Obesity and risk of catheter-related infections in the ICU. A post hoc analysis of four large randomized controlled trials

Abstract

Purpose

Obesity increases the risk of nosocomial infection, but data regarding the role of body mass index (BMI) in catheter related infections are scarce. We used the data gathered from four randomized, controlled trials (RCTs) to investigate the association between body mass index (BMI) and intravascular catheter infections in critically ill obese patients.

Methods

Adult obese patients who required short-term central venous, arterial or dialysis catheter insertion in the intensive care unit (ICU) were analyzed. The association between BMI and major catheter-related infection (MCRI), catheter-related bloodstream infection (CRBSI) and catheter tip colonization was estimated using univariate and multivariate marginal Cox models. Exploratory analysis using dressing disruptions was added.

Results

A total of 2282 obese patients and 4275 catheters from 32 centers were included in this post-hoc analysis. Overall, 66 (1.5%) MCRI, 43 (1%) CRBSI and 399 (9.3%) catheter colonizations were identified. The hazard ratio (HR) for MCRI, CRBSI and colonization increased with BMI. After adjustment for well-known infection risk factors, the BMI ≥ 40 group had an increased risk for MCRI (HR 1.88, 95% CI 1.13–3.12, p = 0.015), CRBSI (HR 2.19, 95% CI 1.19–4.04, p = 0.012) and colonization (HR 1.44, 95% CI 1.12–1.84, p = 0.0038) compared to the BMI < 40 group. The mean dressing disruption per catheter was increased in the BMI ≥ 40 group (2.03 versus 1.68 in the BMI < 40 group, p = 0.05).

Conclusions

Using the largest dataset ever collected from large multicentric RCTs, we showed that patients with BMI ≥ 40 had an increased risk for intravascular catheter infections. Targeted prevention measures should focus on this population with a particular attention to catheter care and dressing disruption.

This is a preview of subscription content, access via your institution.

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    WHO (2020) Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Last accessed 8 Sept 2020

  2. 2.

    Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, Romundstad P, Vatten LJ (2016) BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ 353:2156. https://doi.org/10.1136/bmj.i2156

    Article  Google Scholar 

  3. 3.

    Falagas ME, Kompoti M (2006) Obesity and infection. Lancet Infect Dis 6(7):438–446. https://doi.org/10.1016/S1473-3099(06)70523-0

    Article  PubMed  Google Scholar 

  4. 4.

    Tsai AG, Wadden TA (2013) In the clinic: obesity. Ann Intern Med 159(5):ITC3-1-ITC3-15. https://doi.org/10.7326/0003-4819-159-5-201309030-01003

    Article  Google Scholar 

  5. 5.

    Waisbren E, Rosen H, Bader AM, Lipsitz SR, Rogers SO Jr, Eriksson E (2010) Percent body fat and prediction of surgical site infection. J Am Coll Surg 210(4):381–389. https://doi.org/10.1016/j.jamcollsurg.2010.01.004

    Article  PubMed  Google Scholar 

  6. 6.

    Serrano PE, Khuder SA, Fath JJ (2010) Obesity as a risk factor for nosocomial infections in trauma patients. J Am Coll Surg 211(1):61–67. https://doi.org/10.1016/j.jamcollsurg.2010.03.002

    Article  PubMed  Google Scholar 

  7. 7.

    Kaye KS, Marchaim D, Chen TY, Chopra T, Anderson DJ, Choi Y, Sloane R, Schmader KE (2011) Predictors of nosocomial bloodstream infections in older adults. J Am Geriatr Soc 59(4):622–627. https://doi.org/10.1111/j.1532-5415.2010.03289.x

    Article  PubMed  Google Scholar 

  8. 8.

    Bochicchio GV, Joshi M, Bochicchio K, Nehman S, Tracy JK, Scalea TM (2006) Impact of obesity in the critically ill trauma patient: a prospective study. J Am Coll Surg 203(4):533–538. https://doi.org/10.1016/j.jamcollsurg.2006.07.001

    Article  PubMed  Google Scholar 

  9. 9.

    Pepin JL, Timsit JF, Tamisier R, Borel JC, Levy P, Jaber S (2016) Prevention and care of respiratory failure in obese patients. Lancet Respir Med 4(5):407–418. https://doi.org/10.1016/S2213-2600(16)00054-0

    Article  PubMed  Google Scholar 

  10. 10.

    Dossett LA, Dageforde LA, Swenson BR, Metzger R, Bonatti H, Sawyer RG, May AK (2009) Obesity and site-specific nosocomial infection risk in the intensive care unit. Surg Infect 10(2):137–142. https://doi.org/10.1089/sur.2008.028

    Article  Google Scholar 

  11. 11.

    Tsolakoglou I, Intas G, Stergiannis P, Sakkou A, Chalari E, Tsoumakas K, Elefsiniotis I, Fildissis G (2020) Central-line-associated bloodstream infections (CLABSIs) incidence and the role of obesity: a prospective, observational study in Greece. Adv Exp Med Biol 1196:11–18. https://doi.org/10.1007/978-3-030-32637-1_2

    Article  PubMed  Google Scholar 

  12. 12.

    Timsit JF, Mimoz O, Mourvillier B, Souweine B, Garrouste-Orgeas M, Alfandari S, Plantefeve G, Bronchard R, Troche G, Gauzit R, Antona M, Canet E, Bohe J, Lepape A, Vesin A, Arrault X, Schwebel C, Adrie C, Zahar JR, Ruckly S, Tournegros C, Lucet JC (2012) Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med 186(12):1272–1278. https://doi.org/10.1164/rccm.201206-1038OC

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Souweine B, Lautrette A, Gruson D, Canet E, Klouche K, Argaud L, Bohe J, Garrouste-Orgeas M, Mariat C, Vincent F, Cayot S, Cointault O, Lepape A, Guelon D, Darmon M, Vesin A, Caillot N, Schwebel C, Boyer A, Azoulay E, Bouadma L, Timsit JF (2015) Ethanol lock and risk of hemodialysis catheter infection in critically ill patients. A randomized controlled trial. Am J Respir Crit Care Med 191(9):1024–1032. https://doi.org/10.1164/rccm.201408-1431OC

    Article  PubMed  Google Scholar 

  14. 14.

    Mimoz O, Lucet JC, Kerforne T, Pascal J, Souweine B, Goudet V, Mercat A, Bouadma L, Lasocki S, Alfandari S, Friggeri A, Wallet F, Allou N, Ruckly S, Balayn D, Lepape A, Timsit JF, CLEAN trial investigators (2015) Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet 386(10008):2069–2077. https://doi.org/10.1016/S0140-6736(15)00244-5

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Parienti JJ, Mongardon N, Megarbane B, Mira JP, Kalfon P, Gros A, Marque S, Thuong M, Pottier V, Ramakers M, Savary B, Seguin A, Valette X, Terzi N, Sauneuf B, Cattoir V, Mermel LA, du Cheyron D, 3SITES Study Group (2015) Intravascular complications of central venous catheterization by insertion site. N Eng J Med 373(13):1220–1229. https://doi.org/10.1056/NEJMoa1500964

    CAS  Article  Google Scholar 

  16. 16.

    O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S, Healthcare Infection Control Practices Advisory Committee (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis Off Publ Infect Dis Soc Am 52(9):e162-193. https://doi.org/10.1093/cid/cir257

    Article  Google Scholar 

  17. 17.

    Timsit JF (2005) Updating of the 12th consensus conference of the Societe de Reanimation de langue francaise (SRLF): catheter related infections in the intensive care unit. Ann Fr Anesth Reanim 24(3):315–322. https://doi.org/10.1016/j.annfar.2004.12.022

    Article  PubMed  Google Scholar 

  18. 18.

    Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 49(1):1–45. https://doi.org/10.1086/599376

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Brun-Buisson C, Abrouk F, Legrand P, Huet Y, Larabi S, Rapin M (1987) Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med 147(5):873–877

    CAS  Article  Google Scholar 

  20. 20.

    de Grooth HJ, Timsit JF, Mermel L, Mimoz O, Buetti N, du Cheyron D, Oudemans-van Straaten HM, Parienti JJ, Sites C, Groups D (2020) Validity of surrogate endpoints assessing central venous catheter-related infection: evidence from individual- and study-level analyses. Clin Microbiol Infect Off Publi Eur Soc Clin Microbiol Infect Dis 26(5):563–571. https://doi.org/10.1016/j.cmi.2019.09.022

    Article  Google Scholar 

  21. 21.

    Lee E, Wei L, Amato D (1992) Cox-type regression analysis for large numbers of small groups of correlated failure time observations. In: Klein J, Goel PK (eds) Survival analysis: state of the art: Nato asi series. Kluwer Academic, The Netherlands, pp 237–247

    Google Scholar 

  22. 22.

    Lawrence VJ, Kopelman PG (2004) Medical consequences of obesity. Clin Dermatol 22(4):296–302. https://doi.org/10.1016/j.clindermatol.2004.01.012

    Article  PubMed  Google Scholar 

  23. 23.

    Timsit JF, Bouadma L, Ruckly S, Schwebel C, Garrouste-Orgeas M, Bronchard R, Calvino-Gunther S, Laupland K, Adrie C, Thuong M, Herault MC, Pease S, Arrault X, Lucet JC (2012) Dressing disruption is a major risk factor for catheter-related infections. Crit Care Med 40(6):1707–1714. https://doi.org/10.1097/CCM.0b013e31824e0d46

    Article  PubMed  Google Scholar 

  24. 24.

    Buetti N, Ruckly S, Lucet JC, Mimoz O, Souweine B, Timsit JF (2019) Short-term dialysis catheter versus central venous catheter infections in ICU patients: a post hoc analysis of individual data of 4 multi-centric randomized trials. Intensive Care Med 45(12):1774–1782. https://doi.org/10.1007/s00134-019-05812-w

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Buetti N, Ruckly S, Schwebel C, Mimoz O, Souweine B, Lucet JC, Timsit JF (2020) Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for short-term intravascular catheters: which one is better? Crit Care 24(1):458. https://doi.org/10.1186/s13054-020-03174-0

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O’Grady NP, Pettis AM, Rupp ME, Sandora T, Maragakis LL, Yokoe DS, Society for Healthcare Epidemiology of A (2014) Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 35(7):753–771. https://doi.org/10.1086/676533

    Article  PubMed  Google Scholar 

  27. 27.

    Buetti N, Tabah A, Timsit JF, Zingg W (2020) What is new in catheter use and catheter infection prevention in the ICU. Curr Opin Crit Care 26(5):459–465. https://doi.org/10.1097/MCC.0000000000000754

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The fellowship of NB was supported by Swiss National Science Foundation (Grant numbers: P400PM_183865 and P4P4PM_194449) and a grant from the Bangerter-Rhyner Foundation.

Funding

NB is currently receiving a Mobility grant from the Swiss National Science Foundation (Grant numbers: P400PM_183865 and P4P4PM_194449) and a grant from the Bangerter-Rhyner Foundation. These grants support his fellowship in Paris and Geneva.

Author information

Affiliations

Authors

Contributions

NB, SR and JFT designed the study. OM, LM, NM, JCL, JJP and JFT acquired the data. NB, AL, SR and JFT did the statistical analysis. NB, AL, SR, NM, JJP and JFT analyzed and interpreted the data. NB, LM, NM, BS and JFT drafted the manuscript. All authors critically reviewed the manuscript and approved the final report.

Corresponding author

Correspondence to Jean-François Timsit.

Ethics declarations

Conflicts of interest

The authors have disclosed that they do not have conflict of interest. JFT received fees for lectures to 3M, MSD, Pfizer and Biomerieux; he received research grants from Astellas, 3M, MSD and Pfizer; and he participated to advisory boards of 3M, MSD, Bayer Pharma, Nabriva and Pfizer. JCL received fees for lectures for 3M, Pfizer MSD and research grants from Anios. OM received fees for lectures for 3M and BD; he received research grants from BD. LM has served as a consultant for Citius Pharmaceuticals, Marvao Medical, Leonard-Meron Biosciences, Destiny Pharma and Nobio.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The studies were approved by the national ethic committees; further ethical consent was not required according to the French law for research.

Consent to participate

Informed consent was obtained from all individual participants included in the studies and whose decision-making capacity was intact.

Consent for publication

Not applicable.

Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 30 KB)

Supplementary file2 (DOCX 211 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Buetti, N., Souweine, B., Mermel, L. et al. Obesity and risk of catheter-related infections in the ICU. A post hoc analysis of four large randomized controlled trials. Intensive Care Med (2021). https://doi.org/10.1007/s00134-020-06336-4

Download citation

Keywords

  • Intravascular catheter infections
  • Catheter-related infections
  • Catheter-related bloodstream infections
  • Obesity
  • BMI