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Multilumen central venous catheters increase risk for catheter-related bloodstream infection: prospective
A Templeton1, M Schlegel, F Fleisch
1Infectious Diseases and Hospital Hygiene, Stadtspital Triemli, Birmendorferstr. 497, 8063, Zürich, Switzerland.
Insights
Catheter-related bloodstream infections (CRBSI) are reduced by limiting the number of lumens in central venous catheters (CVCs). Using fewer lumens and blocking unused ones lowers CRBSI risk in surgical patients.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Medical Device Infections
Background:
- Catheter-related bloodstream infections (CRBSI) are a significant cause of hospital-acquired infections, leading to increased mortality and healthcare costs.
- Identifying risk factors for CRBSI is crucial for developing effective prevention strategies.
Purpose of the Study:
- To determine the incidence rate of CRBSI in two Swiss hospitals.
- To identify independent risk factors associated with CRBSI in patients with central venous catheters (CVCs).
Main Methods:
- Prospective study of 1,396 CVCs inserted in 1,162 surgical patients over one year.
- CRBSI defined by definite or probable criteria based on blood and catheter cultures.
- Univariate and multivariate time-to-event analyses were used to identify risk factors.
Main Results:
- The incidence density of CRBSI was 2.5 per 1,000 catheter-days.
- Increased catheter lumens (HR=4.4) and jugular access (HR=2.2) were significant risk factors for CRBSI.
- Blocking unused lumens (HR=0.3) demonstrated a protective effect.
Conclusions:
- The number of catheter lumens and insertion site are independent risk factors for CRBSI.
- Restricting the use of multi-lumen catheters and closing unnecessary lumens can mitigate CRBSI risk.
Background:
Catheter-related bloodstream infections (CRBSI) are a leading cause of nosocomial infections associated with significant mortality and costs. The objective of this study was to determine the rate of CRBSI in two large Swiss hospitals and to identify risk factors for this condition.
Patients And Methods:
During 1 year all central venous catheter (CVC)-inserted in patients admitted for visceral, orthopedic or urologic surgery at the cantonal hospital in St Gallen and cantonal hospital in Chur were included in the study. Catheters were followed for the duration of their insertion. Blood cultures and semiquantitative cultures from catheters were drawn in the presence of local or systemic signs of infection. Primary endpoint was CRBSI defined as definite if (a) the same pathogen grew in at least one blood culture and from the distal segment of the catheter or (b) the same pathogen grew in at least one peripherally and centrally drawn blood culture and the differential time to positivity of central blood culture vs peripheral blood culture was > 120 min. CRBSI was defined as probable if at least one blood culture was positive with a recognized pathogen in the absence of another site of infection. Data were analyzed using univariate and multivariate time-to-event methods.
Results:
During the study period, 1,396 CVCs were prospectively studied in 1,162 patients. Incidence density of all CRBSIs (definite n = 29, probable n = 7) was 2.5 (95% CI: 1.8-3.5) per 1,000 catheter-days. The lowest rate of CRBSI was found in subclavian catheters, the adjusted hazard ratio (HR) for jugular catheters was 2.2 (95% CI: 1.1- 4.3; p = 0.03) and for femoral catheters 2.9 (95% CI: 0.6-14.4; p = 0.19). Each additional lumen increased the risk (HR = 4.4; 95% CI: 2.5-7.7; p < 0.001), whereas the permanent blocking of additional lumens was protective (HR = 0.3; 95% CI: 0.1-0.7; p = 0.006). The most commonly isolated organism were coagulase-negative staphylococci with a rate of 28%.
Conclusion:
Number of lumens and site of access were independent risk factors for CRBSI. The use of catheters with multiple lumens should therefore be restricted as far as possible. If a catheter cannot be removed, the permanent closure of unneeded lumens may reduce the risk of CRBSI.
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