Blood culture differential time to positivity enables safe catheter retention in suspected catheter-related bloodstream infection: a randomized controlled trial

Sabatier, C.; García, X.; Ferrer, Ricard; Duarte, M.; Colomina, María; Alcaráz, Dolores; Fontanals, Dionísia; Vallès, Jordi

doi:10.1016/j.medin.2013.12.012

Cited by 10 publications

(7 citation statements)

References 23 publications

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“…Therefore, the decision of whether to remove and reinsert CVCs in critically ill patients with suspected CRBSI has been a debated issue in the management of ICU patients [ 5 , 8 , 10 , 15 ], in whom suspected and confirmed CRBSI are one entity and initial management is usually identical. To date, only a few studies have directly or indirectly compared the benefit and harm between reinsertion and no reinsertion in patients whose CVCs have been removed [ 16 – 18 ]. For example, an observational study of 60 cancer patients reported that catheter removal and reinsertion were associated with a moderate to severe symptom burden [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…A randomized trial showed that mortality did not differ between the catheter removal group and the watchful waiting group in 64 patients with suspected CRBSI [ 17 ]. Another randomized controlled trial showed that among 52 patients with suspected CRBSI, the mortality rate in patients who underwent immediate reinsertion and delayed reinsertion of new catheters was not different [ 18 ]. Studies with small sample sizes cannot provide strong evidence regarding the association between CVC reinsertion and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Association of immediate reinsertion of new catheters with subsequent mortality among patients with suspected catheter infection: a cohort study

Zhong

Deng

Zhou

et al. 2022

Ann. Intensive Care

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Background Central venous catheter (CVC) insertion complications are a prevalent and important problem in the intensive care unit (ICU), and source control by immediate catheter removal is considered urgent in patients with septic shock suspected to be caused by catheter-related bloodstream infection (CRBSI). We sought to determine the impact of immediate reinsertion of a new catheter (IRINC) on mortality among patients after CVC removal for suspected CRBSI. Methods A propensity score-matched cohort of patients with suspected CRBSI who underwent IRINC or no IRINC in a 32-bed ICU in a university hospital in China from January 2009 through April 2021. Catheter tip culture and clinical symptoms were used to identify patients with suspected CRBSI. The Kaplan–Meier method was used to analyse 30-day mortality before and after propensity score matching, and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality in the matched cohort were estimated with Cox proportional hazards models. Results In total, 1,238 patients who had a CVC removed due to suspected CRBSI were identified. Among these patients, 877 (70.8%) underwent IRINC, and 361 (29.2%) did not. Among 682 propensity score-matched patients, IRINC was associated with an increased risk of 30-day mortality (HR, 1.481; 95% CI, 1.028 to 2.134) after multivariable, multilevel adjustment. Kaplan–Meier analysis found that IRINC was associated with the risk of mortality both before matching (P = 0.00096) and after matching (P = 0.018). A competing risk analysis confirmed the results of the propensity score-matched analysis. The attributable risk associated with bloodstream infection was not significantly different (HR, 1.081; 95% CI 0.964 to 1.213) among patients with suspected CRBSI in terms of 30-day mortality compared with that associated with other infections. Conclusions In this cohort study, IRINC was associated with higher 30-day mortality compared to delayed CVC or no CVC among patients with suspected CRBSI. A large-sample randomized controlled trial is needed to define the best management for CVC in cases of suspected CRBSI because IRINC may also be associated with noninfectious complications. Trial registration This study was registered with the China Clinical Trials Registry (URL: http://www.chictr.org.cn/index.aspx) under the following registration number: ChiCTR1900022175.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of immediate reinsertion of new catheters with subsequent mortality among patients with suspected catheter infection: a cohort study

Zhong

Deng

Zhou

et al. 2022

Ann. Intensive Care

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“…[7–11] and provided the early primary positive result to the clinicians. In addition, the early detection of organisms contributes to optimizing antimicrobial therapy for children [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Value of Time to Positivity of Blood Culture in Children with Bloodstream Infections

