Effect of 3-way stopcock and needleless connector on antibiotic use in intravenous therapy: a real-world study

OBJECTIVE To analyze the association between needleless connectors and three way stopcocks and the use of antibiotics. METHODS This real-world study was designed to collect disposal connectors which were used for luminal microbial culture by perfusion culture and negative pressure suction filtration. Patient’s data and clinical information were collected based on electronic record system and infection control platform. RESULTS A total of 404 connectors were collected from 198 patients, of which 133 were needleless connectors（NC group） and 65 were 3-way stopcock（3WS group）. In the NC group, 54.9% of patients were treated with antibiotics, and in 3WS group, 98.5% of patients were administered with antibiotics empirically, with statistically significant differences（P＜0.001）. The durations of antimicrobial use in the two groups were 4（0-8） d and 12（8-19） d, respectively, and the difference was statistically significant（P＜0.001）. In the NC group, 14.3% of patients had fever, and that of 92.3% in the 3WS group; the difference was statistically significant（P＜0.001）. Perfusion culture showed that 45（22.7%） patients had ligation culture microorganisms, mainly coagulase negative Staphylococcus, Achromobacter denitrificans and Brevundimonas diminuta/vesicularis. There was a statistically significant difference in the positive rate of microbial culture between the two groups（NC vs 3WS, 15.8% vs 36.9%, respectively, P＜0.001）. However, only one case of catheter-related bloodstream infection was methicillin-resistant Staphylococcus aureus（MRSA）, and the infection rate was 0.5%. CONCLUSION Patients using the 3WS are treated with more antibiotics than those using needleless connector, with the higher incidence of fever and a significantly longer length of hospital stay.