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• W2007706173 abstract "To the Editor:Catheter-related bloodstream infections occurring in the intensive care unit (ICU) constitute a common and important problem and are potentially associated with a poor outcome.1Raad I. Making catheter-related bloodstream infections history: from the slogan to the serious strategy.Crit Care Med. 2009; 37: 789-791Crossref PubMed Scopus (1) Google Scholar Whereas risk factors for catheter-related colonization or infection (CRCI) have been well studied,2Safdar N. Kluger D.M. Maki D.G. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies.Medicine (Baltimore). 2002; 81: 466-479Crossref PubMed Scopus (210) Google Scholar, 3Dezfulian C. Lavelle J. Nallamothu B.K. Kaufman S.R. Saint S. Rates of infection for single-lumen versus multilumen central venous catheters: a meta-analysis.Crit Care Med. 2003; 31: 2385-2390Crossref PubMed Scopus (108) Google Scholar, 4Templeton A. Schlegel M. Fleisch F. Rettenmund G. Schöbi B. Henz S. et al.Multilumen central venous catheters increase risk for catheter-related bloodstream infection: prospective surveillance study.Infection. 2008; 36: 322-327Crossref PubMed Scopus (51) Google Scholar, 5Zurcher M. Tramer M.R. Walder B. Colonization and bloodstream infection with single- versus multi-lumen central venous catheters: a quantitative systematic review.Anesth Analg. 2004; 99: 177-182Crossref PubMed Scopus (57) Google Scholar the simultaneous presence of several catheters (arterial, central, and/or dialysis) has not been evaluated as a potential risk factor for CRCI.In a 1-year observational single-center study, we prospectively evaluated the hypothesis that the more simultaneous catheters there are, the more CRCI there is. For each patient, data collection was performed on a standardized form and included demographics and microbiologic studies from all removed catheters. The average number of catheters by exposure day during their ICU stay was calculated by dividing the sum of the total duration of catheter exposure (days) by the length of ICU stay with at least 1 catheter exposure (days) (Fig 1). All patients requiring central venous and/or arterial access were managed with a standardized protocol based on current international guidelines.6O’Grady N.P. Alexander M. Dellinger E.P. Gerberding J.L. Heard S.O. Maki D.G. et al.Guidelines for the prevention of intravascular catheter-related infections.Infect Control Hosp Epidemiol. 2002; 23: 759-769Crossref PubMed Scopus (427) Google Scholar Removed catheter tips were cultured using the simplified quantitative culture technique described by Brun-Buisson et al.7Brun-Buisson C. Abrouk F. Legrand P. Huet Y. Larabi S. Rapin M. Diagnosis of central venous catheter-related sepsis: critical level of quantitative tip cultures.Arch Intern Med. 1987; 147: 873-877Crossref PubMed Scopus (502) Google Scholar Culture was defined as positive when the tip yielded >103 colony forming units/mL. Catheter colonization was defined as a positive culture tip without any sign of local infection. Associations between patient characteristics and CRCI were assessed using a logistic regression model. A risk adjustment was performed according to length of ICU stay with at least 1 catheter exposure. P values less than .05 were considered statistically significant. Analyses were performed using SAS 9.1 (SAS Institute, Cary, NC).Of the 575 patients admitted to our ICU during the study period, 402 (262 men and 140 women) fulfilled the inclusion criteria. One or more intravascular catheters were inserted in the ICU in 228 (57%) patients. The average number of catheters by exposure day was 1.7 (IQR, 1.2-2.0) per ICU-day. There were 29 CRCIs in 20 (9%) patients, giving an incidence density of 3.8 ± 23.1 CRCIs/1,000 catheter-days. By univariate analysis, variables significantly associated with CRCI were simultaneous presence of 3 catheters (7 [3.4%] vs 4 [20%]; odds ratio [OR], 30.28; 95% confidence interval [CI]: 2.95-310.9; P = .004), average number of catheters by exposure day during ICU stay (1.7 [IQR, 1.0-2.0] vs 1.9 [IQR, 1.6-2.0]; OR, 5.10/day; 95% CI: 1.74-14.90; P < .0001), length of ICU stay with at least 1 catheter exposure (days) (8 [IQR, 4-14] vs 15 [IQR, 6.5-33]; OR, 1.08/day; 95% CI: 1.04-1.12; P < .0001), and length of ICU stay (days) (9 [IQR, 4-17.5] vs 16.5 [IQR, 7-39.5]; OR, 1.05/day; 95% CI: 1.02-1.08; P = .0002).To our best knowledge, this preliminary study is the first to suggest that the concurrent presence of several intravascular catheters may be a risk factor for CRCI. However, our study has several limitations. First, a limited number of noncolinear factors were statistically associated with CRCI, thus multivariate analysis could not be performed. Second, the choice of CRCI as an end point judgment criterion was supported by the meta-analysis of Rijnders et al.8Rijnders B.J. Van Wijngaerden E. Peetermans W.E. Catheter-tip colonization as a surrogate end point in clinical studies on catheter-related bloodstream infection: how strong is the evidence?.Clin Infect Dis. 2002; 35: 1053-1058Crossref PubMed Scopus (106) Google Scholar However, catheter tip colonization may not be a necessarily surrogate for further infection; our results should be confirmed in an ICU population with catheter-related bloodstream infection. Third, even if some well-known risk factors of CRCI were prospectively studied, some others such as inexperience of the operator, site of placement, or number of lumens were not accessed. In these conditions, we cannot assert that the simultaneous presence of several catheters is an independent risk factor for CRCI.Our preliminary findings support the hypothesis of a relationship between the simultaneous presence of intravenous catheters and the development of CRCI. Whether or not they reflect infectious risk per se, or represent a marker of illness severity, remains to be assessed in further prospective studies including multivariate analysis. To the Editor: Catheter-related bloodstream infections occurring in the intensive care unit (ICU) constitute a common and important problem and are potentially associated with a poor outcome.1Raad I. Making catheter-related bloodstream infections history: from the slogan to the serious strategy.Crit Care Med. 2009; 37: 789-791Crossref PubMed Scopus (1) Google Scholar Whereas risk factors for catheter-related colonization or infection (CRCI) have been well studied,2Safdar N. Kluger D.M. Maki D.G. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies.Medicine (Baltimore). 2002; 81: 466-479Crossref PubMed Scopus (210) Google Scholar, 3Dezfulian C. Lavelle J. Nallamothu B.K. Kaufman S.R. Saint S. Rates of infection for single-lumen versus multilumen central venous catheters: a meta-analysis.Crit Care Med. 2003; 31: 2385-2390Crossref PubMed Scopus (108) Google Scholar, 4Templeton A. Schlegel M. Fleisch F. Rettenmund G. Schöbi B. Henz S. et al.Multilumen central venous catheters increase risk for catheter-related bloodstream infection: prospective surveillance study.Infection. 2008; 36: 322-327Crossref PubMed Scopus (51) Google Scholar, 5Zurcher M. Tramer M.R. Walder B. Colonization and bloodstream infection with single- versus multi-lumen central venous catheters: a quantitative systematic review.Anesth Analg. 2004; 99: 177-182Crossref PubMed Scopus (57) Google Scholar the simultaneous presence of several catheters (arterial, central, and/or dialysis) has not been evaluated as a potential risk factor for CRCI. In a 1-year observational single-center study, we prospectively evaluated the hypothesis that the more simultaneous catheters there are, the more CRCI there is. For each patient, data collection was performed on a standardized form and included demographics and microbiologic studies from all removed catheters. The average number of catheters by exposure day during their ICU stay was calculated by dividing the sum of the total duration of catheter exposure (days) by the length of ICU stay with at least 1 catheter exposure (days) (Fig 1). All patients requiring central venous and/or arterial access were managed with a standardized protocol based on current international guidelines.6O’Grady N.P. Alexander M. Dellinger E.P. Gerberding J.L. Heard S.O. Maki D.G. et al.Guidelines for the prevention of intravascular catheter-related infections.Infect Control Hosp Epidemiol. 2002; 23: 759-769Crossref PubMed Scopus (427) Google Scholar Removed catheter tips were cultured using the simplified quantitative culture technique described by Brun-Buisson et al.7Brun-Buisson C. Abrouk F. Legrand P. Huet Y. Larabi S. Rapin M. Diagnosis of central venous catheter-related sepsis: critical level of quantitative tip cultures.Arch Intern Med. 1987; 147: 873-877Crossref PubMed Scopus (502) Google Scholar Culture was defined as positive when the tip yielded >103 colony forming units/mL. Catheter colonization was defined as a positive culture tip without any sign of local infection. Associations between patient characteristics and CRCI were assessed using a logistic regression model. A risk adjustment was performed according to length of ICU stay with at least 1 catheter exposure. P values less than .05 were considered statistically significant. Analyses were performed using SAS 9.1 (SAS Institute, Cary, NC). Of the 575 patients admitted to our ICU during the study period, 402 (262 men and 140 women) fulfilled the inclusion criteria. One or more intravascular catheters were inserted in the ICU in 228 (57%) patients. The average number of catheters by exposure day was 1.7 (IQR, 1.2-2.0) per ICU-day. There were 29 CRCIs in 20 (9%) patients, giving an incidence density of 3.8 ± 23.1 CRCIs/1,000 catheter-days. By univariate analysis, variables significantly associated with CRCI were simultaneous presence of 3 catheters (7 [3.4%] vs 4 [20%]; odds ratio [OR], 30.28; 95% confidence interval [CI]: 2.95-310.9; P = .004), average number of catheters by exposure day during ICU stay (1.7 [IQR, 1.0-2.0] vs 1.9 [IQR, 1.6-2.0]; OR, 5.10/day; 95% CI: 1.74-14.90; P < .0001), length of ICU stay with at least 1 catheter exposure (days) (8 [IQR, 4-14] vs 15 [IQR, 6.5-33]; OR, 1.08/day; 95% CI: 1.04-1.12; P < .0001), and length of ICU stay (days) (9 [IQR, 4-17.5] vs 16.5 [IQR, 7-39.5]; OR, 1.05/day; 95% CI: 1.02-1.08; P = .0002). To our best knowledge, this preliminary study is the first to suggest that the concurrent presence of several intravascular catheters may be a risk factor for CRCI. However, our study has several limitations. First, a limited number of noncolinear factors were statistically associated with CRCI, thus multivariate analysis could not be performed. Second, the choice of CRCI as an end point judgment criterion was supported by the meta-analysis of Rijnders et al.8Rijnders B.J. Van Wijngaerden E. Peetermans W.E. Catheter-tip colonization as a surrogate end point in clinical studies on catheter-related bloodstream infection: how strong is the evidence?.Clin Infect Dis. 2002; 35: 1053-1058Crossref PubMed Scopus (106) Google Scholar However, catheter tip colonization may not be a necessarily surrogate for further infection; our results should be confirmed in an ICU population with catheter-related bloodstream infection. Third, even if some well-known risk factors of CRCI were prospectively studied, some others such as inexperience of the operator, site of placement, or number of lumens were not accessed. In these conditions, we cannot assert that the simultaneous presence of several catheters is an independent risk factor for CRCI. Our preliminary findings support the hypothesis of a relationship between the simultaneous presence of intravenous catheters and the development of CRCI. Whether or not they reflect infectious risk per se, or represent a marker of illness severity, remains to be assessed in further prospective studies including multivariate analysis. The authors thank Antoinette Wolfe, MD, for helping to prepare the manuscript and Alex Dyson, MSc, and Mervyn Singer, MB, BS, MD, FRCP, Bloomsbury Institute of Intensive Care Medicine, University College London, for critical comments." @default.
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• W2007706173 title "Catheter-related colonization or infection in critically ill patients: Is the number of simultaneous catheters a risk factor?" @default.
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