• Niccolò Buetti, Jean-Ralph Zahar, Mireille Adda, Stéphane Ruckly, Cédric Bruel, Carole Schwebel, Michael Darmon, Christophe Adrie, Yves Cohen, Shidasp Siami, Virginie Laurent, Bertrand Souweine, Jean-François Timsit, and OUTCOMEREA Network.
• Université Paris Cité Inserm IAME 1137, 75018, Paris, France. niccolo.buetti@gmail.com.
• Intensive Care Med. 2024 Jul 1; 50 (7): 110811181108-1118.

PurposeThis 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.MethodsWe performed a retrospective analysis of prospectively collected data from 29 centers of the OUTCOMEREA network. We developed a propensity score (PS) for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a 1:1 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.ResultsWe included 427 patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched 150 patients with an adequate antimicrobial therapy with 150 controls. In the matched population, 30 (10%) subsequent infections were observed and 62 patients died within 30 days. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day-30 was similar between treated and non-treated groups (subdistribution hazard ratio [sHR] 1.08, 95% confidence interval [CI] 0.62-1.89, p = 0.78). Using Cox proportional hazard models, the 30-day mortality risk was similar between treated and non-treated groups (HR 0.89, 95% CI 0.45-1.74, p = 0.73).ConclusionsAntimicrobial 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.© 2024. The Author(s).

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