Central venous catheter-related infection: does insertion site still matter? A French multicentric cohort study

• Published in: Intensive care medicine 2024-11, Vol.50 (11), p.1830-1840
• Main Authors: Cosme, Vincent, Massart, Nicolas, Reizine, Florian, Machut, Anaïs, Vacheron, Charles-Hervé, Savey, Anne, Friggeri, Arnaud, Lepape, Alain
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesiology; Catheter-Related Infections - epidemiology; Catheter-Related Infections - microbiology; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - methods; Catheters; Central Venous Catheters - adverse effects; Central Venous Catheters - microbiology; Central Venous Catheters - statistics & numerical data; Coagulase; Cohort Studies; Critical Care Medicine; Ecology, environment; Emergency Medicine; Female; Femoral Vein; Femur; France - epidemiology; Gram-negative bacilli; Health; Humans; Incidence; Insertion; Intensive; Intensive care; Intensive care units; Intensive Care Units - statistics & numerical data; Jugular Veins; Life Sciences; Male; Medicine; Medicine & Public Health; Middle Aged; Nosocomial infections; Original; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Regression models; Santé publique et épidémiologie; Subclavian Vein
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-024-07615-0

Purpose We aim to evaluate the association between central venous catheter (CVC) insertion site and microbiological CVC complications in a nationwide cohort. Methods This study was conducted using the healthcare-associated infection surveillance cohort “REA-REZO” involving 193 intensive care units (ICUs). All CVC inserted and removed during the same ICU stay between January 1st 2018 and December 31st 2022 were eligible but only those whose tips were sent for microbiological analysis were included. Primary objective was to describe CVC insertion sites and subsequent catheter-related bloodstream infection (CRBSI). Results Out of 126,997 CVCs, 71,314 were not sent for tip culture, and only 55,663 CVCs were included, (30,548 in internal jugular [IJ], 14,423 in femoral and 10,692 in subclavian [SC] sites). The incidence of CRBSI was 0.7 [0.6–0.8] in the IJ site, 0.7 [0.6–0.9] in the femoral site, and 0.6 [0.4–0.7] CRBSI per 1000 CVC days in the SC site ( p  = 0.248). The multivariable Poisson regression model showed no differences of CRBSI incidence rates between the three insertion sites. Microorganisms observed in CRBSI were coagulase-negative Staphylococci (27.9%), Enterobacterales (27.5%), non-fermenting Gram-negative Bacilli (10.4%), Candida sp . (16.9%), and Staphylococcus aureus (16.9%). Conclusion Low CRBSI incidence rates were reported. CRBSI incidences rates were similar in the three insertion sites. Uncertainty remains due to potential selection bias since many CVCs had to be excluded.