Intravascular catheters and infection risk in the ICU after 10 days

In a recent article in Clinical Microbiology and Infection, Buetti et al. evaluated the infection risk from different types of intravenous catheters in place for more than 10 days and the risk factors associated with infection.

The investigators analyzed data from four randomized controlled trials that had been conducted to assess interventions for preventing catheter infections. They evaluated 15,036 intravascular catheters from 24 intensive care units in France.

Infections occurred in 46 (0.7%) of 6,298 arterial catheters, 62 (1.0%) of 6,036 central venous catheters and 47 (1.7%) of 2,702 short-term dialysis catheters. By using a Cox model, the investigators found that interaction between dwell time beyond 10 days and catheter type was significant for CVCs (P = .008) and DCs (P < .001), thus indicating an increased risk of infection after 10 days. The interaction was not significant for ACs (P = .98).

The investigators then selected 1,405 CVCs and 454 DCs in place for more than 10 days to identify risk factors for infection. Based on a multivariable marginal Cox model, which included factors such as age, sex, diabetes and immunosuppression, the authors found an increased hazard ratio for infection for femoral CVC (HR, 6.33; 95% confidence interval, 1.99-20.09), jugular CVC (HR, 2.82; 95% CI, 1.13-7.07), femoral DC (HR, 4.53; 95% CI, 1.54-13.33) and jugular DC (HR, 4.50; 95% CI, 1.42-14.21) compared with subclavian insertions.

In conclusion, the investigators found that the risk of catheter infections for CVCs and DCs increased significantly 10 days after insertion. The risk was highest for femoral insertions. Further studies should consider the impact of routine replacement of non-subclavian catheters in situ for more than 10 days in reducing the risk of catheter infections.

(Buetti et al. Clin Microbiol Infect. 2023;29(9):P1200.E1-1200.E5)