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

From: How to deal with dialysis catheters in the ICU setting

Author Date Study design No. of patients Catheters number Site of insertion Catheter tip culture Catheter-related infection definition Colonization (/1,000 c.d.) Catheter-related infection (/1,000 c.d.) TC (days, mean ± SD)
Souweinea 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
Westera 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
Harba 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
Chatzinikalaoub 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
Souweinea 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
Schönenberga 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
Kloucheb 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)
Parientib 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
Parientib 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)
Duguéb 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)
Skofica 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
Hermiteb 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 [310] saline lock group vs. 12 [817] citrate lock group
  1. TC time of catheterization; ICU intensive care unit; CAVHDF Continuous arteriovenous hemodiafiltration; CRBSI Catheter-related bloodstream infection; CFU Colony-forming unit; NR not related; Simplified Brun Buisson and Sherertz as previously described [44, 45] aObservational descriptive studies; bcomparison studies.