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Buetti N, Zahar JR, Adda M, Ruckly S, Bruel C, Schwebel C, Darmon M, Adrie C, Cohen Y, Siami S, Laurent V, Souweine B, Timsit JF. Treatment of positive catheter tip culture without bloodstream infections in critically ill patients. A case-cohort study from the OUTCOMEREA network. Intensive Care Med 2024; 50:1108-1118. [PMID: 38913096 PMCID: PMC11245435 DOI: 10.1007/s00134-024-07498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE This study aimed to evaluate the impact on subsequent infections and mortality of an adequate antimicrobial therapy within 48 h after catheter removal in intensive care unit (ICU) patients with positive catheter tip culture. METHODS We performed a retrospective analysis of prospectively collected data from 29 centers of the OUTCOMEREA network. We developed a propensity score (PS) for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a 1:1 case-cohort study matched on the PS score of being adequately treated. A PS-matched subdistribution hazard model was used for detecting subsequent infections and a PS-matched Cox model was used to evaluate the impact of antibiotic therapy on mortality. RESULTS We included 427 patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched 150 patients with an adequate antimicrobial therapy with 150 controls. In the matched population, 30 (10%) subsequent infections were observed and 62 patients died within 30 days. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day-30 was similar between treated and non-treated groups (subdistribution hazard ratio [sHR] 1.08, 95% confidence interval [CI] 0.62-1.89, p = 0.78). Using Cox proportional hazard models, the 30-day mortality risk was similar between treated and non-treated groups (HR 0.89, 95% CI 0.45-1.74, p = 0.73). CONCLUSIONS Antimicrobial therapy was not associated with decreased risk of subsequent infection or death in short-term catheter tip colonization in critically ill patients. Antibiotics may be unnecessary for positive catheter tip cultures.
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Affiliation(s)
- Niccolò Buetti
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France.
- Infection Control Program and WHO Collaborating Centre, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Jean-Ralph Zahar
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- Département de Microbiologie Clinique, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Mireille Adda
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Stéphane Ruckly
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- OUTCOMEREA Network, 93700, Drancy, France
| | - Cédric Bruel
- Medical and Surgical Intensive Care Unit, Paris Saint-Joseph Hospital Network, 75014, Paris, France
| | - Carole Schwebel
- Medical Intensive Care Unit, University Hospital, Grenoble-Alpes, 38000, Grenoble, France
| | - Michael Darmon
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Université Paris Cité, Paris, France
| | - Christophe Adrie
- Réanimation Polyvalente, Centre Hospitalier Delafontaine, Saint-Denis, France
| | - Yves Cohen
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Shidasp Siami
- Réanimation Polyvalente, Centre Hospitalier Sud Essonne-Etampes, Etampes, France
| | - Virginie Laurent
- Polyvalent Intensive Care Unit, André Mignot Hospital, 78150, Le Chesnay, France
| | - Bertrand Souweine
- CHU Clermont-Ferrand, Service de Médecine Intensive et Réanimation, Clermont-Ferrand, France
| | - Jean-François Timsit
- Université Paris Cité Inserm IAME 1137, 75018, Paris, France
- OUTCOMEREA Network, 93700, Drancy, France
- Medical and Infectious Diseases Intensive Care Unit, Bichat Hospital, AP-HP, Paris Cité University, 46 rue Henri Huchard, 75018, Paris, France
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2
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Benichou N, Lebbah S, Hajage D, Martin-Lefèvre L, Pons B, Boulet E, Boyer A, Chevrel G, Lerolle N, Carpentier D, de Prost N, Lautrette A, Bretagnol A, Mayaux J, Nseir S, Megarbane B, Thirion M, Forel JM, Maizel J, Yonis H, Markowicz P, Thiery G, Schortgen F, Tubach F, Ricard JD, Dreyfuss D, Gaudry S. Vascular access for renal replacement therapy among 459 critically ill patients: a pragmatic analysis of the randomized AKIKI trial. Ann Intensive Care 2021; 11:56. [PMID: 33830370 PMCID: PMC8032839 DOI: 10.1186/s13613-021-00843-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vascular access for renal replacement therapy (RRT) is routine question in the intensive care unit. Randomized trials comparing jugular and femoral sites have shown similar rate of nosocomial events and catheter dysfunction. However, recent prospective observational data on RRT catheters use are scarce. We aimed to assess the site of RRT catheter, the reasons for catheter replacement, and the complications according to site in a large population of critically ill patients with acute kidney injury. PATIENTS AND METHODS We performed an ancillary study of the AKIKI study, a pragmatic randomized controlled trial, in which patients with severe acute kidney injury (KDIGO 3 classification) with invasive