The majority of central venous catheters (CVC) removed in the ICU are not colonized, including when a catheter-related infection (CRI) is suspected. We developed and validated a predictive score to reduce unnecessary CVC removal. We conducted a retrospective cohort study from five multicenter randomized controlled trials with systematic catheter-tip culture of consecutive CVCs. Colonization was defined as growth of ≥103 colony-forming units per mL. Risk factors for colonization were identified in the training cohort (CATHEDIA and 3SITES trials; 3899 CVCs of which 575 (15%) were colonized) through multivariable analyses. After internal validation in 500 bootstrapped samples, the CVC-OUT score was computed by attaching points to the robust (> 50% of the bootstraps) risk factors. External validation was performed in the testing cohort (CLEAN, DRESSING2 and ELVIS trials; 6848 CVCs, of which 588 (9%) were colonized). In the training cohort, obesity (1 point), diabetes (1 point), type of CVC (dialysis catheter, 1 point), anatomical insertion site (jugular, 4 points; femoral 5 points), rank of the catheter (second or subsequent, 1 point) and catheterization duration (≥ 5 days, 2 points) were significantly and independently associated with colonization . Area under the ROC curve (AUC) for the CVC-OUT score was 0.69, 95% confidence interval (CI) [0.67–0.72]. In the testing cohort, AUC for the CVC-OUT score was 0.60, 95% CI [0.58–0.62]. Among 1,469 CVCs removed for suspected CRI in the overall population, 1200 (82%) were not colonized. The negative predictive value (NPV) of a CVC-OUT score < 6 points was 94%, 95% CI [93%–95%]. The CVC-OUT score had a moderate ability to discriminate catheter-tip colonization, but the high NPV may contribute to reduce unnecessary CVCs removal. Preference of the subclavian site is the strongest and only modifiable risk factor that reduces the likelihood of catheter-tip colonization and consequently the risk of CRI. Clinical Trials Registration: NCT00277888, NCT01479153, NCT01629550, NCT01189682, NCT00875069.

中文翻译：

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在五个随机试验队列中开发和验证中心静脉导管尖端定植的多变量预测模型

在 ICU 中取出的大多数中心静脉导管 (CVC) 没有定植，包括怀疑导管相关感染 (CRI) 时。我们开发并验证了一个预测分数，以减少不必要的 CVC 移除。我们对五项多中心随机对照试验进行了一项回顾性队列研究，这些试验对连续 CVC 进行了系统的导管尖端培养。定植被定义为每毫升≥103 个菌落形成单位的生长。通过多变量分析，在训练队列（CATHEDIA 和 3SITES 试验；3899 个 CVC，其中 575 个（15%）被定植）中确定了定植的危险因素。在对 500 个自举样本进行内部验证后，通过将点附加到稳健（> 50% 的自举）风险因素来计算 CVC-OUT 分数。在测试队列中进行了外部验证（CLEAN、DRESSING2 和 ELVIS 试验；6848 个 CVC，其中 588 个（9%）被定植）。在训练队列中，肥胖（1 分）、糖尿病（1 分）、CVC 类型（透析导管，1 分）、解剖插入部位（颈静脉，4 分；股骨 5 分）、导管等级（第二个或后续, 1 分) 和插管持续时间 (≥ 5 天, 2 分) 与定植显着且独立相关。CVC-OUT 评分的 ROC 曲线下面积 (AUC) 为 0.69, 95% 置信区间 (CI) [0.67–0.72]。在测试队列中，CVC-OUT 评分的 AUC 为 0.60，95% CI [0.58–0.62]。在总人群中因疑似 CRI 而切除的 1,469 个 CVC 中，1200 个 (82%) 未定植。CVC-OUT 评分 < 6 分的阴性预测值 (NPV) 为 94%, 95% CI [93%–95%]。CVC-OUT 评分在区分导管尖端定植方面具有中等能力，但高 NPV 可能有助于减少不必要的 CVC 去除。锁骨下部位的偏好是最强且唯一可改变的风险因素，可降低导管尖端定植的可能性，从而降低 CRI 的风险。临床试验注册：NCT00277888、NCT01479153、NCT01629550、NCT01189682、NCT00875069。