title: Bacteremia related with arterial catheter in critically ill patients.
abstract: OBJECTIVE
  Catheter-related bloodstream infections (CR-BSI) are an increasing problem in the management of critically ill patients. Our objective was to analyze the incidence and epidemiology of CR-BSI in arterial catheters (AC) in a population of critically ill patients.
  
  
  METHODS
  We conducted a two-year, prospective, non-randomized study of patients admitted for > 24 h in a 24-bed medical-surgical major teaching ICU. We analyzed the arterial catheters and differentiated between femoral and radial locations. Difference testing between groups was performed using the two-tailed t-test and chi-square test as appropriate. Multivariate logistic regression analyses were conducted to identify independent predictors of CR-BSI occurrence and type of micro-organism responsible.
  
  
  RESULTS
  The study included 1456 patients requiring AC placement for ≥ 24 h. A total of 1543 AC were inserted for 14,437 catheter days. The incidence of AC-related bloodstream infections (ACR-BSI) was 3.53 episodes per 1000 catheter days. In the same period the incidence of central venous catheter (CVC)-related bloodstream infections was 4.98 episodes per 1000 catheter days. Logistic regression analysis showed that days of insertion (OR: 1.118 95% confidence interval (CI) 1.026-1.219) and length of ICU stay (OR: 1.052 95% CI: 1.025-1.079) were associated with a higher risk of ACR-BSI. Comparing 705 arterial catheters in femoral location with 838 in radial location, no significant differences in infection rates were found, although there was a trend toward a higher rate among femoral catheters (4.13 vs. 3.36 episodes per 1000 catheter days) (p = 0.72). Among patients with ACR-BSI, Gram-negative bacteria were isolated in 16 episodes (61.5%) in the femoral location and seven (28%) in radial location (OR: 2.586; 95% CI: 1.051-6.363).
  
  
  CONCLUSIONS
  We concluded that as has been reported for venous catheters ACR-BSI plays an important role in critically ill patients. Days of insertion and length of ICU stay increase the risk of ACR-BSI. The femoral site increases the risk for Gram-negative infection.
authors.affiliation: Intensive Care Department, IDIBELL, Hospital Universitario Bellvitge, Feixa LLarga S/N 08907 Hospitalet de Llobregat, Barcelona, Spain. f.esteve@bellvitgehospital.cat
authors.forename: Francisco
authors.initials: F
authors.lastname: Esteve
authors.forename: Miquel
authors.initials: M
authors.lastname: Pujol
authors.forename: Xosé L
authors.initials: XL
authors.lastname: Pérez
authors.forename: Javier
authors.initials: J
authors.lastname: Ariza
authors.forename: Francesc
authors.initials: F
authors.lastname: Gudiol
authors.forename: Enric
authors.initials: E
authors.lastname: Limón
authors.forename: Ricard
authors.initials: R
authors.lastname: Verdaguer
authors.forename: Rafael
authors.initials: R
authors.lastname: Mañez
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology*; D001419:Bacteria; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors