Development and validation of a multivariable prediction model of central venous catheter-tip colonization in a cohort of five randomized trials

Jeanne Iachkine, Niccolò Buetti, Harm-Jan de Grooth, Anaïs R Briant, Olivier Mimoz, Bruno Mégarbane, Jean-Paul Mira, Stéphane Ruckly, Bertrand Souweine, Damien du Cheyron, Leonard A Mermel, Jean-François Timsit, Jean-Jacques Parienti, Jeanne Iachkine, Niccolò Buetti, Harm-Jan de Grooth, Anaïs R Briant, Olivier Mimoz, Bruno Mégarbane, Jean-Paul Mira, Stéphane Ruckly, Bertrand Souweine, Damien du Cheyron, Leonard A Mermel, Jean-François Timsit, Jean-Jacques Parienti

Abstract

Background: The majority of central venous catheters (CVC) removed in the ICU are not colonized, including when a catheter-related infection (CRI) is suspected. We developed and validated a predictive score to reduce unnecessary CVC removal.

Methods: We conducted a retrospective cohort study from five multicenter randomized controlled trials with systematic catheter-tip culture of consecutive CVCs. Colonization was defined as growth of ≥103 colony-forming units per mL. Risk factors for colonization were identified in the training cohort (CATHEDIA and 3SITES trials; 3899 CVCs of which 575 (15%) were colonized) through multivariable analyses. After internal validation in 500 bootstrapped samples, the CVC-OUT score was computed by attaching points to the robust (> 50% of the bootstraps) risk factors. External validation was performed in the testing cohort (CLEAN, DRESSING2 and ELVIS trials; 6848 CVCs, of which 588 (9%) were colonized).

Results: In the training cohort, obesity (1 point), diabetes (1 point), type of CVC (dialysis catheter, 1 point), anatomical insertion site (jugular, 4 points; femoral 5 points), rank of the catheter (second or subsequent, 1 point) and catheterization duration (≥ 5 days, 2 points) were significantly and independently associated with colonization . Area under the ROC curve (AUC) for the CVC-OUT score was 0.69, 95% confidence interval (CI) [0.67-0.72]. In the testing cohort, AUC for the CVC-OUT score was 0.60, 95% CI [0.58-0.62]. Among 1,469 CVCs removed for suspected CRI in the overall population, 1200 (82%) were not colonized. The negative predictive value (NPV) of a CVC-OUT score < 6 points was 94%, 95% CI [93%-95%].

Conclusion: The CVC-OUT score had a moderate ability to discriminate catheter-tip colonization, but the high NPV may contribute to reduce unnecessary CVCs removal. Preference of the subclavian site is the strongest and only modifiable risk factor that reduces the likelihood of catheter-tip colonization and consequently the risk of CRI.

Clinical trials registration: NCT00277888, NCT01479153, NCT01629550, NCT01189682, NCT00875069.

Keywords: Catheter-related infection; Catheter-tip colonization; Central Venous catheters; Intensive care unit; Predictive score.

Conflict of interest statement

JI no conflict; NB no conflict; HJdG. no conflict; AB no conflict; OM received research grants, lecture and consultancy fees from CareFusion; BM no conflict; JPM has no conflict directly related to the article but served on the scientific board of MSD, LFB and ASAI and Astellas; SR no conflict; B.S no conflict; DdC. no conflict; LM served as an advisor/consultant for Citius Pharmaceuticals, Marvao Medical, Leonard-Meron Biosciences, Destiny Pharma and Nobio; JFT. has no conflict directly related to the article but serves on the advisory boards of MSD, Pfizer, Bayer pharma and Nabriva, has given lectures at MSD, Pfizer, Biomerieux, and his university or research team had received research grants from Pfizer and MSD; JJP. no conflict.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart. 1CVC, Central Venous Catheter; 2DC, Dialysis Catheter
Fig. 2
Fig. 2
ROC curves for the simplified based-points score in the training, testing, and overall cohorts. *Threshold ≥ 6 points (“high risk group”) versus a. shows the receiving operator comparison (ROC) curve in the training cohort, b. shows the ROC curve in the testing cohort and c. shows the comparison between a CVC-OUT score ≥ 6 points and the suspicion of catheter-related infection (CRI) in the overall cohort. AUC, area under curve; CI, confidence interval; CRI, catheter-related infection
Fig. 3
Fig. 3
Comparison of the observed percentage of colonized catheters and the score-predicted probability for colonization by points total in the overall cohort (n = 10,747)

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