Ultrasound guidance and risk for intravascular catheter-related infections among peripheral arterial catheters: a post-hoc analysis of two large randomized-controlled trials

Niccolò Buetti, Stéphane Ruckly, Jean-Christophe Lucet, Lila Bouadma, Carole Schwebel, Olivier Mimoz, Jean-François Timsit, Niccolò Buetti, Stéphane Ruckly, Jean-Christophe Lucet, Lila Bouadma, Carole Schwebel, Olivier Mimoz, Jean-François Timsit

Abstract

Background: The impact on infectious risk of ultrasound guidance at insertion remains controversial in short-term arterial catheters (ACs). The present study investigated the association between ultrasound guidance (US) during AC insertion and major catheter-related infections (MCRI), catheter-related bloodstream infections (CR-BSI) or colonization, using univariate and multivariate marginal Cox model for clustered data. The skin colonization at catheter removal was evaluated to explain our results.

Results: We used individual data from two multicenter randomized-controlled trials (RCTs) that included a total of 3029 patients, 10 ICUs and 3950 ACs. US guidance was used for 386 (9.8%) catheter placements. In the univariate Cox model analysis, AC insertion with US versus without US exhibited similar risks for MCRI (HR 0.86, CI 95% 0.27-2.72, p = 0.79), CR-BSI (HR 0.87, CI 95% 0.20-3.72, p = 0.85) and catheter colonization (HR 1.31, CI 95% 0.92-1.86, p = 0.13). After adjustment on confounders, risks associated with US guidance remained similar versus non-US for MCRI (HR 0.71, CI 95% 0.23-2.24, p = 0.56), CR-BSI (HR 0.71, CI 95% 0.17-3.00, p = 0.63) and catheter colonization (HR 0.92, CI 95% 0.63-1.34, p = 0.67). No differences between US and non-US for MCRI, CR-BSI and colonization were observed according to the insertion site, radial or femoral. At catheter removal, the skin colonization was similar between US and non-US groups (p = 0.69).

Conclusions: Using the largest dataset ever collected from large multi-centric RCTs conducted with relatively consistent insertion and maintenance catheter protocols, we showed that the risk of infectious complications for ACs inserted under US guidance is not superior compared to those inserted without US guidance. Trial registration These studies were registered within ClinicalTrials.gov (numbers NCT01629550 and NCT01189682).

Keywords: Arterial; Arterial catheter; Catheter; Catheter tip; Catheter-related bloodstream infection, infectious risk; Intravascular; Ultrasound; Ultrasound guidance.

Conflict of interest statement

The authors declare that they have no competing interests. JFT received fees for lectures to 3 M, MSD, Pfizer, and Biomerieux. JFT received research grants from Astellas, 3 M, MSD, and Pfizer. JFT participated to advisory boards of 3 M, MSD, Bayer Pharma, Nabriva, and Pfizer. JCL received fees for lectures for 3 M, Pfizer MSD, and research grants from Anios. OM received fees for lectures for 3 M and BD. OM received research grants from BD.

Figures

Fig. 1
Fig. 1
Flow chart. ICU intensive care unit, CVC central venous catheter, AC arterial catheter, DC dialysis catheter, US ultrasound guidance. *6 ICUs were included in both studies
Fig. 2
Fig. 2
Adjusted analyses for risk of MCRI, CR-BSI and colonization for ultrasound guidance versus without ultrasound guidance. *Variables used for adjusting MCRI: SAPS II score, dressing, skin antisepsis, vasopressor at insertion. **Variables used for adjusting CR-BSI: SAPS II score, skin antisepsis and antibiotic at insertion. ***Variables used for adjusting colonization: vasopressor at admission, SAPS II score, insertion site, dressing, skin antisepsis, mechanical ventilation at insertion, vasopressor at insertion, and antibiotics at insertion. A hazard ratio (HR) less than one indicated a lower risk of event of ultrasound guidance (US) compared with non-US. CI confidence interval, MCRI Major catheter-related infection, CR-BSI catheter-related bloodstream infection

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