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

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. To the editor, Little is known on the role of local signs at the catheter exit site [1–3]. 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 nonpurulent 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). 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. Open Access


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 nonpurulent 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.
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. Authors' contributions NB, SR, and JFT analyzed and interpreted the data. OM, BS, JCL, OM were responsible for the data collection. NB and JFT were the major contributors in writing the manuscript. All authors read and approved the final manuscript.

Funding
NB is currently receiving a Mobility grant from the Swiss National Science Foundation (Grant Number: P4P4PM_194449). This grant supports his fellowship in Geneva.

Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.  Factors influencing the management of catheter* Redness, non-purulent discharge, and purulent discharge are significantly associated with CRBSI Local signs are absent in almost 60% of CRBSI Local signs observed within the first 7 days are highly predictive for intravascular catheter infections Pathological temperature (body temperature ≥ 38.5 °C or ≤ 36.5 °C), catheter type, and severity of illness in the presence of local signs do not help clinician in predicting intravascular catheter infections