mechanical ventilation, catecholamine infusion or both were randomly assigned to either an early or a delayed RRT initiation strategy. The present study involved all patients who underwent at least one RRT session. Number of RRT catheters, insertion sites, factors potentially associated with the choice of insertion site, duration of catheter use, reason for catheter replacement, and complications were prospectively collected. RESULTS Among the 619 patients included in AKIKI, 462 received RRT and 459 were finally included, with 598 RRT catheters. Femoral site was chosen preferentially (n = 319, 53%), followed by jugular (n = 256, 43%) and subclavian (n = 23, 4%). In multivariate analysis, continuous RRT modality was significantly associated with femoral site (OR = 2.33 (95% CI (1.34-4.07), p = 0.003) and higher weight with jugular site [88.9 vs 83.2 kg, OR = 0.99 (95% CI 0.98-1.00), p = 0.03]. Investigator site was also significantly associated with the choice of insertion site (p = 0.03). Cumulative incidence of catheter replacement did not differ between jugular and femoral site [sHR 0.90 (95% CI 0.64-1.25), p = 0.67]. Catheter dysfunction was the main reason for replacement (n = 47), followed by suspected infection (n = 29) which was actually seldom proven (n = 4). No mechanical complication (pneumothorax or hemothorax) occurred. CONCLUSION Femoral site was preferentially used in this prospective study of RRT catheters in 31 French intensive care units. The choice of insertion site depended on investigating center habits, weight, RRT modality. A high incidence of catheter infection suspicion led to undue replacement.
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Affiliation(s)
- Nicolas Benichou
- AP-HP, Hôpital Européen Georges Pompidou, Service de Néphrologie, 75015, Paris, France.,Université de Paris, Paris, France.,French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Saïd Lebbah
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - David Hajage
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,INSERM, ECEVE, U1123, CIC 1421, F-75013, Paris, France.,Faculté de Médecine Sorbonne, Sorbonne Université, Université, Paris, France
| | | | - Bertrand Pons
- Service de Réanimation, CHU de Pointe À Pitre-Abymes, CHU de La Guadeloupe, Pointe-à-Pitre, France
| | - Eric Boulet
- Réanimation Polyvalente, CH René Dubos, 95301, Pontoise, France
| | - Alexandre Boyer
- Réanimation Médicale CHU Bordeaux, Hôpital Pellegrin, 33000, Bordeaux, France
| | - Guillaume Chevrel
- Service de Réanimation, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
| | - Nicolas Lerolle
- Département de Réanimation Médicale Et Médecine Hyperbare, CHU Angers, Université D'Angers, Angers, France
| | | | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France.,CARMAS Research Group and UPEC-Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Alexandre Lautrette
- Réanimation Médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Bretagnol
- Réanimation Médico-Chirurgicale, Hôpital de La Source, Centre Hospitalier Régional D'Orléans, BP 6709, 45067, Orléans Cedex, France
| | - Julien Mayaux
- Service de Pneumologie Et Réanimation Médicale, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Saad Nseir
- Centre de Réanimation, CHU de Lille, Faculté de Médecine, Université de Lille, 59000, Lille, France
| | - Bruno Megarbane
- Réanimation Médicale Et Toxicologique, Hôpital Lariboisière, INSERM U1144, Université Paris-Diderot, Paris, France
| | - Marina Thirion
- Réanimation Polyvalente, CH Victor Dupouy, 95107, Argenteuil Cedex, France
| | - Jean-Marie Forel
- Service de Réanimation Des Détresses Respiratoires Aiguës Et Infections Sévères, Hôpital Nord Marseille, 13015, Marseille, France
| | - Julien Maizel
- Service de Réanimation Médicale INSERM U1088, Centre Hospitalier Universitaire de Picardie, Amiens, France
| | - Hodane Yonis
- Réanimation Médicale, Hôpital de La Croix Rousse, 69004, Lyon, France
| | | | - Guillaume Thiery
- Service de Réanimation, CHU de Pointe À Pitre-Abymes, CHU de La Guadeloupe, Pointe-à-Pitre, France
| | - Frederique Schortgen
- Centre Hospitalier Inter-Communal, Service de Réanimation Polyvalente Adulte, Créteil, France
| | - Florence Tubach
- Département de Biostatistiques, Santé Publique Et Information Médicale, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,INSERM, ECEVE, U1123, CIC 1421, F-75013, Paris, France.,Univ Pierre Et Marie Curie, Sorbonne Universités, 75013, Paris, France
| | - Jean-Damien Ricard
- Univ Paris Diderot, Sorbonne Paris Cité, IAME, UMRS 1137, 75018, Paris, France.,AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, 92700, Colombes, France
| | - Didier Dreyfuss
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, 92700, Colombes, France.,Université de Paris, Paris, France.,French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Stéphane Gaudry
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Sorbonne Université, 75020, Paris, France. .,AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, 93008, Bobigny, France. .,Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, 125 Rue de Stalingrad, 93000, Bobigny, France.
