the training cohort, obesity (1 point), diabetes (1 point), type of CVC (dialysis catheter, 1 point), anatomical insertion site (jugular, 4 points; femoral 5 points), rank of the catheter (second or subsequent, 1 point) and catheterization duration (≥ 5 days, 2 points) were significantly and independently associated with colonization . Area under the ROC curve (AUC) for the CVC-OUT score was 0.69, 95% confidence interval (CI) [0.67-0.72]. In the testing cohort, AUC for the CVC-OUT score was 0.60, 95% CI [0.58-0.62]. Among 1,469 CVCs removed for suspected CRI in the overall population, 1200 (82%) were not colonized. The negative predictive value (NPV) of a CVC-OUT score < 6 points was 94%, 95% CI [93%-95%]. The CVC-OUT score had a moderate ability to discriminate catheter-tip colonization, but the high NPV may contribute to reduce unnecessary CVCs removal. Preference of the subclavian site is the strongest and only modifiable risk factor that reduces the likelihood of catheter-tip colonization and consequently the risk of CRI. NCT00277888, NCT01479153, NCT01629550, NCT01189682, NCT00875069.

Sections du résumé

BACKGROUND
The majority of central venous catheters (CVC) removed in the ICU are not colonized, including when a catheter-related infection (CRI) is suspected. We developed and validated a predictive score to reduce unnecessary CVC removal.
METHODS
We conducted a retrospective cohort study from five multicenter randomized controlled trials with systematic catheter-tip culture of consecutive CVCs. Colonization was defined as growth of ≥10
RESULTS
In the training cohort, obesity (1 point), diabetes (1 point), type of CVC (dialysis catheter, 1 point), anatomical insertion site (jugular, 4 points; femoral 5 points), rank of the catheter (second or subsequent, 1 point) and catheterization duration (≥ 5 days, 2 points) were significantly and independently associated with colonization . Area under the ROC curve (AUC) for the CVC-OUT score was 0.69, 95% confidence interval (CI) [0.67-0.72]. In the testing cohort, AUC for the CVC-OUT score was 0.60, 95% CI [0.58-0.62]. Among 1,469 CVCs removed for suspected CRI in the overall population, 1200 (82%) were not colonized. The negative predictive value (NPV) of a CVC-OUT score < 6 points was 94%, 95% CI [93%-95%].
CONCLUSION
The CVC-OUT score had a moderate ability to discriminate catheter-tip colonization, but the high NPV may contribute to reduce unnecessary CVCs removal. Preference of the subclavian site is the strongest and only modifiable risk factor that reduces the likelihood of catheter-tip colonization and consequently the risk of CRI.
CLINICAL TRIALS REGISTRATION
NCT00277888, NCT01479153, NCT01629550, NCT01189682, NCT00875069.

Identifiants

DOI: 10.1186/s13054-022-04078-x PMID: 35799302 PMC: PMC9261073
pubmed: 35799302
doi: 10.1186/s13054-022-04078-x
pii: 10.1186/s13054-022-04078-x
pmc: PMC9261073
doi:

Banques de données

ClinicalTrials.gov
['NCT00277888', 'NCT01479153', 'NCT01629550', 'NCT01189682', 'NCT00875069']

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

205

Informations de copyright

© 2022. The Author(s).

Références

Clin Microbiol Infect. 2020 May;26(5):563-571
pubmed: 31586658
Crit Care. 2011;15(2):R100
pubmed: 21418635
Intensive Care Med. 2004 Jun;30(6):1073-80
pubmed: 14999442
Clin Infect Dis. 2005 Dec 1;41(11):1591-8
pubmed: 16267731
J Antimicrob Chemother. 2020 Oct 1;75(10):3056-3061
pubmed: 32688386
Surg Infect (Larchmt). 2009 Apr;10(2):137-42
pubmed: 19388836
JAMA. 2008 May 28;299(20):2413-22
pubmed: 18505951
Ann Intensive Care. 2020 Sep 7;10(1):118
pubmed: 32894389
Intensive Care Med. 2021 Apr;47(4):435-443
pubmed: 33521871
Ann Intensive Care. 2022 May 7;12(1):38
pubmed: 35524924
Crit Care. 2020 Dec 14;24(1):694
pubmed: 33317594
Lancet Infect Dis. 2016 Jun;16(6):724-734
pubmed: 26907734
Intensive Care Med. 2008 Feb;34(2):286-91
pubmed: 17882399
Stat Med. 2004 May 30;23(10):1631-60
pubmed: 15122742
Intensive Care Med. 2012 Oct;38(10):1662-72
pubmed: 22797354
Kidney Int Suppl (2011). 2012 Mar;2(1):89-115
pubmed: 25018921
Lancet Infect Dis. 2002 Nov;2(11):677-85
pubmed: 12409048
Intensive Care Med. 2018 Jun;44(6):742-759
pubmed: 29754308
Intensive Care Med. 2004 Jan;30(1):62-7
pubmed: 14647886
Lancet. 2015 Nov 21;386(10008):2069-2077
pubmed: 26388532
Infect Control Hosp Epidemiol. 1994 Apr;15(4 Pt 1):253-64
pubmed: 8207192
Intensive Care Med. 2018 Mar;44(3):356-358
pubmed: 28523404
Infect Control Hosp Epidemiol. 2022 Apr 19;:1-17
pubmed: 35437133
Intensive Care Med. 2016 Sep;42(9):1418-26
pubmed: 27311311
Clin Infect Dis. 2021 Sep 7;73(5):e1054-e1061
pubmed: 33277646
J Clin Epidemiol. 2015 Feb;68(2):134-43
pubmed: 25579640
Am J Respir Crit Care Med. 2015 May 1;191(9):1024-32
pubmed: 25668557
Crit Care. 2014 Oct 17;18(5):564
pubmed: 25514404
N Engl J Med. 2015 Sep 24;373(13):1220-9
pubmed: 26398070
Arch Intern Med. 1987 May;147(5):873-7
pubmed: 3555377
Medicine (Baltimore). 2018 Oct;97(42):e12782
pubmed: 30334966
Am J Respir Crit Care Med. 2012 Dec 15;186(12):1272-8
pubmed: 23043083
Clin Infect Dis. 2009 Jul 1;49(1):1-45
pubmed: 19489710
Clin Infect Dis. 2002 Nov 1;35(9):1053-8
pubmed: 12384838
BMJ Open. 2018 Dec 22;8(12):e023824
pubmed: 30580270
Crit Care Med. 2002 Dec;30(12):2632-5
pubmed: 12483050
Infection. 2015 Feb;43(1):29-36
pubmed: 25331552
Arch Intern Med. 2002 Jan 14;162(1):25-32
pubmed: 11784216
Intensive Care Med. 2016 Nov;42(11):1753-1765
pubmed: 27734108

Auteurs

Jeanne Iachkine (J)

Department of Clinical Research and Biostatistics, Caen University Hospital and Caen Normandy University, Caen, France.
INSERM U1311 DynaMicURe, Caen Normandy University, Caen, France.

Niccolò Buetti (N)

Infection Control Program and World Health Organization Collaborating Center On Patient Safety, Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Harm-Jan de Grooth (HJ)

Department of Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.

Anaïs R Briant (AR)

Department of Biostatistics and Clinical Research, Caen University Hospital, Avenue de La Côte de Nacre, 30001, F-14000, Caen, CS, France.

Olivier Mimoz (O)

Inserm U1070, Poitiers University, Poitiers University Hospital, 86021, Poitiers, France.

Bruno Mégarbane (B)

Medical and Toxicological Intensive Care Unit, Lariboisière Hospital, AP-HP, INSERM UMRS-1144, Paris University, Paris, France.

Jean-Paul Mira (JP)

Medical ICU, Cochin Hospital, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.

Stéphane Ruckly (S)

ICURESEARCH, Paris, France.

Bertrand Souweine (B)

Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France.

Damien du Cheyron (D)

Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France.

Leonard A Mermel (LA)

Department of Epidemiology and Infection Prevention, Lifespan Hospital System, Providence, Rhode Island, USA.
Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.

Jean-François Timsit (JF)

Medical and Infectious Diseases ICU (MI2), Bichat Hospital, AP-HP, IAME, INSERM, University of Paris, U1137, Paris, France.

Jean-Jacques Parienti (JJ)

Department of Clinical Research and Biostatistics, Caen University Hospital and Caen Normandy University, Caen, France. parienti-jj@chu-caen.fr.
INSERM U1311 DynaMicURe, Caen Normandy University, Caen, France. parienti-jj@chu-caen.fr.

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questionsmedicales.fr › Infection › Infections sur cathéters › Development and validation of a multivariable...
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