determination of a cutoff time point for prophylactic exchange of central venous catheters for prevention 889
table 1. Epidemiology and Characteristics of Central Venous Catheter (n=1,194) and Central Venous Catheter-Related Blood- stream Infection
Parameter CRBSI rate, %
CRBSI incidence, no. per 1,000 CVC days
CVC duration, median d (range; IQR)
CRBSI onset, median d (range; IQR) Jugular vein
Subclavian vein
AUC for CVC duration cutoff time point (95% CI)
Jugular vein Subclavian vein
dCRBSI (n=55)
4.6 2.7
dpCRBSI (n=137)
11.5 6.7
16 (3–41; 12–22) 16 (3–52; 13–22) 14 (3–40; 11–20) 13 (2–40; 10–17) 14 (3–39; 12–21) 13 (2–39; 10–17)
14 (4–40; 10–19) 13 (4–40; 10–18) 0.460 (0.388–0.531) 0.415 (0.373–0.458)
0.517 (0.417–0.617) 0.446 (0.394–0.498) 0.360 (0.255–0.464) 0.340 (0.262–0.417)
NOTE. CVC, central venous catheter; CRBSI, central venous catheter- related bloodstream infection; dCRBSI, definite CRBSI; dpCRBSI, combination of definite and probable CRBSI; IQR, interquartile range; AUC, area under the curve; 95% CI, 95% confidence interval.
difference (median, 14 vs 13 days; P=.15). We also found no significant difference between dCRBSI onset and dpCRBSI onset in subclavian vein CVCs (median, 14 vs 13 days; P=.83) (Table 1). There was also no difference in dCRBSI onset between jugular vein and subclavian vein (median, 14 [range, 3–39] vs 14 days [range, 4–40]; P=.52) and for dpCRBSI (median, 13 [range, 2–39] vs 13 days [range, 4–40]; P=.66), respectively. For the CVC duration cutoff time point, an AUC of 0.460
for dCRBSI and anAUCof 0.415 for dpCRBSIwere calculated. Considering only CVCs inserted in the jugular vein, an AUC of 0.517 for dCRBSI and an AUC of 0.446 for dpCRBSI were calculated. Furthermore, considering subclavian vein CVCs only, the AUCs for dCRBSI and dpCRBSI were 0.360 and 0.340, respectively (Table 1). In conclusion, in this large cohort of patients with hemato-
logical malignancies and high risk for CRBSI, we could not determinate an optimal cutoff time point atwhich a prophylactic CVCexchange should be implemented in clinical care to prevent CRBSI, irrespective of the CVC insertion site (jugular vein or subclavian vein) or the strength of CRBSI definition (dCRBSI or dpCRBSI). The main reason for this finding is the very wide range of CRBSI onset. In all but 1 calculation, the AUC for CVC duration cutoff time point was <0.500; for dCRBSI and jugular vein CVC, the AUC was 0.517, but the lower bound of the 95% confidence interval was also <0.500. Therefore, CVC duration was of nonpredictive significance. Of course, the CRBSI risk increases with CVC duration.5,8 Therefore, decision making for preventive CVC removal or exchange is based on experience of the clinicians so far. A risk score at CVC insertion would be helpful to identify high-risk CVCs.
acknowledgment
Financial support: No financial support was provided relevant to this article. Potential conflicts of interest: L.M.B. has received lecture honoraria from
Astellas and MSD travel grants from 3M and Gilead. M.J.G.T.V. has served at the speakers’ bureau of Pfizer, Merck, Gilead Sciences, Organobalance, Falk Foundation, and Astellas Pharma, has received research funding from 3M, DaVolterra, MSD/Merck, Astellas Pharma, Seres Therapeutics and Gilead Sciences, and is a consultant to Berlin Chemie and DaVolterra. All other authors report no conflicts of interest relevant to this article.
Enrico Schalk, MD;1
Lena M. Biehl, MD;2,3 Jacqueline Färber, MD;4 Dirk Schlüter, MD;4
Maria J. G. T. Vehreschild, MD;2,3 Thomas Fischer, MD1
Affiliation: 1. Department of Hematology and Oncology, Medical
Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany; 2. University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany; 3. German Center for Infection Research (DZIF), Site Bonn/Cologne, Cologne, Germany; 4. Department of Medical Microbiology, Infection Control and Prevention, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany. Address correspondence to Enrico Schalk, MD, Otto-von-Guericke University Magdeburg, Medical Center, Department of Hematology and Oncology, Leipziger Str. 44, D-39120 Magdeburg, Germany (enrico.
schalk@med.ovgu.de). Infect Control Hosp Epidemiol 2017;38:888–889 © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3807-0026. DOI: 10.1017/ice.2017.92
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