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Dahyot-Fizelier C, Lasocki S, Kerforne T, Perrigault PF, Geeraerts T, Asehnoune K, Cinotti R, Launey Y, Cottenceau V, Laffon M, Gaillard T, Boisson M, Aleyrat C, Frasca D, Mimoz O. Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial. Lancet Respir Med 2024; 12:375-385. [PMID: 38262428 DOI: 10.1016/s2213-2600(23)00471-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Patients with acute brain injury are at high risk of ventilator-associated pneumonia (VAP). The benefit of short-term antibiotic prophylaxis remains debated. We aimed to establish the effect of an early, single dose of the antibiotic ceftriaxone on the incidence of early VAP in patients with severe brain injury who required mechanical ventilation. METHODS PROPHY-VAP was a multicentre, randomised, double-blind, placebo-controlled, assessor-masked, superiority trial conducted in nine intensive care units in eight French university hospitals. We randomly assigned comatose (Glasgow Coma Scale score [GCS] ≤12) adult patients (age ≥18 years) who required mechanical ventilation for at least 48 h after acute brain injury to receive intravenous ceftriaxone 2 g or placebo once within the 12 h following tracheal intubation. Participants did not receive selective oropharyngeal and digestive tract decontamination. The primary outcome was the proportion of patients developing early VAP from the 2nd to the 7th day of mechanical ventilation, confirmed by masked assessors. The analysis was reported in the modified intention-to-treat population, which comprised all randomly assigned patients except those who withdrew or did not give consent to continue and those who did not receive the allocated treatment because they met a criterion for non-eligibility. The trial is registered with ClinicalTrials.gov, NCT02265406. FINDINGS From Oct 14, 2015, to May 27, 2020, 345 patients were randomly assigned (1:1) to receive ceftriaxone (n=171) or placebo (n=174); 330 received the allocated intervention and 319 were included in the analysis (162 in the ceftriaxone group and 157 in the placebo group). 166 (52%) participants in the analysis were men and 153 (48%) were women. 15 patients did not receive the allocated intervention after randomisation and 11 withdrew their consent. Adjudication confirmed 93 cases of VAP, including 74 early infections. The incidence of early VAP was lower in the ceftriaxone group than in the placebo group (23 [14%] vs 51 [32%]; hazard ratio 0·60 [95% CI 0·38-0·95], p=0·030), with no microbiological impact and no adverse effects attributable to ceftriaxone. INTERPRETATION In patients with acute brain injury, a single ceftriaxone dose decreased the risk of early VAP. On the basis of our findings, we recommend that an early, single dose of ceftriaxone be included in all bundles for the prevention of VAP in patients with brain injury who require mechanical ventilation. FUNDING French Ministry of Social Affairs and Health.
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Affiliation(s)
- Claire Dahyot-Fizelier
- UFR de Médicine et Pharmacie, INSERM U1070, PHAR2, Université de Poitiers, Poitiers, France; Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France.
| | - Sigismond Lasocki
- Intensive Care Unit, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Thomas Kerforne
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France
| | - Pierre-Francois Perrigault
- Anaesthesia and Intensive Care Department, Centre Hospitalier Universitaire de Montpellier, Montpellier Université, Montpellier, France
| | - Thomas Geeraerts
- Anaesthesia and Critical Care Unit, Centre Hospitalier Universitaire de Toulouse, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Karim Asehnoune
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Raphaël Cinotti
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Yoann Launey
- Department of Anaesthesia and Critical Care Medicine, Critical Care Unit, Centre Hospitalier Universitaire de Rennes, Université de Rennes, Rennes, France
| | - Vincent Cottenceau
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marc Laffon
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Thomas Gaillard
- Intensive Care Unit, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Matthieu Boisson
- UFR de Médicine et Pharmacie, INSERM U1070, PHAR2, Université de Poitiers, Poitiers, France; Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France
| | - Camille Aleyrat
- Direction de la Recherche Clinique et Innovation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Denis Frasca
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France; Direction de la Recherche Clinique et Innovation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Olivier Mimoz
- UFR de Médicine et Pharmacie, INSERM U1070, PHAR2, Université de Poitiers, Poitiers, France; Service des Urgences Adultes, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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Marjanovic N, Piton M, Lamarre J, Alleyrat C, Couvreur R, Guenezan J, Mimoz O, Frat JP. High-flow nasal cannula oxygen versus noninvasive ventilation for the management of acute cardiogenic pulmonary edema: a randomized controlled pilot study. Eur J Emerg Med 2024:00063110-990000000-00118. [PMID: 38364020 DOI: 10.1097/mej.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Whether high-flow nasal oxygen can improve clinical signs of acute respiratory failure in acute heart failure (AHF) is uncertain. OBJECTIVE To compare the effect of high-flow oxygen with noninvasive ventilation (NIV) on respiratory rate in patients admitted to an emergency department (ED) for AHF-related acute respiratory failure. DESIGN, SETTINGS AND PARTICIPANTS Multicenter, randomized pilot study in three French EDs. Adult patients with acute respiratory failure due to suspected AHF were included. Key exclusion criteria were urgent need for intubation, Glasgow Coma Scale <13 points or hemodynamic instability. INTERVENTION Patients were randomly assigned to receive high-flow oxygen (minimum 50 l/min) or noninvasive bilevel positive pressure ventilation. OUTCOMES MEASURE The primary outcome was change in respiratory rate within the first hour of treatment and was analyzed with a linear mixed model. Secondary outcomes included changes in pulse oximetry, heart rate, blood pressure, blood gas samples, comfort, treatment failure and mortality. MAIN RESULTS Among the 145 eligible patients in the three participating centers, 60 patients were included in the analysis [median age 86 (interquartile range (IQR), 90; 92) years]. There was a median respiratory rate of 30.5 (IQR, 28; 33) and 29.5 (IQR, 27; 35) breaths/min in the high-flow oxygen and NIV groups respectively, with a median change of -10 (IQR, -12; -8) with high-flow nasal oxygen and -7 (IQR, -11; -5) breaths/min with NIV [estimated difference -2.6 breaths/min (95% confidence interval (CI), -0.5-5.7), P = 0.052] at 60 min. There was a median SpO2 of 95 (IQR, 92; 97) and 96 (IQR, 93; 97) in the high-flow oxygen and NIV groups respectively, with a median change at 60 min of 2 (IQR, 0; 5) with high-flow nasal oxygen and 2 (IQR, -1; 5) % with NIV [estimated difference 0.8% (95% CI, -1.1-2.8), P = 0.60]. PaO2, PaCO2 and pH did not differ at 1 h between groups, nor did treatment failure, intubation and mortality rates. CONCLUSION In this pilot study, we did not observe a statistically significant difference in changes in respiratory rate among patients with acute respiratory failure due to AHF and managed with high-flow oxygen or NIV. However, the point estimate and its large confidence interval may suggest a benefit of high-flow oxygen. TRIAL REGISTRATION NCT04971213 (https://clinicaltrials.gov).
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Affiliation(s)
- Nicolas Marjanovic
- CHU de Poitiers, Service d'Accueil des Urgences et SAMU 86
- INSERM, CIC-1402, IS-ALIVE
- Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers
| | - Melyne Piton
- CHU de Poitiers, Service d'Accueil des Urgences et SAMU 86
| | | | | | | | | | - Olivier Mimoz
- CHU de Poitiers, Service d'Accueil des Urgences et SAMU 86
| | - Jean-Pierre Frat
- INSERM, CIC-1402, IS-ALIVE
- Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
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Marjanovic N, Jonchier M, Guenezan J, Delelis-Fanien H, Reuter PG, Mimoz O. Telemedicine in Nursing Home Residents Requiring a Call to an Emergency Medical Communication Center. J Am Med Dir Assoc 2024; 25:195-200.e1. [PMID: 38623779 DOI: 10.1016/j.jamda.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To compare the proportion of nursing home residents dispatched to an emergency department (ED) after a call to the emergency medical communication center (EMCC) according to the availability or nonavailability of telemedicine. DESIGN This prospective, observational trial was conducted in the EMCC and 74 nursing homes in a French county. SETTING AND PARTICIPANTS All nursing home residents who needed to contact the EMCC between June 2019 and April 2020 were included in the study. We excluded calls notifying the death of a resident, for completing data from a previous call, and for nursing home staff. METHODS The primary outcome was the proportion of residents dispatched to an ED after their first call to the EMCC. The secondary outcomes were the proportion of second calls, proportion of residents dispatched to an ED after a second call, and proportion of death within 30 days. RESULTS We included 3103 calls in the final analysis (355 from equipped nursing homes and 2748 from unequipped nursing homes). The proportion of patients dispatched to an ED after the first call was lower among telemedicine-equipped than among telemedicine-unequipped nursing homes (41% vs 50%; odds ratio, 0.71; 95% CI, 0.56-0.90). The proportion of a second call for the same purpose within 72 hours, proportion of dispatching to an ED at the second call, and proportion of deaths within 30 days were similar between the groups. CONCLUSION AND IMPLICATIONS The use of telemedicine by nursing home residents requiring a call to the EMCC is associated with a reduction in the number of dispatches to an ED without any increase in the number of 72-hour callbacks or 30-day mortality rates.
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Affiliation(s)
- Nicolas Marjanovic
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France.
| | - Maxime Jonchier
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France
| | - Jérémy Guenezan
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France
| | - Henri Delelis-Fanien
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France
| | - Paul-Georges Reuter
- Emergency Department and Prehospital Care, University Hospital of Rennes, Rennes, France
| | - Olivier Mimoz
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France
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Marjanovic N, Autin M, Violeau M, Mimoz O, Guenezan J. Telemedicine for the management of patients calling an Emergency Medical Communication Center for dyspnea: a before-after study. Eur J Emerg Med 2023; 30:445-447. [PMID: 37883239 DOI: 10.1097/mej.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Nicolas Marjanovic
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers
| | - Mathieu Autin
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers
| | - Mathieu Violeau
- Emergency Department and Prehospital Care, General Hospital of Niort, Niort, France
| | - Olivier Mimoz
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers
| | - Jérémy Guenezan
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers
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Buetti N, Ruckly S, Souweine B, Mimoz O, Timsit JF. Risk of infections in intravascular catheters in situ for more than 10 days: a post hoc analysis of randomized controlled trials. Clin Microbiol Infect 2023; 29:1200.e1-1200.e5. [PMID: 37245658 DOI: 10.1016/j.cmi.2023.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. DISCUSSION 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.
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Affiliation(s)
- Niccolò Buetti
- 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.
| | | | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, France; Université de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France
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Boulet N, Lefrant JY, Mimoz O, Roger C, Pirracchio R. Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. Anaesth Crit Care Pain Med 2023:101271. [PMID: 37356619 DOI: 10.1016/j.accpm.2023.101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Nicolas Boulet
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Jean Yves Lefrant
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France; Université de Poitiers, Inserm U1070, Poitiers, France.
| | - Claire Roger
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States; Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States.
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Marie D, Dahyot-Fizelier C, Barrau S, Boisson M, Frasca D, Jamet A, Chauvet S, Ferrand N, Pichot A, Mimoz O, Kerforne T. Impact of Radial Arterial Location on Catheter Lifetime in ICU Surgical Intensive Care. Crit Care Explor 2023; 5:e0905. [PMID: 37091478 PMCID: PMC10115551 DOI: 10.1097/cce.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
The use of arterial catheters is frequent in intensive care for hemodynamic monitoring of patients and for blood sampling, but they are often removed because of dysfunction. The primary objective is to compare the prevalence of radial arterial catheter dysfunction according to location in relation to the radiocarpal joint in intensive care patients. DESIGN Prospective randomized, controlled, single-center study. SETTING The surgical ICU of the university hospital of Poitiers in France. PATIENTS From January 2016 to April 2017, all patients over 18 years old admitted to the surgical ICU and requiring an arterial catheter were included. INTERVENTIONS Randomization into two groups: catheter placed near the wrist (within 4 cm of the radiocarpal joint) and catheter placed away the wrist. The primary endpoint was the prevalence of dysfunction. We also compared the prevalence of infection and colonization. MEASUREMENTS AND MAIN RESULTS One hundred seven catheters were analyzed (14 failed placements with no difference between the two groups, and 16 catheters excluded for missing data), with 58 catheters in near the wrist group and 49 in away the wrist group. We did not find any significant difference in the number of catheter dysfunctions between the two groups (p = 0.56). The prevalence density of catheter dysfunction was 30.5 of 1,000 catheter days for near the wrist group versus 26.7 of 1,000 catheter days for away the wrist group. However, we observed a significant difference in terms of catheter-related infection in favor of away the wrist group (p = 0.04). In addition, distal positioning of the catheter was judged easier by the physicians. CONCLUSIONS The distal or proximal position of the arterial catheter in the radial position has no influence on the occurrence of dysfunction. However, there may be an association with the prevalence of infections.
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Affiliation(s)
- Damien Marie
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Claire Dahyot-Fizelier
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- CHU de Poitiers, service des urgences, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Stéphanie Barrau
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Matthieu Boisson
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Denis Frasca
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Angeline Jamet
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Stéphane Chauvet
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Nathan Ferrand
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Amélie Pichot
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Olivier Mimoz
- CHU de Poitiers, service des urgences, Poitiers, France
- Université de Poitiers, Faculté de Médecine, Poitiers, France
- INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Thomas Kerforne
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- INSERM U1082 (IRTOMIT), Poitiers, France
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Drugeon B, Guenezan J, Pichon M, Devos A, Fouassin X, Neveu A, Boinot L, Pratt V, Mimoz O. Incidence, complications and costs of peripheral venous catheter-related bacteraemia: A retrospective, single centre study. J Hosp Infect 2023; 135:67-73. [PMID: 36918069 DOI: 10.1016/j.jhin.2023.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
The aim of the present study was to estimate the current incidence, complications and costs of BSI attributable to PVC. Patients with PVC-related BSI (cases) were matched with patients without PVC-related BSI (controls). From January 1st, 2018 to March 31th, 2020 9,833 out of 113,068 patients visiting the emergency department (9%) were hospitalised in a medical ward after insertion of a PVC. Among them, 581 (6%) had at least one positive blood culture (BC). Twenty-five (4%) of these were judged as having a PVC-related BSI. Major complications were noted in nine patients. One patient presented severe sepsis requiring admission to intensive care unit for eleven days followed by thoracic (T4 to T7) spondylodiscitis requiring prolonged antimicrobial therapy. Another patient developed mitral valve endocarditis also requiring prolonged antimicrobial therapy. One patient developed a pre-sacral abscess three months after initial PVC infection and required hospital readmission for 19 days for drainage. Median [IQR] hospital stay costs were €11,597 [€8,479-€23,759] for cases and €6,789 [€4,019-€10,764] for controls, leading to median additional costs of €5,587. In conclusion, even though the risk of developing PVC-related BSI in patients admitted to medical wards may seem low, complications of PVC-related BSI are severe, and the associated mortality remains high. The financial resources used to treat these complications could be better spent on prevention, including the use of high-quality materials and technologies, and improved training of health care providers.
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Affiliation(s)
- B Drugeon
- CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France; Université de Poitiers, INSERM U1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France
| | - J Guenezan
- CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France; Université de Poitiers, INSERM U1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France
| | - M Pichon
- Université de Poitiers, INSERM U1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France; CHU de Poitiers, Département des Agents Infectieux, Laboratoire de Bactériologie-Hygiène, Poitiers, France
| | - A Devos
- CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France
| | - X Fouassin
- CHU de Poitiers, Direction du Système D'Information - Dossiers Patient, Poitiers, France
| | - A Neveu
- CHU de Poitiers, Direction du Système D'Information - Dossiers Patient, Poitiers, France
| | - L Boinot
- CHU de Poitiers, Direction du Système D'Information - Dossiers Patient, Poitiers, France
| | - V Pratt
- CHU de Poitiers, Direction du Système D'Information - Dossiers Patient, Poitiers, France
| | - O Mimoz
- CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France; Université de Poitiers, INSERM U1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France.
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Iachkine J, Buetti N, de Grooth HJ, Briant AR, Mimoz O, Mégarbane B, Mira JP, Valette X, Daubin C, du Cheyron D, Mermel LA, Timsit JF, Parienti JJ. Development and validation of a multivariable model predicting the required catheter dwell time among mechanically ventilated critically ill patients in three randomized trials. Ann Intensive Care 2023; 13:5. [PMID: 36645531 PMCID: PMC9842826 DOI: 10.1186/s13613-023-01099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The anatomic site for central venous catheter insertion influences the risk of central venous catheter-related intravascular complications. We developed and validated a predictive score of required catheter dwell time to identify critically ill patients at higher risk of intravascular complications. METHODS We retrospectively conducted a cohort study from three multicenter randomized controlled trials enrolling consecutive patients requiring central venous catheterization. The primary outcome was the required catheter dwell time, defined as the period between the first catheter insertion and removal of the last catheter for absence of utility. Predictors were identified in the training cohort (3SITES trial; 2336 patients) through multivariable analyses based on the subdistribution hazard function accounting for death as a competing event. Internal validation was performed in the training cohort by 500 bootstraps to derive the CVC-IN score from robust risk factors. External validation of the CVC-IN score were performed in the testing cohort (CLEAN, and DRESSING2; 2371 patients). RESULTS The analysis was restricted to patients requiring mechanical ventilation to comply with model assumptions. Immunosuppression (2 points), high creatinine > 100 micromol/L (2 points), use of vasopressor (1 point), obesity (1 point) and older age (40-59, 1 point; ≥ 60, 2 points) were independently associated with the required catheter dwell time. At day 28, area under the ROC curve for the CVC-IN score was 0.69, 95% confidence interval (CI) [0.66-0.72] in the training cohort and 0.64, 95% CI [0.61-0.66] in the testing cohort. Patients with a CVC-IN score ≥ 4 in the overall cohort had a median required catheter dwell time of 24 days (versus 11 days for CVC-IN score < 4 points). The positive predictive value of a CVC-IN score ≥ 4 was 76.9% for > 7 days required catheter dwell time in the testing cohort. CONCLUSION The CVC-IN score, which can be used for the first catheter, had a modest ability to discriminate required catheter dwell time. Nevertheless, preference of the subclavian site may contribute to limit the risk of intravascular complications, in particular among ventilated patients with high CVC-IN score. Trials Registration NCT01479153, NCT01629550, NCT01189682.
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Affiliation(s)
- Jeanne Iachkine
- grid.411149.80000 0004 0472 0160Department of Clinical Research and Biostatistics, Caen University Hospital and Caen Normandy University, Caen, France ,grid.460771.30000 0004 1785 9671INSERM U1311 DYNAMICURE, Caen Normandy University, Caen, France
| | - Niccolò Buetti
- grid.8591.50000 0001 2322 4988Infection 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
- grid.12380.380000 0004 1754 9227Department of Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Anaïs R. Briant
- grid.411149.80000 0004 0472 0160Department of Clinical Research and Biostatistics, Caen University Hospital and Caen Normandy University, Caen, France
| | - Olivier Mimoz
- grid.11166.310000 0001 2160 6368Inserm U1070, Poitiers University, Poitiers, France ,grid.411162.10000 0000 9336 4276Poitiers University Hospital, 86021 Poitiers, France
| | - Bruno Mégarbane
- Medical and Toxicological Intensive Care Unit, Lariboisière Hospital, AP-HP, INSERM, UMRS-1144, Paris University, Paris, France
| | - Jean-Paul Mira
- grid.411784.f0000 0001 0274 3893Medical ICU, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Xavier Valette
- grid.411149.80000 0004 0472 0160Department of Medical Intensive Care, Caen University Hospital, 14000 Caen, France
| | - Cédric Daubin
- grid.411149.80000 0004 0472 0160Department of Medical Intensive Care, Caen University Hospital, 14000 Caen, France
| | - Damien du Cheyron
- grid.411149.80000 0004 0472 0160Department of Medical Intensive Care, Caen University Hospital, 14000 Caen, France
| | - Leonard A. Mermel
- grid.411024.20000 0001 2175 4264Department of Epidemiology and Infection Prevention, Lifespan Hospital System, Providence, RI USA ,grid.40263.330000 0004 1936 9094Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Jean-François Timsit
- grid.411119.d0000 0000 8588 831XMedical and Infectious Diseases ICU (MI2), Bichat Hospital, AP-HP, University of Paris, IAME, INSERM U1137, Paris, France
| | - Jean-Jacques Parienti
- grid.411149.80000 0004 0472 0160Department of Clinical Research and Biostatistics, Caen University Hospital and Caen Normandy University, Caen, France ,grid.460771.30000 0004 1785 9671INSERM U1311 DYNAMICURE, Caen Normandy University, Caen, France
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10
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Iachkine J, Buetti N, de Grooth HJ, Briant AR, Mimoz O, Mégarbane B, Mira JP, Ruckly S, Souweine B, du Cheyron D, Mermel LA, Timsit JF, Parienti JJ. Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials. Crit Care 2022; 26:205. [PMID: 35799302 PMCID: PMC9261073 DOI: 10.1186/s13054-022-04078-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
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 ≥103 colony-forming units per mL. Risk factors for colonization were identified in the training cohort (CATHEDIA and 3SITES trials; 3899 CVCs of which 575 (15%) were colonized) through multivariable analyses. After internal validation in 500 bootstrapped samples, the CVC-OUT score was computed by attaching points to the robust (> 50% of the bootstraps) risk factors. External validation was performed in the testing cohort (CLEAN, DRESSING2 and ELVIS trials; 6848 CVCs, of which 588 (9%) were colonized).
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.
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11
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Magimel-Pelonnier E, Marjanovic N, Couvreur R, Drugeon B, Mimoz O, Guenezan J. Photography tele-transmission by regular ambulance staff for the management of mild traumatic injury: the NiCEPHORE randomised-controlled trial. Scand J Trauma Resusc Emerg Med 2022; 30:53. [PMID: 36242052 PMCID: PMC9569019 DOI: 10.1186/s13049-022-01026-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background Handling emergency calls in French emergency medical call centres (EMCCs) can be challenging considering the frequent lack of relevant information. Tele-transmission device use in regular ambulances seems like a good solution to provide the EMCC physician with a more accurate assessment of the scene, particularly for mild traumatic injury (MTI). We measured the impact of ambulance staff tele-transmitted photography on prehospital dispatching optimisation for patients calling the EMCC with MTI. Methods We conducted a prospective, single-centre, randomised-controlled trial comparing two groups of patients calling the EMCC with MTI who were or were not allocated to photography tele-transmission by ambulance staff. The primary outcome was the proportion of patients referred away from the nearest hospital (left at home for outpatient care; referred to a higher-level hospital; handled by a medical intensive care ambulance for advanced pre-hospital care) used as a marker of better orientation. Results Between 29 April 2019 and 21 July 2020, 165 patients were randomised and 152 analysed. Photography tele-transmission resulted in better patient dispatching (24/73 [33%] patients in the intervention group vs 9/79 [11%] patients in the control group, OR 3.80 [1.63–8.90]; p = 0.03), without increasing the proportion of patients initially left at home for outpatient care and visiting an ED within 10 days for secondary trauma-related care (1/14 [7%] vs 1/4 [25%], OR 0.25 [0.01–24.1]; p = 0.41). The proportion of patients unnecessarily referred to an ED was 7% [4/59 patients] in the intervention group vs 16% [12/75 patients] in the control group (OR 0.38 [0.09–1.36]; p = 0.10). Conclusion Photography tele-transmission by regular ambulance staff could improve the dispatching of patients calling French EMCCs with MTI. Trial registration The study is registered with Clinicaltrials.gov (NCT04034797).
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Affiliation(s)
- E Magimel-Pelonnier
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France.
| | - N Marjanovic
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France
| | - R Couvreur
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France
| | - B Drugeon
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France
| | - O Mimoz
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France
| | - J Guenezan
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France
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12
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Prat M, Guenezan J, Drugeon B, Burucoa C, Mimoz O, Pichon M. Impact of Skin Disinfection on Cutaneous Microbiota, before and after Peripheral Venous Catheter Insertion. Antibiotics (Basel) 2022; 11:antibiotics11091209. [PMID: 36139988 PMCID: PMC9495181 DOI: 10.3390/antibiotics11091209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction. Patients with invasive medical devices are at high risk for infection. Skin colonization is the initial stage of these infections, leading to the recommendation of practices requiring disinfection using antiseptics. Microbial communities playing a major role in skin health could be impacted by antiseptic procedures. Aim. To characterize and compare the bacterial communities of skin samples from patients before an antisepsis procedure, and after removal of the medical device itself, according to the nature of the antiseptic molecule (povidone iodine or chlorhexidine). Methods. The study focused on alterations in bacterial communities depending on the nature of the antiseptic procedure and type of intravascular device. After amplification of 16S rDNA, libraries (n = 498 samples) were sequenced using MiSeq platform. Results. Using an in-house pipeline (QIIME2 modules), while no alteration in skin microbiota diversity was associated with antiseptic procedure or PVC type, according to culture results (p < 0.05), alterations were at times associated with restricted diversity and higher dissimilarity (p < 0.05). Antiseptic procedures and PVC types were associated with the modification of specific bacterial representations with modulation of the Bacillota/Bacteroidota (Firmicutes/Bacteroidetes) ratio (modulation of C. acnes, Prevotella, Lagierella, and Actinomyces spp.) (p < 0.05). At baseline, the microbiota shows certain bacteria that are significantly associated with future PVC colonization and/or bacteremia (p < 0.05). All of these modulations were associated with altered expression of metabolic pathways (p < 0.05). Discussion. Finally, this work highlights the need to optimize the management of patients requiring intravascular devices, possibly by modulating the skin microbiota.
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Affiliation(s)
- Manon Prat
- CHU Poitiers, Bacteriology Laboratory, Infectious Agents Department, 86021 Poitiers, France
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
| | - Jeremy Guenezan
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
- CHU Poitiers, Emergency Room Department, 86021 Poitiers, France
| | - Bertrand Drugeon
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
| | - Christophe Burucoa
- CHU Poitiers, Bacteriology Laboratory, Infectious Agents Department, 86021 Poitiers, France
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
| | - Olivier Mimoz
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
- CHU Poitiers, Emergency Room Department, 86021 Poitiers, France
| | - Maxime Pichon
- INSERM U1070, Pharmacology of Antimicrobial Agents and Antibiotic Resistance, University of Poitiers, 86073 Poitiers, France
- CHU Poitiers, Emergency Room Department, 86021 Poitiers, France
- Correspondence: ; Tel.: +33-(0)5-4944-4143
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13
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Chauzy A, Gregoire N, Ferrandière M, Lasocki S, Ashenoune K, Seguin P, Boisson M, Couet W, Marchand S, Mimoz O, Dahyot-Fizelier C. Population pharmacokinetic/pharmacodynamic study suggests continuous infusion of ceftaroline daily dose in ventilated critical care patients with early-onset pneumonia and augmented renal clearance. J Antimicrob Chemother 2022; 77:3173-3179. [PMID: 36059138 DOI: 10.1093/jac/dkac299] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Ceftaroline could be suitable to treat early-onset ventilator-associated pneumonia (VAP) because of its antibacterial spectrum. However, augmented renal clearance (ARC) is frequent in ICU patients and may affect ceftaroline pharmacokinetics and efficacy. The objective of the study was to explore the impact of ARC on ceftaroline pharmacokinetics and evaluate whether the currently recommended dosing regimen (600 mg every 12 h) is appropriate to treat VAP in ICU patients. METHODS A population pharmacokinetic model was developed using pharmacokinetic data from 18 patients with measured creatinine clearance (CLCR) ranging between 83 and 309 mL/min. Monte Carlo simulations were conducted to determine the PTA and the cumulative fraction of response (CFR) against Streptococcus pneumoniae and MRSA for five dosing regimens. Study registered at ClinicalTrials.gov (NCT03025841). RESULTS Ceftaroline clearance increased non-linearly with CLCR, with lower concentrations and lower probability of reaching pharmacokinetic/pharmacodynamic targets when CLCR increases. For the currently recommended dosing regimen, the probability of having unbound ceftaroline concentrations above the MIC over the entire dose range is greater than 90% for MICs below 0.125 mg/L. Considering the distribution of MICs, this regimen would not be effective against MRSA infections (CFR between 21% and 67% depending on CLCR), but would be effective against S. pneumoniae infections (CFR >86%). CONCLUSIONS The recommended dosing regimen of ceftaroline seems sufficient for covering S. pneumoniae in ICU patients with ARC, but not for MRSA. Among the dosing regimens tested it appears that a constant infusion (50 mg/h) after a loading dose of 600 mg could be more appropriate for MRSA infections.
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Affiliation(s)
- Alexia Chauzy
- INSERM U1070, Pharmacologie des Anti-infectieux et Antibiorésistance, Poitiers, France.,Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France
| | - Nicolas Gregoire
- INSERM U1070, Pharmacologie des Anti-infectieux et Antibiorésistance, Poitiers, France.,Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.,CHU de Poitiers, Laboratoire de Toxicologie-Pharmacocinétique, Poitiers, France
| | - Martine Ferrandière
- Groupe ATLANREA, CHU de Nantes, Nantes, France.,CHU de Tours, Service d'Anesthésie-Réanimation, Tours, France
| | - Sigismond Lasocki
- Groupe ATLANREA, CHU de Nantes, Nantes, France.,CHU d'Angers, Service d'Anesthésie-Réanimation, Angers, France
| | - Karim Ashenoune
- Groupe ATLANREA, CHU de Nantes, Nantes, France.,CHU de Nantes, Service d'Anesthésie-Réanimation, Hôtel Dieu - HME, Nantes, France
| | - Philippe Seguin
- Groupe ATLANREA, CHU de Nantes, Nantes, France.,CHU de Rennes, Service d'Anesthésie-Réanimation, Pontchaillou, Rennes, France
| | - Matthieu Boisson
- INSERM U1070, Pharmacologie des Anti-infectieux et Antibiorésistance, Poitiers, France.,Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.,Groupe ATLANREA, CHU de Nantes, Nantes, France.,CHU de Poitiers, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Poitiers, France
| | - William Couet
- INSERM U1070, Pharmacologie des Anti-infectieux et Antibiorésistance, Poitiers, France.,Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.,CHU de Poitiers, Laboratoire de Toxicologie-Pharmacocinétique, Poitiers, France
| | - Sandrine Marchand
- INSERM U1070, Pharmacologie des Anti-infectieux et Antibiorésistance, Poitiers, France.,Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.,CHU de Poitiers, Laboratoire de Toxicologie-Pharmacocinétique, Poitiers, France
| | - Olivier Mimoz
- INSERM U1070, Pharmacologie des Anti-infectieux et Antibiorésistance, Poitiers, France.,Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.,Groupe ATLANREA, CHU de Nantes, Nantes, France.,CHU de Poitiers, Service des Urgences & SAMU 86, Poitiers, France
| | - Claire Dahyot-Fizelier
- INSERM U1070, Pharmacologie des Anti-infectieux et Antibiorésistance, Poitiers, France.,Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.,Groupe ATLANREA, CHU de Nantes, Nantes, France.,CHU de Poitiers, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Poitiers, France
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Maunoury F, Drugeon B, Boisson M, Marjanovic N, Couvreur R, Mimoz O, Guenezan J. Cost-effectiveness analysis of bundled innovative devices versus standard approach in the prevention of unscheduled peripheral venous catheters removal due to complications in France. PLoS One 2022; 17:e0269750. [PMID: 35700207 PMCID: PMC9197036 DOI: 10.1371/journal.pone.0269750] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/25/2022] [Indexed: 12/29/2022] Open
Abstract
The objective of the study was to perform a cost-effectiveness analysis of bundled devices (BDs) versus standard devices (SDs) for the prevention of unscheduled peripheral venous catheter (PVC) removal due to complication from a French investigator-initiated, open-label, single center, randomized-controlled, two-by-two factorial trial (CLEAN-3 study). A 14-day time non homogeneous semi-markovian model was performed to be fitted to longitudinal individual patient data from CLEAN-3 database. This model includes five health states and eight transitional events; a base case scenario, two scenario analyses and bootstrap sensitivity analyses were performed. The cost-effectiveness criterion was the cost per patient with unscheduled PVC removal avoided. 989 adult (age≥18 years) patients were analyzed to compare the BDs group (494 patients), and the SDs group (495 patients). The assessed intervention was a combination of closed integrated catheters, positive displacement needleless-connectors, disinfecting caps, and single-use prefilled flush syringes compared with the use of open catheters and three-way stopcocks for treatment administration. For the base case scenario, an unscheduled 1st PVC removal before discharge was significantly more frequent in the SDs group (235 patients (47.5%) in the SDs group and 172 patients (34.8%) in the BDs group, p = 0.00006). After adjustment for 1st catheter time, the number of patients with unscheduled PVC removal per day was of 16 (95%CI: 15; 18) patients (out of 100) in the BDs group and of 26 (95%CI: 24; 28) patients (out of 100) in the SDs group. The mean cost per patient (adjusted on catheter-time) was of €144 (95%CI: €135-€154) for patients in the SDs group versus €102 (95%CI: €95-€109) for patients in the BDs group; the mean saving per patient was of €42 (95%CI: €32-€54). As a consequence, the assessed BDs strategy was less costly and more effective than the SDs strategy. Trail registration: CLEAN-3 study is registered with ClinicalTrials.gov, NCT03757143.
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Affiliation(s)
- Franck Maunoury
- Statesia, Le Mans, France
- University of Le Mans, GAINS, IRA, Le Mans, France
- * E-mail:
| | - Bertrand Drugeon
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Poitiers, France
| | - Matthieu Boisson
- School of Medicine and Pharmacy, University of Poitiers, Poitiers, France
- Intensive Care and Peri-Operative Medicine Department, University Hospital of Poitiers, Anesthesia, Poitiers, France
| | - Nicolas Marjanovic
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Poitiers, France
| | - Raphael Couvreur
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Poitiers, France
- School of Medicine and Pharmacy, University of Poitiers, Poitiers, France
| | - Olivier Mimoz
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Poitiers, France
- School of Medicine and Pharmacy, University of Poitiers, Poitiers, France
- INSERM U1070, Pharmacology of anti-infective drugs, Poitiers, France
| | - Jeremy Guenezan
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Poitiers, France
- School of Medicine and Pharmacy, University of Poitiers, Poitiers, France
- INSERM U1070, Pharmacology of anti-infective drugs, Poitiers, France
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Joannes-Boyau O, Le Conte P, Bonnet MP, Cesareo E, Chousterman B, Chaiba D, Douay B, Futier E, Harrois A, Huraux C, Ichai C, Meaudre Desgouttes E, Mimoz O, Muller L, Oberlin M, Peschanski N, Quintard H, Rousseau G, Savary D, Tran-Dinh A, Villoing B, Chauvin A, Weiss E. Guidelines for the choice of intravenous fluids for vascular filling in critically ill patients, 2021. Anaesth Crit Care Pain Med 2022; 41:101058. [PMID: 35526312 DOI: 10.1016/j.accpm.2022.101058] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To provide recommendations for the appropriate choice of fluid therapy for resuscitation of critically ill patients. DESIGN A consensus committee of 24 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Emergency Medicine (Société française de médecine d'urgence, SFMU) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline elaboration process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Some recommendations were left ungraded. METHODS Four fields were defined: patients with sepsis or septic shock, patients with haemorrhagic shock, patients with acute brain failure, and patients during the peripartum period. For each field, the panel focused on two questions: (1) Does the use of colloids, as compared to crystalloids, reduce morbidity and mortality, and (2) Does the use of some specific crystalloids effectively reduce morbidity and mortality. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE methodology. RESULTS The SFAR/SFMU guideline panel provided nine statements on the appropriate choice of fluid therapy for resuscitation of critically ill patients. After two rounds of rating and various amendments, strong agreement was reached for 100% of the recommendations. Out of these recommendations, two have a high level of evidence (Grade 1 +/-), six have a moderate level of evidence (Grade 2 +/-), and one is based on expert opinion. Finally, no recommendation was formulated for two questions. CONCLUSIONS Substantial agreement among experts has been obtained to provide a sizable number of recommendations aimed at optimising the choice of fluid therapy for resuscitation of critically ill patients.
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Affiliation(s)
- Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation SUD, CHU de Bordeaux, Hôpital Magellan, Bordeaux, France.
| | - Philippe Le Conte
- Nantes Université, Faculté de Médecine, CHU de Nantes, Service des Urgences, Nantes, France
| | - Marie-Pierre Bonnet
- Sorbonne Université, Service d'Anesthésie-Réanimation, Hôpital Trousseau, DMU DREAM, GRC 29, APHP, Paris, France; INSERM U1153, Equipe de Recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité, Paris, France
| | - Eric Cesareo
- Samu 69, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, Place d'Arsonval, F-69437 Lyon Cedex 03, France
| | - Benjamin Chousterman
- APHP, CHU Lariboisière, Département d'Anesthésie-Réanimation, DMU PARABOL, FHU, PROMICE, Paris, France; Université de Paris, INSERM U942 MASCOT, Paris, France
| | - Djamila Chaiba
- Service des Urgences Médico-Chirurgicales, Hôpital Simone Veil, Eaubonne, France
| | - Bénédicte Douay
- SMUR/Service des Urgences, Hôpital Beaujon, AP-HP Nord, Clichy, France
| | - Emmanuel Futier
- Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Département Anesthésie et Réanimation, Hôpital Estaing, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS, Inserm U-1103, Clermont-Ferrand, France
| | - Anatole Harrois
- Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Université Paris-Saclay, Paris, France
| | | | - Carole Ichai
- Université Côte D'Azur, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Service de Réanimation Polyvalente, Nice, France
| | - Eric Meaudre Desgouttes
- Service Anesthésiologie-Réanimation Chirurgicale, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France
| | - Olivier Mimoz
- Service des Urgences Adultes & SAMU 86, CHU de Poitiers, Poitiers, France; Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France; Inserm U1070, Pharmacology of Antimicrobial Agents, Poitiers, France
| | - Laurent Muller
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, CHU Nîmes, Montpellier, France
| | - Mathieu Oberlin
- Structure des Urgences, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Peschanski
- Service des Urgences-SAMU-SMUR-CHU Rennes, Rennes, France; Faculté de Médecine-Université Rennes-1, Rennes, France
| | - Hervé Quintard
- Service des Soins Intensifs Adultes, Hôpitaux Universitaires de Genève, Switzerland
| | | | | | - Alexy Tran-Dinh
- Service d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Barbara Villoing
- SAU-SMUR, CHU Cochin Hôtel Dieu, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Anthony Chauvin
- Services des Urgences/SMUR, Hôpital Lariboisière, Université de Paris Cité, Paris, France
| | - Emmanuel Weiss
- Service Anesthésie-Réanimation, Hôpital Beaujon, DMU PARABOL, AP-HP Nord, Clichy, France; Centre de Recherche sur l'Inflammation, UMR_S1149, Université de Paris, Paris, France
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16
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Boisson M, Abbas M, Rouaux J, Guenezan J, Mimoz O. Prevention of surgical site infections in low-income and middle-income countries: When more is not better. Anaesth Crit Care Pain Med 2022; 41:101046. [PMID: 35217220 DOI: 10.1016/j.accpm.2022.101046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Matthieu Boisson
- Service d'Anesthésie Réanimation & Médecine Péri-opératoire, Centre Hospitalier Universitaire de Poitiers, Poitiers, 86021, France; Inserm U1070, Université de Poitiers, Poitiers, France.
