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

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An Editorial to this article was published on 27 February 2021

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.

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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

Authors and Affiliations

  1. University of Paris, INSERM, IAME, 75006, Paris, France

    Niccolò Buetti, Stéphane Ruckly, Jean-Christophe Lucet & Jean-François Timsit

  2. Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France

    Bertrand Souweine

  3. Division of Infectious Diseases, Department of Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA

    Leonard Mermel

  4. Services Des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, 86021, Poitiers, France

    Olivier Mimoz

  5. Université de Poitiers, Inserm U1070, Poitiers, France

    Olivier Mimoz

  6. ICURESEARCH, 6B Avenue de Romans, Saint Marcellin, France

    Ambre Loiodice

  7. Service d’Anesthésie-Réanimation Chirurgicale, Hôpitaux Universitaires Henri Mondor, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm U955 équipe 3, Faculté de Santé, Université Paris-Est Créteil, Créteil, France

    Nicolas Mongardon

  8. AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75877, Paris Cedex, France

    Jean-Christophe Lucet

  9. Department of Biostatistics and Clinical Research, Caen University Hospital, 14000, Caen, France

    Jean-Jacques Parienti

  10. GRAM 2.0, EA2656, UNICAEN, Normandie University Hospital, Caen, France

    Jean-Jacques Parienti

  11. Infection Control Program and World Health Organization Collaborating Centre On Patient Safety, University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Niccolò Buetti

  12. AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018, Paris, France

    Jean-François Timsit

Authors
  1. Niccolò Buetti
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  2. Bertrand Souweine
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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.

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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.

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

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

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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 47, 435–443 (2021). https://doi.org/10.1007/s00134-020-06336-4

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