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Patient- and Device-Specific Risk Factors for Peripherally Inserted Central Venous Catheter—Related Bloodstream Infections

Published online by Cambridge University Press:  02 January 2015

Makhawadee Pongruangporn ,
M. Cristina Ajenjo ,
Anthony J. Russo ,
Kathleen M. McMullen ,
Catherine Robinson ,
Robert C. Williams  and
David K. Warren
Makhawadee Pongruangporn*
Affiliation:
Infectious Disease Division, Washington University School of Medicine, St. Louis, Missouri Barnes-Jewish Hospital, St. Louis, Missouri
M. Cristina Ajenjo
Affiliation:
Infectious Disease Division, Washington University School of Medicine, St. Louis, Missouri Department of Infectious Diseases, School of Medicine, Pontificia Universidad Catóica de Chile, Santiago, Chile
Anthony J. Russo
Affiliation:
Barnes-Jewish Hospital, St. Louis, Missouri
Kathleen M. McMullen
Affiliation:
Barnes-Jewish Hospital, St. Louis, Missouri
Catherine Robinson
Affiliation:
Barnes-Jewish Hospital, St. Louis, Missouri
Robert C. Williams
Affiliation:
Infectious Disease Division, Washington University School of Medicine, St. Louis, Missouri
David K. Warren
Affiliation:
Infectious Disease Division, Washington University School of Medicine, St. Louis, Missouri Barnes-Jewish Hospital, St. Louis, Missouri
*
Infectious Disease Division, Washington University School of Medicine, 660 South Euclid, Campus Box 8051, St. Louis, MO 63110 (mpongrua@dom.wustl.edu)
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Abstract

Objective.

To determine the patient- and device-specific risk factors for hospital-acquired peripherally inserted central venous catheter–related bloodstream infections (PICC BSIs) in adult patients.

Design.

Nested case-control study.

Setting.

Barnes-Jewish Hospital, a 1,252-bed tertiary care teaching hospital.

Patients.

Adult patients with PICCs placed from January 1, 2006, through July 31, 2008.

Methods.

PICC BSI cases were identified using the National Healthcare Safety Network definition. Uninfected control patients with PICCs in place were randomly selected at a 3: 1 ratio. Patient- and device-related variables were examined using multivariate analysis.

Results.

The overall PICC BSI rate was 3.13 per 1,000 catheter-days. Independent risk factors for PICC BSIs included congestive heart failure (odds ratio [OR], 2.0 [95% confidence interval (CI), 1.26–3.17]; P = .003), intra-abdominal perforation (OR, 5.66 [95% CI, 1.76–18.19]; P = .004), Clostidium difficile infection (OR, 2.25 [95% CI, 1.17–4.33]; P = .02), recent chemotherapy (OR, 3.36 [95% CI, 1.15–9.78]; P = .03), presence of tracheostomy (OR, 5.88 [95% CI, 2.99–11.55]; P < .001), and type of catheter (OR for double lumen, 1.89 [95% CI, 1.15–3.10]; P = .01; OR for triple lumen, 2.87 [95% CI, 1.39–5.92]; P = .004). Underlying chronic obstructive pulmonary disease (OR, 0.48 [95% CI, 0.29–0.78]; P = .03) and admission to surgical (OR, 0.43 [95% CI, 0.24–0.79]; P = .006) or oncology and orthopedic (OR, 0.35 [95% CI, 0.13–0.99]; P = .05) services were less likely to be associated with having a PICC BSI.

Conclusions.

We identified several novel factors related to PICC BSIs. These factors may inform preventive measures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 2 , February 2013 , pp. 184 - 189
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013 

