Nonuniform Risk of Bloodstream Infection with Increasing Central Venous Catheter-Days

Abstract Objective: To determine whether the conventional rate for central venous catheter (CVC)-associated bloodstream infection (BSI) accurately reflects risk for patients exposed for a variety of in situ periods. Patients and Methods: Intensive care unit patients (n = 1,375) were monitored for 7,467 CVC-days. They were monitored until catheter removal, until diagnosis of CVC-associated BSI, or for 24 hours after discharge. Results: The BSI rate was 3.7 per 1,000 CVC-days. Ninety-three percent of these patients had CVCs in situ for 1-15 days. These patients were exposed to 59.7% of all CVC-days; the remaining 7% were exposed to 40.3% of all CVC-days. BSI rates stratified by exposure periods of 1-5 and 6-15 days were 2.1 and 4.5 per 1,000 CVC-days, respectively. The rates for 16-30 and 31-320 days were 10.2 and 2.1 per 1,000 CVC-days, respectively. The probability of BSI with a CVC in situ was 6 in 100 by day 15, 14 in 100 by day 25, 21 in 100 by day 30, and 53 in 100 by day 320. Conclusion: The conventional aggregated rate better reflects the risk for the majority of patients rather than for patients exposed to the majority of CVC-days. It does not reflect the true probability of risk for all exposures, especially beyond 30 days. CVCs in situ from 1 to 15 days had less risk of BSI than CVCs in situ more than 15 days, which may explain why scheduled CVC replacement at days 5 to 7 has not been found beneficial.

[1]  E. Lesaffre,et al.  Statistical Methods in Medical Research. Editorial. , 2005, Statistical methods in medical research.

[2]  M. Courtney,et al.  Routine Changing of Intravenous Administration Sets Does Not Reduce Colonization or Infection in Central Venous Catheters , 2004, Infection Control & Hospital Epidemiology.

[3]  S. Hugonnet,et al.  Nosocomial Bloodstream Infection and Clinical Sepsis , 2004, Emerging infectious diseases.

[4]  Nnis System.  National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. , 2003, American journal of infection control.

[5]  M. McLaws,et al.  The Hospital Infection Standardised Surveillance (HISS) programme: analysis of a two-year pilot. , 2003, The Journal of hospital infection.

[6]  Michael K Gould,et al.  Preventing complications of central venous catheterization. , 2003, The New England journal of medicine.

[7]  H. Eraksoy,et al.  Annals of Clinical Microbiology and Antimicrobials Open Access Central Venous Catheter Related Infections: Risk Factors and the Effect of Glycopeptide Antibiotics , 2003 .

[8]  K. Polderman,et al.  Central venous catheter use. Part 2: infectious complications. , 2002, Intensive care medicine.

[9]  F Golliot,et al.  Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. , 2001, JAMA.

[10]  National Nosocomial Infections Surveillance (NNIS) System Report, Data Summary from January 1992-June 2001, issued August 2001. , 2001, American journal of infection control.

[11]  K. Polderman,et al.  Central venous catheter use , 2001, Intensive Care Medicine.

[12]  D. Fraenkel,et al.  Can We Achieve Consensus on Central Venous Catheter-Related Infections? , 2000, Anaesthesia and intensive care.

[13]  G. Collin.  Decreasing catheter colonization through the use of an antiseptic-impregnated catheter: a continuous quality improvement project. , 1999, Chest.

[14]  S. Finfer,et al.  Incidence and Predictors of Central Venous Catheter Related Infection in Intensive Care Patients , 1999, Anaesthesia and intensive care.

[15]  L. Mermel,et al.  Prevention of Central Venous Catheter-Related Bloodstream Infection by Use of an Antiseptic-Impregnated Catheter , 1997, Annals of Internal Medicine.

[16]  D. Cook,et al.  Central venous catheter replacement strategies: a systematic review of the literature. , 1997, Critical care medicine.

[17]  A. Widmer,et al.  Intravascular catheter-associated infections. , 1997, Schweizerische medizinische Wochenschrift.

[18]  M. Arrowsmith.  Central venous catheter infections: concepts and controversies. , 1997, Intensive care medicine.

[19]  M. Pearson.  Guideline for Prevention of Intravascular-Device–Related Infections , 1996, Infection Control & Hospital Epidemiology.

[20]  M. Pearson.  Guideline for Prevention of Intravascular-Device–Related Infections , 1996, Infection Control & Hospital Epidemiology.

[21]  M. Pearson.  Guideline for prevention of intravascular device-related infections. Part I. Intravascular device-related infections : an overview. The Hospital Infection Control Practices Advisory Committee , 1996 .

[22]  P. Collignon.  Intravascular catheter associated sepsis: a common problem , 1994 .

[23]  K. J. Schwenzer,et al.  A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. , 1992, The New England journal of medicine.

[24]  S. Bonawitz,et al.  Prevention of central venous catheter sepsis: a prospective randomized trial. , 1991, The American surgeon.

[25]  J J Gart,et al.  Approximate interval estimation of the ratio of binomial parameters: a review and corrections for skewness. , 1988, Biometrics.

[26]  J. Pratt.  Length of Confidence Intervals , 1961 .