Central venous catheter-related infection in critically ill patients

Objective

To analyze the incidence of catheter-related local infection (CRLI) and catheter-related bloodstream infection (CRBSI) of central venous catheters (CVC) in critically ill patients.

Methods

A prospective study of patients admitted to the ICU from1 May 2000 to 31 October 2001. A multiple proportion comparison of CRLI and CRBSI incidence density between the different catheter accesses was performed using the Fisher–Freeman–Halton exact test. P < 0.05 was considered significant.

Results

During this period of time 988 patients (60.12% male) were admitted to the ICU. The mean age was 55.63 ± 18.49 years, APACHE II score was 13.65 ± 5.83, and mortality was 14.37. The number of patients with CVC, the number of CVC and the days on risk for each CVC were: global, 890, 1608 and 11,378; peripheral access, 257, 331 and 2169; jugular, 618, 698 and 4131; subclavia, 321, 432 and 3862; femoral, 111, 147 and 1216. The number of CRLI and CRBSI per 1000 days of catheterization were: general, 4.74 and 1.40; peripheral access, 2.30 and 0.92; jugular, 6.29 and 0.97; subclavia, 1.81 and 1.29; femoral, 13.15 and 4.11. Femoral venous access had the highest incidence density of CRLI (13.15/1000 catheter-days, P < 0.01) and CRBSI (4.11/1000 catheter-days, P < 0.05). Jugular venous access had a higher incidence density of CRLI (6.29/1000 catheter-days, P < 0.01) than subclavian or peripheral access. The 16 CRBSI were due to the following microorganisms: five Staphylococcus cogulasa negativo, three Staphylococcus aureus, one Streptococcus faecalis, one Bacillus spp, two Escherichia coli, one Enterobacter, one Pseudomonas aeruginosa, two Candida albicans.

Conclusions

CDC guidelines for the prevention of catheter-related infection notice that the subclavian is preferable to femoral and jugular venous accesses. Our data support these recommendations, but also suggest a new refinement; namely that a peripherally inserted central catheter is preferable to femoral and jugular accesses, and that jugular is preferable to femoral venous access.