PICC line associated blood stream infections: an analysis of host and device factors
Keywords:
PICC line; bloodstream infection;Abstract
Background: Risk factors for PICC CLABSI (peripherally inserted central venous catheter/ central line associated bloodstream infections) have been evaluated in a limited number of prospective and retrospective studies with conflicting results.
Methods: A six year retrospective review of PICC CLABSI within a single institution was performed. PICC CLABSI cases were matched to uninfected controls and host and device data were extracted from comprehensive medical record reviews. A statistical analysis of PICC CLABSI risk factors compared to matched controls was performed.
Results: 6756 patients had a PICC line placed during the study period (January 1, 2008 - December 31, 2013). Fifty-six (0.83%) CLABSI were identified and matched to 245 uninfected controls. Factors associated with PICC CLABSI included: sepsis (P<0.0001), history of smoking (P=0.002), hyperlipidemia (P=0.048), duration of PICC (P<0.0001), area of insertion (P=0.019), use of de-clotting agents ( P=0.0009), complication after PICC line insertion (P=0.0008), and use of anti-MRSA antibiotics after PICC insertion ( P=0.006). In multivariant analysis, there was a significant association between PICC CLABSI and sepsis (OR=4.9, CI 2.2-11.1), history of smoking (OR=2.9, CI 1.3 – 6.2) and gastrostomy (OR =6.5, CI 2.2 – 19.4).
Conclusions: Risk factors for PICC CLABSI in an institution with low rates of infection include both host factors (sepsis, smoking, gastrostomy tube) and device factors (area of insertion, complications, use of de-clotting agents, anti-MRSA antibiotics after PICC placement, and PICC duration). Preventative measures targeting modifiable risk factors may decrease rates of PICC CLABSI in the future.
References
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22. Edgeworth J (2009): Intravascular catheter infections. J of Hosp Infection 73:323-330.
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24. Wylie MC, Graham DA, Potter-Bynoe G, et al. Risk Factors for Central Line-Associated Bloodstream Infection in Pediatric Intensive Care Units. Infect Control Hosp Epidemiol Oct, 2010; 31; 10; p1049-p1056.
25. Blomberg J, Lagergren J, Martin L, et al. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol 2012 Jun;47(6):737-42.
26. Shellito PC, Malt RA. Tube Gastrostomy: Techniques and Compliations. Ann. Surg 1985; 201(2):180 – 185.
27. Moghnieh R, Siblani L, Ghadban D, et al. Extensively drug-resistant Acinetobacter baumannii in a Lebanese intensive care unit: risk factors for acquisition and determination of a colonization score. J Hosp Infect 92 (2016) 47e53.
28. Bonizzoli M, Batacchi S, Cianchi G, et al. Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med 2011;37:284–9.
29. Revel-Vilk S, Yacobovich J, Tamary H, et al. Risk factors for central venous catheter thrombotic complications in children and adolescents with cancer. Cancer 2010;116:4197–205.
30. Johansson E, Hammarskjöld F, Lundberg D, et al. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: A systematic review of the literature, Acta Oncol 2013; 52:5, 886-892.
31. Johansson E, Hammarskjöld F, Lundberg D, et al. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: A systematic review of the literature, Acta Oncol 2013; 52:5, 886-892.
32. Herc E, Patel P, Washer LL, et al. A Model to Predict Central-Line-Associated Bloodstream Infection Among Patients With Peripherally Inserted Central Catheters: The MPC Score.
Infect Control Hosp Epidemiol 2017 Oct; 38(10):1155-1166.
2. Chopra V, Flanders SA, Saint S, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med. 2015;163:S1–S40.
3. Drew DA, Weiner DE, Peripherally Inserted Central Catheters (PICCs) in CKD: PICC’ing the Best Access for Kidney Disease Patients. Am. J. Kidney Dis 2016; 67(5):724-727.
4. Gunst M, Matsushima K, Vanek S, et al. Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units. Surg Infect 2011;12(4):279-282.
5. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81(9):1159-1171.
6. Merrell SW, Peatross BG, Grossman MD, et al. Peripherally inserted central venous catheters. Low-risk alternatives for ongoing venous access. West J Emerg Med 1994;160(1):25-30.
7. Chopra V, O'Horo JC, Rogers MA, et al. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2013;34(9):908-918.
8. Mollee P, Jones M, Stackelroth J, et al. Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. J Hosp Infect 2011;78(1):26-30.
9. 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 2002;81(6):466-479.