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Timsit JF, Baleine J, Bernard L, Calvino-Gunther S, Darmon M, Dellamonica J, Desruennes E, Leone M, Lepape A, Leroy O, Lucet JC, Merchaoui Z, Mimoz O, Misset B, Parienti JJ, Quenot JP, Roch A, Schmidt M, Slama M, Souweine B, Zahar JR, Zingg W, Bodet-Contentin L, Maxime V. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care 2020; 10:118. [PMID: 32894389 PMCID: PMC7477021 DOI: 10.1186/s13613-020-00713-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.
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Affiliation(s)
- Jean-François Timsit
- APHP/Hopital Bichat-Medical and Infectious Diseases ICU (MI2), 46 rue Henri Huchard, 75018, Paris, France.,UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Université de Paris, Sorbonne Paris Cité, 75018, Paris, France
| | - Julien Baleine
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve University Hospital, 371 Avenue Doyen G Giraud, 34295, Montpellier Cedex 5, France
| | - Louis Bernard
- Infectious Diseases Unit, University Hospital Tours, Nîmes 2 Boulevard, 37000, Tours, France
| | - Silvia Calvino-Gunther
- CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, 38000, Grenoble, France
| | - Michael Darmon
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Jean Dellamonica
- Centre Hospitalier Universitaire de Nice, Médecine Intensive Réanimation, Archet 1, UR2CA Unité de Recherche Clinique Côte d'Azur, Université Cote d'Azur, Nice, France
| | - Eric Desruennes
- Clinique d'anesthésie pédiatrique, Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, CHU Lille, 59000, Lille, France.,Unité accès vasculaire, Centre Oscar Lambret, 3 rue Frédéric Combemale, 59000, Lille, France
| | - Marc Leone
- Anesthésie Réanimation, Hôpital Nord, 13015, Marseille, France
| | - Alain Lepape
- Service d'Anesthésie et de Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, Lyon, France.,UMR CNRS 5308, Inserm U1111, Laboratoire des Pathogènes Émergents, Centre International de Recherche en Infectiologie, Lyon, France
| | - Olivier Leroy
- Medical ICU, Chatilliez Hospital, Tourcoing, France.,U934/UMR3215, Institut Curie, PSL Research University, 75005, Paris, France
| | - Jean-Christophe Lucet
- AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.,INSERM IAME, U1137, Team DesCID, University of Paris, Paris, France
| | - Zied Merchaoui
- Pediatric Intensive Care, Paris South University Hospitals AP-HP, Le Kremlin Bicêtre, France
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, 86021, Poitiers, France.,Université de Poitiers, Poitiers, France.,Inserm U1070, Poitiers, France
| | - Benoit Misset
- Department of Intensive Care, Sart-Tilman University Hospital, and University of Liège, Liège, Belgium
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research and Department of Infectious Diseases, Caen University Hospital, 14000, Caen, France.,EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0) UNICAEN, CHU Caen Medical School Université Caen Normandie, Caen, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.,INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Antoine Roch
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Service des Urgences, 13015, Marseille, France.,Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Matthieu Schmidt
- Assistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris, France.,INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651, Paris Cedex 13, France
| | - Michel Slama
- Medical Intensive Care Unit, CHU Sud Amiens, Amiens, France
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-Ralph Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France.,Service de Microbiologie Clinique et Unité de Contrôle et de Prévention Du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Walter Zingg
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laetitia Bodet-Contentin
- Medical Intensive Care Unit, INSERM CIC 1415, CRICS-TriGGERSep Network, CHRU de Tours and Université de Tours, Tours, France
| | - Virginie Maxime
- Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230, Garches, France.
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Menaker J, Galvagno S, Rabinowitz R, Penchev V, Hollis A, Kon Z, Deatrick K, Amoroso A, Herr D, Mazzeffi M. Epidemiology of blood stream infection in adult extracorporeal membrane oxygenation patients: A cohort study. Heart Lung 2019; 48:236-239. [DOI: 10.1016/j.hrtlng.2019.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/04/2019] [Accepted: 01/13/2019] [Indexed: 12/12/2022]
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A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill. Intensive Care Med 2018; 44:742-759. [PMID: 29754308 DOI: 10.1007/s00134-018-5212-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/05/2018] [Indexed: 12/14/2022]
Abstract
Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU. It discusses the optimal therapy of catheter-related infections and thrombosis. Prevention of complications is a multidisciplinary task that combines both improvement of the process of care and introduction of new technologies. We emphasize the main component of the prevention strategies that should be used in critical care and propose areas of future investigation in this field.
