title: Should central venous catheter be systematically removed in patients with suspected catheter related infection?
abstract: BACKGROUND
  Best clinical practice for patients with suspected catheter-related infection (CRI) remains unclear according to the latest Infectious Diseases Society of America (IDSA) guidelines. Thus, the objective of this study was to analyze clinical practice concerning the central venous catheter (CVC) and its impact on prognosis in patients with suspected CRI.
  
  
  METHODS
  We performed a prospective, multicenter, observational study in 18 Spanish Intensive Care Units (ICUs). Inclusion criteria were patients with CVC and suspected CRI. The following exclusion criteria were used: age less than 18 years; pregnancy; lactation; human immunodeficiency virus; neutropenia; solid or haematological tumor; immunosuppressive or radiation therapy; transplanted organ; intravascular foreign body; haemodynamic instability; suppuration or frank erythema/induration at the insertion site of the CVC, and patients with bacteremia or fungemia. The end-point of the study was mortality at 30 days of CRI suspicion.
  
  
  RESULTS
  The study included 384 patients. In 214 (55.8%) patients, CVC was removed at the moment of CRI suspicion, in 114 (29.7%) CVC was removed later and in 56 (14.6%) CVC was not removed. We did not find significant differences between survivors (n =311) and non-survivors (n =73) at 30 days according to CVC decision (P =0.26). The rate of confirmed catheter-related bloodstream infection (CRBSI) was higher in survivors than in non-survivors (14.5% versus 4.1%; P =0.02). Mortality rate was lower in patients with CRBSI than in the group of patients whose clinical symptoms were due to other causes (3/48 (6.25%) versus 70/336 (20.8%); P =0.02). We did not find significant differences in mortality in patients with confirmed CRBSI according to CVC removal at the moment of CRI suspicion (n =38) or later (n =10) (7.9% versus 0; P =0.99).
  
  
  CONCLUSIONS
  In patients with suspected CRI, immediate CVC removal may be not necessary in all patients. Other aspects should be taken into account in the decision-making, such as vascular accessibility, the risk of mechanical complications during new cannulation that may be life-threatening, and the possibility that the CVC may not be the origin of the suspected CRI.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lorente
authors.forename: María M
authors.initials: MM
authors.lastname: Martín
authors.forename: Pablo
authors.initials: P
authors.lastname: Vidal
authors.forename: Sergio
authors.initials: S
authors.lastname: Rebollo
authors.forename: María I
authors.initials: MI
authors.lastname: Ostabal
authors.forename: Jordi
authors.initials: J
authors.lastname: Solé-Violán
mesh_terms: D016470:Bacteremia / Q000175:diagnosis / Q000401:mortality*; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000401:mortality*; D062905:Central Venous Catheters / Q000009:adverse effects*; D003428:Cross Infection / Q000175:diagnosis / Q000401:mortality*; D020878:Device Removal; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D011379:Prognosis; D011446:Prospective Studies