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Pulmonary artery catheter epidemiology of risk in pre–heart-transplant recipients

Published online by Cambridge University Press:  30 April 2019

Zachary A Yetmar
Affiliation:
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
Brian Lahr
Affiliation:
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
John O’Horo
Affiliation:
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota Division of Pulmonary and Critical Care Medicine, Rochester, Minnesota
Atta Behfar
Affiliation:
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
Priya Sampathkumar
Affiliation:
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Elena Beam*
Affiliation:
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
*
Author for correspondence: Elena Beam, Email: beam.elena@mayo.edu

Abstract

Objective:

Central-line–associated bloodstream infections (CLABSIs) are a known complication of central venous access. Pulmonary artery catheters (PAC) are frequently used in pre–heart-transplant patients, but the rate of CLABSI in this population is unknown. We sought to estimate the rate of CLABSI and identify factors associated with development of infection in patients actively listed for heart transplantation with a PAC.

Design:

Retrospective cohort study.

Setting:

This study was conducted in 3 intensive care units at an academic tertiary-care center in Minnesota.

Patients:

61 pre–heart-transplant patients in an intensive care unit with a PAC in place from January 2013 to December 2016, totaling 219 PACs.

Methods:

At-risk patients, pertinent risk factors, and demographic data were obtained using Mayo Clinic’s Unified Data Platform. CLABSIs were identified through internal infection prevention and control data. Characteristics of PAC use and infection rate were collected and analyzed using Kaplan-Meier estimates and time-dependent Cox models.

Results:

Among pre–heart-transplant patients with a PAC, there were 14 CLABSIs, for an infection rate of 5.46 of 1,000 PAC days (95% confidence interval [CI], 2.98–9.15). The most common causative organism was coagulase-negative Staphylococcus (79%). In unadjusted analyses, CLABSI was associated with shorter time to transplant (hazard ratio [HR], 2.49; P = .027), but not mortality (HR, 1.79; P = .355).

Conclusions:

The rate of CLABSI with PAC is high. Prolonged PAC use in the pre–heart-transplant population should be revisited.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: These data were presented in part as an abstract (no. 2094) at the Infectious Diseases Society of America Annual Meeting on October 6, 2018, in San Francisco, California.

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