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The Clinical and Economic Consequences of Nosocomial Central Venous Catheter-Related Infection: Are Antimicrobial Catheters Useful?

Published online by Cambridge University Press:  02 January 2015

Sanjay Saint ,
David L. Veenstra  and
Benjamin A. Lipsky
Sanjay Saint
Affiliation:
Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan Ann Arbor Veterans'Affairs Health Services Research and Development Service, Ann Arbor, Michigan
David L. Veenstra*
Affiliation:
Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, Washington
Benjamin A. Lipsky
Affiliation:
Veterans'Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington Department of Medicine, University of Washington School of Medicine, Seattle, Washingtion
*
University of Washington, Box 357630, Seattle, WA 98195-7630
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Abstract

Central venous catheters (CVCs) are essential for many hospitalized patients, but they are associated with important infectious complications. Recent studies have indicated that CVCs coated with antimicrobial agents reduce the incidence of catheter-related bloodstream infection (CR BSI). To estimate the clinical and economic consequences of short-term central venous catheter-related infection and the potential usefulness of antimicrobial-coated catheters, we reviewed and synthesized the available relevant literature. Statistical pooling was used to estimate the incidence of both catheter colonization and CR BSI. The attributable mortality of CR BSI was also evaluated. In addition, the economic consequences of both local and systemic catheter-related infection was estimated from literature reports that used micro-costing and other techniques.

Among patients in whom standard, noncoated CVCs are in place for an average of 8 days, 24.7% are expected to develop catheter colonization (95% confidence interval [CI95], 22.0%-27.5%). Approximately 5.2% (CI95 3.9%-6.5%) will develop CR BSI. The attributable mortality of CR BSI remains unclear, but recent studies are consistent with a range from 4% to 20%. An episode of local catheter-related infection leads to an additional cost of approximately $400, whereas the additional cost of CR BSI ranges from approximately $6,005 to $9,738. Formal economic analyses indicate that CVCs coated with antibacterial agents (such as chlorhexidine-silver sulfadiazine or minocycline-rifampin) likely reduce infectious complications, yielding economic advantages. In light of the substantial clinical and economic burden of catheter-related infection, hospital personnel should adopt proven cost-effective methods to reduce this common and important nosocomial complication.

Type
Reviews
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 6 , June 2000 , pp. 375 - 380
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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References

