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Cited by 174Central Venous Catheters and HemodialysisNosocomial Infections in ICUVascular Procedures and Complications

Arterial Catheters as a Source of Bloodstream Infection: A Systematic Review and Meta-Analysis*

O’Horo, John C., Maki, Dennis G., Krupp, Anna E., Safdar, Nasia·2014·Critical Care Medicine
DOI 10.1097/ccm.0000000000000166
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Abstract

OBJECTIVE: Catheter-related bloodstream infections are associated with significant costs and adverse consequences. Arterial catheters are commonly used in the critical care setting and are among the most heavily manipulated vascular access devices. We sought to evaluate the prevalence of arterial catheter-related bloodstream infection. DATA SOURCES: PubMed, CinAHL, EMBASE, and Web of Science. STUDY SELECTION: Included studies reported prevalence rate of catheter-related bloodstream infection for arterial catheters used for critical illness or postoperative monitoring. For the purposes of this study, catheter-related bloodstream infection was defined as positive blood culture collected from an arterial catheter and from the periphery with the same organism in a patient demonstrating systemic signs of sepsis. DATA EXTRACTION: The study population, site of insertion, antiseptic preparation, catheter days, and prevalence of catheter-related bloodstream infection were abstracted. When data were not available, authors were contacted for further information. DATA SYNTHESIS: Forty-nine studies met criteria including 222 cases of arterial catheter-related bloodstream infection in 30,841 catheters. Pooled incidence was 3.40/1,000 catheters or 0.96/1,000 catheter days. Prevalence was considerably higher in the subgroup of studies that cultured all catheters (1.26/1,000 catheter days) compared with those studies that cultured only when the arterial catheter was suspected as the source for the catheter-related bloodstream infection (0.70/1,000 catheter days). Pooled data also found a significantly increased risk of infection for femoral site of insertion compared with radial artery for arterial catheter placement (relative risk, 1.93; 95% CI, 1.32-2.84; p = 0.001) CONCLUSIONS: Arterial catheters are an underrecognized cause of catheter-related bloodstream infection. Pooled incidence when catheters were systematically cultured and correlated to blood culture results indicated a substantial burden of arterial catheter-related bloodstream infection. Selection of a radial site over a femoral site will help reduce the risk of arterial catheter-related bloodstream infection. Future studies should evaluate technologies applied to preventing central venous catheter-related bloodstream infection to arterial catheters as well.

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Crossref · 10.1097/ccm.0000000000000166

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  • Procalcitonin has been studied most extensively both in critically ill and noncritically ill patients, both for initiation and discontinuation of therapy.

    “Procalcitonin has been studied most extensively both in critically ill and noncritically ill patients, both for initiation and discontinuation of therapy (307).”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [307]

  • A systematic review found higher risk of infections with femoral compared with radial arterial catheters, and pooled incidence of bloodstream infection was 0.96 per 1000 catheter days.

    “A systematic review showed higher risk of infections when femoral arterial catheters were used compared to radial artery catheters (RR 1.93; 95% CI 1.32–2.84), and the overall pooled incidence of bloodstream infection was 0.96 per 1000 catheter days [384].”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [384]

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Authors
O’Horo, J. C., Maki, D. G., Krupp, A. E., & Safdar, N.
Affiliations
  • William S. Middleton Memorial Veterans Hospital (US)
  • University of Wisconsin–Madison (US)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-06
Volume
42
Issue
6
Pages
1334-1339
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0000000000000166
OpenAlex
W2162373825
Cited by
174
References
59
Citations by year
2026: 7 · 2025: 15 · 2024: 33 · 2023: 13 · 2022: 12 · 2021: 17 · 2020: 17 · 2019: 5 · 2018: 12 · 2017: 9 · 2016: 8 · 2015: 17 · 2014: 9
FWCI
3.09
Type
journal article
Language
en
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
Keywords
arterial catheters, catheter-related bloodstream infection, infection prevalence, femoral artery catheterization, radial artery catheterization, catheter site selection, antiseptics, catheter dwell time, sepsis, intensive care, postoperative monitoring
MeSH terms
Catheterization, Peripheral, Cross Infection, Humans, Intensive Care Units, Practice Guidelines as Topic, Catheter-Related Infections

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