학술논문
Jugular versus Femoral Short-Term Catheterization and Risk of Infection in Intensive Care Unit Patients. Causal Analysis of Two Randomized Trials
Document Type
Academic Journal
Author
Timsit, Jean-François; Bouadma, Lila; Mimoz, Olivier; Parienti, Jean-Jacques; Garrouste-Orgeas, Maïté; Alfandari, Serge; Plantefeve, Gaétan; Bronchard, Régis; Troche, Gilles; Gauzit, Remy; Antona, Marion; Canet, Emmanuel; Bohe, Julien; Herrault, Marie-Christine; Schwebel, Carole; Ruckly, Stéphane; Souweine, Bertrand; Lucet, Jean-Christophe
Source
American Journal of Respiratory and Critical Care Medicine. Nov 15, 2013 188(10):1232-1239
Subject
Language
English
ISSN
1073-449X
Abstract
RATIONALE:: OBJECTIVES:: METHODS:: MEASUREMENTS AND MAIN RESULTS:: We included 2,128 patients (2,527 catheters and 19,481 catheter-days). We found no difference in catheter-related bloodstream infection (internal jugular 1.0 vs. femoral 1.1 per 1,000 catheter-days; hazard ratio [HR], 0.63 [0.25-1.63]; P = 0.34), major catheter-related infection (internal jugular 1.8 vs. femoral 1.4 per 1,000 catheter-days; HR, 0.91 [0.38-2.18]; P = 0.34), and colonization (internal jugular 11.6 vs. femoral 12.9 per 1,000 catheter-days; HR, 0.80 [0.25-1.63]; P = 0.15). However, colonization was higher with femoral for female (HR, 0.39 [0.24-0.63]; P < 0.001) and, at the significance limit, catheter maintained for more than 4 days (HR, 0.73 [0.53-1.01]; P = 0.05). The absence of benefit of internal jugular before Day 5 was related to a higher skin colonization at the internal jugular site for catheters removed before Day 5. After the fourth day, dressing disruption became more frequent with femoral catheters and may explain the subsequent risk of catheter colonization. Differences in cutaneous and catheter colonization between internal jugular and femoral was suppressed by the use of chlorhexidine-impregnated dressings. CONCLUSIONS:: Clinical trial registered with www.clinicaltrials.gov (NCT00417235 and NCT01189682).