1. Raad, II, Bodey, GP Infectious complications of indwelling vascular catheters. Clin Infect Dis 1992;15:197–208.Google Scholar
2. Weinstein, MP, Towns, ML, Quartey, SM, Mirrett, S, Reimer, LG, Parmigiani, G, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997;24:584–602.CrossRefGoogle ScholarPubMed
3. Maki, DG. Infections caused by intravascular devices used for infusion therapy. In: Bisno, AL, Waldvogel, FA, eds. Infections Associated With Indwelling Medical Devices. Washington, DC: ASM Press; 1994:155–205.Google Scholar
4. Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.Google Scholar
5. Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977;296:1305–1309.CrossRefGoogle ScholarPubMed
6. Sherertz, RJ, Heard, SO, Raad, II. Diagnosis of triple-lumen catheter infection: comparison of roll plate, sonication, and flushing methodologies. J Clin Microbiol 1997;35:641–646.Google Scholar
7. Pearson, ML. Guideline for prevention of intravascular device-related infections. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:438–473.Google Scholar
8. Flynn, PM, Shenep, JL, Barrett, FF. Differential quantitation with a commercial blood culture tube for diagnosis of catheter-related infection. J Clin Microbiol 1988;26:1045–1046.Google Scholar
9. Blot, F, Nitenberg, G, Chachaty, E, Raynard, B, Germann, N, Antoun, S, et al. Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancd 1999;354:1071–1077.Google Scholar
10. Bozzetti, F, Terno, G, Camerini, E, Baticci, F, Scarpa, D, Pupa, A. Pathogenesis and predictability of central venous catheter sepsis. Surgery 1982;91:383–389.Google Scholar
11. Hampton, AA, Sherertz, RJ. Vascular-access infections in hospitalized patients. Surg Clin North Am 1988;68:57–71.CrossRefGoogle ScholarPubMed
12. Corona, ML, Peters, SG, Narr, BJ, Thompson, RL. Infections related to central venous catheters. Mayo Clin Proc 1990;65:979–986.Google Scholar
13. Snydman, DR, Gorbea, HF, Pober, BR, Majka, JA, Murray, SA, Perry, LK. Predictive value of surveillance skin cultures in total-parenteral-nutrition-related infection. Lancet 1982;2:1385–1388.Google Scholar
14. Sitges-Serra, A, Puig, P, Linares, J, Perez, JL, Farrero, N, Jaurrieta, E, et al. Hub colonization as the initial step in an outbreak of catheter-related sepsis due to coagulase negative staphylococci during parenteral nutrition. JPEN J Parenter Enteral Nutr 1984;8:668–672.CrossRefGoogle Scholar
15. Kovacevich, DS, Faubion, WC, Bender, JM, Schaberg, DR, Wesley, JR. Association of parenteral nutrition catheter sepsis with urinary tract infections. JPEN J Parenter Enteral Nutr 1986;10:639–641.CrossRefGoogle ScholarPubMed
16. Maki, DG, Rhame, FS, Mackel, DC, Bennett, JV. Nationwide epidemic of septicemia caused by contaminated intravenous products, I: epidemiologic and clinical features. Am J Med 1976;60:471–485.Google Scholar
17. Tennenberg, S, Lieser, M, McCurdy, B, Boomer, G, Howington, E, Newman, C, et al. A prospective randomized trial of an antibiotic- and antiseptic-coated central venous catheter in the prevention of catheter-related infections. Arch Surg 1997;132:1348–1351.CrossRefGoogle ScholarPubMed
18. Maki, DG, Stolz, SM, Wheeler, S, Mermel, L. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial. Ann Intern Med 1997;127:257–266.CrossRefGoogle ScholarPubMed
19. van Heerden, PV, Webb, SA, Fong, S, Golledge, CL, Roberts, BL, Thompson, WR. Central venous catheters revisited—infection rates and an assessment of the new Fibrin Analysing System brush. Anaesth Intensive Care 1996;24:330–333.CrossRefGoogle Scholar
20. Hannan, M, Juste, R, Shankar, U, Nightingale, C, Azadian, B, Soni, N. Colonization of triple lumen catheters. A study on antiseptic-bonded and standard catheters. Clin Intensive Care 1996;7:56. Abstract.Google Scholar
21. Bach, A, Bohrer, H, Bottiger, BW, Motsch, J, Martin, E. Reduction of bacterial colonization of triple-lumen catheters with antiseptic bonding in septic patients. Anesthesiology 1994;81:A261. Abstract.CrossRefGoogle Scholar
22. Bach, A, Schmidt, H, Bottiger, B, Schreiber, B, Bohrer, H, Motsch, J, et al. Retention of antibacterial activity and bacterial colonization of antiseptic-bonded central venous catheters. J Antimicrob Chemother 1996;37:315–322.Google Scholar
23. Heard, SO, Wagle, M, Vijayakumar, E, McLean, S, Brueggemann, A, Napolitano, LM, et al. Influence of triple-lumen central venous catheters coated with Chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia. Arch Intern Med 1998;158:81–87.Google Scholar