| | - Mohamed Abbas
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Jil Rouaux
- Service d'Anesthésie, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France
| | - Jérémy Guenezan
- Inserm U1070, Université de Poitiers, Poitiers, France; Service des Urgences Adultes & SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, 86021, France
| | - Olivier Mimoz
- Inserm U1070, Université de Poitiers, Poitiers, France; Service des Urgences Adultes & SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, 86021, France
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17
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Riou B, Charpentier S, Chauvin A, Contenti J, Dumas F, Levraut J, Macrez R, Mimoz O, Pateron D. Critères du Conseil national des universités (CNU) de médecine d’urgence pour la nomination des maîtres de conférences et professeurs associés mi-temps. Ann Fr Med Urgence 2022. [DOI: 10.3166/afmu-2022-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Boisson M, Bouglé A, Sole-Lleonart C, Dhanani J, Arvaniti K, Rello J, Rouby JJ, Mimoz O. Nebulized Antibiotics for Healthcare- and Ventilator-Associated Pneumonia. Semin Respir Crit Care Med 2022; 43:255-270. [PMID: 35042259 DOI: 10.1055/s-0041-1740340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Global emergence of multidrug-resistant and extensive drug-resistant gram-negative bacteria has increased the risk of treatment failure, especially for healthcare- or ventilator-associated pneumonia (HAP/VAP). Nebulization of antibiotics, by providing high intrapulmonary antibiotic concentrations, represents a promising approach to optimize the treatment of HAP/VAP due to multidrug-resistant and extensive drug-resistant gram-negative bacteria, while limiting systemic antibiotic exposure. Aminoglycosides and colistin methanesulfonate are the most common nebulized antibiotics. Although optimal nebulized drug dosing regimen is not clearly established, high antibiotic doses should be administered using vibrating-mesh nebulizer with optimized ventilator settings to ensure safe and effective intrapulmonary concentrations. When used preventively, nebulized antibiotics reduced the incidence of VAP without any effect on mortality. This approach is not yet recommended and large randomized controlled trials should be conducted to confirm its benefit and explore the impact on antibiotic selection pressure. Compared with high-dose intravenous administration, high-dose nebulized colistin methanesulfonate seems to be more effective and safer in the treatment of ventilator-associated tracheobronchitis and VAP caused by multidrug resistant and extensive-drug resistant gram-negative bacteria. Adjunctive nebulized aminoglycosides could increase the clinical cure rate and bacteriological eradication in patients suffering from HAP/VAP due to multidrug-resistant and extensive drug-resistant gram-negative bacteria. As nebulized aminoglycosides broadly diffuse in the systemic circulation of patients with extensive bronchopneumonia, monitoring of plasma trough concentrations is recommended during the period of nebulization. Large randomized controlled trials comparing high dose of nebulized colistin methanesulfonate to high dose of intravenous colistin methanesulfonate or to intravenous new β-lactams in HAP/VAP due to multidrug-resistant and extensive drug-resistant gram-negative bacteria are urgently needed.
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Affiliation(s)
- Matthieu Boisson
- INSERM U1070, Université de Poitiers, UFR de Médecine Pharmacie, Poitiers, France.,Service de Prévention et de Contrôle de l'Infection, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Adrien Bouglé
- Medicine Sorbonne University, Anaesthesiology and Critical Care, Cardiology Institute, Paris, France.,Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Candela Sole-Lleonart
- Intensive Care Unit, Consorci Hospitalari de Vic (CHV), The University of Vic - Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Jayesh Dhanani
- Department of Intensive care medicine, Centre for Clinical Research, The University of Queensland, The Royal Brisbane and Women's Hospital Herston, Brisbane, Australia
| | - Kostoula Arvaniti
- Intensive Care Unit Department, Papageorgiou Hospital of Thessaloniki, Thessaloniki, Greece
| | - Jordi Rello
- Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Clinical Research and Innovation in Pneumonia and Sepsis, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.,Clinical Research, CHU Nîmes, Université Montpellier-Nîmes, Nîmes, France
| | - Jean-Jacques Rouby
- Department of Anaesthesiology and Critical Care, Medicine Sorbonne University, Multidisciplinary Intensive Care Unit, La Pitié Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Olivier Mimoz
- INSERM U1070 Université de Poitiers, UFR de Médecine Pharmacie and Service des Urgences Adultes & SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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19
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Drugeon B, Pichon M, Marjanovic N, Mousse S, Seguin S, Raynaud C, Rahoui A, Frasca D, Mimoz O, Guenezan J. Peripheral venous catheter colonisation after skin disinfection with 0.5% aqueous sodium hypochlorite, preceded or not by one application of 70% ethanol (DACLEAN): A single centre, randomised, open-label, pilot study. J Hosp Infect 2021; 120:123-126. [PMID: 34822950 DOI: 10.1016/j.jhin.2021.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
Few data are available on the efficacy of 0.5% aqueous sodium hypochlorite (SH) for skin disinfection before peripheral catheter insertion. A total of 239 patients were randomly assigned to either one application of SH alone or one application of SH preceded by one application of 70% ethanol (ET-SH). Catheter colonisation, defined as a catheter tip culture growing more than 1000 CFU of a micro-organism per mL, occurred in 29 patients (33% - 89 colonisations per 1000 catheter days) in the SH group and in 31 patients (33% - 126 colonisations per 1000 catheter days) in the ET-SH.
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Affiliation(s)
| | - Maxime Pichon
- CHU Poitiers, Département des Agents Infectieux, Laboratoire de Bactériologie-Hygiène, France; Université de Poitiers, INSERM 1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France
| | | | | | | | - Camille Raynaud
- CHU Poitiers, Services des Urgences et SAMU 86, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France
| | - Alexandre Rahoui
- CHU Poitiers, Services des Urgences et SAMU 86, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France
| | - Denis Frasca
- CHU Poitiers, Services des Urgences et SAMU 86, France; Université de Nantes, INSERM U1246, Methods in Patients-centered Outcomes and Health Research - SPHERE, Nantes, France
| | - Olivier Mimoz
- CHU Poitiers, Services des Urgences et SAMU 86, France; Université de Poitiers, INSERM 1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France.
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20
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Buetti N, Ruckly S, Lucet JC, Mageau A, Dupuis C, Souweine B, Mimoz O, Timsit JF. Practices and intravascular catheter infection during on- and off-hours in critically ill patients. Ann Intensive Care 2021; 11:153. [PMID: 34714451 PMCID: PMC8556470 DOI: 10.1186/s13613-021-00940-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/17/2021] [Indexed: 12/14/2022] Open
Abstract
Background The potential relationship between intravascular catheter infections with their insertion during weekend or night-time (i.e., off-hours or not regular business hours) remains an open issue. Our primary aim was to describe differences between patients and catheters inserted during on- versus off-hours. Our secondary aim was to investigate whether insertions during off-hours influenced the intravascular catheter infectious risks. Methods We performed a post hoc analysis using the databases from four large randomized-controlled trials. Adult patients were recruited in French ICUs as soon as they required central venous catheters or peripheral arterial (AC) catheter insertion. Off-hours started at 6 P.M. until 8:30 A.M. during the week; at weekend, we defined off-hours from 1 P.M. on Saturday to 8.30 A.M. on Monday. We performed multivariable marginal Cox models to estimate the effect of off-hours (versus on-hours) on major catheter-related infections (MCRI) and catheter-related bloodstream infections (CRBSIs). Results We included 7241 patients in 25 different ICUs, and 15,208 catheters, including 7226 and 7982 catheters inserted during off- and on-hours, respectively. Catheters inserted during off-hours were removed after 4 days (IQR 2, 9) in median, whereas catheters inserted during on-hours remained in place for 6 days (IQR 3,10; p < 0.01) in median. Femoral insertion was more frequent during off-hours. Among central venous catheters and after adjusting for well-known risk factors for intravascular catheter infection, we found a similar risk between off- and on-hours for MCRI (HR 0.91, 95% CI 0.61–1.37, p = 0.65) and CRBSI (HR 1.05, 95% CI 0.65–1.68, p = 0.85). Among central venous catheters with a dwell-time > 4 or > 6 days, we found a similar risk for MCRI and CRBSI between off- and on-hours. Similar results were observed for ACs. Conclusions Off-hours did not increase the risk of intravascular catheter infections compared to on-hours. Off-hours insertion is not a sufficient reason for early catheter removal, even if femoral route has been selected. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00940-3.
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Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM, IAME, 75006, Paris, France. .,Infection Control Program and WHO Collaborating Centre On Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | | | - Jean-Christophe Lucet
- University of Paris, INSERM, IAME, 75006, Paris, France.,AP-HP, Infection Control Unit, Bichat- Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Arthur Mageau
- University of Paris, INSERM, IAME, 75006, Paris, France
| | - Claire Dupuis
- University of Paris, INSERM, IAME, 75006, Paris, France
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, 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
| | - Jean-François Timsit
- University of Paris, INSERM, IAME, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
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21
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Marjanovic N, Guenezan J, Mimoz O. Response. Chest 2021; 160:e245-e247. [PMID: 34366055 DOI: 10.1016/j.chest.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Nicolas Marjanovic
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, Poitiers, France; Université de Poitiers, Faculté de Médecine-Pharmacie, Poitiers, France; INSERM CIC1402 Team 5 Acute Lung Injury and Ventilatory support, Poitiers, France
| | - Jérémy Guenezan
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France
| | - Olivier Mimoz
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, Poitiers, France; Université de Poitiers, Faculté de Médecine-Pharmacie, Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, Poitiers, France.
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22
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Guenezan J, Garcia M, Mimoz O. Regarding Use of Povidone Iodine to Reduce Nasopharyngeal Viral Load in Patients With COVID-19-Reply. JAMA Otolaryngol Head Neck Surg 2021; 147:681. [PMID: 33914066 DOI: 10.1001/jamaoto.2021.0684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jérémy Guenezan
- Emergency Department, University Hospital of Poitiers, Poitiers, France
| | - Magali Garcia
- Virology Laboratory, University Hospital of Poitiers, Poitiers, France
| | - Olivier Mimoz
- Emergency Department, University Hospital of Poitiers, Poitiers, France
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23
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Alem L, Bacqué J, Guihenneuc J, Delelis-Fanien H, Mimoz O, Migeot V. Quality indicators development and prioritisation for emergency medical call centres: a stakeholder consensus. BMJ Open Qual 2021; 10:bmjoq-2020-001176. [PMID: 34035128 PMCID: PMC8154933 DOI: 10.1136/bmjoq-2020-001176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Emergency medical regulation is a risky activity. In France, emergency medical societies have proposed activity and performance indicators, but their lists are non-exhaustive, unstructured and used heterogeneously among emergency medical call centres (Centres de Réception et de Régulation des Appels, CRRA). Our objective was to build by means of regional stakeholder consensus an operational quality dashboard for CRRAs. Methods We conducted an observational step in a French CRRA from June to September 2018 and at the same time listed existing activity and quality indicators through a rapid international literature review. We adapted and classified all indicators identified in a structured table. We prioritised them from April to September 2019 by seeking consensus with one regulator physician and one medical regulation assistant from the 13 CRRAs of the largest French region. We used an adapted Delphi method with a prioritisation scale from 1 to 9. Results The rapid review of literature included 33 studies among the 414 identified and, with the first observational step, resulted in a list of 360 quality indicators covering the following areas: material resources, human resources, quality approach, call handling and postcall support. 15 of the 26 members participated in the entire process. Seventy indicators were considered as priorities with strong agreement among participants. We built an operational dashboard of quality indicators deemed high priority and provided 70 descriptive indicator sheets. Conclusion Our study allowed to build an operational quality dashboard for CRRAs as a ready-to-use support for an internal audit, for prioritisation of quality approach actions and for national and international benchmarking.
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Affiliation(s)
- Lucie Alem
- Public Health Department, University Hospital Centre, Poitiers, France
| | - Julie Bacqué
- Emergency Department, University Hospital Centre, Poitiers, France
| | - Jérémy Guihenneuc
- Public Health Department, University Hospital Centre, Poitiers, France
| | | | - Olivier Mimoz
- Emergency Department, University Hospital Centre, Poitiers, France.,Medicine and Pharmacy, University of Poitiers, Poitiers, France
| | - Virginie Migeot
- Public Health Department, University Hospital Centre, Poitiers, France.,Medicine and Pharmacy, University of Poitiers, Poitiers, France
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24
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Zhou HY, de Kraker MEA, Mimoz O, Boisson M, Harbarth S, Buetti N. Concentration of chlorhexidine gluconate-alcohol for skin antisepsis at the intravascular catheter insertion site. J Hosp Infect 2021; 115:128-130. [PMID: 34022271 DOI: 10.1016/j.jhin.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- H Y Zhou
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - M E A de Kraker
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - O Mimoz
- Service des Urgences Adultes & SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, France; INSERM U1070, Pharmacologie des agents anti-infectieux, Université de Poitiers, Poitiers, France
| | - M Boisson
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; INSERM U1070, Pharmacologie des agents anti-infectieux, Université de Poitiers, Poitiers, France
| | - S Harbarth
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - N Buetti
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; University of Paris, INSERM, IAME, Paris, France.
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25
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Guenezan J, Kerforne T, Boisson M, Dahyot-Fizelier C, Mimoz O. Benefit from extending infusion set replacement intervals of central venous and arterial catheters in hospitalised patients. Anaesth Crit Care Pain Med 2021; 40:100884. [PMID: 33971374 DOI: 10.1016/j.accpm.2021.100884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jérémy Guenezan
- Service des Urgences Adultes & SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France; Université de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France
| | - Thomas Kerforne
- Université de Poitiers, Poitiers, France; Service d'Anesthésie Réanimation & Médecine Péri-opératoire, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France
| | - Matthieu Boisson
- Université de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France; Service d'Anesthésie Réanimation & Médecine Péri-opératoire, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France
| | - Claire Dahyot-Fizelier
- Université de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France; Service d'Anesthésie Réanimation & Médecine Péri-opératoire, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France
| | - Olivier Mimoz
- Service des Urgences Adultes & SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France; Université de Poitiers, Poitiers, France; Inserm U1070, Poitiers, France.
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26
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Guenezan J, Garcia M, Strasters D, Jousselin C, Lévêque N, Frasca D, Mimoz O. Povidone Iodine Mouthwash, Gargle, and Nasal Spray to Reduce Nasopharyngeal Viral Load in Patients With COVID-19: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2021; 147:400-401. [PMID: 33538761 DOI: 10.1001/jamaoto.2020.5490] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jeremy Guenezan
- Emergency Department, University Hospital of Poitiers, Poitiers, France
| | - Magali Garcia
- Virology laboratory, University Hospital of Poitiers, Poitiers, France
| | - Deidre Strasters
- Emergency Department, University Hospital of Poitiers, Poitiers, France
| | - Clément Jousselin
- Virology laboratory, University Hospital of Poitiers, Poitiers, France
| | - Nicolas Lévêque
- Virology laboratory, University Hospital of Poitiers, Poitiers, France
| | - Denis Frasca
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
| | - Olivier Mimoz
- Emergency Department, University Hospital of Poitiers, Poitiers, France
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27
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Buetti N, Mimoz O, Schwebel C, Ruckly S, Castry M, Dupuis C, Souweine B, Lucet JC, Timsit JF. Insertion Site and Infection Risk among Peripheral Arterial Catheters. Am J Respir Crit Care Med 2021; 203:630-633. [PMID: 33052721 DOI: 10.1164/rccm.202007-3008le] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Niccolò Buetti
- University of Paris INSERM IAME Paris, France.,Infection Control Program and WHO Collaborating Centre on Patient Safety University of Geneva Hospitals and Faculty of Medicine Geneva, Switzerland
| | - Olivier Mimoz
- Centre Hospitalier Universitaire de Poitiers Poitiers, France.,Université de Poitiers Poitiers, France.,Inserm U1070 Poitiers, France
| | - Carole Schwebel
- Centre Hospitalier Universitaire de Grenoble-Alpes Grenoble, France.,INSERM U1039 Radiopharmaceutiques Biocliniques La Tronche, France
| | | | | | | | | | - Jean-Christophe Lucet
- University of Paris INSERM IAME Paris, France.,AP-HP, Infection Control Unit Bichat-Claude Bernard University Hospital Paris, France and
| | - Jean-François Timsit
- University of Paris INSERM IAME Paris, France.,AP-HP, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard University Hospital Paris, France
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28
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Buetti N, Mimoz O, Mongardon N, Parienti JJ, Timsit JF. Ultrasound-guided catheterization and infectious risk in obese ICU patients. Intensive Care Med 2021; 47:632-634. [PMID: 33772343 DOI: 10.1007/s00134-021-06382-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Niccolò Buetti
- INSERM, IAME, University of Paris, 75006, Paris, France. .,Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - 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
| | - Nicolas Mongardon
- Service d'Anesthésie-Réanimation Chirurgicale, Hôpitaux Universitaires Henri Mondor, DMU CARE, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm U955 équipe 3, Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, Caen University Hospital, 14000, Caen, France.,GRAM 2.0, EA2656, UNICAEN, Normandie University Hospital, Caen, France
| | - Jean-François Timsit
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
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Marjanovic N, Boisson M, Asehnoune K, Foucrier A, Lasocki S, Ichai C, Leone M, Pottecher J, Lefrant JY, Falcon D, Veber B, Chabanne R, Drevet CM, Pili-Floury S, Dahyot-Fizelier C, Kerforne T, Seguin S, de Keizer J, Frasca D, Guenezan J, Mimoz O. Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated: The AGATE Multicenter Randomized Controlled Study. Chest 2021; 160:499-508. [PMID: 33727034 DOI: 10.1016/j.chest.2021.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is the most frequent health care-associated infection in severely ill patients, and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination. RESEARCH QUESTION Is continuous regulation of tracheal cuff pressure using a pneumatic device superior to manual assessment three times daily using a portable manometer (routine care) in preventing VAP in patients with severe trauma? STUDY DESIGN AND METHODS In this open-label, randomized controlled superiority trial conducted in 13 French ICUs, adults (age ≥ 18 years) with severe trauma (Injury Severity Score > 15) and requiring invasive mechanical ventilation for ≥ 48 h were enrolled. Patients were randomly assigned (1:1) via a secure Web-based random number generator in permuted blocks of variable sizes to one of two groups according to the method of tracheal cuff pressure control. The primary outcome was the proportion of patients developing VAP within 28 days following the tracheal intubation, as determined by two assessors masked to group assignment, in the modified intention-to-treat population. This study is closed to new participants. RESULTS A total of 434 patients were recruited between July 31, 2015, and February 15, 2018, of whom 216 were assigned to the intervention group and 218 to the control group. Seventy-three patients (33.8%) developed at least one episode of VAP within 28 days following the tracheal intubation in the intervention group compared with 64 patients (29.4%) in the control group (adjusted subdistribution hazard ratio, 0.96; 95% CI, 0.76-1.20; P = .71). No serious adverse events related to the use of the pneumatic device were noted. INTERPRETATION Continuous regulation of cuff pressure of the tracheal tube using a pneumatic device was not superior to routine care in preventing VAP in patients with severe trauma. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT02534974; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Nicolas Marjanovic
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France; Université de Poitiers, Faculté de Médecine, Poitiers, France; INSERM CIC1402 Team 5 Acute Lung Injury and Ventilatory Support, Pharmacologie des Agents anti-infectieux, France
| | - Matthieu Boisson
- Université de Poitiers, Faculté de Médecine, Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, France; Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France
| | - Karim Asehnoune
- Service d'Anesthésie-Réanimation chirurgicale, CHU de Nantes, France
| | | | | | - Carole Ichai
- Service de Réanimation Polyvalente, CHU de Nice, France
| | - Marc Leone
- Aix Marseille Université, Service d'Anesthésie et de Réanimation, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, France
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire, Strasbourg, France; Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Jean-Yves Lefrant
- EA 2992 IMAGINE, Université de Montpellier, Montpellier, France; Pôle Anesthésie Réanimation Douleur Urgences, CHU Nîmes, France
| | | | - Benoit Veber
- Surgical Intensive Care Unit, Rouen University Hospital, France
| | - Russell Chabanne
- Department of Perioperative Medicine, Neurocritical Care Unit, Neuro-Anesthesiology Clinic, CHU de Clermont-Ferrand, France
| | | | - Sébastien Pili-Floury
- Department of Anesthesiology and Intensive Care Medicine, CHU de Besancon, Besançon, France; EA3920 and SFR-FED 4234 INSERM, Université de Franche-Comté, Besançon, France
| | - Claire Dahyot-Fizelier
- Université de Poitiers, Faculté de Médecine, Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, France; Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France
| | - Thomas Kerforne
- Université de Poitiers, Faculté de Médecine, Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, France; Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France
| | - Sabrina Seguin
- Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France
| | - Joe de Keizer
- Plateforme Méthodologie-Biostatistique-Data-Management, CHU de Poitiers, France
| | - Denis Frasca
- Université de Poitiers, Faculté de Médecine, Poitiers, France; Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France; INSERM U1246, Methods in Patients-centered outcomes and Health Research-SPHERE, Nantes, France
| | - Jérémy Guenezan
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, France
| | - Olivier Mimoz
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France; Université de Poitiers, Faculté de Médecine, Poitiers, France; INSERM U1070, Pharmacologie des Agents anti-infectieux, France.
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Buetti N, Ruckly S, Lucet JC, Mimoz O, Souweine B, Timsit JF. Factors influencing local signs at catheter insertion site regardless of catheter-related bloodstream infections. Crit Care 2021; 25:71. [PMID: 33596980 PMCID: PMC7891164 DOI: 10.1186/s13054-021-03490-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/04/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Niccolò Buetti
- INSERM, IAME, University of Paris, 75006, Paris, France. .,Infection Control Program and WHO Collaborating Centre On Patient Safety, Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | | | - Jean-Christophe Lucet
- INSERM, IAME, University of Paris, 75006, Paris, France.,AP-HP, Infection Control Unit, Bichat- Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Olivier Mimoz
- Services Des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, 86021, Poitiers, France.,Inserm U1070, Poitiers, France
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-François Timsit
- INSERM, IAME, University of Paris, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
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Guenezan J, Marjanovic N, Drugeon B, Neill RO, Liuu E, Roblot F, Palazzo P, Bironneau V, Prevost F, Paul J, Pichon M, Boisson M, Frasca D, Mimoz O. Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, open-label, single centre, randomised-controlled, two-by-two factorial trial. Lancet Infect Dis 2021; 21:1038-1048. [PMID: 33539734 DOI: 10.1016/s1473-3099(20)30738-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/15/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Two billion peripheral venous catheters are sold globally each year, but the optimal skin disinfection and types of devices are not well established. We aimed to show the superiority of disinfection with 2% chlorhexidine plus alcohol over 5% povidone iodine plus alcohol in preventing infectious complications, and of closed integrated catheters, positive displacement needleless-connectors, disinfecting caps, and single-use prefilled flush syringes used in combination (innovation group) over open catheters and three-way stopcocks for treatment administration (standard group) in preventing catheter failure. METHODS We did an open-label, randomised-controlled trial with a two-by-two factorial design, for which we enrolled adults (age ≥18 years) visiting the emergency department at the Poitiers University Hospital, France, and requiring one peripheral venous catheter before admission to the medical wards. Before catheter insertion, patients were randomly assigned (1:1:1:1) using a secure web-based random-number generator to one of four treatment groups based on skin preparation and type of devices (innovative devices or standard devices; 2% chlorhexidine plus alcohol or 5% povidone iodine plus alcohol). Primary outcomes were the incidence of infectious complications (local infection, catheter colonisation, or bloodstream infections) and time between catheter insertion and catheter failure (occlusion, dislodgment, infiltration, phlebitis, or infection). This study is registered with ClinicalTrials.gov, NCT03757143. FINDINGS 1000 patients were recruited between Jan 7, and Sept 6, 2019, of whom 500 were assigned to the chlorhexidine plus alcohol group and 500 to the povidone iodine plus alcohol group (250 with innovative solutions and 250 with standard devices in each antiseptic group). No significant interaction was found between the two study interventions. Local infections occurred less frequently with chlorhexidine plus alcohol than with povidone iodine plus alcohol (0 [0%] of 496 patients vs six [1%] of 493 patients) and the same was observed for catheter colonisation (4/431 [1%] vs 70/415 [17%] catheters among the catheters cultured; adjusted subdistribution hazard ratio 0·08 [95% CI 0·02-0·18]). Median time between catheter insertion and catheter failure was longer in the innovation group compared with the standard group (50·4 [IQR 29·6-69·4] h vs 30·0 [16·6-52·6] h; p=0·0017). Minor skin reactions occurred in nine (2%) patients in the chlorhexidine plus alcohol group and seven (1%) patients in the povidone iodine plus alcohol group. INTERPRETATION For skin antisepsis, chlorhexidine plus alcohol provides greater protection of peripheral venous catheter-related infectious complications than does povidone iodine plus alcohol. Use of innovative devices extends the catheter complication-free dwell time. FUNDING Becton Dickinson.
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Affiliation(s)
- Jérémy Guenezan
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France; INSERM U1070, Pharmacologie des Agents Anti-Infectieux, Poitiers, France
| | - Nicolas Marjanovic
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France
| | - Bertrand Drugeon
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France
| | - Rodérick O Neill
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France
| | | | - France Roblot
- Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France; INSERM U1070, Pharmacologie des Agents Anti-Infectieux, Poitiers, France; Service des Maladies Infectieuses et Tropicales, CHU de Poitiers, France
| | - Paola Palazzo
- Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France; Service de Neurologie, CHU de Poitiers, France
| | | | | | - Julie Paul
- Plateforme Méthodologie-Data-Management, CHU de Poitiers, France
| | - Maxime Pichon
- Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France; INSERM U1070, Pharmacologie des Agents Anti-Infectieux, Poitiers, France; Département des agents infectieux, Laboratoire de Bactériologie-Hygiène, Chu de Poitiers, France
| | - Matthieu Boisson
- Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France; INSERM U1070, Pharmacologie des Agents Anti-Infectieux, Poitiers, France; Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France
| | - Denis Frasca
- Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France; Service d'Anesthésie, Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, France; INSERM U1246, Methods in Patients-centered outcomes and Health Research - SPHERE, Nantes, France
| | - Olivier Mimoz
- Service des Urgences et SAMU 86 Centre 15, CHU de Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France; INSERM U1070, Pharmacologie des Agents Anti-Infectieux, Poitiers, France.
