Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials
Abstract Background The impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs). The present study investigated the association between ultrasound guidance (US) during AC insertion and major catheter-related infections (MCRI), cathet...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-07-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-020-00705-4 |
| _version_ | 1818525642762747904 |
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| author | Niccolò Buetti Stéphane Ruckly Jean-Christophe Lucet Lila Bouadma Carole Schwebel Olivier Mimoz Jean-François Timsit |
| author_facet | Niccolò Buetti Stéphane Ruckly Jean-Christophe Lucet Lila Bouadma Carole Schwebel Olivier Mimoz Jean-François Timsit |
| author_sort | Niccolò Buetti |
| collection | DOAJ |
| description | Abstract Background The impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs). The present study investigated the association between ultrasound guidance (US) during AC insertion and major catheter-related infections (MCRI), catheter-related bloodstream infections (CR-BSI) or colonization, using univariate and multivariate marginal Cox model for clustered data. The skin colonization at catheter removal was evaluated to explain our results. Results We used individual data from two multicenter randomized-controlled trials (RCTs) that included a total of 3029 patients, 10 ICUs and 3950 ACs. US guidance was used for 386 (9.8%) catheter placements. In the univariate Cox model analysis, AC insertion with US versus without US exhibited similar risks for MCRI (HR 0.86, CI 95% 0.27–2.72, p = 0.79), CR-BSI (HR 0.87, CI 95% 0.20–3.72, p = 0.85) and catheter colonization (HR 1.31, CI 95% 0.92–1.86, p = 0.13). After adjustment on confounders, risks associated with US guidance remained similar versus non-US for MCRI (HR 0.71, CI 95% 0.23–2.24, p = 0.56), CR-BSI (HR 0.71, CI 95% 0.17–3.00, p = 0.63) and catheter colonization (HR 0.92, CI 95% 0.63–1.34, p = 0.67). No differences between US and non-US for MCRI, CR-BSI and colonization were observed according to the insertion site, radial or femoral. At catheter removal, the skin colonization was similar between US and non-US groups (p = 0.69). Conclusions Using the largest dataset ever collected from large multi-centric RCTs conducted with relatively consistent insertion and maintenance catheter protocols, we showed that the risk of infectious complications for ACs inserted under US guidance is not superior compared to those inserted without US guidance. Trial registration These studies were registered within ClinicalTrials.gov (numbers NCT01629550 and NCT 01189682). |
| first_indexed | 2024-12-11T06:11:41Z |
| format | Article |
| id | doaj.art-59c9b9a96a4a49978a8ae5c85af9b595 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-11T06:11:41Z |
| publishDate | 2020-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-59c9b9a96a4a49978a8ae5c85af9b5952022-12-22T01:18:06ZengSpringerOpenAnnals of Intensive Care2110-58202020-07-011011710.1186/s13613-020-00705-4Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trialsNiccolò Buetti0Stéphane Ruckly1Jean-Christophe Lucet2Lila Bouadma3Carole Schwebel4Olivier Mimoz5Jean-François Timsit6University of Paris, INSERM IAME, U1137, Team DeSCIDUniversity of Paris, INSERM IAME, U1137, Team DeSCIDUniversity of Paris, INSERM IAME, U1137, Team DeSCIDUniversity of Paris, INSERM IAME, U1137, Team DeSCIDMedical Intensive Care Unit, Grenoble University HospitalServices Des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de PoitiersUniversity of Paris, INSERM IAME, U1137, Team DeSCIDAbstract Background The impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs). The present study investigated the association between ultrasound guidance (US) during AC insertion and major catheter-related infections (MCRI), catheter-related bloodstream infections (CR-BSI) or colonization, using univariate and multivariate marginal Cox model for clustered data. The skin colonization at catheter removal was evaluated to explain our results. Results We used individual data from two multicenter randomized-controlled trials (RCTs) that included a total of 3029 patients, 10 ICUs and 3950 ACs. US guidance was used for 386 (9.8%) catheter placements. In the univariate Cox model analysis, AC insertion with US versus without US exhibited similar risks for MCRI (HR 0.86, CI 95% 0.27–2.72, p = 0.79), CR-BSI (HR 0.87, CI 95% 0.20–3.72, p = 0.85) and catheter colonization (HR 1.31, CI 95% 0.92–1.86, p = 0.13). After adjustment on confounders, risks associated with US guidance remained similar versus non-US for MCRI (HR 0.71, CI 95% 0.23–2.24, p = 0.56), CR-BSI (HR 0.71, CI 95% 0.17–3.00, p = 0.63) and catheter colonization (HR 0.92, CI 95% 0.63–1.34, p = 0.67). No differences between US and non-US for MCRI, CR-BSI and colonization were observed according to the insertion site, radial or femoral. At catheter removal, the skin colonization was similar between US and non-US groups (p = 0.69). Conclusions Using the largest dataset ever collected from large multi-centric RCTs conducted with relatively consistent insertion and maintenance catheter protocols, we showed that the risk of infectious complications for ACs inserted under US guidance is not superior compared to those inserted without US guidance. Trial registration These studies were registered within ClinicalTrials.gov (numbers NCT01629550 and NCT 01189682).http://link.springer.com/article/10.1186/s13613-020-00705-4CatheterIntravascularArterial catheterCatheter tipUltrasoundUltrasound guidance |
| spellingShingle | Niccolò Buetti Stéphane Ruckly Jean-Christophe Lucet Lila Bouadma Carole Schwebel Olivier Mimoz Jean-François Timsit Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials Annals of Intensive Care Catheter Intravascular Arterial catheter Catheter tip Ultrasound Ultrasound guidance |
| title | Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials |
| title_full | Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials |
| title_fullStr | Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials |
| title_full_unstemmed | Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials |
| title_short | Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials |
| title_sort | ultrasound guidance and risk for intravascular catheter related infections among peripheral arterial catheters a post hoc analysis of two large randomized controlled trials |
| topic | Catheter Intravascular Arterial catheter Catheter tip Ultrasound Ultrasound guidance |
| url | http://link.springer.com/article/10.1186/s13613-020-00705-4 |
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