Validation of a Clinical Scale for Early Detection of Infections at the Exit Site of Central Venous Catheters for Hemodialysis

IF 8.3 2区材料科学 Q1 MATERIALS SCIENCE, MULTIDISCIPLINARY

ACS Applied Materials & Interfaces Pub Date : 2024-09-01 DOI:10.1016/j.ekir.2024.06.034

José Luis Cobo-Sánchez , Ian Blanco-Mavillard , Raquel Pelayo-Alonso , Noelia Mancebo-Salas , Ismael Fernández-Fernández , Irene Larrañeta-Inda , Ana Ulzurrun-García , Isidro Sánchez-Villar , Fernando González-García , Julia Hernando-García , Ma Jesús Rollán-de la Sota , Luís Miguel Vieira-Barbosa Lopes , Ma del Rosario Prieto-Rebollo , Carolina Sesmero-Ramos , Catalina Jaume-Riutort , Rafael Casas-Cuesta , Mateo Alcántara-Crespo , Joan Ernest de Pedro-Gómez

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Abstract

Introduction

Exit-site infections (ESI) of central venous catheters for hemodialysis (CVC-HD) has been associated with early catheter removal and an increased risk of CVC-HD related bacteremia. No specific clinical scales to predict ESI have previously been validated.

Methods

A multicenter prospective cohort study was performed to validate the proposed scale, which is based on the following 5 signs and symptoms: (i) pain at exit site during interdialytic period; (ii) hyperemia or erythema ≥2 cm from exit site; (iii) inflammation, induration, or swelling at exit site; (iv) fever ≥38 °C not attributable to other causes, and (v) obvious abscess or purulent exudate at the exit site. Adult patients with a tunneled CVC-HD for at least 1 month after insertion has been included. During each hemodialysis session, the exit site was assessed with the proposed scale by nurses. If any item was present, a pericatheter skin swab culture was collected: positive results were gold standard. The scale was validated using receiver operating characteristic (ROC) curves and logistic regression analysis. For this purpose, the logit function was applied, and the ESI probability calculated, as elogit ESI/1 + elogit ESI.

Results

Three hundred thirty-seven CVC-HDs from 310 patients were analyzed, producing 515 cultures (117 infected and 398 healthy). The final version of the scale includes the following 3 signs and symptoms, which present the greatest predictive capacity: (i) pain at exit site during interdialytic period, (ii) hyperemia or erythema ≥2 cm from exit site, and (iii) abscess or purulent exudate at the exit site. The final version generated an area under the ROC curve (AUC) of 88.3% (95% confidence interval [CI]: 85.2%–91%; P < 0.001), Youden index 0.7557 ≈ 1, sensitivity 80.34% (95% CI: 71.36%–87.71%) and specificity 95.23% (95% CI: 92.73%–97%).

Conclusions

The validation shows that the scale has good predictive properties, detecting approximately 90% of ESI with very acceptable validity parameters.

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血液透析中心静脉导管出口部位感染早期检测临床量表的验证

血液透析中心静脉导管（CVC-HD）的出口部位感染（ESI）与导管的早期移除和 CVC-HD 相关菌血症的风险增加有关。此前还未验证过预测 ESI 的特定临床量表。一项多中心前瞻性队列研究对所提出的量表进行了验证，该量表基于以下 5 种体征和症状：(i) 间隔期内出口部位疼痛；(ii) 距出口部位≥2 厘米的充血或红斑；(iii) 出口部位炎症、压痕或肿胀；(iv) 非其他原因引起的发热≥38 °C；(v) 出口部位明显的脓肿或脓性渗出物。包括插入隧道式 CVC-HD 至少 1 个月的成年患者。在每次血液透析过程中，护士都会使用建议的量表对出口部位进行评估。如果出现任何项目，则采集导管周围皮肤拭子培养：阳性结果为金标准。该量表采用接收器操作特征曲线（ROC）和逻辑回归分析进行验证。为此，采用了 logit 函数，并计算出 ESI 概率，即 elogit ESI/1 + elogit ESI。对来自 310 名患者的 337 份 CVC-HD 进行了分析，共培养出 515 份培养物（117 份感染培养物和 398 份健康培养物）。该量表的最终版本包括以下 3 个预测能力最强的体征和症状：(i) 间隔期内出口部位疼痛；(ii) 距出口部位≥2 厘米的充血或红斑；(iii) 出口部位脓肿或脓性渗出物。最终版本的 ROC 曲线下面积 (AUC) 为 88.3%（95% 置信区间 [CI]：85.2%-91%；< 0.001），Youden 指数为 0.7557 ≈ 1，灵敏度为 80.34%（95% CI：71.36%-87.71%），特异度为 95.23%（95% CI：92.73%-97%）。验证结果表明，该量表具有良好的预测性，可检测出约 90% 的 ESI，其有效性参数非常容易接受。

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来源期刊

ACS Applied Materials & Interfaces 工程技术-材料科学：综合

CiteScore

16.00

自引率

6.30%

发文量

4978

审稿时长

1.8 months

期刊介绍： ACS Applied Materials & Interfaces is a leading interdisciplinary journal that brings together chemists, engineers, physicists, and biologists to explore the development and utilization of newly-discovered materials and interfacial processes for specific applications. Our journal has experienced remarkable growth since its establishment in 2009, both in terms of the number of articles published and the impact of the research showcased. We are proud to foster a truly global community, with the majority of published articles originating from outside the United States, reflecting the rapid growth of applied research worldwide.