Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial.
OBJECTIVE
To find a subset of patients with suspected central venous catheter (CVC)-related infection (CRI) in whom CVC removal is not needed.


METHODS
Randomized controlled trial.


METHODS
Thirty-three-bed ICU.


METHODS
One hundred and forty four patients with suspected CRI in which a change of CVCs was planned were evaluated for inclusion.


METHODS
Hemodynamically stable patients without proven bacteremia, no insertion site infection, and no intravascular foreign body were randomized to a standard-of-care group (SOC, all CVCs were changed as planned) or a watchful waiting group (WW, CVCs changed when bacteremia was subsequently confirmed or hemodynamic instability occurred).


RESULTS
Study groups were compared for incidence of CVC-related bloodstream infection (CR-BSI), resolution of fever, C-reactive protein, SOFA score, duration of ICU stay, and mortality. Of 144 patients with suspected CRI, 80 patients met exclusion criteria. Sixty-four were randomized. Forty-seven of 80 excluded patients were shown to be bacteremic, 20 (25%) of whom had a CR-BSI. Five of 64 (8%) included patients had a CR-BSI during their subsequent ICU stay (two in SOC and three in WW group). All 38 CVCs were changed in the SOC group versus 16 of 42 in the WW group (62% reduction, P<0.01). Resolution of fever, C-reactive protein, SOFA score, duration of ICU stay, and ICU mortality did not differ between SOC and WW group ( P>0.1 for all).


CONCLUSIONS
The use of a simple clinical algorithm permits a substantial decrease in the number of unnecessarily removed CVCs without increased morbidity.
Rijnders
Bart J
BJ
Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands. b.rijnders@erasmusmc.nl
Peetermans
Willy E
WE
Verwaest
Charles
C
Wilmer
Alexander
A
Van Wijngaerden
Eric
E
D000465:Algorithms; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D001530:Belgium / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric