Log in | Register

A multicentre analysis of catheter-related infection based on a hierarchical model

J. F. Timsit| F. L‘Hériteau| A. Lepape| A. Francais| S. Ruckly| A. G. Venier| P. Jarno| S. Boussat| B. Coignard| A. Savey
Original
Volume 38, Issue 10 / October , 2012

Pages 1662 - 1672

Abstract

Purpose

To decrease intensive care unit (ICU)-acquired catheter-related infections (CRI), it is essential that healthcare workers receive training and that quality improvement programmes are in place. The aim of our study was to evaluate risk factors for catheter colonisation and infection, focussing specifically on local care bundles.

Methods

Data were collected prospectively in 51 ICUs [7,188 patients, 8,626 central venous catheters (CVCs)] during two 6-month periods in 2007 and 2008, using a standardized questionnaire on catheter insertion, care and removal. Colonisation and CRI incidence were 6.1 and 2.2/1,000 CVC-days, respectively. A hierarchical mixed logistic model was used to identify risk factors for CRI and colonisation.

Results

Written CVC protocols were available in 46 (90 %) ICUs and were strictly followed in 38 ICUs. Factors significantly associated with CRI fell into three overall categories: (1) patient-related factors—immunosuppression [odds ratio (OR) 1.42, p = 0.02], medical diagnosis at admission (OR 1.64, p = 0.03) and trauma patient (OR 2.54, p < 0.001); (2) catheter-related factors—catheter rank (OR 1.7, p < 0.0001, non-subclavian catheter (OR 2.1, p < 0.001) and longer time with the catheter (p < 10−4); (3) centre-related factors—quantitative tip culture method (OR 2.55, p = 0.005) and alcohol-based povidone-iodine [OR 0.68, 95 % confidence interval (CI) 0.49–0.96] or alcohol-based chlorhexidine preparations (OR 0.69, 95 % CI 0.34–1.39) as compared to an aqueous povidone-iodine preparation (p < 0.001).

Conclusions

We identified several risk factors for CRI that are amenable to improvement (preference for the subclavian route and use of an antiseptic solution containing alcohol). However, several patient-related factors were also found, and the use of quantitative catheter culture methods increased culture sensitivity, thereby increasing the CRI rate. Case-mix issues and the culture method should be taken into account when assessing the risk of CRI across centres.

Keywords

References

  1. Warren DK, Zack JE, Elward AM, Cox MJ, Fraser VJ (2001) Nosocomial primary bloodstream infections in intensive care unit patients in a nonteaching community medical center: a 21-month prospective study. Clin Infect Dis 33:1329–1335
    • View reference on PubMed
    • View reference on publisher's website
  2. 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 24:315–322
    • View reference on PubMed
    • View reference on publisher's website
  3. Timsit JF (2007) Diagnosis and prevention of catheter-related infections. Curr Opin Crit Care 13:563–571
    • View reference on PubMed
    • View reference on publisher's website
  4. Gastmeier P, Geffers C (2006) Prevention of catheter-related bloodstream infections: analysis of studies published between 2002 and 2005. J Hosp Infect 64:326–335
    • View reference on PubMed
    • View reference on publisher's website
  5. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732
    • View reference on PubMed
    • View reference on publisher's website
  6. Timsit JF, Dubois Y, Minet C, Bonadona A, Lugosi M, Ara-Somohano C, Hamidfar-Roy R, Schwebel C (2011) New materials and devices for preventing catheter-related infections. Ann Intensive Care 1:34
    • View reference on PubMed
    • View reference on publisher's website
  7. Desenclos JC (2009) RAISIN—a national programme for early warning, investigation and surveillance of healthcare-associated infection in France. Euro Surveill 14(46)
  8. Hansen S, Schwab F, Behnke M, Carsauw H, Heczko P, Klavs I, Lyytikainen O, Palomar M, Riesenfeld Orn I, Savey A, Szilagyi E, Valinteliene R, Fabry J, Gastmeier P (2009) National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project. J Hosp Infect 71:66–73
    • View reference on PubMed
    • View reference on publisher's website
  9. ECDC (2010) European surveillance of healthcare-associated infections in intensive care units—HAIICU Protocol v1.01. Available at: http://www.ecdc.europa.eu/en/aboutus/calls/Procurement%20Related%20Documents/5_ECDC_HAIICU_protocol_v1_1.pdf
  10. Blakely TA, Woodward AJ (2000) Ecological effects in multi-level studies. J Epidemiol Community Health 54:367–374
    • View reference on PubMed
    • View reference on publisher's website
  11. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, Dudeck MA, Pollock DA, Horan TC (2009) National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 37:783–805
    • View reference on PubMed
    • View reference on publisher's website
  12. Lucet JC, Boudama L, Zahar JR, Schwebel C, Geffory A, Pease S, Herault MC, Haouache H, Adrie C, Thuong M, Francais A, Garrouste-Orgeas M, Timsit JF (2010) Infectious risk associated with arterial catheters compared to central venous catheters. Crit Care Med 38:552–559
    • View reference on publisher's website
  13. 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 (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52:e162–e193
    • View reference on PubMed
    • View reference on publisher's website
  14. Badley AD, Steckelberg JM, Wollan PC, Thompson RL (1996) Infectious rates of central venous pressure catheters: comparison between newly placed catheters and those that have been changed. Mayo Clin Proc 71:838–846
    • View reference on PubMed
    • View reference on publisher's website
  15. L’Heriteau F, Olivier M, Maugat S, Joly C, Merrer J, Thaler F, Grandbastien B, Beaucaire G, Astagneau P (2007) Impact of a five-year surveillance of central venous catheter infections in the REACAT intensive care unit network in France. J Hosp Infect 66:123–129
    • View reference on PubMed
    • View reference on publisher's website
  16. Timsit JF, Sebille V, Farkas JC, Misset B, Martin JB, Chevret S, Carlet J (1996) Effect of subcutaneous tunneling on internal jugular catheter-related sepsis in critically ill patients: a prospective randomized multicenter study. JAMA 276:1416–1420
    • View reference on PubMed
    • View reference on publisher's website
  17. Vandecasteele SJ, Van Eldere J, Merckx R, Peetermans WE (2004) The effect of systemic antibiotics on the microbiological diagnosis of experimental foreign body infections caused by Staphylococcus epidermidis. Diagn Microbiol Infect Dis 48:89–95
    • View reference on PubMed
    • View reference on publisher's website
  18. Souweine B, Heng AE, Aumeran C, Thiolliere F, Gazuy N, Deteix P, Traore O (2008) Do antibiotics administered at the time of central venous catheter removal interfere with the evaluation of colonization? Intensive Care Med 34:286–291
  19. 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 49:1–45
    • View reference on PubMed
    • View reference on publisher's website
  20. Zahar JR, Timsit JF, Garrouste-Orgeas M, Francais A, Vesin A, Descorps-Declere A, Dubois Y, Souweine B, Haouache H, Goldgran-Toledano D, Allaouchiche B, Azoulay E, Adrie C (2011) Outcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality. Crit Care Med 39:1886–1895
    • View reference on PubMed
    • View reference on publisher's website
  21. Timsit JF, Schwebel C, Bouadma L, Geffroy A, Garrouste-Orgeas M, Pease S, Herault MC, Haouache H, Calvino-Gunther S, Gestin B, Armand-Lefevre L, Leflon V, Chaplain C, Benali A, Francais A, Adrie C, Zahar JR, Thuong M, Arrault X, Croize J, Lucet JC (2009) Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA 301:1231–1241
    • View reference on PubMed
    • View reference on publisher's website
  22. Rijnders BJ, Van Wijngaerden E, Peetermans WE (2002) Catheter-tip colonization as a surrogate end point in clinical studies on catheter-related bloodstream infection: how strong is the evidence? Clin Infect Dis 35:1053–1058
    • View reference on PubMed
    • View reference on publisher's website
  23. Timsit JF, Lugosi M, Minet C, Schwebel C (2011) Should we still need to systematically perform catheter culture in the intensive care unit? Crit Care Med 39:1556–1558
    • View reference on PubMed
    • View reference on publisher's website
  24. Siegman-Igra Y, Anglim AM, Shapiro DE, Adal KA, Strain BA, Farr BM (1997) Diagnosis of vascular catheter-related bloodstream infection: a meta-analysis. J Clin Microbiol 35:928–936
    • View reference on PubMed
  25. Bouza E, Alvarado N, Alcala L, Sanchez-Conde M, Perez MJ, Munoz P, Martin-Rabadan P, Rodriguez-Creixems M (2005) A prospective, randomized, and comparative study of 3 different methods for the diagnosis of intravascular catheter colonization. Clin Infect Dis 40:1096–1100
    • View reference on PubMed
    • View reference on publisher's website
  26. Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S (2002) Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 136:792–801
    • View reference on PubMed
  27. Parienti JJ, du Cheyron D, Ramakers M, Malbruny B, Leclercq R, Le Coutour X, Charbonneau P (2004) Alcoholic povidone-iodine to prevent central venous catheter colonization: a randomized unit-crossover study. Crit Care Med 32:708–713
    • View reference on PubMed
    • View reference on publisher's website
  28. Mimoz O, Villeminey S, Ragot S, Dahyot-Fizelier C, Laksiri L, Petitpas F, Debaene B (2007) Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for central venous catheter care. Arch Intern Med 167:2066–2072
    • View reference on PubMed
    • View reference on publisher's website
  29. Edmiston CE Jr, Seabrook GR, Johnson CP, Paulson DS, Beausoleil CM (2007) Comparative of a new and innovative 2 % chlorhexidine gluconate-impregnated cloth with 4 % chlorhexidine gluconate as topical antiseptic for preparation of the skin prior to surgery. Am J Infect Control 35:89–96
    • View reference on PubMed
    • View reference on publisher's website
  30. Timsit JF (2000) Scheduled replacement of central venous catheters is not necessary. Infect Control Hosp Epidemiol 21:371–374
    • View reference on PubMed
    • View reference on publisher's website
  31. Safdar N, Kluger DM, Maki DG (2002) A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies. Medicine (Baltimore) 81:466–479
    • View reference on publisher's website
  32. Deshpande KS, Hatem C, Ulrich HL, Currie BP, Aldrich TK, Bryan-Brown CW, Kvetan V (2005) The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 33:13–20 (Discussion 234–235)
    • View reference on PubMed
    • View reference on publisher's website
  33. Goetz AM, Wagener MM, Miller JM, Muder RR (1998) Risk of infection due to central venous catheters: effect of site of placement and catheter type. Infect Control Hosp Epidemiol 19:842–845
    • View reference on PubMed
    • View reference on publisher's website
  34. Parienti JJ, Thirion M, Megarbane B, Souweine B, Ouchikhe A, Polito A, Forel JM, Marque S, Misset B, Airapetian N, Daurel C, Mira JP, Ramakers M, du Cheyron D, Le Coutour X, Daubin C, Charbonneau P (2008) Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA 299:2413–2422
    • View reference on PubMed
    • View reference on publisher's website
  35. Lorente L, Henry C, Martin MM, Jimenez A, Mora ML (2005) Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Crit Care 9:R631–R635
    • View reference on PubMed
    • View reference on publisher's website
  36. Lorente L, Jimenez A, Garcia C, Galvan R, Castedo J, Martin MM, Mora ML (2008) Catheter-related bacteremia from femoral and central internal jugular venous access. Eur J Clin Microbiol Infect Dis 27:867–871
    • View reference on PubMed
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement