title: Community-acquired bacteremias from tunneled central intravenous lines: results from studies of a single vendor.
abstract: Tunneled central intravenous catheters are a common method for rendering prolonged outpatient intravenous therapy. Their safety, however, has not been well studied. We conducted a retrospective evaluation of bacteremias associated with tunneled central intravenous catheters managed by a single home health care vendor during a 1-year period. All catheters were inserted in the operating room under sterile conditions. To calculate total line days, the dates of catheter insertion and removal were obtained from either the hospital operating room or the home health care agency. Catheter care was conducted according to written protocols. Total line days were calculated. Community-acquired bacteremia (defined as bacteremia occurring more than 6 days after the patients' discharge from the hospital) was determined from records available in the infection control department. Sixty-eight patients received intravenous therapy from the vendor during the 1-year study period. Total line days were 5548 (median 52 days/patient). Eleven episodes of bacteremia occurred in five patients, providing an incidence density rate of 2.0 infections/1000 catheter days. The most frequent bacteria encountered were Staphylococcus epidermidis (five), Klebsiella pneumoniae (two), and Acinetobacter calcoaceticus var anitratus (two). Median time to bacteremia was 103 days. Two patients, both younger than 4 years, accounted for seven of the infections; both had short-bowel syndrome. On the basis of historical comparisons, outpatient intravenous therapy appears to be associated with a lower risk of bacteremia than in-hospital therapy. These data can provide quality improvement information and may be a means for comparing home infusion therapy vendors.
authors.affiliation: Infectious Disease Division, Baystate Medical Center, Springfield, MA 01199.
authors.forename: R B
authors.initials: RB
authors.lastname: Brown
authors.forename: D
authors.initials: D
authors.lastname: Cipriani
authors.forename: M
authors.initials: M
authors.lastname: Schulte
authors.forename: A
authors.initials: A
authors.lastname: Corl
authors.forename: R
authors.initials: R
authors.lastname: Pieczarka
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000209:etiology; D016954:Acinetobacter calcoaceticus; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000592:standards; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000209:etiology; D007711:Klebsiella pneumoniae; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology; D013212:Staphylococcus epidermidis; D013997:Time Factors