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32
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Buetti N, Ruckly S, Lucet JC, Bouadma L, Garrouste-Orgeas M, Schwebel C, Mimoz O, Souweine B, Timsit JF. Local signs at insertion site and catheter-related bloodstream infections: an observational post hoc analysis using individual data of four RCTs. Crit Care 2020; 24:694. [PMID: 33317594 PMCID: PMC7737269 DOI: 10.1186/s13054-020-03425-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Little is known on the association between local signs and intravascular catheter infections. This study aimed to evaluate the association between local signs at removal and catheter-related bloodstream infections (CRBSI), and which clinical conditions may predict CRBSIs if inflammation at insertion site is present. Methods We used individual data from four multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies for arterial and central venous catheters. We used multivariate logistic regressions in order to evaluate the association between ≥ 1 local sign, redness, pain, non-purulent discharge and purulent discharge, and CRBSI. Moreover, we assessed the probability for each local sign to observe CRBSI in subgroups of clinically relevant conditions. Results A total of 6976 patients and 14,590 catheters (101,182 catheter-days) and 114 CRBSI from 25 ICUs with described local signs were included. More than one local sign, redness, pain, non-purulent discharge, and purulent discharge at removal were observed in 1938 (13.3%), 1633 (11.2%), 59 (0.4%), 251 (1.7%), and 102 (0.7%) episodes, respectively. After adjusting on confounders, ≥ 1 local sign, redness, non-purulent discharge, and purulent discharge were associated with CRBSI. The presence of ≥ 1 local sign increased the probability to observe CRBSI in the first 7 days of catheter maintenance (OR 6.30 vs. 2.61 [> 7 catheter-days], pheterogeneity = 0.02). Conclusions Local signs were significantly associated with CRBSI in the ICU. In the first 7 days of catheter maintenance, local signs increased the probability to observe CRBSI.
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Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM, IAME, 75006, Paris, France. .,Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | | | - Jean-Christophe Lucet
- University of Paris, INSERM, IAME, 75006, Paris, France.,AP-HP, Infection Control Unit, Bichat- Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Lila Bouadma
- University of Paris, INSERM, IAME, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Maité Garrouste-Orgeas
- University of Paris, INSERM, IAME, 75006, Paris, France.,Medical Unit, French British Hospital, Levallois-Perret, France
| | - Carole Schwebel
- Medical Intensive Care Unit, Grenoble University Hospital, Grenoble 1 University, La Tronche, France.,Inserm U1039, Radiopharmaceutiques Biocliniques, Domaine de la Merci, 38700, La Tronche, 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
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-François Timsit
- University of Paris, INSERM, IAME, 75006, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
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Kalfon P, Boucekine M, Estagnasie P, Geantot MA, Berric A, Simon G, Floccard B, Signouret T, Fromentin M, Nyunga M, Audibert J, Ben Salah A, Mauchien B, Sossou A, Venot M, Robert R, Follin A, Renault A, Garrouste-Orgeas M, Collange O, Levrat Q, Villard I, Thevenin D, Pottecher J, Patrigeon RG, Revel N, Vigne C, Azoulay E, Mimoz O, Auquier P, Baumstarck K. Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay. Crit Care 2020; 24:685. [PMID: 33287910 PMCID: PMC7722444 DOI: 10.1186/s13054-020-03396-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/18/2020] [Indexed: 01/13/2023]
Abstract
Background The short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay. Methods The study involved 34 ICUs. Adult patients who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Discomforts, including the pain-related discomfort, were assessed using the French 18-item questionnaire on discomfort in ICU patients, the “Inconforts des Patients de REAnimation” (IPREA). Patients scored each item from 0 (minimal discomfort) to 10 (maximal discomfort). Associations between patient characteristics at ICU admission, life support therapies and main potentially painful procedures performed during the ICU stay and pain-related discomfort scores assessed at the end of the ICU stay were analyzed. Results Patients with complete IPREA questionnaires (n = 2130) were included. The median pain-related discomfort score was 3 (IQR 0–5). From the univariate analysis, pain-related discomfort scores were negatively correlated with age and positively correlated with ICU stay duration; surgical patients reported significant higher pain-related discomfort scores than medical patients; chest drain insertion, chest drain removal, use of bladder catheter, central venous catheter (CVC) insertion, complex dressing change, and intra-hospital transport were associated with pain-related discomfort scores. From the multivariate analyses using generalized estimating equations models, only age, chest drain removal, use of a bladder catheter, CVC insertion, and intra-hospital transport were the main risk factors associated with pain-related discomfort scores. Conclusion Patients who underwent chest drain removal, bladder catheter, CVC insertion, and intra-hospital transport during their ICU stay reported higher pain-related discomfort scores (with respect to the whole ICU stay and assessed at the end of their ICU stay) than patients who did not experience these events. This study may pave the way for further targeted studies aiming at investigating a causal link between these common procedures in the ICU and adult critically ill patients’ perceptions of their ICU stay regarding recalled pain. Trial Registration: Clinicaltrials.gov Identifier NCT02442934, retrospectively registered on May 13, 2015
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Affiliation(s)
- Pierre Kalfon
- Réanimation polyvalente, Hôpital Louis Pasteur, Centre Hospitalier de Chartres, Le Coudray, 28018, Chartres Cedex, France.
| | - Mohamed Boucekine
- Unité de recherche EA3279, Aix-Marseille Université, Marseille, France
| | | | | | - Audrey Berric
- Réanimation polyvalente, Centre Hospitalier Intercommunal Toulon/La Seyne sur mer, Toulon, France
| | | | - Bernard Floccard
- Réanimation polyvalente, CHU Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Mélanie Fromentin
- Réanimation chirurgicale, CHU Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Martine Nyunga
- Réanimation polyvalente, CH Victor Provo, Roubaix, France
| | - Juliette Audibert
- Réanimation polyvalente, Hôpital Louis Pasteur, Centre Hospitalier de Chartres, Le Coudray, 28018, Chartres Cedex, France
| | - Adel Ben Salah
- Réanimation polyvalente, Hôpital Louis Pasteur, Centre Hospitalier de Chartres, Le Coudray, 28018, Chartres Cedex, France
| | - Bénédicte Mauchien
- Réanimation polyvalente, Hôpital Louis Pasteur, Centre Hospitalier de Chartres, Le Coudray, 28018, Chartres Cedex, France
| | | | - Marion Venot
- Réanimation médicale, CHU Saint-Louis, AP-HP, Paris, France
| | - René Robert
- Réanimation médicale, CHU La Milétrie, Poitiers, France
| | - Arnaud Follin
- Réanimation chirurgicale, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | | | | | - Olivier Collange
- Réanimation chirurgicale polyvalente, Hôpital Civil, CHU Strasbourg, Strasbourg, France
| | - Quentin Levrat
- Réanimation, Groupe Hospitalier de La Rochelle-Ré-Aunis, La Rochelle, France
| | | | | | - Julien Pottecher
- Réanimation Chirurgicale, Hôpital Hautepierre, CHU Strasbourg, Strasbourg, France
| | | | - Nathalie Revel
- Réanimation Médico-Chirurgicale, Hôpital Pasteur, CHU Nice, Nice, France
| | - Coralie Vigne
- Réanimation Chirurgicale, CHU Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Elie Azoulay
- Réanimation médicale, CHU Saint-Louis, AP-HP, Paris, France
| | - Olivier Mimoz
- Réanimation médicale, CHU La Milétrie, Poitiers, France
| | - Pascal Auquier
- Unité de recherche EA3279, Aix-Marseille Université, Marseille, France
| | - Karine Baumstarck
- Unité de recherche EA3279, Aix-Marseille Université, Marseille, France
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Buetti N, Mimoz O, Mermel L, Ruckly S, Mongardon N, Dupuis C, Mira JP, Lucet JC, Mégarbane B, Bailly S, Parienti JJ, Timsit JF. Ultrasound Guidance and Risk for Central Venous Catheter-Related Infections in the Intensive Care Unit: A Post Hoc Analysis of Individual Data of 3 Multicenter Randomized Trials. Clin Infect Dis 2020; 73:e1054-e1061. [PMID: 33277646 DOI: 10.1093/cid/ciaa1817] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ultrasound (US) guidance is frequently used in critically ill patients for central venous catheter (CVC) insertion. The effect of US on infectious risk remains controversial, and randomized controlled trials (RCTs) have assessed mainly noninfectious complications. This study assessed infectious risk associated with catheters inserted with US guidance vs use of anatomical landmarks. METHODS We used individual data from 3 large RCTs for which a prospective, high-quality data collection was performed. Adult patients were recruited in various intensive care units (ICUs) in France as soon as they required short-term CVC insertion. We applied marginal Cox models with inverse probability weighting to estimate the effect of US-guided insertion on catheter-related bloodstream infections (CRBSIs, primary outcome) and major catheter-related infections (MCRIs, secondary outcome).We also evaluated insertion site colonization at catheter removal. RESULTS Our post hoc analysis included 4636 patients and 5502 catheters inserted in 2088 jugular, 1733 femoral, and 1681 subclavian veins, in 19 ICUs. US guidance was used for 2147 catheter insertions. Among jugular and femoral CVCs and after weighting, we found an association between US and CRBSI (hazard ratio [HR], 2.21 [95% confidence interval {CI}, 1.17-4.16]; P = .014) and between US and MCRI (HR, 1.55 [95% CI, 1.01-2.38]; P = .045). Catheter insertion site colonization at removal was more common in the US-guided group (P = .0045) among jugular and femoral CVCs in situ for ≤7 days (n = 606). CONCLUSIONS In prospectively collected data in which catheters were not randomized to insertion by US or anatomical landmarks, US guidance was associated with increased risk of infection.
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Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM, IAME, Paris, France.,Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, INSERM, Poitiers, France
| | - Leonard Mermel
- Division of Infectious Diseases, Rhode Island Hospital and Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Nicolas Mongardon
- Service d'Anesthésie-Réanimation Chirurgicale, Hôpitaux Universitaires Henri Mondor, DMU CARE, Assistance Publique-Hôpitaux de Paris, Inserm U955 équipe 3, Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | | | - Jean-Paul Mira
- Groupe Hospitalier Paris Centre, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Jean-Christophe Lucet
- University of Paris, INSERM, IAME, Paris, France.,Infection Control Unit, Bichat- Claude Bernard University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bruno Mégarbane
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, INSERM UMRS-1144, Université de Paris, Paris, France
| | - Sébastien Bailly
- Université Grenoble Alpes, Inserm U1042, HP2, and EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France.,Equipe d'Accueil 2656, Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Université Caen Normandie, Caen, France
| | - Jean-François Timsit
- University of Paris, INSERM, IAME, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Marjanovic N, Guenezan J, Mimoz O. Techniques d’oxygénation non invasives aux urgences. Méd Intensive Réa 2020. [DOI: 10.37051/mir-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Buetti N, Souweine B, Mermel L, Mimoz O, Ruckly S, Loiodice A, Mongardon N, Lucet JC, Parienti JJ, Timsit JF. Concurrent systemic antibiotics at catheter insertion and intravascular catheter-related infection in the ICU: a post hoc analysis using individual data from five large RCTs. Clin Microbiol Infect 2020; 27:1279-1284. [PMID: 33152538 DOI: 10.1016/j.cmi.2020.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Data on the impact of systemic antibiotics at the time of catheter insertion are scarce. Therefore, we assessed the association between concurrent antibiotic administration at insertion and short-term catheter-related infections. METHODS We used individual data gathered from five large, randomized, controlled ICU trials. We analysed adult patients who required arterial, short-term central venous or dialysis catheter insertion in the ICU. The effect of antibiotics at insertion on major catheter-related infection (MCRI), catheter-related bloodstream infection (CRBSI) and colonization was estimated using multivariate marginal Cox and propensity score models. RESULTS We included 10 269 patients and 18 743 catheters from 36 ICUs. Antibiotic use was ongoing at the time of 11 361 catheter insertions (60.6%). After adjusting for well-known risk factors for intravascular catheter infection, we observed a similar risk for MCRI (HR 0.83, 95%CI 0.62-1.10, p 0.19) and CRBSI (HR 0.85, 95%CI 0.60-1.22, p 0.38) between the antibiotic and no-antibiotic groups. A confirmatory analysis using propensity score showed consistent results. No specific antibiotic subclasses reduced the risk of MCRI. Non-fermenting Gram-negative bacilli were more frequently observed in the antibiotic group. CONCLUSIONS Ongoing antibiotic administration at the time of catheter insertion was not associated with a decrease risk of catheter-related infections and should not be carried out for preventing such infections. Our results bring new insights to antimicrobial stewardship in critically ill patients and may direct empirical antimicrobial therapy if an intravascular catheter infection is suspected.
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Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM, IAME, F-75006, Paris, France; Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Leonard Mermel
- Division of Infectious Diseases, Rhode Island Hospital and Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Olivier Mimoz
- Service des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, France, Université de Poitiers, Poitiers, France, Inserm U1070, Poitiers, 86021, France
| | | | - Ambre Loiodice
- ICURESEARCH, 6B avenue de Romans, Saint Marcellin, France
| | - Nicolas Mongardon
- Service d'Anesthésie-Réanimation Chirurgicale, Hôpitaux Universitaires Henri Mondor, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm U955 équipe 3, Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | - Jean-Christophe Lucet
- University of Paris, INSERM, IAME, F-75006, Paris, France; AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research and Department of Infectious Diseases, Caen University Hospital, Caen, 14000, France; EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Université Caen Normandie, Caen, France
| | - Jean-François Timsit
- University of Paris, INSERM, IAME, F-75006, Paris, France; Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
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Schults J, Kleidon T, Chopra V, Cooke M, Paterson R, Ullman AJ, Marsh N, Ray-Barruel G, Hill J, Devrim İ, Hammarskjold F, Pedreira ML, Bertoglio S, Egan G, Mimoz O, van Boxtel T, DeVries M, Magalhaes M, Hallam C, Oakley S, Rickard CM. International recommendations for a vascular access minimum dataset: a Delphi consensus-building study. BMJ Qual Saf 2020; 30:722-730. [PMID: 32963025 PMCID: PMC8380895 DOI: 10.1136/bmjqs-2020-011274] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/13/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Data regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset. METHODS A modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was conducted involving international vascular access specialists. In Rounds 1 and 2, electronic surveys were distributed to healthcare professionals specialising in vascular access. Survey respondents were asked to rate the importance of variables, feasibility of data collection and acceptability of items, definitions and response options. In Round 3, a purposive expert panel met to review Round 1 and 2 ratings and reach consensus (defined as ≥70% agreement) on the final items to be included in a minimum dataset for vascular access devices. RESULTS A total of 64 of 225 interdisciplinary healthcare professionals from 11 countries responded to Round 1 and 2 surveys (response rate of 34% and 29%, respectively). From the original 52 items, 50 items across five domains emerged from the Delphi procedure.Items related to demographic and clinical characteristics (n=5; eg, age), device characteristics (n=5; eg, device type), insertion (n=16; eg, indication), management (n=9; eg, dressing and securement), and complication and removal (n=15, eg, occlusion) were identified as requirements for a minimum dataset to track and evaluate vascular access device use and outcomes. CONCLUSION We developed and internally validated a minimum dataset for vascular access device research. This study generated new knowledge to enable healthcare systems to collect relevant, useful and meaningful vascular access data. Use of this standardised approach can help benchmark clinical practice and target improvements worldwide.
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Affiliation(s)
- Jessica Schults
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia .,Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Tricia Kleidon
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Vineet Chopra
- The Patient Safety Enhancement Program, Division of Hospital Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Marie Cooke
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Rebecca Paterson
- Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Amanda J Ullman
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Nicole Marsh
- Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.,Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Gillian Ray-Barruel
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.,QUII Jubilee Hospital, Nathan, Queensland, Australia
| | - Jocelyn Hill
- Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - İlker Devrim
- Dr. Behçet Uz Training and Research Hospital, İzmir, Turkey
| | - Fredrik Hammarskjold
- Department of Anaesthesia and Intensive Care, County Hospital Ryhov, Jonkoping, Sweden
| | | | - Sergio Bertoglio
- Department of Surgery, University of Genoa, Genova, Liguria, Italy
| | - Gail Egan
- Interventional Radiology, Stanford Health Care, Stanford, California, USA
| | - Olivier Mimoz
- Emergency Department, University Hospital Centre Poitiers, Poitiers, France
| | - Ton van Boxtel
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michelle DeVries
- Indiana University Health Methodist Hospital, Indianapolis, Indiana, USA
| | - Maria Magalhaes
- Neonatal Intensive Care, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio, Brazil
| | - Carole Hallam
- Infection Prevention Society, Seafield, West Lothian, UK
| | | | - Claire M Rickard
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.,Association for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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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: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Pichon M, Guenezan J, Drugeon B, Rammaert B, Burucoa C, Roblot F, Mimoz O. Supériorité de la chlorhexidine-alcoolique à 2 % et d’un ensemble de dispositifs innovant pour prévenir les complications liées à l’utilisation des cathéters veineux périphériques. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Buetti N, Ruckly S, Schwebel C, Mimoz O, Souweine B, Lucet JC, Timsit JF. Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for short-term intravascular catheters: which one is better? Crit Care 2020; 24:458. [PMID: 32703235 PMCID: PMC7376730 DOI: 10.1186/s13054-020-03174-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/12/2020] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related bloodstream infections (CRBSI). Chlorhexidine-impregnated sponge dressings (sponge-dress) and gel dressings (gel-dress) have never been directly compared. We used the data collected for two randomized-controlled trials to perform a comparison between sponge-dress and gel-dress. METHODS Adult critically ill patients who required short-term central venous or arterial catheter insertion were recruited. Our main analysis included only patients with CHG-impregnated dressings. The effect of gel-dress (versus sponge-dress) on major catheter-related infections (MCRI) and CRBSI was estimated using multivariate marginal Cox models. The comparative risks of dressing disruption and contact dermatitis were evaluated using logistic mix models for clustered data. An explanatory analysis compared gel-dress with standard dressings using either CHG skin disinfection or povidone iodine skin disinfection. RESULTS A total of 3483 patients and 7941 catheters were observed in 16 intensive care units. Sponge-dress and gel-dress were utilized for 1953 and 2108 catheters, respectively. After adjustment for confounders, gel-dress showed similar risk for MCRI compared to sponge-dress (HR 0.80, 95% CI 0.28-2.31, p = 0.68) and CRBSI (HR 1.13, 95% CI 0.34-3.70, p = 0.85), less dressing disruptions (OR 0.72, 95% CI 0.60-0.86, p < 0.001), and more contact dermatitis (OR 3.60, 95% CI 2.51-5.15, p < 0.01). However, gel-dress increased the risk of contact dermatitis only if CHG was used for skin antisepsis (OR 1.94, 95% CI 1.38-2.71, p < 0.01). CONCLUSIONS We described a similar infection risk for gel-dress and sponge-dress. Gel-dress showed fewer dressing disruptions. Concomitant use of CHG for skin disinfection and CHG-impregnated dressing may significantly increase contact dermatitis. TRIALS REGISTRATION These studies were registered within ClinicalTrials.gov (numbers NCT01189682 and NCT00417235 ).
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Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France.
| | - Stéphane Ruckly
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France
| | - Carole Schwebel
- Médecine Intensive Réanimation, C.H.U de Grenoble-Alpes, Grenoble, France.,INSERM UMR S 1039, Radiopharmaceutiques Biocliniques, Faculté de Médecine de Grenoble, Domaine de la Merci, 38700, La Tronche, France
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,Université de Poitiers, Poitiers, France.,INSERM U1070, Poitiers, France
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-Christophe Lucet
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France.,AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Jean-François Timsit
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
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Marjanovic N, Guénézan J, Frat JP, Mimoz O, Thille AW. High-flow nasal cannula oxygen therapy in acute respiratory failure at Emergency Departments: A systematic review. Am J Emerg Med 2020; 38:1508-1514. [PMID: 32389397 DOI: 10.1016/j.ajem.2020.04.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/17/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES The use of high-flow oxygen therapy (HFOT) through nasal cannula for the management of acute respiratory failure at the emergency department (ED) has been only sparsely studied. We conducted a systematic review of randomized-controlled and quasi-experimental studies comparing the early use of HFOT versus conventional oxygen therapy (COT) in patients with acute respiratory failure admitted to EDs. METHODS A systematic research of literature was carried out for all published control trials comparing HFOT with COT in adult patients admitted in EDs. Eligible data were extracted from Medline, Embase, Pascal, Web of Science and the Cochrane database. The primary outcome was the need for mechanical ventilation, i.e. intubation or non-invasive ventilation as rescue therapy. Secondary outcomes included respiratory rate, dyspnea level, ED length of stay, intubation and mortality. RESULTS Out of 1829 studies screened, five studies including 673 patients were retained in the analysis (350 patients treated with HFOT and 323 treated with COT). The need for mechanical ventilation was similar in both treatments (RR = 0.75; 95% CI 0.41 to 1.35; P = 0.31; I2 = 16%). Respiratory rate was lower with HFOT (Mean difference (MD) = -3.14 breaths/min; 95% CI = -4.9 to -1.4; P < 0.001; I2 = 39%), whereas sensation of dyspnea did not differ. (MD = -1.04; 95% CI = -2.29 to -0.22; P = 0.08; I2 = 67%). ED length of stay and mortality were similar between groups. CONCLUSION The early use of HFOT in patients admitted to an ED for acute respiratory failure did not reduce the need for mechanical ventilation as compared to COT. However, HFOT decreased respiratory rate. REGISTRATION PROSPERO ID CRD42019125696.
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Affiliation(s)
- Nicolas Marjanovic
- CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France; INSERM, CIC-1402 Team 5 ALIVE, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France.
| | - Jérémy Guénézan
- CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France
| | - Jean-Pierre Frat
- INSERM, CIC-1402 Team 5 ALIVE, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France; CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Olivier Mimoz
- CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France
| | - Arnaud W Thille
- INSERM, CIC-1402 Team 5 ALIVE, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie de Poitiers, Poitiers, France; CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
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Rouby JJ, Monsel A, Leone M, Mimoz O, Laterre PF, Pugin J. The IASIS, INHALE and VAPORISE trials. Reasons for a triple failure: Study design, aminoglycosides dosing and technique of nebulisation. Anaesth Crit Care Pain Med 2020; 39:179-183. [PMID: 32156643 DOI: 10.1016/j.accpm.2020.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Medicine Sorbonne University, Paris, France.
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Medicine Sorbonne University, Paris, France
| | - Marc Leone
- Department of Anaesthesiology and Critical Care, North Hospital, University Aix-Marseille, Marseille, France
| | - Olivier Mimoz
- Department of Anaesthesiology and Intensive Care, University Hospital of Poitiers, University of Poitiers, Poitiers, France
| | - Pierre-François Laterre
- Saint Luc Clinical Coordinating Centre, Department of Critical Care Medicine, St Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
| | - Jérôme Pugin
- Intensive Care Division, University Hospitals of Geneva, Geneva, Switzerland
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Grégoire N, Marchand S, Ferrandière M, Lasocki S, Seguin P, Vourc'h M, Barbaz M, Gaillard T, Launey Y, Asehnoune K, Couet W, Mimoz O. Population pharmacokinetics of daptomycin in critically ill patients with various degrees of renal impairment. J Antimicrob Chemother 2020; 74:117-125. [PMID: 30295740 DOI: 10.1093/jac/dky374] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/20/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives The objective of this study was to characterize the pharmacokinetics of unbound and total concentrations of daptomycin in infected ICU patients with various degrees of renal impairment. From these results, the probability of attaining antimicrobial efficacy and the risks of toxicity were assessed. Methods Twenty-four ICU patients with various renal functions and requiring treatment of complicated skin and soft-tissue infections, bacteraemia, or endocarditis with daptomycin were recruited. Daptomycin (Cubicin®) at 10 mg/kg was administered every 24 h for patients with creatinine clearance (CLCR) ≥30 mL/min and every 48 h for patients with CLCR <30 mL/min. Total and unbound plasma concentrations and urine concentrations of daptomycin were analysed simultaneously following a population pharmacokinetic approach. Simulations were conducted to estimate the probability of attaining efficacy (unbound AUCu/MIC >40 or >80) or toxicity (Cmin >24.3 mg/L) targets. Results Exposure to unbound daptomycin increased when the renal function decreased, thus increasing the probability of reaching the efficacy targets, but also the risk of toxicity. Modifications of the unbound fraction (fu) of daptomycin did not affect the pharmacokinetics of unbound daptomycin, but did affect the pharmacokinetics of total daptomycin. Conclusions Daptomycin at 10 mg/kg q24h allowed efficacy pharmacokinetic/pharmacodynamic targets for ICU patients with CLCR ≥30 mL/min to be reached. For patients with CLCR <30 mL/min, halving the rate of drug administration, i.e. 10 mg/kg q48h, was sufficient to reach these targets. No adverse events were observed, but the toxicity of the 10 mg/kg q24h dosing regimen should be further assessed, particularly for patients with altered renal function.
