Title: Abstract No. 291: When Is the Optimal Time To Replace a Central Venous Catheter Following a Catheter Related Bloodstream Infection?
Abstract: PurposeThe optimal time to replace a central venous catheter (CVC) following a catheter related bloodstream infection (CRBSI) has not been established. It is assumed that a catheter free interval will make repeat infection less likely. We hypothesized that placing a new CVC at least 1 week after the initial infected CVC was removed would decrease the rate of repeat infection.Materials and MethodsA retrospective review of the medical records from December 2001 to January 2007 at one university hospital identified 1902 individuals who had ≥ 2 CVCs placed by Interventional Radiology. 74 cases met the inclusion criteria by having a CRBSI of the 1st CVC (CVC1), a 2nd CVC (CVC2) placed within 30 days, and at least 60 days of follow up. A CRBSI was defined as a positive blood culture with a positive catheter tip culture. The primary outcome of the study was the rate of repeat bloodstream infection (BSI) with the same organism with a matching antibiogram within 60 days of placement of CVC2. A secondary outcome of the study was mortality within 60 days after placement of CVC2.ResultsThe overall incidence of repeat BSI with the same organism was 6.76% (5 of 74) for the entire group. The rate of repeat BSI was 7.94% (5 of 63) with < 7 catheter free days and was 0% (0 of 11) with ≥ 7 catheter free days. The group with repeat BSI was more likely to have CVC1 used for total parenteral nutrition (TPN) compared to the group without repeat BSI; 80% (4 of 5) vs. 30.4% (21 of 69), p=0.042. This group with repeat BSI was also more likely to be of an older age; 69.8 ± 16.6 years vs. 52.3 ± 16.4 years, p=0.024. All cause mortality for the entire group was 5.41% (4 of 74) within 60 days of CVC2 placement. There were no deaths attributable to repeat BSI.ConclusionThe results suggest there may be a benefit to waiting at least 7 days after a CRBSI before placing a second CVC. Those receiving TPN through CVC1 and older patients may also be at higher risk for repeat BSI. PurposeThe optimal time to replace a central venous catheter (CVC) following a catheter related bloodstream infection (CRBSI) has not been established. It is assumed that a catheter free interval will make repeat infection less likely. We hypothesized that placing a new CVC at least 1 week after the initial infected CVC was removed would decrease the rate of repeat infection. The optimal time to replace a central venous catheter (CVC) following a catheter related bloodstream infection (CRBSI) has not been established. It is assumed that a catheter free interval will make repeat infection less likely. We hypothesized that placing a new CVC at least 1 week after the initial infected CVC was removed would decrease the rate of repeat infection. Materials and MethodsA retrospective review of the medical records from December 2001 to January 2007 at one university hospital identified 1902 individuals who had ≥ 2 CVCs placed by Interventional Radiology. 74 cases met the inclusion criteria by having a CRBSI of the 1st CVC (CVC1), a 2nd CVC (CVC2) placed within 30 days, and at least 60 days of follow up. A CRBSI was defined as a positive blood culture with a positive catheter tip culture. The primary outcome of the study was the rate of repeat bloodstream infection (BSI) with the same organism with a matching antibiogram within 60 days of placement of CVC2. A secondary outcome of the study was mortality within 60 days after placement of CVC2. A retrospective review of the medical records from December 2001 to January 2007 at one university hospital identified 1902 individuals who had ≥ 2 CVCs placed by Interventional Radiology. 74 cases met the inclusion criteria by having a CRBSI of the 1st CVC (CVC1), a 2nd CVC (CVC2) placed within 30 days, and at least 60 days of follow up. A CRBSI was defined as a positive blood culture with a positive catheter tip culture. The primary outcome of the study was the rate of repeat bloodstream infection (BSI) with the same organism with a matching antibiogram within 60 days of placement of CVC2. A secondary outcome of the study was mortality within 60 days after placement of CVC2. ResultsThe overall incidence of repeat BSI with the same organism was 6.76% (5 of 74) for the entire group. The rate of repeat BSI was 7.94% (5 of 63) with < 7 catheter free days and was 0% (0 of 11) with ≥ 7 catheter free days. The group with repeat BSI was more likely to have CVC1 used for total parenteral nutrition (TPN) compared to the group without repeat BSI; 80% (4 of 5) vs. 30.4% (21 of 69), p=0.042. This group with repeat BSI was also more likely to be of an older age; 69.8 ± 16.6 years vs. 52.3 ± 16.4 years, p=0.024. All cause mortality for the entire group was 5.41% (4 of 74) within 60 days of CVC2 placement. There were no deaths attributable to repeat BSI. The overall incidence of repeat BSI with the same organism was 6.76% (5 of 74) for the entire group. The rate of repeat BSI was 7.94% (5 of 63) with < 7 catheter free days and was 0% (0 of 11) with ≥ 7 catheter free days. The group with repeat BSI was more likely to have CVC1 used for total parenteral nutrition (TPN) compared to the group without repeat BSI; 80% (4 of 5) vs. 30.4% (21 of 69), p=0.042. This group with repeat BSI was also more likely to be of an older age; 69.8 ± 16.6 years vs. 52.3 ± 16.4 years, p=0.024. All cause mortality for the entire group was 5.41% (4 of 74) within 60 days of CVC2 placement. There were no deaths attributable to repeat BSI. ConclusionThe results suggest there may be a benefit to waiting at least 7 days after a CRBSI before placing a second CVC. Those receiving TPN through CVC1 and older patients may also be at higher risk for repeat BSI. The results suggest there may be a benefit to waiting at least 7 days after a CRBSI before placing a second CVC. Those receiving TPN through CVC1 and older patients may also be at higher risk for repeat BSI.
Publication Year: 2008
Publication Date: 2008-02-01
Language: en
Type: article
Indexed In: ['crossref']
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