Clinical factors associated with peripherally inserted central catheters (PICC) related bloodstream infections: a
Koko Barrigah-Benissan1,2, Jerome Ory1,2, Claire Simon3
1Department of Microbiology and Infection Control, CHU Nimes, Nimes, France.
Background:
Despite their spread in daily practice, few data is available on clinical factors associated with peripherally inserted central catheter (PICC)-related bloodstream infections (PR-BSI). We aimed to assess the PR-BSI incidence, microbiology, and factors associated with PR-BSI with a focus on clinical symptoms.
Methods:
We conducted a retrospective cohort study in a French university hospital. We screened all PICC insertions performed from April 1st, 2018, to April 1st, 2019, and included PICC insertions in adult patients. We assessed the PR-BSI incidence, the factors associated with PR-BSI using a Cox model, and negative and positive predictive values (NPVs and PPVs) of each clinical sign for PR-BSI.
Results:
Of the 901 PICCs inserted in 783 patients (38,320 catheters days), 214 PICCs (24%) presented with a complication. The most prevalent complication was PR-BSI (1.9 per 1000 catheter days; 8.1% of inserted PICCs ). Enterobacterales (N = 27, 37%) and coagulase negative Staphylococci (N = 24, 33%), were the main microorganisms responsible for PR-BSI. Factors independently associated with occurrence of PR-BSI were fever (hazard ratio 13.21, 95% confidence interval 6.00-29.11, p < 0.001) and chills (HR 3.66, 95%CI 1.92-6.99, p < 0.001). All clinical signs and a duration of PICC maintenance ≥ 28 days, had a low PPVs (≤ 67.1%) but high NPVs (≥ 92.5%) for PR-BSI.
Conclusions:
Monitoring of clinical signs, especially fever and chills, with caution and limitation of device maintenance duration, could improve PICC management.
Insights
Fever and chills are key indicators for peripherally inserted central catheter (PICC)-related bloodstream infections (PR-BSI). Monitoring these symptoms and limiting PICC duration can help manage PR-BSI risks.
Area of Science:
- Infectious Diseases
- Medical Devices
- Clinical Microbiology
Background:
- Limited data exists on clinical factors associated with peripherally inserted central catheter (PICC)-related bloodstream infections (PR-BSI).
- PICC devices are widely used in clinical practice, necessitating a better understanding of associated infection risks.
Purpose of the Study:
- To assess the incidence and microbiology of PR-BSI.
- To identify clinical factors and symptoms associated with PR-BSI.
- To evaluate the predictive values of clinical signs for PR-BSI.
Main Methods:
- Retrospective cohort study conducted in a French university hospital.
- Inclusion of adult patients with PICC insertions over a one-year period.
- Analysis of PR-BSI incidence, associated factors using Cox models, and predictive values of clinical signs.
Main Results:
- The incidence of PR-BSI was 1.9 per 1000 catheter days (8.1% of inserted PICCs).
- Enterobacterales and coagulase-negative Staphylococci were the primary causative microorganisms.
- Fever (HR 13.21) and chills (HR 3.66) were independently associated with PR-BSI.
- Clinical signs showed low positive predictive values but high negative predictive values for PR-BSI.
Conclusions:
- Fever and chills are significant clinical indicators for PR-BSI.
- Limiting the duration of PICC maintenance may help reduce infection risk.
- Close monitoring of clinical signs is crucial for effective PICC management.
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