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Patient- and device-specific risk factors for peripherally inserted central venous catheter-related bloodstream
Makhawadee Pongruangporn1, M Cristina Ajenjo, Anthony J Russo
1Infectious Disease Division, Washington University School of Medicine, St. Louis, MO 63110, USA. mpongrua@dom.wustl.edu
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.
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