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Scientific article
Open access
English

Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials

Published inCritical care, vol. 26, no. 1, 205
First online date2022-07-07
Abstract

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 ≥103 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.

eng
Keywords
  • Catheter-related infection
  • Catheter-tip colonization
  • Central Venous catheters
  • Intensive care unit
  • Predictive score
  • Catheter-Related Infections / epidemiology
  • Catheter-Related Infections / etiology
  • Catheterization, Central Venous / adverse effects
  • Central Venous Catheters / adverse effects
  • Cohort Studies
  • Humans
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Renal Dialysis
  • Retrospective Studies
Citation (ISO format)
IACHKINE, Jeanne et al. Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials. In: Critical care, 2022, vol. 26, n° 1, p. 205. doi: 10.1186/s13054-022-04078-x
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Identifiers
ISSN of the journal1364-8535
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Technical informations

Creation08/30/2022 7:31:00 AM
First validation08/30/2022 7:31:00 AM
Update time03/16/2023 10:52:56 AM
Status update03/16/2023 10:52:48 AM
Last indexation02/01/2024 9:43:11 AM
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