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Kitano T, Takagi K, Arai I, Yasuhara H, Ebisu R, Ohgitani A, Kitagawa D, Oka M, Masuo K, Minowa H. Efficacy of routine catheter tip culture in a neonatal intensive care unit. Pediatr Int 2018; 60:423-427. [PMID: 29468780 DOI: 10.1111/ped.13538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/11/2017] [Accepted: 02/16/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Routine catheter tip cultures are not recommended because some cases of colonization, such as with Staphylococcus aureus, can lead to subsequent bacteremia. To evaluate the safety of colonization without antimicrobial treatment, as well as the effectiveness of routine catheter tip cultures in the neonatal intensive care unit (NICU), we performed a retrospective data analysis in a Japanese community hospital. METHODS We reviewed all peripherally inserted central venous catheter tip culture results from the NICU ward between April 2012 and June 2017 and noted outcome (i.e. antimicrobial treatment or subsequent infection). We then performed a cost analysis for routine catheter tip culturing on patients who were symptom free during the study period. RESULTS Of the 93 positive cases in 80 patients from 1,051 catheter tip cultures, seven patients had suspected infection and were treated with antimicrobials. The other 73 symptom-free, positive patients had no subsequent or exacerbated symptoms indicative of an infection, and did not have antimicrobial treatment. The total cost for catheter tip culturing during the study period was ¥548 731. After excluding patients with symptoms of infection at the time of culture, the efficacy of routine catheter tip cultures on symptom-free patients was estimated to be zero. CONCLUSION Symptom-free colonization did not affect clinician management in this study, and all colonized patients without suspected infection were safely managed without antimicrobials. Furthermore, routine catheter tip culturing was not cost-effective; therefore, this practice may be no longer recommended in the NICU.
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Affiliation(s)
- Taito Kitano
- Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kumiko Takagi
- Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Ikuyo Arai
- Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Hajime Yasuhara
- Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Reiko Ebisu
- Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Ayako Ohgitani
- Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
| | - Daisuke Kitagawa
- Department of Microbiology, Nara Prefecture General Medical Center, Nara, Japan
| | - Miyako Oka
- Department of Microbiology, Nara Prefecture General Medical Center, Nara, Japan
| | - Kazue Masuo
- Department of Microbiology, Nara Prefecture General Medical Center, Nara, Japan
| | - Hideki Minowa
- Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
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8
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Timsit JF, L‘Hériteau F, Lepape A, Francais A, Ruckly S, Venier AG, Jarno P, Boussat S, Coignard B, Savey A. A multicentre analysis of catheter-related infection based on a hierarchical model. Intensive Care Med 2012; 38:1662-72. [DOI: 10.1007/s00134-012-2645-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 06/22/2012] [Indexed: 01/26/2023]
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9
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Isolated positive catheter cultures in the intensive care unit: what is the clinical significance? Crit Care Med 2011; 39:2586-7; author reply 2587. [PMID: 22005243 DOI: 10.1097/ccm.0b013e3182281b0c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Isolated positive catheter cultures in the intensive care unit: What is the clinical significance? Crit Care Med 2011. [DOI: 10.1097/ccm.0b013e31822b3a11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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11
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Timsit JF, Dubois Y, Minet C, Bonadona A, Lugosi M, Ara-Somohano C, Hamidfar-Roy R, Schwebel C. New materials and devices for preventing catheter-related infections. Ann Intensive Care 2011; 1:34. [PMID: 21906266 PMCID: PMC3170570 DOI: 10.1186/2110-5820-1-34] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 08/18/2011] [Indexed: 11/16/2022] Open
Abstract
Catheters are the leading source of bloodstream infections for patients in the intensive care unit (ICU). Comprehensive unit-based programs have proven to be effective in decreasing catheter-related bloodstream infections (CR-BSIs). ICU rates of CR-BSI higher than 2 per 1,000 catheter-days are no longer acceptable. The locally adapted list of preventive measures should include skin antisepsis with an alcoholic preparation, maximal barrier precautions, a strict catheter maintenance policy, and removal of unnecessary catheters. The development of new technologies capable of further decreasing the now low CR-BSI rate is a major challenge. Recently, new materials that decrease the risk of skin-to-vein bacterial migration, such as new antiseptic dressings, were extensively tested. Antimicrobial-coated catheters can prevent CR-BSI but have a theoretical risk of selecting resistant bacteria. An antimicrobial or antiseptic lock may prevent bacterial migration from the hub to the bloodstream. This review discusses the available knowledge about these new technologies.
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Affiliation(s)
- Jean-François Timsit
- Medical Polyvalent Intensive Care Unit, University Joseph Fourier, Albert Michallon Hospital, BP 217, 38043 Grenoble Cedex 9, France.
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