Skip to main content
Erschienen in: Intensive Care Medicine 6/2005

01.06.2005 | Original

Indwelling time and risk of infection of dialysis catheters in critically ill cancer patients

verfasst von: Abbas Harb, Georges Estphan, Gérard Nitenberg, Elisabeth Chachaty, Bruno Raynard, François Blot

Erschienen in: Intensive Care Medicine | Ausgabe 6/2005

Einloggen, um Zugang zu erhalten

Abstract

Objective

Despite the lack of evidence to support routine scheduled replacement of dialysis catheters (DCs) this practice continues to be widely used in many intensive care units (ICUs). This study evaluated whether additional risks of catheter-related infection (CRI) are incurred with a conservative attitude in critically ill cancer patients.

Design and setting

Prospective, observational study over a 14-month period in a 15-bed medicosurgical unit in a comprehensive cancer center.

Patients

Seventy-nine double-lumen DCs were evaluated in 47 patients. Incidence rates of infection per 1000 days of catheter use were examined over 7-day periods.

Measurements and results

The mean indwelling time was 6.9±5.5 days. Twelve DCs (15.2%) were removed for suspected CRI. Catheter-tip cultures remained negative in 74 cases (93.7%). Overall, one bacteremic CRI, two colonization episodes, and two contaminations were diagnosed, leading to DC colonization and DC-related bacteremia incidence rates of, respectively, 5.4 and 1.8 per 1000 days. When the catheter colonization rate was examined at 7-day intervals, the incidence rate was similar whatever the indwelling time: 5.8, 4.8, and 6.0 per 1000 days, respectively, for the 49 catheters left in place for 7 days or less, 8–14 days (21 DCs), and more than 14 days (9 DCs). The DC colonization incidence rate was similar to that of the 42 short-term catheters inserted during the same period in the same patients (5.9 per 1000 days).

