TY - JOUR
T1 - Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials
AU - Iachkine, Jeanne
AU - Buetti, Niccolò
AU - de Grooth, Harm-Jan
AU - Briant, Anaïs R.
AU - Mimoz, Olivier
AU - Mégarbane, Bruno
AU - Mira, Jean-Paul
AU - Ruckly, Stéphane
AU - Souweine, Bertrand
AU - du Cheyron, Damien
AU - Mermel, Leonard A.
AU - Timsit, Jean-François
AU - Parienti, Jean-Jacques
N1 - Funding Information: JI received a grant (“Bourse Année Recherche”) from the Caen University Hospital; NB received a grant from the Swiss National Science Foundation (grant number: P4P4PM_194449). CATHEDIA was funded by the Centre Hospitalier Universitaire de Caen, Caen, France, and supported by an unrestricted academic grant from the French Health Ministry (Programme Hospitalier de Recherche Clinique National 2003). 3SITES was supported by a grant from the Hospital Program for Clinical Research, French Ministry of Health (PHRC-N 2010, 06-03). CLEAN was supported by the University Hospital of Poitiers and CareFusion. DRESSING-2 was supported by University of Grenoble and 3 M Company. ELVIS was supported by grants from the French Ministry of Health (Programme Hospitalier de Recherche Clinique National 2008 “ELVIS” and Programme Hospitalier de Recherche Clinique Inter-regional 2009 “ESCAPE”). Publisher Copyright: © 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - Catheter-related infection
KW - Catheter-tip colonization
KW - Central Venous catheters
KW - Intensive care unit
KW - Predictive score
UR - http://www.scopus.com/inward/record.url?scp=85133577470&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s13054-022-04078-x
DO - https://doi.org/10.1186/s13054-022-04078-x
M3 - Article
C2 - 35799302
SN - 1466-609X
VL - 26
JO - Critical care (London, England)
JF - Critical care (London, England)
IS - 1
M1 - 205
ER -