Continuous Renal Replacement Therapy May Increase the Risk of Catheter Infection

Abstract

Background and objectives:Little is known about the risks of catheter-related infections in patients undergoing intermittent hemodialysis (IHD) as compared with continuous renal replacement therapy (CRRT) techniques. We compared the two modalities among critically ill adults requiring acute renal replacement therapy (RRT).Design, setting, participants, & measurements: We used the multicenter Cathedia study cohort of 736 critically ill adults requiring RRT. Cox marginal structural models were used to compare time to catheter-tip colonization at removal (intent-totreat, primary endpoint) among patients who started IHD (n ‫؍‬ 470) versus CRRT (n ‫؍‬ 266). On-treatment analysis was also conducted to take into account changes in prescription of RRT modality.Results: Hazard rate of catheter-tip colonization did not increase within the first 10 days of catheter use. Predictors of catheter-tip colonization were higher lactate levels and hypertension, while systemic antibiotics, antiseptics-impregnated catheters, and mechanical ventilation were associated with decreased risk. The incidence of catheter-tip colonization per 1000 catheter-days was 42.7 in the IHD group and 27.7 in the CRRT group (P < 0.01). This association was no longer significant after correction for channeling bias (weighted HR, 0.96; 95% CI: 0.77 to 1.20, P ‫؍‬ 0.73). On-treatment analysis revealed an increased risk of primary endpoint during CRRT exposure as compared with IHD exposure (weighted HR, 0.71; 95% CI: 0.56 to 0.92, P < 0.009).Conclusions: Our results do not support the use of CRRT when IHD could be an alternative to reduce the risk of catheter-related infection.

Vascular Access Sites for Acute Renal Replacement in Intensive Care Units

“…Gender and body temperature were marginally different between samples. Although both factors were not associated with catheter-tip colonization in our study (12), men carry more microorganisms on the skin than do women (13). The first site and thus the order of catheterization were randomized, which increases internal validity of the results.…”

Incidence of Adverse Events during Continuous Renal Replacement Therapy

“…In a randomized trial to compare jugular versus femoral routes for central venous access, Parienti et al found the rate of CRBSI was 2.3 per 1,000 catheter days when the jugular vein was used for access [37] . In a later report, Parienti et al, noted that the incidence of CRBSI was 1.2 per 1,000 catheter days in patients who received CRRT [40] . These reports indicated a lower CRBSI rate than what we found in our cohort (4.2 per 1,000 catheter days).…”

Quasi-Experimental Study of Sodium Citrate Locks and the Risk of Acute Hemodialysis Catheter Infection among Critically Ill Patients

“…Maximal barrier precautions for catheter insertion and maintenance were already in use during the control period, chlorhexidine skin antisepsis was not available, avoidance of the femoral vein for vascular access was not relevant compared to avoidance of the jugular vein (7,39), and exposures to central venous access were similar between the two periods. Moreover, the patient risk factors (2) and interventions that could increase or decrease the risk of catheter infection were prospectively monitored and standardized. Nevertheless, the possible increased use of ultrasound for catheter insertion from 2004 and 2012, as well as other unrecorded confounding factors, has not been taken into account.…”

“…ritically ill patients with acute kidney injury (AKI) who require renal replacement therapy (RRT) are particularly vulnerable to nosocomial infections (1,2). Therefore, any improvement in catheter management strategies that could delay the risk of catheter-related bloodstream infection (CRBSI) has the potential to improve patient safety (3) and reduce costs (4).…”