You have full access to this open access article. This study aimed to evaluate the impact on subsequent infections and mortality of an adequate antimicrobial therapy within 48 h after catheter removal in intensive care unit ICU patients with positive catheter tip culture.
We developed a propensity score PS for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a case-cohort study matched on the PS score of being adequately treated. A PS-matched subdistribution hazard model was used for detecting subsequent infections and a PS-matched Cox model was used to evaluate the impact of antibiotic therapy on mortality.
We included patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched patients with an adequate antimicrobial therapy with controls. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day was similar between treated and non-treated groups subdistribution hazard ratio [sHR] 1.
Using Cox proportional hazard models, the day mortality risk was similar between treated and non-treated groups HR 0. Antimicrobial therapy was not associated with decreased risk of subsequent infection or death in short-term catheter tip colonization in critically ill patients. Antibiotics may be unnecessary for positive catheter tip cultures. Adequate antimicrobial therapy was not associated with decreased risk of subsequent infection or death in short-term catheter tip colonization in critically ill patients.
These findings could significantly impact future management strategies when addressing positive catheter tip cultures in critically ill patients. Catheter-associated bloodstream infections were associated with a substantially increased attributable mortality [ 4 , 5 , 6 ] and an additional 15 days of ICU length-of-stay [ 7 ].
