Clinical impact of delayed catheter removal for patients with central-venous-catheter-related Gram-negative bacteraemia

Lee, Yu‐Mi; Moon, Chisook; Kim, Young Jin; Lee, Hee-Joo; Lee, Mi Suk; Park, Ki Ho

doi:10.1016/j.jhin.2018.01.004

Cited by 40 publications

(30 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This recommendation is justified by two findings reported in the literature: (1) more than 20% of central catheters in place on a given day are not justified, even in the intensive care unit [ 165 ], and (2) the maintenance of a catheter in the presence of proven infection is always hazardous and associated with mortality excess [ 166 , 167 ], particularly in the case of multidrug-resistant bacteria.…”

Section: Summary Of the Resultsmentioning

confidence: 99%

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Timsit

Baleine

Bernard

et al. 2020

Ann. Intensive Care

125

View full text Add to dashboard Cite

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.

show abstract

Section: Summary Of the Resultsmentioning

confidence: 99%

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Timsit

Baleine

Bernard

et al. 2020

Ann. Intensive Care

125

View full text Add to dashboard Cite

show abstract

“…Previous studies have found mixed results regarding timing of catheter removal and mortality. [ 25 , 26 ] Given the large burden of unremoved CVCs in our study, it seems prudent to remove a CVC once a MDRO CLABSI has been identified as a first step in improving patient outcomes. Future studies with larger sample sizes can help clarify what role early CVC removal has in impacting clinical outcomes of MDRO CLABSIs.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that failure to remove a CVC is associated with an increased risk of hematogenous complications as well as mortality. [ 23 , 24 ] In one study of gram-negative CLABSIs, [ 25 ] there was a strong association between failure to remove a CVC and mortality. In addition, this study included patients with MDR gram-negative CLABSIs and found that CVC removal was particularly helpful in reducing mortality in this small sub group.…”

Section: Discussionmentioning

confidence: 99%

“…Previous work has shown that patients with gram-negative MDRO CLABSIs fare worse when their catheters are not removed. [ 25 ] Therefore, we felt it was more useful to include different types of MDROs rather than comparing to patients with non-MDRO infections. In addition, there were differences between patients that had their catheter removed and those that did not.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Catheter removal and outcomes of multidrug-resistant central-line-associated bloodstream infection

Burnham¹,

Rojek

Kollef

2018

Medicine

View full text Add to dashboard Cite

Central-line-associated bloodstream infections (CLABSIs) are responsible for ∼1/3 of all deaths from healthcare-associated infections in the United States. Of these, multidrug-resistant organisms (MDROs) are responsible for 20% to 67%. However, whether catheter removal affects clinical outcomes for MDRO CLABSIs has not been studied. Our objective was to determine the relationship between failure to remove a central venous catheter (CVC) and 30-day all-cause mortality in patients with MDRO CLABSIs. We used a retrospective cohort from Barnes-Jewish Hospital (1/1/2009–10/1/2015) to study patients with a multidrug-resistant Staphylococcus aureus, Enterococcus species, Enterobacteriaceae, Acinetobacter species, or Pseudomonas aeruginosa CLABSI. Risk factors for 30-day mortality, including catheter removal, were assessed for association with 30-day mortality using Cox proportional hazards models. The CLABSIs were assessed prospectively at the time of occurrence by infection prevention specialists. A total of 430 patients met inclusion criteria, 173 (40.2%) with Enterococcus, 116 (27.0%) Enterobacteriaceae, 81 (18.8%) S aureus, 44 (10.2%) polymicrobial, 11 (2.6%) P aeruginosa, and 5 (1.2%) Acinetobacter CLABSIs. Removal of a CVC occurred in 50.2% of patients, of which 4.2% died by 30 days (n = 9). For patients whose CVC remained in place, 45.3% died (n = 97). Failure to remove a CVC was strongly associated with 30-day all-cause mortality with a hazard ratio of 13.5 (6.8–26.7), P < .001. Other risk factors for 30-day mortality included patient comorbidities (cardiovascular disease, congestive heart failure, cirrhosis), and being in an intensive care unit at the time of MDRO isolation. Failure to remove a CVC was strongly associated with 30-day all-cause mortality for patients with MDRO CLABSIs in this single center retrospective cohort. This suggests that patients presenting with MDRO CLABSIs should all undergo CVC removal.

show abstract

“…Catheter removal is strongly recommended in patients with CR-BSI due to S. aureus, gram-negative bacilli, enterococci, fungi, or multidrug-resistant (MDR) bacteria. 15,[135][136][137][138][139] If CoNS are identified, and if blood culture contamination is ruled out, the catheter should be removed: CVC retention does not have any impact on the resolution of CoNS bacteremia but is a significant risk factor of recurrence. 140 In general, for CR-BSI (i.e., bacteremic catheter infection), the catheter removal is preferable as it allows a complete removal of the source of infection.…”

Section: Management Of Catheter-related Infectionsmentioning

confidence: 99%

Management and Prevention of Central Venous Catheter-Related Infections in the ICU

Buetti

Timsit

2019

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Central venous catheter-related bloodstream infections (CR-BSI) are a frequent event in the intensive care unit (ICU) setting. In contrast to other nosocomial infections, most risk factors for CR-BSI are linked to the device and can be prevented efficiently. Rates of CR-BSI higher than 1 per 1,000 catheter days are no longer acceptable. A continuous quality improvement program is effective to reduce them. Key elements of prevention of CR-BSI are hand hygiene, avoidance of insertion of unnecessary catheters, full sterile barrier precautions at insertion, preferential use of subclavian venous insertion site, cutaneous antisepsis with 2% chlorhexidine alcoholic preparation, use of chlorhexidine-impregnated dressings, immediate replacement of moistened or detached catheter dressings, and removal of catheters as soon as possible. Audit and feedback of the process of care, infection rates, and periodic re-education of health care providers are other instrumental tools in the prevention of CR-BSI. Catheter removal is the main therapeutic intervention, especially recommended in the case of sepsis or shock. While awaiting culture results, an empiric antimicrobial treatment of CR-BSI should target gram-positive microorganism (i.e., Staphylococcus aureus) and gram-negative coverage should be based on clinical variables, patients' risk factors, and previous colonization status. While a short course of antimicrobials (7 days) is sufficient for noncomplicated CR-BSI, a longer course of 14 days should be preferred for uncomplicated S. aureus and Candida CR-BSI. In case of persisting fever or positive blood culture after 3 days despite adequate antimicrobial therapy and catheter removal, catheter-related complications (e.g., endocarditis, thrombophlebitis, septic metastasis) should be ruled out.

show abstract

Clinical impact of delayed catheter removal for patients with central-venous-catheter-related Gram-negative bacteraemia

Cited by 40 publications

References 44 publications

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

Catheter removal and outcomes of multidrug-resistant central-line-associated bloodstream infection

Management and Prevention of Central Venous Catheter-Related Infections in the ICU

Contact Info

Product

Resources

About