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Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis
John C O'Horo1, Dennis G Maki, Anna E Krupp
11Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. 2William S. Middleton Memorial Veterans Hospital, Madison, WI. 3Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. 4University of Wisconsin Hospital and Clinics, Madison, WI.
Insights
Catheter-related bloodstream infections (CRBSIs) from arterial catheters are a significant concern. Studies show a pooled incidence of 3.40 per 1,000 catheters, with femoral sites posing a higher infection risk than radial sites.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Vascular Access
Background:
- Catheter-related bloodstream infections (CRBSIs) pose significant risks and costs in critical care.
- Arterial catheters are frequently used and manipulated in intensive care units.
- The prevalence of CRBSI specifically related to arterial catheters requires thorough evaluation.
Purpose of the Study:
- To determine the prevalence of catheter-related bloodstream infections associated with arterial catheters.
- To identify risk factors influencing the incidence of arterial CRBSI.
Main Methods:
- Systematic literature search of PubMed, CinAHL, EMBASE, and Web of Science.
- Included studies reported CRBSI prevalence for arterial catheters in critically ill or postoperative patients.
- Data extraction included study population, insertion site, antiseptic use, catheter days, and CRBSI prevalence; authors were contacted for missing data.
Main Results:
- Forty-nine studies comprising 222 CRBSI cases in 30,841 catheters were analyzed.
- Pooled incidence was 3.40 per 1,000 catheters or 0.96 per 1,000 catheter days.
- Femoral insertion sites showed a significantly higher risk (RR, 1.93) compared to radial sites.
Conclusions:
- Arterial catheters are an underrecognized source of bloodstream infections.
- Systematic culturing reveals a substantial burden of arterial CRBSI.
- Choosing radial over femoral insertion sites can mitigate infection risk.
Objective:
Catheter-related bloodstream infections are associated with significant costs and adverse consequences. Arterial catheters are commonly used in the critical care setting and are among the most heavily manipulated vascular access devices. We sought to evaluate the prevalence of arterial catheter-related bloodstream infection.
Data Sources:
PubMed, CinAHL, EMBASE, and Web of Science.
Study Selection:
Included studies reported prevalence rate of catheter-related bloodstream infection for arterial catheters used for critical illness or postoperative monitoring. For the purposes of this study, catheter-related bloodstream infection was defined as positive blood culture collected from an arterial catheter and from the periphery with the same organism in a patient demonstrating systemic signs of sepsis.
Data Extraction:
The study population, site of insertion, antiseptic preparation, catheter days, and prevalence of catheter-related bloodstream infection were abstracted. When data were not available, authors were contacted for further information.
Data Synthesis:
Forty-nine studies met criteria including 222 cases of arterial catheter-related bloodstream infection in 30,841 catheters. Pooled incidence was 3.40/1,000 catheters or 0.96/1,000 catheter days. Prevalence was considerably higher in the subgroup of studies that cultured all catheters (1.26/1,000 catheter days) compared with those studies that cultured only when the arterial catheter was suspected as the source for the catheter-related bloodstream infection (0.70/1,000 catheter days). Pooled data also found a significantly increased risk of infection for femoral site of insertion compared with radial artery for arterial catheter placement (relative risk, 1.93; 95% CI, 1.32-2.84; p = 0.001) CONCLUSIONS: Arterial catheters are an underrecognized cause of catheter-related bloodstream infection. Pooled incidence when catheters were systematically cultured and correlated to blood culture results indicated a substantial burden of arterial catheter-related bloodstream infection. Selection of a radial site over a femoral site will help reduce the risk of arterial catheter-related bloodstream infection. Future studies should evaluate technologies applied to preventing central venous catheter-related bloodstream infection to arterial catheters as well.
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