Abstract
BackgroundCentral venous catheter (CVC) insertion complications are a prevalent and significant problem in the intensive care unit (ICU), but optimal strategy for management in patients with suspected catheter-related bloodstream infection (CRBSI) remains unclear. We sought to determine the effect of immediate reinsertion of new catheter (IRINC) on 30-day mortality among patients after central venous catheter (CVC) removal for suspected CRBSI.MethodsWe conducted a propensity-score-matched cohort of suspected CRBSI who underwent IRINC or not in a 32-bed ICU of university hospital in China during the period from January 2009 through April 2021. We used the results of catheter tip culture to identify patients with suspected CRBSI by index for institutional electronic laboratory databases. The inclusion criteria were age ≥ 18 years, CVC and suspected CRBSI. The exclusion criteria were dialysis catheters, peripheral catheterization, length of stay less than 48 hours, and patients with no access to medical records. Kaplan-Meier method was used to analyze 30-day mortality before and after propensity-score-matching, and adjusted hazard ratio (HR) and 95% confidence interval (CI) for mortality in matched cohort were estimated with Cox proportional hazards models.ResultsIn total, 1238 patients with CVC removal due to suspected CRBSI were identified. Among these patients, 877 (70.8%) underwent IRINC, and 361 (29.2%) did not. In 682 propensity score-matched patients, IRINC was associated with an increased risk of 30-day mortality (HR, 1.481; 95% CI, 1.028 to 2.134) after multivariable, multilevel adjustment. Kaplan-Meier analysis found that IRINC showed a similar risk of mortality before matching (P=0.00096) and after matching (P=0.018). The competing risks analysis confirmed the results of the propensity score-matched analysis. The attributable risk for bloodstream infection was not significantly different (HR, 1.081; 95% CI 0.964 to 1.213) but that for pneumonia was significantly different (HR, 1.128; 95% CI 1.031 to 1.233) in patients with suspected CRBSI in terms of 30-day mortality.ConclusionsIRINC during suspected CRBSI was associated with an increased 30-day mortality risk. These data suggest that it is necessary to focus more on other insertion-related complications along with preventing CRBSI in critically ill patients.Trial RegistrationThis study was registered with the China Clinical Trials Registry (ChiCTR1900022175), URL: http://www.chictr.org.cn/index.aspx.
Association of Immediate Reinsertion of New Catheters With Subsequent Mortality Among Patients With Suspected Catheter Infection: a Cohort Study