10. Yumani DF, van den Dungen FA, van Weissenbruch MM. Incidence and risk factors for catheter-associated bloodstream infections in neonatal intensive care. Acta Paediatr (Oslo, Norway : 1992). 2013;102(7):e293-298.
11. Baxi SM, Shuman EK, Scipione CA, et al. Impact of postplacement adjustment of peripherally inserted central catheters on the risk of bloodstream infection and venous thrombus formation. ?Infect. Control Hosp. Epidemiol 2013;34(8):785-792.
12. Velissaris D, Karamouzos V, Lagadinou M, Pierrakos C, Marangos M. Peripheral Inserted Central Catheter Use and Related Infections in Clinical Practice: A Literature Update. J Clin Med Res. 2019;11(4):237–246.
13. Pongruangporn M, Ajenjo MC, Russo AJ, et al. Patient- and device-specific risk factors for peripherally inserted central venous catheter-related bloodstream infections. Infect Control Hosp Epidemiol 2013;34(2):184-189.
14. Levine, Hallie. Consumer Reports Identifies Which Hospitals Do a Good Job—and Which Don't. Consumer Reports, www.consumerreports.org/hospital-safety/hospital-acquired-infections-zero-tolerance (2016, accessed 10 January 2017).
15. Ziegler MJ, Pellegrini DC, Safdar N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection. 2015;43(1):29–36.
16. Yaseen M, Al-Hameed F, Osman K, et al. A project to reduce the rate of central line associated bloodstream infection in ICU patients to a target of zero. BMJ Qual Improv Rep 2016; 5(1): u212545.
17. Berenholtz SM, Pronovost PJ, Lipsett PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004 Oct;32(10):2014-20.
18. O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52:e162, by permission of Oxford University Press. Copyright © 2011.
19. Krafte-Jacobs B, Sivit CJ, Mejia R, et al. Catheter-related thrombosis in critically ill children: comparison of catheters with and without heparin bonding. J Pediatr 1995;126(1):50.
20. Pierce CM, Wade A, Mok Q. Heparin-bonded central venous lines reduce thrombotic and infective complications in critically ill children. Intensive Care Med 2000;26(7):967.
21. Advani S, Reich NG, Sengupta A, et al. 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(9):1108–1115.
22. Edgeworth J (2009): Intravascular catheter infections. J of Hosp Infection 73:323-330.
23 Raad II, Baba M, Bodey GP. Diagnosis of catheter-related infections: the role of surveillance and targeted quantitative skin cultures. Clin Infect Dis 1995;20(3):593.
24. Wylie MC, Graham DA, Potter-Bynoe G, et al. Risk Factors for Central Line-Associated Bloodstream Infection in Pediatric Intensive Care Units. Infect Control Hosp Epidemiol Oct, 2010; 31; 10; p1049-p1056.
25. Blomberg J, Lagergren J, Martin L, et al. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol 2012 Jun;47(6):737-42.
26. Shellito PC, Malt RA. Tube Gastrostomy: Techniques and Compliations. Ann. Surg 1985; 201(2):180 – 185.
27. Moghnieh R, Siblani L, Ghadban D, et al. Extensively drug-resistant Acinetobacter baumannii in a Lebanese intensive care unit: risk factors for acquisition and determination of a colonization score. J Hosp Infect 92 (2016) 47e53.
28. Bonizzoli M, Batacchi S, Cianchi G, et al. Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med 2011;37:284–9.
29. Revel-Vilk S, Yacobovich J, Tamary H, et al. Risk factors for central venous catheter thrombotic complications in children and adolescents with cancer. Cancer 2010;116:4197–205.
30. Johansson E, Hammarskjöld F, Lundberg D, et al. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: A systematic review of the literature, Acta Oncol 2013; 52:5, 886-892.
31. Johansson E, Hammarskjöld F, Lundberg D, et al. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: A systematic review of the literature, Acta Oncol 2013; 52:5, 886-892.
32. Herc E, Patel P, Washer LL, et al. A Model to Predict Central-Line-Associated Bloodstream Infection Among Patients With Peripherally Inserted Central Catheters: The MPC Score.
Infect Control Hosp Epidemiol 2017 Oct; 38(10):1155-1166.
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Published
2021-01-26
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Alkully, T., Hensley, S. ., Khuder, S., Luke, N., Ruzieh, M., & Duggan, J. (2021). PICC line associated blood stream infections: an analysis of host and device factors. Translation: The University of Toledo Journal of Medical Sciences, 8. Retrieved from https://openjournals.utoledo.edu/index.php/translation/article/view/347
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