Infectious complications of Midline catheters: an epidemiological study

Midline catheters — A good alternative device?

“…Thus, CRBSI rates for MCs appear low, but the lack of consensus in infection definitions makes benchmarking between studies problematic, and validation of existing definitions for MC use is urgently needed. Queixalos et.al's [5] results suggest MC infection risk may be higher than previously reported, with the CRBSI incidence of 7% (10 of 136 patients) markedly higher than even those reported for central VADs. MCs are generally thought to have lower infection risk than central VADs, although a recent meta-analysis found CRBSI incidence in MCs not significantly different to that of peripherally inserted central catheters at 0.58% (40/6,900) versus 0.48% (127/26,422) respectively (RR = 0.77, 95% CI: 0.50-1.17, p = .22) [18].…”

“…Queixalos et al's [5] results add to emerging evidence on the infection burden of MCs. Our exploration of MC literature found seven observational studies reporting MC infections in hospitalised patients -in Australia [10,11], Europe [12,13] and North America [14][15][16].…”

“…In contrast, CRBSI additionally requires one positive peripheral blood culture and (i) an organism matched positive tip culture, or (ii) matched blood cultures drawn from both the device and peripheral vein meeting a differential time to positivity of more than 120 minutes (catheter versus peripheral blood), or (iii) simultaneous quantitative blood cultures with a ratio of > 3:1 cfu/ml (catheter vs. peripheral blood) [9]. Queixalos' study provides an interesting opportunity to compare the relative infection incidence obtained with the two definitions, and in this case, they produced similar results [5]. CRCS incidence was slightly higher at 9% compared with CRBSI 7%, suggesting that while the CRCS criteria are easier to apply, they do not drastically increase rates over microbiologically proven criteria.…”

“…As highlighted by Queixalos et al [5], the midline catheter (MC) has become an increasingly popular VAD choice for hospitalised patients. MCs offer an alternative to PIVCs and are considered appropriate to meet patients' needs for short to moderate duration (up to 14 days) IV treatment [6].…”

“…Queixalos et al [5] describe in this issue the infectious outcomes of 136 MCs from the University Hospital of Poitiers. The authors report both the European definition of Catheter Related Clinical Sepsis (CRCS; termed "catheter infection" in the study), as well as the Catheter Related Bloodstream Infection (CRBSI) definition more common in North America [9].…”