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Affiliation(s)
- Nicolas Grégoire
- Inserm U1070, Pôle Biologie Santé, 1 rue Georges Bonnet, Poitiers, France.,Université de Poitiers, UFR Médecine-Pharmacie, 6 rue de la milétrie, Poitiers, France
| | - Sandrine Marchand
- Inserm U1070, Pôle Biologie Santé, 1 rue Georges Bonnet, Poitiers, France.,Université de Poitiers, UFR Médecine-Pharmacie, 6 rue de la milétrie, Poitiers, France.,CHU de Poitiers, Service de Toxicologie-Pharmacocinétique, 2 rue de la milétrie, Poitiers, France
| | - Martine Ferrandière
- CHU de Tours, Service d'anesthésie et réanimation, 2 boulevard Tonnellé, Tours cedex 9, France
| | - Sigismond Lasocki
- CHU d'Angers, Service d'anesthésie et réanimation, 4 rue Larrey, Angers, France
| | - Philippe Seguin
- CHU de Rennes, Service de réanimation chirurgicale, 2 rue Henri Le Guilloux, Rennes, France
| | - Mickaël Vourc'h
- CHU de Nantes, Service d'anesthésie et réanimation, Hôtel Dieu, 1 Place Alexis-Ricordeau, Nantes, France
| | - Mathilde Barbaz
- CHU de Tours, Service d'anesthésie et réanimation, 2 boulevard Tonnellé, Tours cedex 9, France
| | - Thomas Gaillard
- CHU d'Angers, Service d'anesthésie et réanimation, 4 rue Larrey, Angers, France
| | - Yoann Launey
- CHU de Rennes, Service de réanimation chirurgicale, 2 rue Henri Le Guilloux, Rennes, France
| | - Karim Asehnoune
- CHU de Nantes, Service d'anesthésie et réanimation, Hôtel Dieu, 1 Place Alexis-Ricordeau, Nantes, France
| | - William Couet
- Inserm U1070, Pôle Biologie Santé, 1 rue Georges Bonnet, Poitiers, France.,Université de Poitiers, UFR Médecine-Pharmacie, 6 rue de la milétrie, Poitiers, France.,CHU de Poitiers, Service de Toxicologie-Pharmacocinétique, 2 rue de la milétrie, Poitiers, France
| | - Olivier Mimoz
- Inserm U1070, Pôle Biologie Santé, 1 rue Georges Bonnet, Poitiers, France.,Université de Poitiers, UFR Médecine-Pharmacie, 6 rue de la milétrie, Poitiers, France.,CHU de Poitiers, Service des Urgences - SAMU 86 - SMUR, 2 rue de la milétrie, Poitiers, France
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Martin C, Auboyer C, Boisson M, Dupont H, Gauzit R, Kitzis M, Leone M, Lepape A, Mimoz O, Montravers P, Pourriat JL. Antibioprophylaxie en chirurgie et médecine interventionnelle (patients adultes). Actualisation 2017. Anesthésie & Réanimation 2019. [DOI: 10.1016/j.anrea.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Buetti N, Ruckly S, Lucet JC, Mimoz O, Souweine B, Timsit JF. 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 2019; 45:1774-1782. [PMID: 31624854 DOI: 10.1007/s00134-019-05812-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/27/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Little is known on catheter-related infections associated with short-term dialysis catheters (DC). Recommendations for infection prevention are mostly derived from those related to central venous catheters (CVC). A comparison of infectious risk of DCs and CVCs would be instrumental for improving infection control prevention strategies. This study aimed to describe differences in infectious risk between DC and CVC. METHODS We used individual data from 4 multicenter randomized controlled trials in intensive care units (ICUs) that evaluated various prevention strategies regarding colonization, major catheter-related infections (MCRI) and catheter-related bloodstream infections (CR-BSI). We selected only catheters with non-chlorhexidine gluconate impregnated dressings. A marginal Cox model for clustered data was used for the evaluation of the daily hazard rate for catheter-tip colonization, MCRI and CR-BSI. RESULTS We included 3029 patients and 4148 catheters (31,547 catheter-days) which comprised 1872 DCs and 2276 CVCs. After adjustment on confounders, we identified an increased risk in DC compared to CVC for colonization (HR 1.45, 95% CI 1.03-2.04, p = 0.04) and for MCRI (HR 2.97, 95% CI 1.03-8.51, p = 0.04) in the first 7 days of catheter maintenance. The daily hazard rate for colonization and MCRI was generally higher for DC in the first catheter-days, whereas it was similar between DC and CVC for longer catheterizations. CONCLUSIONS The daily risk of colonization and MCRI was significantly higher in DC compared to CVC within the first 7 days of catheter maintenance. Targeted prevention strategies for DC should mostly focus on the period following the insertion.
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Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France
| | - Stéphane Ruckly
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France
| | - Jean-Christophe Lucet
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France.,AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, 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
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean-François Timsit
- University of Paris, INSERM IAME, U1137, Team DesCID, Paris, France. .,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.
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Martin C, Auboyer C, Boisson M, Dupont H, Gauzit R, Kitzis M, Leone M, Lepape A, Mimoz O, Montravers P, Pourriat J. Antibioprophylaxis in surgery and interventional medicine (adult patients). Update 2017. Anaesth Crit Care Pain Med 2019; 38:549-562. [DOI: 10.1016/j.accpm.2019.02.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Deboevere N, Marjanovic N, Sierecki M, Marchetti M, Dubocage M, Magimel E, Mimoz O, Guenezan J. Value of copeptin and the S-100b protein assay in ruling out the diagnosis of stroke-induced dizziness pattern in emergency departments. Scand J Trauma Resusc Emerg Med 2019; 27:72. [PMID: 31387626 PMCID: PMC6683417 DOI: 10.1186/s13049-019-0651-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/23/2019] [Indexed: 11/16/2022] Open
Abstract
Background Dizziness is a frequent reason for visiting emergency departments (EDs). Differentiating stroke from other causes is challenging for physicians. The role of biomarkers has been poorly assessed. We evaluated whether copeptin and S100b protein (PS100b) assessment, alone or in combination, could rule out stroke in patients visiting EDs for dizziness. Methods We included patients 18 years of age or older, visiting the adult ED of a French university hospital for a new episode of dizziness evolving for less than 72 h. All patients underwent standardized physical examination (HINT [Head Impulse test, Nystagmus, test of skew deviation] maneuvers), copeptin and S-100b protein (PS100) measurement and injected brain imaging. Stroke diagnosis involved diffusion-weighted magnetic resonance imaging or, if not available, neurological examination and contrast brain CT scan compatible with the diagnosis. Results Of the 135 patients participating in the study, 13 (10%) had stroke. The sensitivity, specificity and positive and negative predictive values of copeptin/PS100 combination were 100% (95%CI, 77–100%), 48% (40–57%), 14% (11–27%) and 100% (94–100%), respectively. Values for copeptin alone were 77% (CI95% 0.50–0.91), 50% (CI95% 0.49–0.58), 14% (CI95% 0.08–0.24), 93% (CI95% 0.87–0.98), and for PS100 alone were 54% (CI95% 0.29–0.77), 97% (CI95% 0.92–0.99), 64% (CI95% 0.35–0.84), 95% (CI95% 0.90–0.98). Conclusions Absence of copeptin and PS100 elevation seems to ruling out the diagnosis of stroke in patients visiting the ED for a new episode of dizziness. These results need to be confirmed in a large-scale study.
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Affiliation(s)
- N Deboevere
- Service d'Acceuil des Urgences, SAMU 86, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France.
| | - N Marjanovic
- Service d'Acceuil des Urgences, SAMU 86, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France
| | - M Sierecki
- Service d'Acceuil des Urgences, SAMU 86, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France
| | - M Marchetti
- Service d'Acceuil des Urgences, SAMU 86, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France
| | - M Dubocage
- Service d'Acceuil des Urgences, SAMU 86, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France
| | - E Magimel
- Service d'Acceuil des Urgences, SAMU 86, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France
| | - O Mimoz
- Service d'Acceuil des Urgences, SAMU 86, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France.,INSERM U1070, Université de Poitiers, Poitiers, France
| | - J Guenezan
- Service d'Acceuil des Urgences, SAMU 86, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers, France
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Boisson M, Corbi P, Kerforne T, Camilleri L, Debauchez M, Demondion P, Eljezi V, Flecher E, Lepelletier D, Leprince P, Nesseler N, Nizou JY, Roussel JC, Rozec B, Ruckly S, Lucet JC, Timsit JF, Mimoz O. Multicentre, open-label, randomised, controlled clinical trial comparing 2% chlorhexidine-70% isopropanol and 5% povidone iodine-69% ethanol for skin antisepsis in reducing surgical-site infection after cardiac surgery: the CLEAN 2 study protocol. BMJ Open 2019; 9:e026929. [PMID: 31213447 PMCID: PMC6596966 DOI: 10.1136/bmjopen-2018-026929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/14/2019] [Accepted: 04/12/2019] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Surgical-site infection (SSI) is the second most frequent cause of healthcare-associated infection worldwide and is associated with increased morbidity, mortality and healthcare costs. Cardiac surgery is clean surgery with low incidence of SSI, ranging from 2% to 5%, but with potentially severe consequences.Perioperative skin antisepsis with an alcohol-based antiseptic solution is recommended to prevent SSI, but the superiority of chlorhexidine (CHG)-alcohol over povidone iodine (PVI)-alcohol, the two most common alcohol-based antiseptic solutions used worldwide, is controversial. We aim to evaluate whether 2% CHG-70% isopropanol is more effective than 5% PVI-69% ethanol in reducing the incidence of reoperation after cardiac surgery. METHODS AND ANALYSIS The CLEAN 2 study is a multicentre, open-label, randomised, controlled clinical trial of 4100 patients undergoing cardiac surgery. Patients will be randomised in 1:1 ratio to receive either 2% CHG-70% isopropanol or 5% PVI-69% ethanol for perioperative skin preparation. The primary endpoint is the proportion of patients undergoing any re-sternotomy between day 0 and day 90 after initial surgery and/or any reoperation on saphenous vein/radial artery surgical site between day 0 and day 30 after initial surgery. Data will be analysed on the intention-to-treat principle. ETHICS AND DISSEMINATION This protocol has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER EudraCT 2017-005169-33 and NCT03560193.
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Affiliation(s)
- Matthieu Boisson
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- INSERM U1070, Universite de Poitiers UFR Medecine et Pharmacie, Poitiers, France
| | - Pierre Corbi
- Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Thomas Kerforne
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lionel Camilleri
- Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Mathieu Debauchez
- Cardiothoracic Surgery Unit, Institut Mutualiste Montsouris, Paris, France
| | - Pierre Demondion
- Cardiothoracic Surgery Unit, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Vedat Eljezi
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Erwan Flecher
- Cardiothoracic Surgery Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Didier Lepelletier
- Infection Control Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pascal Leprince
- Cardiothoracic Surgery Unit, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Nicolas Nesseler
- Anaesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | | | - Bertrand Rozec
- Anesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Stéphane Ruckly
- INSERM UMR 1137, Universite Paris Diderot UFR de Medecine Site Xavier-Bichat, Paris, France
| | - Jean-Christophe Lucet
- Infection Control Unit, Hopital Bichat - Claude-Bernard, Paris, France
- Iame, INSERM, Paris, France
| | - Jean-François Timsit
- INSERM UMR 1137, Universite Paris Diderot UFR de Medecine Site Xavier-Bichat, Paris, France
- Medical and Infectious Diseases Intensive Care Unit, Hopital Bichat - Claude-Bernard, Paris, France
| | - Olivier Mimoz
- INSERM U1070, Universite de Poitiers UFR Medecine et Pharmacie, Poitiers, France
- Emergency Department and Prehospital Care, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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Dakhouche W, Dutilh J, Saleh-Jawiche I, Mimoz O, Meurice JC. Prise en charge ambulatoire des pneumothorax de grande abondance par cathéter de Furhman « queue de cochon » avec valve unidirectionnelle au CHU de Poitiers. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2019.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Karpanen TJ, Casey AL, Whitehouse T, Timsit JF, Mimoz O, Palomar M, Elliott TSJ. A clinical evaluation of two central venous catheter stabilization systems. Ann Intensive Care 2019; 9:49. [PMID: 30997586 PMCID: PMC6470223 DOI: 10.1186/s13613-019-0519-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background Central venous catheters (CVCs) are commonly secured with sutures which are associated with microbial colonization and infection. We report a comparison of a suture-free system with standard sutures for securing short-term CVC in an international multicentre, prospective, randomized, non-blinded, observational feasibility study. Consented critical care patients who had a CVC inserted as part of their clinical management were randomized to receive either sutures or the suture-free system to secure their CVC. The main outcome measures were CVC migration (daily measurement of catheter movement) and unplanned catheter removals. Results The per cent of unplanned CVC removal in the two study groups was 2% (suture group 2 out of 86 patients) and 6% (suture-free group 5 out of 85 patients). Both securement methods were well tolerated in terms of skin irritation. The time and ease of application and removal of either securement systems were not rated significantly different. There was also no significant difference in CVC migration between the two securement systems in exploratory univariate and multivariate analyses. Overall, 42% (36 out of 86) of the CVC secured with sutures and 56% (48 out of 85) of the CVC secured with the suture-free securement system had CVC migration of ≥ 2 mm. Conclusions The two securement systems performed similarly in terms of CVC migration and unplanned removal of CVC; however, the feasibility study was not powered to detect statistically significant differences in these two parameters. Trial registration ISRCTN, ISRCTN13939744. Registered 9 July 2015, http://www.isrctn.com/ISRCTN13939744.
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Affiliation(s)
- Tarja J Karpanen
- Department of Clinical Microbiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - Anna L Casey
- Department of Clinical Microbiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
| | - Tony Whitehouse
- Department of Anaesthetics and Intensive Care, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Edgbaston, B15 2WB, UK
| | - Jean-Francois Timsit
- APHP, Medical and infectious diseases ICU, Bichat Hospital, 75018, Paris, France.,Descision Science in Infectious Diseases, IAME U 1137 Inserm/Université Sorbonne-Paris-Cité, 75018, Paris, France
| | - Olivier Mimoz
- Service des Urgences - SAMU 86, CHU de Poitiers, 6021, Poitiers Cedex, France.,INSERM U1070, Université de Poitiers, 86021, Poitiers Cedex, France
| | - Mercedes Palomar
- Servicio de Medicina Intensiva, Hospital Universitari Arnau de Vilanova de Lleida, Av. Rovira Roure, 80, 25198, Lleida, Spain
| | - Tom S J Elliott
- Corporate Division, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
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