Abstract
PurposePrevious studies have suggested that peripheral venous catheter is a significant source of gram-negative bacteraemia in patients with malignancy. We aimed to identify risk factors and develop a clinical prediction rule for the involvement of gram-negative organisms in peripheral venous catheter-associated bloodstream infections (PVC-BSIs) among patients with malignancy.MethodsThis retrospective cohort study was conducted at a 700-bed cancer hospital in Japan. Consecutive patients diagnosed with PVC-BSI based on clinical and microbiological criteria were included in this study. Based on clinical and microbiological characteristics of PVC-BSIs in cancer patients, a logistic regression model for predicting gram-negative organisms as causative organisms in PVC-BSIs was then developed.ResultsOf the 99 patients included in our cohort, 60 patients (60.6%) had gram-negative PVC-BSIs. The median age of patients with PVC-BSIs was 67 years (interquartile range [IQR], 59–74 years), and the median Pitt bactearemia score was 1 (IQR, 0–3). The median duration of catherization was 5 days (IQR, 4–7 days) and 70 patients (70.7%) received peripheral parenteral nutrition that contained amino acids. On multivariable analysis, age ≥65 years (odds ratio [OR], 3.07; 95% confidence interval [CI], 1.10–8.62), showering (OR, 3.15; 95% CI, 1.07–9.26), Pitt bacteraemia score ≥2 points (OR, 6.96; 95% CI, 2.52–19.2), and use of peripheral parenteral nutrition (OR, 0.31; 95% CI, 0.10–0.98) were independent predictors for gram-negative PVC-BSIs among all PVC-BSIs. The simplified PVC-GN scores established to predict gram-negative PVC-BSIs had a optimism-corrected c-index of 0.775.ConclusionGram-negative bacteria were more commonly responsible for PVC-BSI than Gram-positive bacteria among cancer patients in this cohort. Involvement of Gram-negative bacteria in PVC-BSIs could be predicted with readily available clinical variables.
Highlights
Mortality rates of bloodstream infections in patients with malignancy are significantly higher than in patients without malignancy [1]
Involvement of Gram-negative bacteria in peripheral intravenous catheters (PVCs)-BSIs could be predicted with readily available clinical variables
A single center study in Spain reported that the rate of gram-negative bacteremia as causative organisms in central venous catheter-associated bloodstream infection increased to 40.2% in 2007–2008, compared with 4.7% in 1991–1992 [5]
Summary
Mortality rates of bloodstream infections in patients with malignancy are significantly higher than in patients without malignancy [1]. The most common cause of bloodstream infections in patients with malignancy is intravascular catheter-associated bloodstream infection [2]. In catheter-associated bloodstream infections, gram-negative bacilli appear to be becoming more common causative organisms. A single center study in Spain reported that the rate of gram-negative bacteremia as causative organisms in central venous catheter-associated bloodstream infection increased to 40.2% in 2007–2008, compared with 4.7% in 1991–1992 [5]. While central line-associated bloodstream infections have become an important metric in assessing patient safety, peripheral intravenous catheters (PVCs) remains undereappreciated as an intravascular device that is responsible for catheter-associated bloodstream infections. Compared with central venous catheters (CVCs), the risk per catheter-day of PVC-associated bloodstream infection is lower. A systematic review on PVC-associated bloodstream infections reported that PVC-associated bloodstream infections on average accounted for 6.3% of hospital-acquired bloodstream infections and 23% of hospital-acquired catheter-associated bloodstream infections [7]
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