Table 2 Characteristics of the main trials studying dialysis catheter infection in ICU

Souweine^a

1995-1996

Prospective, open, monocentric

170

151

Femoral and jugular

Simplified Brun Buisson

CRBSI: catheter colonization and blood culture positive for the same organism; site infection: presence of pus at the insertion site.

24.2

1.5

6.8 ± 6

Wester^a

1997-1998

Prospective, open, monocentric, CAVHDF, ICU

43

139

Axillary arteries, femoral veins and arteries, subclavian veins

Semiquantitative culture: >15 CFU; quantitative culture: >10^3 CFU

Exit site infection: erythema, tenderness, induration, or purulence within 2 cm of the skin at the exit site of the catheter; CRBSI: Same organism isolated from a culture of the catheter and from the blood with clinical symptoms of infection; in the absence of laboratory confirmation, defervescence after removal of a catheter may be considered indirect evidence of CRBSI.

46.8% vs. 39.1%

2.2%

4.2 ± 2 vs. 7.3 ± 4.5

Harb^a

1998-1999

prospective, open, monocentric, ICU

47

79

Femoral, subclavian, and jugular

Simplified Brun Buisson

Infected catheter: positive catheter tip culture with clinical signs of sepsis resolving within 48 hours after catheter removal; CRBSI: same microorganism isolated from the catheter tip culture and from cultured peripheral blood culture drawn during catheter placement or within the 24 hours following removal of the catheter. Differential time of positivity >2 hours.

5.4 (3.7%)

1.8 (1.2%)

6.9 ± 5.5

Chatzinikalaou^b

2000-2002

prospective, randomized, monocentric, antibiotic coated dialysis catheters, 82% ICU

130

130: 66 antibiotic coated vs. 64 non-coated catheters

Femoral

Sherertz

fever (>38°C), chills, hypotension, skin organisms cultured from at least one blood cultures from a peripheral vein that was not related to infection of another site, and antimicrobial therapy; same organism isolated from peripheral blood culture and from DC tip culture (>1,000 CFU); presence of a positive quantitative catheter culture in a patient with clinical signs of sepsis that disappeared within 48 hours after catheter removal.

22% of all catheters (20% of antibiotics coated catheters vs. 25% of uncoated catheters)

14.3 (11% of uncoated catheter)

8 ± 6

Souweine^a

2001-2004

prospective, open, monocentric

99

130

Femoral and jugular

Simplified Brun Buisson

CRBSI: isolation of the same phenotypic microorganism from both peripheral-blood culture and catheter-tip culture growing greater than 10^3 CFU/mL when there was no other source for bacteremia.

9.1

0

6.7 ± 4

Schönenberg^a

2003-2007

prospective, open, monocentric

173

173

Subclavian, jugular, and femoral

NR

CRBSI: criteria for laboratory diagnosis of infection and clinical signs of sepsis. Laboratory diagnosis of infection is defined as a positive blood culture with a strain not descending from a different site of infection.

NR

3.8

9.2

Klouche^b

2004-2005

prospective, monocentric, randomized, ICU

30

30: 15 tunneled vs. 15 non- tunneled catheters

Femoral

NR

Association of fever or chills or an overtly purulent exit site with a positive catheter clot or catheter culture result

NR

6.7%

13.5 ± 9.2 (tunneled) vs. 5.6 ± 3.4 (non-tunneled)

Parienti^b

2004-2007

prospective, multicentric, randomized, few coated catheter (21%), ICU

637

637: 366 jugular vs. 370 femoral catheters

Femoral and jugular

Simplified Brun Buisson

catheter tip colonization plus at least one peripheral blood culture yielding the same species with the same antimicrobial susceptibility as the catheter tip within 48 hours of catheter removal, with no other apparent source of sepsis

40.8 (25.9%, femoral catheter) vs. 35.7 (24.9%, jugular catheter)

1.5 (0.5%, femoral catheter) vs. 2.3 (0.5%, jugular catheter)

4.9 ± 2

Parienti^b

2004-2007

prospective, multicentric, randomized, few coated catheter (21%), ICU

637

637: 470 intermittent RRT vs. 266 continuous RRT

Femoral and jugular

Simplified Brun Buisson

catheter tip colonization plus at least one peripheral blood culture yielding the same species with the same antimicrobial susceptibility as the catheter tip within 48 hours of catheter removal, with no other apparent source of sepsis

38.9 (25.4%) [42.7 (intermittent hemodialysis) vs. 27.7 (continuous renal replacement therapy)]

1.9 (1.3%) [2.6 (intermittent hemodialysis) vs. 1.2 (continuous renal replacement therapy)]

6.3 (6.2) vs. 6.6 (6)

Dugué^b

2004-2007

prospective, multicentric, randomized, few coated catheter (21%), ICU

134

268: 57 femoral then jugular vs. 77 jugular then femoral catheter

femoral and jugular

simplified Brun Buisson

NR

25,4% (femoral catheter) vs. 26,9%(jugular catheter)

NR

7.9 (5.6)

Skofic^a

2004-2008

retrospective, monocentric, prospectively data collection

290

534

femoral, subclavian, and jugular

NR

exit site infection: local inflammation with purulent discharge and positive exit site culture; suspected CRBSI: proven systemic infection without any other recognized source of infection; confirmed CRBSI: at least one positive blood culture from a peripheral vein along with at least one positive blood culture from the catheter or positive catheter tip culture with an identical microorganism; possible CRBSI: at least one positive microbiological culture, good clinical response to catheter removal and antibiotic therapy, but lacking all criteria for confirmed CRBSI.

NR

4.6 (5.2%)

11

Hermite^b

2009-2010

prospective, monocentric, randomized, ICU

78

135: 77 saline vs. 58 citrate lock

femoral and jugular

NR

CRBSI: fever (>38°C) with concordant positive blood cultures drawn from the catheter and a peripheral vein or a peripheral blood culture and a concordant exit site culture; probable CRBSI: fever with one positive blood culture, in the absence of any other clinically identifiable source of infection other than the catheter.

NR

30 (saline lock) vs. 24 (citrate lock)

6 [3–10] saline lock group vs. 12 [8–17] citrate lock group