title: Patient- and device-specific risk factors for peripherally inserted central venous catheter-related bloodstream infections.
abstract: 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.
  
  
  METHODS
  Nested case-control study.
  
  
  METHODS
  Barnes-Jewish Hospital, a 1,252-bed tertiary care teaching hospital.
  
  
  METHODS
  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.
authors.affiliation: Infectious Disease Division, Washington University School of Medicine, St. Louis, MO 63110, USA. mpongrua@dom.wustl.edu
authors.forename: Makhawadee
authors.initials: M
authors.lastname: Pongruangporn
authors.forename: M Cristina
authors.initials: MC
authors.lastname: Ajenjo
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Russo
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: McMullen
authors.forename: Catherine
authors.initials: C
authors.lastname: Robinson
authors.forename: Robert C
authors.initials: RC
authors.lastname: Williams
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000209:etiology*; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000209:etiology*; D016001:Confidence Intervals; D003428:Cross Infection / Q000209:etiology*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D012307:Risk Factors