Objective
To evaluate dialysis with or without perfusion lumen catheter-related infections, and to compare with central venous catheter in an intensive care unit.
Methods
Catheters inserted and extracted at least 2 days after, in the intensive care unit, are cultured using the quantitative tip cultures technique described by Brun-Buisson. Colonization is defined by a quantitative tip culture yielding ≥ 103 colony-forming units/ml, site infection by catheter colonization with presence of pus at the insertion site, catheter-related bacteremia by catheter colonization and blood culture positive for the same organism.
Findings
Between May 2000 and May 2001, 112 catheters were inserted in 59 patients: 40 central venous catheters, 21 doublelumen dialysis catheters, and 51 three-lumen dialysis catheters with perfusion lumen. The mean disease severity assessed by SAPS II at the ICU admission do not differ for the three groups (48 ± 22, 47 ± 20, and 54 ± 20.9). The mean duration of catheterization was 8.1 days for CVCs, 8.9 for HDCs without perfusion lumen, and 8.9 for HDCs with perfusion lumen (non significant). There was no difference between the two types of DCs and CVCs in catheter colonization and catheter-related bacteremia incidence rates, whatever the insertion site.
Six site infections and three bacteremia happened during the study. As for the local infections, two concern the CVCs (jugular site), four concern the HDCs with perfusion lumen (two jugular sites and two femoral sites). Bacteremia concern one HDC (femoral site) and two HDCs with perfusion lumen (femoral and jugular sites).
Interpretation
The frequency of DC-related infection on CVC-related infection were similar in the ICU patients. There is no increase of the infectious risk due to the use of catheters associating perfusion lumen and dialysis lumen in the ICU patient.
Table.
| CVCs | Doublelumen HDCs | Three-lumen HDCs | |
|---|---|---|---|
| Rate infections | 2 | 1 | 6 |
| Rate colonizations | 10 | 10 | 12 |
| Ratio infections/colonization | 0.2 | 0.1 | 0.5 |
| Total duration of catheterization | 356 | 154 | 412 |
| Infection incidence rates per 1000 days of catheter use | 28/1000 | 64/1000 | 29/1000 |
| Colonization incidence rates per 1000 days of catheter use | 5.6/1000 | 6.49/1000 | 14.5/1000 |