title: The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis.
abstract: BACKGROUND
  Peripherally inserted central catheters (PICCs) are associated with central line-associated bloodstream infection (CLABSI). The magnitude of this risk relative to central venous catheters (CVCs) is unknown.
  
  
  OBJECTIVE
  To compare risk of CLABSI between PICCs and CVCs.
  
  
  METHODS
  MEDLINE, CinAHL, Scopus, EmBASE, and Cochrane CENTRAL were searched. Full-text studies comparing the risk of CLABSI between PICCs and CVCs were included. Studies involving adults 18 years of age or older who underwent insertion of a PICC or a CVC and reported CLABSI were included in our analysis. Studies were evaluated using the Downs and Black scale for risk of bias. Random effects meta-analyses were used to generate summary estimates of CLABSI risk in patients with PICCs versus CVCs.
  
  
  RESULTS
  Of 1,185 studies identified, 23 studies involving 57,250 patients met eligibility criteria. Twenty of 23 eligible studies reported the total number of CLABSI episodes in patients with PICCs and CVCs. Pooled meta-analyses of these studies revealed that PICCs were associated with a lower risk of CLABSI than were CVCs (relative risk [RR], 0.62; 95% confidence interval [CI], 0.40-0.94). Statistical heterogeneity prompted subgroup analysis, which demonstrated that CLABSI reduction was greatest in outpatients (RR [95% CI], 0.22 [0.18-0.27]) compared with hospitalized patients who received PICCs (RR [95% CI], 0.73 [0.54-0.98]). Thirteen of the included 23 studies reported CLABSI per catheter-day. Within these studies, PICC-related CLABSI occurred as frequently as CLABSI from CVCs (incidence rate ratio [95% CI], 0.91 [0.46-1.79]).
  
  
  CONCLUSIONS
  Only 1 randomized trial met inclusion criteria. CLABSI definition and infection prevention strategies were variably reported. Few studies reported infections by catheter-days.
  
  
  CONCLUSIONS
  Although PICCs are associated with a lower risk of CLABSI than CVCs in outpatients, hospitalized patients may be just as likely to experience CLABSI with PICCs as with CVCs. Consideration of risks and benefits before PICC use in inpatient settings is warranted.
authors.affiliation: Patient Safety Enhancement Program, Hospital Outcomes Program of Excellence and Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center and University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Vineet
authors.initials: V
authors.lastname: Chopra
authors.forename: John C
authors.initials: JC
authors.lastname: O'Horo
authors.forename: Mary A M
authors.initials: MA
authors.lastname: Rogers
authors.forename: Dennis G
authors.initials: DG
authors.lastname: Maki
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects*; D055499:Catheter-Related Infections / Q000209:etiology*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D006801:Humans; D012307:Risk Factors