Factors influencing local signs at catheter insertion site regardless of catheter-related bloodstream infections

To the editor,

Little is known on the role of local signs at the catheter exit site [1,2,3]. Using a large cohort with high-quality data from four randomized-controlled trials we recently showed that local signs at insertion site (i.e., a composite endpoint including redness, pain, purulent and non-purulent discharge) were significantly associated with catheter-related bloodstream infections (CRBSI) [4]. However, a question remains open: Which factors may influence local signs regardless of CRBSI? To our knowledge, no data in the recent literature are available.

We therefore re-analyzed our large cohort with 6976 patients and 14,590 short-term catheters, and we used as a primary endpoint “ ≥ 1 local sign.” We used multivariable logistic regression in order to identify variables associated with ≥ 1 local sign. Logistic models were stratified for the different centers included in the analysis.

Importantly, patients over 75 years (OR 0.82, 95% CI 0.72–0.94, p = 0.0044), with high SOFA score (OR 0.66, 95% CI 0.55–0.79, p < 0.001), immunosuppression (OR 0.72, 95% CI 0.59–0.88, p = 0.0014), catheter duration ≤ 7 days (OR 0.30, 95% CI 0.27–0.34, p < 0.001), and jugular (OR 0.62, 95% CI 0.49–0.80, p = 0.0001) or femoral (OR 0.76, 95% CI 0.64–0.90, p = 0.0012) sites significantly decreased the risk to develop local signs (Table 1) regardless of CRBSI. Clinicians should deserve particular attention to these specific populations of critically ill patients, who may decrease the risk of developing local signs. Among patients with CRBSI (n = 114), severely injured patients (i.e., with high SOFA score or under vasoactive medications), immunosuppressed patients and femoral catheters had fewer local signs (data not shown).

Table 1 Risk factors of having ≥ 1 local sign (multivariable logistic regression)

In our previous analysis, we found that local signs observed within the first 7 catheter-days are predictive for intravascular catheter infections [4]: We are convinced that especially in this subgroup clinicians should be aware of the frequent absence of local signs in elderly, severe, immunosuppressed patients, and jugular/femoral catheters in the decision-making process.

Interestingly, pathological temperature (body temperature ≥ 38.5 °C or ≤ 36.5 °C), catheter type, and severity of illness in the presence of local signs did not help clinician in predicting intravascular catheter infections [4]. In light of all these considerations, we summarized in Table 2 practical clinical implications that may help ICU specialists when dealing with local signs and suspicion of intravascular catheter infections.

Table 2 Practical clinical implications