Pan

Zhao

Zhang

2019

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Objective This study was to investigate the microbiological characteristics and the relationship between the time to positivity (TTP) of blood cultures and different bacterial species and to assess the clinical value of TTP in children with bloodstream infections (BSIs). Methods The TTP of all the blood cultures from children with suspected BSIs was retrospectively collected in 2016. The microbiological characteristics and the relationship between the TTP of blood cultures and different bacterial species were also analyzed. Results A total of 808 strains were isolated from 15835 blood cultures collected, and 145 (17.9%) were Gram-negative, 636 (78.7%) were Gram-positive, and 27 (3.3%) were fungi. The bacteria were divided into definite pathogens (174), possible pathogens (592), fungi (27), and contaminants (15). The average TTP of all positive blood cultures was 30.97 and ranged from 3.23 h to 92.73 h. The TTP of Gram-negative strains was significantly shorter than that of Gram-positive strains (P < 0.001) and fungi (P = 0.032). The mean TTP for E. coli (15.60 h) was shortest within the group of Gram-negative isolates, and the mean TTP for Streptococcus (17.34 h) within the group of Gram-positive isolates. Significant difference of the TTP was detected in methicillin-resistant vs methicillin-susceptible S. aureus, extended-spectrum beta-lactamases (ESBLs) positive vs negative Enterobacteriaceae, and extensive drug-resistant and non-XDR A. baumannii. The median TTP in patients with BSI was significantly shorter than in those without it (P < 0.001). ROC curve analysis indicated that the TTP cutoff value of CoNS, S. aureus, E. coli, and K. pneumoniae was 22.72 h, 19.6 h, 18.58 h, and 16.43 h, respectively, with most sensitive and specific predictor of BSIs. Conclusions Our data acknowledged that TTP is a valuable index for the early prognosis of BSIs. TTP not only provides additional utility as a general predictor of bacteria with smear result but also provides the implication of drug-resistant organisms.

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“…Our study showed most pathogens as Gram‐negative bacilli, mainly of refractory Acinetobacter baumannii , Klebsiella pneumoniae , Maltophilias, and Pseudomonas aeruginosa , similar to previous studies. The risk factors of catheter‐related infections include nutrition status, severity of the disease, catheter placement and indwelling time, history of surgery and so forth . Multiple studies have indicated a marked increase of infection risk 10 days after catheterization .…”

Section: Discussionmentioning

confidence: 99%

“…A generalized concept of catheter‐related infection covers the following three aspects: (i) Catheter‐related bloodstream infection (CRBSI): Clinical presentation of infection‐related symptoms, with at least 1 blood culture obtained by peripheral venipuncture and catheter tip culture, or separate culture of catheter tip and peripheral blood samples revealing the same bacteria ; (ii) Catheter‐related colonization (CRCOL): Presentation of clinical symptoms and catheter tip culture with at least one microbial colonization ; and (iii) Suspected catheter‐related infection: Presentation of clinical symptoms excluding other underlying causes, with negative microbial culture .…”

Section: Methodsmentioning

confidence: 99%

Vascular Access in Patients Treated with Continuous Renal Replacement Therapy: A Report from a Single Center in China

Ren

et al. 2019

Ther Apher Dial

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Our aim was to analyze the practice pattern of vascular access use and complication rates in patients receiving continuous renal replacement therapy from a large Chinese urban medical center. Patients who had received continuous renal replacement therapy (CRRT) from April to October 2014 in our center were included in this study. Demographic data, primary disease, department for hospitalization, blood pressure, heart rate, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, presence of mechanical ventilation, CRRT modalities, choice of functioning vascular access, site and duration of catheter insertion, presence of recatheterization, cumulative catheter indwelling time, catheter malfunction and catheter‐related infections, as well as laboratory test results, were collected. A total of 292 patients were enrolled in our study, including 175 males (59.9%) and 117 females (40.1%), aged 50.8 ± 18.6 years (range, 12 to 94 years). Acute kidney injury, multiple organ dysfunction syndrome, and systemic inflammatory response syndrome were the main indications for treatment with CRRT. Initial vascular access was non‐cuffed temporary catheters in 280 patients and was preferentially obtained in the right internal jugular vein (54.3%). There were 32 (11.4%) patients requiring re‐catheterization. Catheter malfunction occurred in 7.14% of all patients, and the median time of catheter malfunction was found at the 5th day. By multivariate analysis, it was found that the main risk factors of catheter malfunction were cumulative treatment time of CRRT and the level of hemoglobin. The average time of catheter‐related infections was 10.7 days after insertion and the catheter‐related infections occurred at a rate of 7.19 per 1000 catheter days. The main risk factors for catheter‐related infections were cumulative time of catheterization and the level of serum albumin. In this cohort of critically ill patients, the main risk factors for catheter malfunction were cumulative CRRT time and the level of hemoglobin. In addition, the main risk factors for catheter‐related infections were cumulative time of catheterization and the level of serum albumin.

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Blood culture differential time to positivity enables safe catheter retention in suspected catheter-related bloodstream infection: a randomized controlled trial

Cited by 10 publications

References 23 publications

Association of immediate reinsertion of new catheters with subsequent mortality among patients with suspected catheter infection: a cohort study

Association of immediate reinsertion of new catheters with subsequent mortality among patients with suspected catheter infection: a cohort study

Value of Time to Positivity of Blood Culture in Children with Bloodstream Infections

Vascular Access in Patients Treated with Continuous Renal Replacement Therapy: A Report from a Single Center in China

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