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Multicenter Study
. 2024 Jul;50(7):1108-1118.
doi: 10.1007/s00134-024-07498-1. Epub 2024 Jun 24.

Treatment of positive catheter tip culture without bloodstream infections in critically ill patients. A case-cohort study from the OUTCOMEREA network

Niccolò Buetti  1   2 , Jean-Ralph Zahar  3   4 , Mireille Adda  5 , Stéphane Ruckly  3   6 , Cédric Bruel  7 , Carole Schwebel  8 , Michael Darmon  9 , Christophe Adrie  10 , Yves Cohen  11 , Shidasp Siami  12 , Virginie Laurent  13 , Bertrand Souweine  5 , Jean-François Timsit  3   6   14 ; OUTCOMEREA Network
Collaborators, Affiliations
Multicenter Study

Treatment of positive catheter tip culture without bloodstream infections in critically ill patients. A case-cohort study from the OUTCOMEREA network

Niccolò Buetti et al. Intensive Care Med. 2024 Jul.

Abstract

Purpose: This study aimed to evaluate the impact on subsequent infections and mortality of an adequate antimicrobial therapy within 48 h after catheter removal in intensive care unit (ICU) patients with positive catheter tip culture.

Methods: We performed a retrospective analysis of prospectively collected data from 29 centers of the OUTCOMEREA network. We developed a propensity score (PS) for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a 1:1 case-cohort study matched on the PS score of being adequately treated. A PS-matched subdistribution hazard model was used for detecting subsequent infections and a PS-matched Cox model was used to evaluate the impact of antibiotic therapy on mortality.

Results: We included 427 patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched 150 patients with an adequate antimicrobial therapy with 150 controls. In the matched population, 30 (10%) subsequent infections were observed and 62 patients died within 30 days. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day-30 was similar between treated and non-treated groups (subdistribution hazard ratio [sHR] 1.08, 95% confidence interval [CI] 0.62-1.89, p = 0.78). Using Cox proportional hazard models, the 30-day mortality risk was similar between treated and non-treated groups (HR 0.89, 95% CI 0.45-1.74, p = 0.73).

Conclusions: Antimicrobial therapy was not associated with decreased risk of subsequent infection or death in short-term catheter tip colonization in critically ill patients. Antibiotics may be unnecessary for positive catheter tip cultures.

Keywords: Catheter tip; Catheter-related bloodstream infections; Critically ill; Mortality; Positive catheter tip cultures.

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Conflict of interest statement

J-FT reported advisory boards participation for Merck, Gilead, Beckton-Dickinson, Pfizer, Shionogi, Roche diagnostic, Advanz Pharma, research grants from Merck, Pfizer, Thermofischer. MD received support from the “Société de reanimation de langue francaise” and “Groupe de Recherche en Réanimation respiratoire et Onco-hematologique”.

Figures

Fig. 1
Fig. 1
Flow-chart. CRBSI catheter-related bloodstream infection
Fig. 2
Fig. 2
Cumulative risk of subsequent infection and death in matched patients with and without adequate therapy within 48 h
Fig. 3
Fig. 3
Subsequent infection and mortality risk for patients treated with and without adequate therapy within 48 h after catheter removal. HR hazard ratio, sHR subdistribution hazard ratio, CI confidence interval
See this image and copyright information in PMC

References

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