Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy.
BACKGROUND
Intravenous therapy in the outpatient and home settings is commonplace for many diseases and nutritional disorders. Few data are available on the rate of and risk factors for bloodstream infection among patients receiving such therapy.


OBJECTIVE
To determine rates of and risk factors for bloodstream infection among patients receiving home infusion therapy.


METHODS
Prospective, observational cohort study.


METHODS
Cleveland, Ohio, and Toronto, Ontario, Canada.


METHODS
Patients receiving home infusion therapy through a central or midline catheter.


METHODS
Primary laboratory-confirmed bloodstream infection.


RESULTS
Among 827 patients (988 catheters), the most common diagnoses were infections other than HIV (67%), cancer (24%), nutritional and digestive disease (17%), heart disease (14%), receipt of bone marrow or solid organ transplants (11%), and HIV infection (7%). Sixty-nine bloodstream infections occurred during 69,532 catheter-days (0.99 infections per 1000 days). In a Cox regression model with time-dependent covariates, independent risk factors for bloodstream infection were recent receipt of a bone marrow transplant (hazard ratio, 5.8 [95% CI, 3.0 to 11.3]), receipt of total parenteral nutrition (hazard ratio, 4.1 [CI, 2.3 to 7.2]), receipt of therapy outside the home (for example, in an outpatient clinic or physician's office) (hazard ratio, 3.6 [CI, 2.2 to 5.9]), use of a multilumen catheter (hazard ratio, 2.8 [CI, 1.7 to 4.7]), and previous bloodstream infection (hazard ratio, 2.5 [CI, 1.5 to 4.2]). Rates of bloodstream infection per 1000 catheter-days varied from 0.16 for patients with none of these 5 risk factors to 6.77 for patients with 3 or more risk factors. Centrally inserted venous catheters were associated with a higher risk than implanted ports were, but the difference was not statistically significant.


CONCLUSIONS
Bloodstream infections seem to be infrequent among outpatients receiving infusions through central and midline catheters. However, the rate of infection increases with bone marrow transplantation, parenteral nutrition, infusion therapy in a hospital clinic or physician's office, and use of multilumen catheters. Compared with implanted ports or peripherally inserted catheters, centrally inserted venous catheters may confer greater risk for bloodstream infection.
Tokars
J I
JI
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Cookson
S T
ST
McArthur
M A
MA
Boyer
C L
CL
McGeer
A J
AJ
Jarvis
W R
WR
D002404:Catheterization / Q000009:adverse effects; D005260:Female; D018718:Home Infusion Therapy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology