Journal article
Concurrent systemic antibiotics at catheter insertion and intravascular catheter-related infection in the ICU: a post hoc analysis using individual data from five large RCTs.
- Buetti N University of Paris, INSERM, IAME, F-75006, Paris, France; Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address: niccolo.buetti@gmail.com.
- Souweine B Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France.
- Mermel L Division of Infectious Diseases, Rhode Island Hospital and Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
- Mimoz O Service des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, France, Université de Poitiers, Poitiers, France, Inserm U1070, Poitiers, 86021, France.
- Ruckly S University of Paris, INSERM, IAME, F-75006, Paris, France.
- Loiodice A ICURESEARCH, 6B avenue de Romans, Saint Marcellin, France.
- Mongardon N Service d'Anesthésie-Réanimation Chirurgicale, Hôpitaux Universitaires Henri Mondor, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm U955 équipe 3, Faculté de Santé, Université Paris-Est Créteil, Créteil, France.
- Lucet JC University of Paris, INSERM, IAME, F-75006, Paris, France; AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.
- Parienti JJ Department of Biostatistics and Clinical Research and Department of Infectious Diseases, Caen University Hospital, Caen, 14000, France; EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Université Caen Normandie, Caen, France.
- Timsit JF University of Paris, INSERM, IAME, F-75006, Paris, France; Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.
- 2020-11-05
Published in:
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. - 2020
Catheter-related bloodstream infection
Catheter-related infection
ICU
Intravascular catheter infection
Systemic antibiotics
English
OBJECTIVES
Data on the impact of systemic antibiotics at the time of catheter insertion are scarce. Therefore, we assessed the association between concurrent antibiotic administration at insertion and short-term catheter-related infections.
METHODS
We used individual data gathered from five large, randomized, controlled ICU trials. We analysed adult patients who required arterial, short-term central venous or dialysis catheter insertion in the ICU. The effect of antibiotics at insertion on major catheter-related infection (MCRI), catheter-related bloodstream infection (CRBSI) and colonization was estimated using multivariate marginal Cox and propensity score models.
RESULTS
We included 10 269 patients and 18 743 catheters from 36 ICUs. Antibiotic use was ongoing at the time of 11 361 catheter insertions (60.6%). After adjusting for well-known risk factors for intravascular catheter infection, we observed a similar risk for MCRI (HR 0.83, 95%CI 0.62-1.10, p 0.19) and CRBSI (HR 0.85, 95%CI 0.60-1.22, p 0.38) between the antibiotic and no-antibiotic groups. A confirmatory analysis using propensity score showed consistent results. No specific antibiotic subclasses reduced the risk of MCRI. Non-fermenting Gram-negative bacilli were more frequently observed in the antibiotic group.
CONCLUSIONS
Ongoing antibiotic administration at the time of catheter insertion was not associated with a decrease risk of catheter-related infections and should not be carried out for preventing such infections. Our results bring new insights to antimicrobial stewardship in critically ill patients and may direct empirical antimicrobial therapy if an intravascular catheter infection is suspected.
Data on the impact of systemic antibiotics at the time of catheter insertion are scarce. Therefore, we assessed the association between concurrent antibiotic administration at insertion and short-term catheter-related infections.
METHODS
We used individual data gathered from five large, randomized, controlled ICU trials. We analysed adult patients who required arterial, short-term central venous or dialysis catheter insertion in the ICU. The effect of antibiotics at insertion on major catheter-related infection (MCRI), catheter-related bloodstream infection (CRBSI) and colonization was estimated using multivariate marginal Cox and propensity score models.
RESULTS
We included 10 269 patients and 18 743 catheters from 36 ICUs. Antibiotic use was ongoing at the time of 11 361 catheter insertions (60.6%). After adjusting for well-known risk factors for intravascular catheter infection, we observed a similar risk for MCRI (HR 0.83, 95%CI 0.62-1.10, p 0.19) and CRBSI (HR 0.85, 95%CI 0.60-1.22, p 0.38) between the antibiotic and no-antibiotic groups. A confirmatory analysis using propensity score showed consistent results. No specific antibiotic subclasses reduced the risk of MCRI. Non-fermenting Gram-negative bacilli were more frequently observed in the antibiotic group.
CONCLUSIONS
Ongoing antibiotic administration at the time of catheter insertion was not associated with a decrease risk of catheter-related infections and should not be carried out for preventing such infections. Our results bring new insights to antimicrobial stewardship in critically ill patients and may direct empirical antimicrobial therapy if an intravascular catheter infection is suspected.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.cmi.2020.10.026
- PMID 33152538
- Persistent URL
- https://sonar.ch/global/documents/170679
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