24. Collin, GR. Decreasing catheter colonization through the use of an antiseptic-impregnated catheter: a continuous quality improvement project. Chest 1999;115:1632–1640.Google Scholar
25. Ciresi, DL, Albrecht, RM, Volkers, PA, Scholten, DJ. Failure of antiseptic bonding to prevent central venous catheter-related infection and sepsis. Am Surg 1996;62:641–646.Google Scholar
26. Pemberton, LB, Ross, V, Cuddy, P, Kremer, H, Fessler, T, McGurk, E. No difference in catheter sepsis between standard and antiseptic central venous catheters. A prospective randomized trial. Arch Surg 1996;131:986–989.Google Scholar
27. Ramsay, J, Nolte, F, Schwarzmann, S. Incidence of catheter colonization and catheter-related infection with an antiseptic-impregnated triple lumen catheter. Crit Care Med 1994;22:A115. AbstractGoogle Scholar
28. Trazzera, S, Stern, G, Rakesh, B, Sinha, S, Reiser, P. Examination of antimicrobial-coated central venous catheters in patients at high- risk for catheter-related infections in a medical intensive care unit and leukemia/bone marrow transplant unit. Crit Care Med 1995;23:A152. Abstract.Google Scholar
29. George, SJ, Vuddamalay, P, Boscoe, MJ. Antiseptic-impregnated central venous catheters reduce the incidence of bacterial colonization and associated infection in immunocompromised transplant patients. Eur J Anaesthesiol 1997;14:428–431.Google Scholar
30. Drummond, MF, O'Brien, B, Stoddart, GL, Torrance, GW. Methods for the Economic Evaluation of Health Care Programmes. New York City, NY: Oxford University Press; 1997.Google Scholar
31. Laird, NM, Mosteller, F. Some statistical methods for combining experimental results. Int J Technol Assess Health Care 1990;6:5–30.Google Scholar
32. Saint, S, Veenstra, DL, Sullivan, SD. The use of meta-analysis in cost-effectiveness analysis: issues and recommendations. PharmacoEconomics 1999;15:1–8.CrossRefGoogle ScholarPubMed
33. Veenstra, DL, Saint, S, Saha, S, Lumley, T, Sullivan, SD. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. 1999;281:261–267.Google ScholarPubMed
34. National Nosocomial Infections Surveillance (NNIS) System report, data summary from October 1986-April 1998, issued June 1998. Am J Infect Control 1998;26:522–533.Google Scholar
35. Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.Google Scholar
36. Pittet, D, Wenzel, RP. Nosocomial bloodstream infections in the critically ill. JAMA 1994;272:1819–1820.Google Scholar
37. Smith, RL, Meixler, SM, Simberkoff, MS. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest 1991;100: 164–167.Google Scholar
38. Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976–981.Google Scholar
39. Soufir, L, Timsit, JF, Mahe, C, Carlet, J, Regnier, B, Chevret, S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infect Control Hosp Epidemiol 1999;20:396–401.Google Scholar
40. Civetta, JM, Hudson-Civetta, J, Ball, S. Decreasing catheter-related infection and hospital costs by continuous quality improvement. Crit Care Med 1996;24:1660–1665.Google Scholar
41. Wenzel, RP, Thompson, RL, Landry, SM, Russell, BS, Miller, PJ, Ponce de Leon, S, et al. Hospital-acquired infections in intensive care unit patients: an overview with emphasis on epidemics. Infect Control 1983;4:371–375.Google Scholar
42. Arnow, PM, Quimosing, EM, Beach, M. Consequences of intravascular catheter sepsis. Clin Infect Dis 1993;16:778–784.Google Scholar
43. Veenstra, DL, Saint, S, Sullivan, SD. Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection. JAMA 1999;282:554–560.CrossRefGoogle ScholarPubMed
44. Saint, S, Matthay, MA. Risk reduction in the intensive care unit. Am J Med 1998;105:515–523.Google Scholar
45. Randolph, AG, Cook, DJ, Gonzales, CA, Brun-Buisson, C. Tunneling short-term central venous catheters to prevent catheter-related infection: a meta-analysis of randomized, controlled trials. Crit Care Med 1998;26:1452–1457.Google Scholar
46. Randolph, AG, Cook, DJ, Gonzales, CA, Andrew, M. Benefit of heparin in peripheral venous and arterial catheters: systematic review and metaanalysis of randomised controlled trials. BMJ 1998;316:969–975.CrossRefGoogle ScholarPubMed
47. Randolph, AG, Cook, DJ, Gonzales, CA, Andrew, M. Benefit of heparin in central venous and pulmonary artery catheters: a meta-analysis of randomized controlled trials. Chest 1998;113:165–171.Google Scholar
48. Darouiche, RO, Raad, II, Heard, SO, Thornby, JI, Wenker, OC, Gabrielli, A, et al. A comparison of two antimicrobial-impregnated central venous catheters. Catheter Study Group. N Engl J Med 1999;340:1–8.Google Scholar