Conclusions

The stable low risk for DC-related infections over time does not support the rationale for scheduled replacement, even in immunocompromised cancer patients.
Literatur
1.
Zurück zum Zitat O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA (2002) Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 23:759–769 O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA (2002) Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 23:759–769
2.
Zurück zum Zitat Rubinson L, Haponik EF, Wu AW, Diette GB (2003) Internists’ adherence to guidelines for prevention of intravascular catheter infections. JAMA 290:2802 Rubinson L, Haponik EF, Wu AW, Diette GB (2003) Internists’ adherence to guidelines for prevention of intravascular catheter infections. JAMA 290:2802
3.
Zurück zum Zitat Cyna AM, Hovenden JL, Lehmann A, Rajaseker K, Kalia P (1998) Routine replacement of central venous catheters: telephone survey of intensive care units in mainland Britain. BMJ 316:1944–1945 Cyna AM, Hovenden JL, Lehmann A, Rajaseker K, Kalia P (1998) Routine replacement of central venous catheters: telephone survey of intensive care units in mainland Britain. BMJ 316:1944–1945
4.
Zurück zum Zitat Souweine B, Traore O, Aublet-Cuvelier B, Badrikian L, Bret L, Sirot J, Gazuy N, Laveran H, Deteix P (1999) Dialysis and central venous catheter infections in critically ill patients: results of a prospective study. Crit Care Med 27:2394–2398 Souweine B, Traore O, Aublet-Cuvelier B, Badrikian L, Bret L, Sirot J, Gazuy N, Laveran H, Deteix P (1999) Dialysis and central venous catheter infections in critically ill patients: results of a prospective study. Crit Care Med 27:2394–2398
5.
Zurück zum Zitat Wester JPJ, de Koning EJP, Geers ABM, Vincent HH, de Jongh BM, Tersmette M, Leusink JA (2002) Catheter replacement in continuous arteriovenous hemodiafiltration: the balance between infectious and mechanical complications. Crit Care Med 30:1261–1266 Wester JPJ, de Koning EJP, Geers ABM, Vincent HH, de Jongh BM, Tersmette M, Leusink JA (2002) Catheter replacement in continuous arteriovenous hemodiafiltration: the balance between infectious and mechanical complications. Crit Care Med 30:1261–1266
6.
Zurück zum Zitat Blot F, Guiguet M, Nitenberg G, Leclercq B, Gachot B, Escudier B (1997) Prognostic factors for neutropenic patients in an intensive care unit. Respective roles of underlying malignancies and acute organ failures. Eur J Cancer 33:1031–1037 Blot F, Guiguet M, Nitenberg G, Leclercq B, Gachot B, Escudier B (1997) Prognostic factors for neutropenic patients in an intensive care unit. Respective roles of underlying malignancies and acute organ failures. Eur J Cancer 33:1031–1037
7.
Zurück zum Zitat Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963 Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
8.
Zurück zum Zitat Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ-system failure. Ann Surg 11:685–693 Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ-system failure. Ann Surg 11:685–693
9.
Zurück zum Zitat Raad II, Hohn DC, Gilbreath BJ, Suleiman N, Hill LA, Bruso PA, Marts K, Mansfield PF, Bodey GP (1994) Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 15:231–238 Raad II, Hohn DC, Gilbreath BJ, Suleiman N, Hill LA, Bruso PA, Marts K, Mansfield PF, Bodey GP (1994) Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 15:231–238
10.
Zurück zum Zitat Blot F, Chachaty E, Raynard B, Antoun S, Bourgain JL, Nitenberg G (2001) Mechanisms and risk factors for infection of pulmonary artery catheters and introducer sheaths in cancer patients admitted to an intensive care unit. J Hosp Infect 48:289–297 Blot F, Chachaty E, Raynard B, Antoun S, Bourgain JL, Nitenberg G (2001) Mechanisms and risk factors for infection of pulmonary artery catheters and introducer sheaths in cancer patients admitted to an intensive care unit. J Hosp Infect 48:289–297
11.
Zurück zum Zitat Brun-Buisson C, Abrouk F, Legrand P, Huet Y, Larabi S, Rapin M (1987) Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med 147:873–877 Brun-Buisson C, Abrouk F, Legrand P, Huet Y, Larabi S, Rapin M (1987) Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med 147:873–877
12.
Zurück zum Zitat Blot F, Nitenberg G, Chachaty E, Raynard B, Germann N, Antoun S, Laplanche A, Brun-Buisson C, Tancrède C (1999) Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of central vs. peripheral blood cultures. Lancet 354:1071–1077 Blot F, Nitenberg G, Chachaty E, Raynard B, Germann N, Antoun S, Laplanche A, Brun-Buisson C, Tancrède C (1999) Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of central vs. peripheral blood cultures. Lancet 354:1071–1077
13.
Zurück zum Zitat Rijnders, B. J, W. E. Peetermans et al (2004) Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial. Intensive Care Med 30:1073–1080 Rijnders, B. J, W. E. Peetermans et al (2004) Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial. Intensive Care Med 30:1073–1080
14.
Zurück zum Zitat Brun-Buisson, C (2004) Suspected central venous catheter-associated infection: can the catheter be safely retained? Intensive Care Med 30:1005–1007 Brun-Buisson, C (2004) Suspected central venous catheter-associated infection: can the catheter be safely retained? Intensive Care Med 30:1005–1007
15.
Zurück zum Zitat Uldall PR, Merchant N, Woods F, Yarworski U, Vas S (1981) Changing subclavian haemodialysis cannulas to reduce infection. Lancet 8234:1373 Uldall PR, Merchant N, Woods F, Yarworski U, Vas S (1981) Changing subclavian haemodialysis cannulas to reduce infection. Lancet 8234:1373
16.
Zurück zum Zitat Cook D, Randolph A et al (1997) Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med 25:1417–24 Cook D, Randolph A et al (1997) Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med 25:1417–24
17.
Zurück zum Zitat Pronovost PJ, Wu AW, Sexton JB (2004) Acute decompensation after removing a central line: practical approaches to increasing safety in the intensive care unit. Ann Intern Med 140:1025–1033 Pronovost PJ, Wu AW, Sexton JB (2004) Acute decompensation after removing a central line: practical approaches to increasing safety in the intensive care unit. Ann Intern Med 140:1025–1033
18.
Zurück zum Zitat Nitenberg G, Blot F (2004) Diagnosis of catheter-related infections. In: O’ Grady, Pittet (eds) Catheter-related infections in the critically ill, 2nd edn. Kluwer, Boston, pp 59–76 Nitenberg G, Blot F (2004) Diagnosis of catheter-related infections. In: O’ Grady, Pittet (eds) Catheter-related infections in the critically ill, 2nd edn. Kluwer, Boston, pp 59–76
Metadaten
Titel
Indwelling time and risk of infection of dialysis catheters in critically ill cancer patients
verfasst von
Abbas Harb
Georges Estphan
Gérard Nitenberg
Elisabeth Chachaty
Bruno Raynard
François Blot
Publikationsdatum
01.06.2005
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 6/2005
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-005-2621-5

Weitere Artikel der Ausgabe 6/2005

Intensive Care Medicine 6/2005 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.