Dialysis and central venous catheter infections in critically ill patients: Results of a prospective study

Souweine, Bertrand; Traoré, Ousmane; Aublet-Cuvelier, Bruno; Badrikian, Laurence; Bret, Laurent; Sirot, J.; Gazuy, N; Laveran, H.; Deteix, P

doi:10.1097/00003246-199911000-00012

Cited by 54 publications

(51 citation statements)

References 32 publications

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“…The higher mortality in this population may compete with catheterrelated bloodstream infection. In agreement with previous reports (17,19), the most frequently cultured microorganism was Staphylococcus epidermidis. Predominance of fungi may be, in part explained by greater broad-spectrum, predominantly antibacterial, antibiotic use in CRRT patients than IHD, as suggested by greater antimicrobial use noted in the Table 1.…”

Section: Discussionsupporting

confidence: 93%

“…Of note, differences in the microbial findings could not be explained by anatomic site differences, since the mode of RRT served as a blocking variable in the jugular versus femoral randomization process (Table 1). Also, Gram positive bacteria were responsible for all catheter-related bloodstream infection, as previously reported (17).…”

Section: Discussionsupporting

confidence: 72%

“…Consequently, acute RRT catheter-tip colonization may be less prone to lead to bloodstream infection than non-RRT catheters. This hypothesis is supported by two small single-center studies by Souweine et al (17,18), which compared dialysis and non-RRT catheter-related infection rates. Although not statistically significant, both studies (17,18) reported higher rates of colonization but lower rates of catheterrelated bloodstream infection in dialysis versus non-RRT catheters.…”

Section: Discussionmentioning

confidence: 84%

See 2 more Smart Citations

Continuous Renal Replacement Therapy May Increase the Risk of Catheter Infection

Parienti

Dugué

Daurel³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives:Little is known about the risks of catheter-related infections in patients undergoing intermittent hemodialysis (IHD) as compared with continuous renal replacement therapy (CRRT) techniques. We compared the two modalities among critically ill adults requiring acute renal replacement therapy (RRT).Design, setting, participants, & measurements: We used the multicenter Cathedia study cohort of 736 critically ill adults requiring RRT. Cox marginal structural models were used to compare time to catheter-tip colonization at removal (intent-totreat, primary endpoint) among patients who started IHD (n ‫؍‬ 470) versus CRRT (n ‫؍‬ 266). On-treatment analysis was also conducted to take into account changes in prescription of RRT modality.Results: Hazard rate of catheter-tip colonization did not increase within the first 10 days of catheter use. Predictors of catheter-tip colonization were higher lactate levels and hypertension, while systemic antibiotics, antiseptics-impregnated catheters, and mechanical ventilation were associated with decreased risk. The incidence of catheter-tip colonization per 1000 catheter-days was 42.7 in the IHD group and 27.7 in the CRRT group (P < 0.01). This association was no longer significant after correction for channeling bias (weighted HR, 0.96; 95% CI: 0.77 to 1.20, P ‫؍‬ 0.73). On-treatment analysis revealed an increased risk of primary endpoint during CRRT exposure as compared with IHD exposure (weighted HR, 0.71; 95% CI: 0.56 to 0.92, P < 0.009).Conclusions: Our results do not support the use of CRRT when IHD could be an alternative to reduce the risk of catheter-related infection.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 84%

See 1 more Smart Citation

Continuous Renal Replacement Therapy May Increase the Risk of Catheter Infection

Parienti

Dugué

Daurel³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…The catheterization duration (7 days) reported in this study was similar to those reported in previous studies (5,8,(15)(16)(17)(18), ranging from 4.2 days (16) to 12.0 days (5). This short-term indwelling duration suggests that the extraluminal route of cathetertip colonization predominated (19).…”

Section: Discussionsupporting

confidence: 88%

Quasi-Experimental Study of Sodium Citrate Locks and the Risk of Acute Hemodialysis Catheter Infection among Critically Ill Patients

Parienti

Deryckere

Mégarbane

et al. 2014

Antimicrob Agents Chemother

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“…The catheter duration was 7 days, in accordance with previous studies (22,29,30). The median indwelling time reported in this study is 2 days longer than the 5 days reported in the overall Cathedia cohort (7).…”

Section: Discussionsupporting

confidence: 65%

Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

Dugué

Levesque²,

Fischer

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Several temporary venous catheterizations are sometimes required for acute renal replacement therapy (RRT) in the intensive care unit (ICU). This study compares first and second catheterizations in the femoral and jugular veins in terms of patient safety.Design, setting, participants, & measurements A crossover study from the catheter-dialysis randomized study (Cathedia), which was conducted among 736 critically ill adults requiring RRT, was performed. Catheter insertion complications, catheter-tip colonization, catheter dysfunction and urea reduction ratio (URR) were analyzed considering the crossover and longitudinal designs.Results This study analyzed 134 patients who underwent two different sites of catheterization, 57 and 77 of whom were initially randomized in the femoral and jugular site, respectively. Using anatomic landmarks, time to insert a femoral catheter was shorter (P=0.01) and more successful (P=0.003) compared with catheterization in the jugular site. Time to catheter-tip colonization at removal was not significantly different between the two sites of insertion (median, 14 days in both groups; hazard ratio, 0.99; 95% confidence interval, 0.61-1.59; P=0.96), as well as time to dysfunction. URRs were analyzed from 395 dialysis sessions (n=48 patients). No significant difference (P=0.49) in mean URR was detected between sessions performed through femoral (n=213; 50.9%) and jugular (n=182; 49.5%) dialysis catheters.Conclusions These results validate prior results of this study group and extend external validity to the second catheter used for RRT in the ICU. Femoral and internal jugular acute vascular access sites are both acceptable for RRT therapy in the ICU.

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Dialysis and central venous catheter infections in critically ill patients: Results of a prospective study

Cited by 54 publications

References 32 publications

Continuous Renal Replacement Therapy May Increase the Risk of Catheter Infection

Continuous Renal Replacement Therapy May Increase the Risk of Catheter Infection

Quasi-Experimental Study of Sodium Citrate Locks and the Risk of Acute Hemodialysis Catheter Infection among Critically Ill Patients

Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

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