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Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials
BACKGROUND: The majority of central venous catheters (CVC) removed in the ICU are not colonized, including when a catheter-related infection (CRI) is suspected. We developed and validated a predictive score to reduce unnecessary CVC removal. METHODS: We conducted a retrospective cohort study from fi...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9261073/ https://www.ncbi.nlm.nih.gov/pubmed/35799302 http://dx.doi.org/10.1186/s13054-022-04078-x |
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author | Iachkine, Jeanne Buetti, Niccolò de Grooth, Harm-Jan Briant, Anaïs R. Mimoz, Olivier Mégarbane, Bruno Mira, Jean-Paul Ruckly, Stéphane Souweine, Bertrand du Cheyron, Damien Mermel, Leonard A. Timsit, Jean-François Parienti, Jean-Jacques |
author_facet | Iachkine, Jeanne Buetti, Niccolò de Grooth, Harm-Jan Briant, Anaïs R. Mimoz, Olivier Mégarbane, Bruno Mira, Jean-Paul Ruckly, Stéphane Souweine, Bertrand du Cheyron, Damien Mermel, Leonard A. Timsit, Jean-François Parienti, Jean-Jacques |
author_sort | Iachkine, Jeanne |
collection | PubMed |
description | BACKGROUND: The majority of central venous catheters (CVC) removed in the ICU are not colonized, including when a catheter-related infection (CRI) is suspected. We developed and validated a predictive score to reduce unnecessary CVC removal. METHODS: We conducted a retrospective cohort study from five multicenter randomized controlled trials with systematic catheter-tip culture of consecutive CVCs. Colonization was defined as growth of ≥10(3) colony-forming units per mL. Risk factors for colonization were identified in the training cohort (CATHEDIA and 3SITES trials; 3899 CVCs of which 575 (15%) were colonized) through multivariable analyses. After internal validation in 500 bootstrapped samples, the CVC-OUT score was computed by attaching points to the robust (> 50% of the bootstraps) risk factors. External validation was performed in the testing cohort (CLEAN, DRESSING2 and ELVIS trials; 6848 CVCs, of which 588 (9%) were colonized). RESULTS: In the training cohort, obesity (1 point), diabetes (1 point), type of CVC (dialysis catheter, 1 point), anatomical insertion site (jugular, 4 points; femoral 5 points), rank of the catheter (second or subsequent, 1 point) and catheterization duration (≥ 5 days, 2 points) were significantly and independently associated with colonization . Area under the ROC curve (AUC) for the CVC-OUT score was 0.69, 95% confidence interval (CI) [0.67–0.72]. In the testing cohort, AUC for the CVC-OUT score was 0.60, 95% CI [0.58–0.62]. Among 1,469 CVCs removed for suspected CRI in the overall population, 1200 (82%) were not colonized. The negative predictive value (NPV) of a CVC-OUT score < 6 points was 94%, 95% CI [93%–95%]. CONCLUSION: The CVC-OUT score had a moderate ability to discriminate catheter-tip colonization, but the high NPV may contribute to reduce unnecessary CVCs removal. Preference of the subclavian site is the strongest and only modifiable risk factor that reduces the likelihood of catheter-tip colonization and consequently the risk of CRI. Clinical Trials Registration: NCT00277888, NCT01479153, NCT01629550, NCT01189682, NCT00875069. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04078-x. |
format | Online Article Text |
id | pubmed-9261073 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-92610732022-07-08 Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials Iachkine, Jeanne Buetti, Niccolò de Grooth, Harm-Jan Briant, Anaïs R. Mimoz, Olivier Mégarbane, Bruno Mira, Jean-Paul Ruckly, Stéphane Souweine, Bertrand du Cheyron, Damien Mermel, Leonard A. Timsit, Jean-François Parienti, Jean-Jacques Crit Care Research BACKGROUND: The majority of central venous catheters (CVC) removed in the ICU are not colonized, including when a catheter-related infection (CRI) is suspected. We developed and validated a predictive score to reduce unnecessary CVC removal. METHODS: We conducted a retrospective cohort study from five multicenter randomized controlled trials with systematic catheter-tip culture of consecutive CVCs. Colonization was defined as growth of ≥10(3) colony-forming units per mL. Risk factors for colonization were identified in the training cohort (CATHEDIA and 3SITES trials; 3899 CVCs of which 575 (15%) were colonized) through multivariable analyses. After internal validation in 500 bootstrapped samples, the CVC-OUT score was computed by attaching points to the robust (> 50% of the bootstraps) risk factors. External validation was performed in the testing cohort (CLEAN, DRESSING2 and ELVIS trials; 6848 CVCs, of which 588 (9%) were colonized). RESULTS: In the training cohort, obesity (1 point), diabetes (1 point), type of CVC (dialysis catheter, 1 point), anatomical insertion site (jugular, 4 points; femoral 5 points), rank of the catheter (second or subsequent, 1 point) and catheterization duration (≥ 5 days, 2 points) were significantly and independently associated with colonization . Area under the ROC curve (AUC) for the CVC-OUT score was 0.69, 95% confidence interval (CI) [0.67–0.72]. In the testing cohort, AUC for the CVC-OUT score was 0.60, 95% CI [0.58–0.62]. Among 1,469 CVCs removed for suspected CRI in the overall population, 1200 (82%) were not colonized. The negative predictive value (NPV) of a CVC-OUT score < 6 points was 94%, 95% CI [93%–95%]. CONCLUSION: The CVC-OUT score had a moderate ability to discriminate catheter-tip colonization, but the high NPV may contribute to reduce unnecessary CVCs removal. Preference of the subclavian site is the strongest and only modifiable risk factor that reduces the likelihood of catheter-tip colonization and consequently the risk of CRI. Clinical Trials Registration: NCT00277888, NCT01479153, NCT01629550, NCT01189682, NCT00875069. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04078-x. BioMed Central 2022-07-07 /pmc/articles/PMC9261073/ /pubmed/35799302 http://dx.doi.org/10.1186/s13054-022-04078-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis 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://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Iachkine, Jeanne Buetti, Niccolò de Grooth, Harm-Jan Briant, Anaïs R. Mimoz, Olivier Mégarbane, Bruno Mira, Jean-Paul Ruckly, Stéphane Souweine, Bertrand du Cheyron, Damien Mermel, Leonard A. Timsit, Jean-François Parienti, Jean-Jacques Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials |
title | Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials |
title_full | Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials |
title_fullStr | Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials |
title_full_unstemmed | Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials |
title_short | Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials |
title_sort | development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9261073/ https://www.ncbi.nlm.nih.gov/pubmed/35799302 http://dx.doi.org/10.1186/s13054-022-04078-x |
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