PICC-associated Bloodstream Infections: Prevalence, Patterns, and Predictors

Vineet Chopra,David Ratz,Latoya Kuhn,Tracy Lopus,Carol Chenoweth,Sarah Krein

doi:10.1016/j.amjmed.2014.01.001

Abstract

BackgroundGrowing use of peripherally inserted central catheters (PICCs) has led to recognition of the risk of PICC-associated bloodstream infection. We sought to identify rates, patterns, and patient, provider, and device characteristics associated with this adverse outcome. MethodsA retrospective cohort of consecutive adults who underwent PICC placement from June 2009 to July 2012 was assembled. Using multivariable logistic and Cox-proportional hazards regression models, covariates specified a priori were analyzed for their association with PICC-associated bloodstream infection. Odds ratios (OR) and hazard ratios (HR) with corresponding 95% confidence intervals (CI) were used to express the association between each predictor and the outcome of interest. ResultsDuring the study period, 966 PICCs were inserted in 747 unique patients for a total of 26,887 catheter days. Indications for PICC insertion included: long-term antibiotic administration (52%, n = 503), venous access (21%, n = 201), total parenteral nutrition (16%, n = 155), and chemotherapy (11%, n = 107). On bivariate analysis, intensive care unit (ICU) status (OR 3.23; 95% CI, 1.84-5.65), mechanical ventilation (OR 4.39; 95% CI, 2.46-7.82), length of stay (hospital, OR 1.04; 95% CI, 1.02-1.06 and ICU, OR 1.03; 95% CI, 1.02-1.04), PowerPICCs (C. R. Bard, Inc., Murray Hill, NJ; OR 2.58; 95% CI, 1.41-4.73), and devices placed by interventional radiology (OR 2.57; 95% CI, 1.41-4.68) were associated with PICC-bloodstream infection. Catheter lumens were strongly associated with this event (double lumen, OR 5.21; 95% CI, 2.46-11.04, and triple lumen, OR 10.84; 95% CI, 4.38-26.82). On multivariable analysis, only hospital length of stay, ICU status, and number of PICC lumens remained significantly associated with PICC bloodstream infection. Notably, the HR for PICC lumens increased substantially, suggesting earlier time to infection among patients with multi-lumen PICCs (HR 4.08; 95% CI, 1.51-11.02 and HR 8.52; 95% CI, 2.55-28.49 for double- and triple-lumen devices, respectively). ConclusionsPICC-associated bloodstream infection is most associated with hospital length of stay, ICU status, and number of device lumens. Policy and procedural oversights targeting these factors may be necessary to reduce the risk of this adverse outcome.

Highlights

RNI,b Carol Chenoweth,OMDv,eMrS,cthe past decade, use of peripherally inserted central catheters n Arbor, Mich; bVA Ann Arbor (PICCs) to achieve nonpermanent yet durable venous access has grown dramatically.1,2 Originally developed in 1975 for delivering total parenteral nutrition,3
PICCs today serve roles spanning delivery of short- and d to recognition of the and patient, provider, long-term intravenous antibiotics to invasive hemodynamic ent from June 2009 to ds regression models, ed bloodstream infecervals (CI) were used for a total of 26,887 ation (52%, n 1⁄4 503), chemotherapy (11%, .84-5.65), mechanical I, 1.02-1.06 and ICU, 2.58; 95% CI, 1.41were associated with nt
Requests for reprints should be addressed to Vineet Chopra, MD, MSc, Department of General Medicine, University of Michigan Health System, 2800 Plymouth Road, Building 16, Rm 432W, Ann Arbor, MI 48109

Summary

Introduction

RNI,b Carol Chenoweth,OMDv,eMrS,cthe past decade, use of peripherally inserted central catheters n Arbor, Mich; bVA Ann Arbor (PICCs) to achieve nonpermanent yet durable venous access has grown dramatically.1,2 Originally developed in 1975 for delivering total parenteral nutrition,3. Evidence-‐Based Algorithm for Management of PICC-‐ therapy Associated DVT revalence, in upper-extremiTtyhroDmVbTo.s8i5s-8;7TrCeuartmrenent tguidelines tion, and early removal of PICCs are but a few provider

Results

Conclusion