Institutional members access full text with Ovid®

Share this article on:

Arterial Catheters as a Source of Bloodstream Infection: A Systematic Review and Meta-Analysis*

O’Horo, John C. MD1; Maki, Dennis G. MD, MS2; Krupp, Anna E. RN3; Safdar, Nasia MD, PhD2,3,4

doi: 10.1097/CCM.0000000000000166
Feature Articles

Objective: Catheter-related bloodstream infections are associated with significant costs and adverse consequences. Arterial catheters are commonly used in the critical care setting and are among the most heavily manipulated vascular access devices. We sought to evaluate the prevalence of arterial catheter-related bloodstream infection.

Data Sources: PubMed, CinAHL, EMBASE, and Web of Science.

Study Selection: Included studies reported prevalence rate of catheter-related bloodstream infection for arterial catheters used for critical illness or postoperative monitoring. For the purposes of this study, catheter-related bloodstream infection was defined as positive blood culture collected from an arterial catheter and from the periphery with the same organism in a patient demonstrating systemic signs of sepsis.

Data Extraction: The study population, site of insertion, antiseptic preparation, catheter days, and prevalence of catheter-related bloodstream infection were abstracted. When data were not available, authors were contacted for further information.

Data Synthesis: Forty-nine studies met criteria including 222 cases of arterial catheter-related bloodstream infection in 30,841 catheters. Pooled incidence was 3.40/1,000 catheters or 0.96/1,000 catheter days. Prevalence was considerably higher in the subgroup of studies that cultured all catheters (1.26/1,000 catheter days) compared with those studies that cultured only when the arterial catheter was suspected as the source for the catheter-related bloodstream infection (0.70/1,000 catheter days). Pooled data also found a significantly increased risk of infection for femoral site of insertion compared with radial artery for arterial catheter placement (relative risk, 1.93; 95% CI, 1.32–2.84; p = 0.001)

Conclusions: Arterial catheters are an underrecognized cause of catheter-related bloodstream infection. Pooled incidence when catheters were systematically cultured and correlated to blood culture results indicated a substantial burden of arterial catheter-related bloodstream infection. Selection of a radial site over a femoral site will help reduce the risk of arterial catheter-related bloodstream infection. Future studies should evaluate technologies applied to preventing central venous catheter-related bloodstream infection to arterial catheters as well.

Supplemental Digital Content is available in the text.

1Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

2William S. Middleton Memorial Veterans Hospital, Madison, WI.

3Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.

4University of Wisconsin Hospital and Clinics, Madison, WI.

* See also p. 1533.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

The authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Nasia Safdar, MD, PhD, UW Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI 53705-2281. E-mail:

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins