• Hagen Bomberg, Ina Bayer, Stefan Wagenpfeil, Paul Kessler, Hinnerk Wulf, Thomas Standl, André Gottschalk, Jens Döffert, Werner Hering, Jürgen Birnbaum, Claudia Spies, Bernd Kutter, Jörg Winckelmann, Simone Liebl-Biereige, Winfried Meissner, Oliver Vicent, Thea Koch, Daniel I Sessler, Thomas Volk, and Alexander Raddatz.
• From the Department of Anesthesiology, Intensive Care Medicine and Pain Medicine (H.B., I.B., T.V., A.R.), and the Institute for Medical Biometry, Epidemiology and Medical Informatics (S.W.), Saarland University, University Medical Center, Homburg/Saar, Germany; the Department of Anesthesiology, Intensive Care and Pain Medicine, Orthopedic University Hospital, Frankfurt, Germany (P.K.); the Department of Anesthesiology and Intensive Care Therapy, Philipps University Marburg, Germany (H.W.); the Department of Anesthesia, Intensive and Palliative Care Medicine, Academic Hospital Solingen, Germany (T.S.); the Department of Anesthesiology, Intensive Care and Pain Medicine, Friederikenstift Hannover, Germany (A.G.); the Department of Anesthesiology and Intensive Care Medicine, Hospital Calw-Nagold, Germany (J.D.); the Department of Anesthesiology, St. Marien-Hospital, Siegen, Germany (W.H.); the Department of Anesthesiology and Operative Intensive Care Medicine, Charité Campus Virchow Klinikum and Campus Mitte, Charité University Medicine Berlin, Germany (J.B., C.S.); the Department of Anesthesiology, Intensive Care and Pain Therapy, University and Rehabilitation Clinics, Ulm, Germany (B.K., J.W.); the Department of Anesthesiology, Intensive Care and Pain Therapy, HELIOS Hospital Erfurt, Germany (S.L.-B.); the Department of Anesthesiology and Intensive Care, Jena University Hospital, Germany (W.M.); the Department of Anesthesiology, Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany (O.V., T.K.); and the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.).
• Anesthesiology. 2018 Apr 1; 128 (4): 764-773.

BackgroundProlonged catheter use is controversial because of the risk of catheter-related infection, but the extent to which the risk increases over time remains unknown. We thus assessed the time-dependence of catheter-related infection risk up to 15 days.MethodsOur analysis was based on the German Network for Regional Anesthesia, which includes 25 centers. We considered 44,555 patients who had surgery between 2007 and 2014 and had continuous regional anesthesia as well as complete covariable details. Cox regression analysis was performed and adjusted for confounding covariables to examine the relationship between catheter duration and probability of infection-free catheter use.ResultsAfter adjustment for confounding factors, the probability of infection-free catheter use decreases with each day of peripheral and epidural catheter use. In peripheral catheters, it was 99% at day 4 of catheter duration, 96% at day 7, and 73% at day 15. In epidural catheters, it was 99% at day 4 of catheter duration, 95% at day 7, and 73% at day 15. Only 31 patients (0.07%) had severe infections that prompted surgical intervention. Among these were five catheters that initially had only mild or moderate signs of infection and were left in situ; all progressed to severe infections.ConclusionsInfection risk in catheter use increases over time, especially after four days. Infected catheters should be removed as soon as practical.Visual AbstractAn online visual overview is available for this article at http://links.lww.com/ALN/B683.

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