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References

1. Moureau, N. Vascular safety: it's all about PICCs. Nurs Manage 2006;37:22–27.Google Scholar
2. Turcotte, S, Dube, S, Beauchamp, G. Peripherally inserted central venous catheters are not superior to central venous catheters in the acute care of surgical patients on the ward. World J Surg 2006;30:1605–1619.Google Scholar
3. Graham, DR, Keldermans, MM, Klemm, LW, Semenza, NJ, Shafer, ML. Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters. Am J Med 1991;91:95S-100S.Google Scholar
4. Merrell, SW, Peatross, BG, Grossman, MD, Sullivan, JJ, Harker, WG. Peripherally inserted central venous catheters: low-risk alternatives for ongoing venous access. West J Med 1994;160:25–30.Google Scholar
5. Skiest, DJ, Abbott, M, Keiser, P. Peripherally inserted central catheters in patients with AIDS are associated with a low infection rate. Clin Infect Dis 2000;30:949–952.Google Scholar
6. Hanna, HA, McFadyen, S, Marts, K, Richardson, D, Radd, II. Prospective evaluation of 1.67 million catheter-days of PICCs in cancer patients: long durability and low infection rate. In: Program and Abstracts of the 41th Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, IL: September 22-25, 2001. Abstract K-2045.Google Scholar
7. Todd, J. Peripherally inserted central catheters and their use in i.v. therapy. Br J Nurs 1999;8:140–148.Google Scholar
8. Todd, J, Hammond, P. Choice and use of peripherally inserted central catheters by nurses. Prof Nurse 2004;19:493–497.Google Scholar
9. Safdar, N, Maki, DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 2005;128:489–495.Google Scholar
10. Correa, L, Pittet, D. Problems and solutions in hospital-acquired bacteraemia. J Hosp Infect 2000;46:89–95.Google Scholar
11. Warren, DK, Zack, JE, Elward, AM, Cox, MJ, Fraser, VJ. Nosocomial primary bloodstream infections in intensive care unit patients in a nonteaching community medical center: a 21-month prospective study. Clin Infect Dis 2001;33:1329–1335.Google Scholar
12. Mermel, LA. Infections caused by intravascular devices. In: Pffeifer, JA, ed. APIC Text of Infection Control and Epidemiology. 2nd ed. St. Louis: Mosby, 2000:30–38.Google Scholar
13. Lorente, L, Henry, C, Martin, MM, Jimenez, A, Mora, ML. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Crit Care 2005;9:R631–R635.Google Scholar
14. Safdar, N, Kluger, DM, Maki, DG. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies. Medicine (Baltimore) 2002;81:466–479.Google Scholar
15. Merrer, J, De, JB, Golliot, F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001;286:700–707.Google Scholar
16. Conly, JM, Grieves, K, Peters, B. A prospective, randomized study comparing transparent and dry gauze dressings for central venous catheters. J Infect Dis 1989;159:310–319.Google Scholar
17. Armstrong, CW, Mayhall, CG, Miller, KB, et al. Clinical predictors of infection of central venous catheters used for total parenteral nutrition. Infect Control Hosp Epidemiol 1990;11:71–78.Google Scholar
18. Segura, M, Alvarez-Lerma, F, Tellado, JM, et al. A clinical trial on the prevention of catheter-related sepsis using a new hub model. Ann Surg 1996;223:363–369.Google Scholar
19. Richet, H, Hubert, B, Nitemberg, G, et al. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients. J Clin Microbiol 1990;28:2520–2525.Google Scholar
20. Alonso-Echanove, J, Edwards, JR, Richards, MJ, et al. Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units. Infect Control Hosp Epidemiol 2003;24:916–925.Google Scholar
21. Ishizuka, M, Nagata, H, Takagi, K, Kubota, K. Total parenteral nutrition is a major risk factor for central venous catheter-related bloodstream infection in colorectal cancer patients receiving postoperative chemotherapy. Eur Surg Res 2008;41:341–345.Google Scholar
22. Kahn, MG, Steib, SA, Fraser, VJ, Dunagan, WC. An expert system for culture-based infection control surveillance. Proc Annu Symp Comput Appi Med Care 1993:171–175.Google Scholar
23. Kahn, MG, Steib, SA, Dunagan, WC, Fraser, VJ. Monitoring expert system performance using continuous user feedback. J Am Med Inform Assoc 1996;3:216–223.Google Scholar
24. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
25. Ogura, JM, Francois, KE, Perlow, JH, Elliott, JP. Complications associated with peripherally inserted central catheter use during pregnancy. Am J Obstet Gynecol 2003;188:1223–1225.Google Scholar
26. Worth, LJ, Seymour, JF, Slavin, MA. Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices. Support Care Cancer 2009;17:811–818.Google Scholar
27. Pettit, J. Assessment of infants with peripherally inserted central catheters: part 1. Detecting the most frequently occurring complications. Adv Neonatal Care 2002;2:304–315.Google Scholar
28. Cowl, CT, Weinstock, JV, Al-Jurf, A, Ephgrave, K, Murray, JA, Dillon, K. Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters. Clin Nutr 2000;19:237–243.Google Scholar
29. Griffiths, VR, Philpot, P. Peripherally inserted central catheters (PICCs): do they have a role in the care of the critically ill patient? Intensive Crit Care Nurs 2002;18:37–47.Google Scholar
30. Harter, C, Ostendorf, T, Bach, A, Egerer, G, Goldschmidt, H, Ho, AD. Peripherally inserted central venous catheters for autologous blood progenitor cell transplantation in patients with haemato-logical malignancies. Support Care Cancer 2003;11:790–794.Google Scholar
31. Edwards, JR, Peterson, KD, Andrus, ML, Dudeck, MA, Pollock, DA, Horan, TC. National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008;36:609–626.Google Scholar
32. Marschall, J, Mermel, LA, Classen, D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S22–S30.Google Scholar
33. Samore, MH, Wessolossky, MA, Lewis, SM, Shubrooks, SJ Jr, Karchmer, AW. Frequency, risk factors, and outcome for bacteremia after percutaneous transluminal coronary angioplasty. Am J Cardiol 1997;79:873–877.Google Scholar
34. Nieboer, P, de Vries, EG, Mulder, NH, et al. Factors influencing catheter-related infections in the Dutch multicenter study on high-dose chemotherapy followed by peripheral SCT in high-risk breast cancer patients. Bone Marrow Transplant 2008;42:475–481.Google Scholar
35. Lorente, L, Jimenez, A, Roca, I, Martin, MM, Mora, ML. Influence of tracheostomy on the incidence of catheter-related bloodstream infection in the catheterization of jugular vein by posterior access. Eur J Clin Microbiol Infect Dis 2011;30:1049–1051.Google Scholar
36. Lorente, L, Jimenez, A, Martin, MM, et al. Influence of tracheostomy on the incidence of central venous catheter-related bacteremia. Eur J Clin Microbiol Infect Dis 2009;28:1141–1145.Google Scholar
37. Advani, S, Reich, NG, Sengupta, A, Gosey, L, Milstone, AM. Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit. Clin Infect Dis 2011;52:1108–1115.Google Scholar
38. Yeung, C, May, J, Hughes, R. Infection rate for single lumen v triple lumen subclavian catheters. Infect Control Hosp Epidemiol 1988;9:154–158.Google Scholar
39. Zurcher, M, Tramer, MR, Walder, B. Colonization and bloodstream infection with singleversus multi-lumen central venous catheters: a quantitative systematic review. Anesth Analg 2004;99:177–182.Google Scholar
40. Donlan, RM, Costerton, JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 2002;15:167–193.Google Scholar