PICC-associated bloodstream infections: prevalence, patterns, and predictors.
BACKGROUND
Growing use of peripherally inserted central catheters (PICCs) has led to recognition of the risk of PICC-associated bloodstream infection. We sought to identify rates, patterns, and patient, provider, and device characteristics associated with this adverse outcome.


METHODS
A retrospective cohort of consecutive adults who underwent PICC placement from June 2009 to July 2012 was assembled. Using multivariable logistic and Cox-proportional hazards regression models, covariates specified a priori were analyzed for their association with PICC-associated bloodstream infection. Odds ratios (OR) and hazard ratios (HR) with corresponding 95% confidence intervals (CI) were used to express the association between each predictor and the outcome of interest.


RESULTS
During the study period, 966 PICCs were inserted in 747 unique patients for a total of 26,887 catheter days. Indications for PICC insertion included: long-term antibiotic administration (52%, n = 503), venous access (21%, n = 201), total parenteral nutrition (16%, n = 155), and chemotherapy (11%, n = 107). On bivariate analysis, intensive care unit (ICU) status (OR 3.23; 95% CI, 1.84-5.65), mechanical ventilation (OR 4.39; 95% CI, 2.46-7.82), length of stay (hospital, OR 1.04; 95% CI, 1.02-1.06 and ICU, OR 1.03; 95% CI, 1.02-1.04), PowerPICCs (C. R. Bard, Inc., Murray Hill, NJ; OR 2.58; 95% CI, 1.41-4.73), and devices placed by interventional radiology (OR 2.57; 95% CI, 1.41-4.68) were associated with PICC-bloodstream infection. Catheter lumens were strongly associated with this event (double lumen, OR 5.21; 95% CI, 2.46-11.04, and triple lumen, OR 10.84; 95% CI, 4.38-26.82). On multivariable analysis, only hospital length of stay, ICU status, and number of PICC lumens remained significantly associated with PICC bloodstream infection. Notably, the HR for PICC lumens increased substantially, suggesting earlier time to infection among patients with multi-lumen PICCs (HR 4.08; 95% CI, 1.51-11.02 and HR 8.52; 95% CI, 2.55-28.49 for double- and triple-lumen devices, respectively).


CONCLUSIONS
PICC-associated bloodstream infection is most associated with hospital length of stay, ICU status, and number of device lumens. Policy and procedural oversights targeting these factors may be necessary to reduce the risk of this adverse outcome.
The Center for Clinical Management Research and The Patient Safety Enhancement Program, Ann Arbor, Mich; VA Ann Arbor Healthcare System, Ann Arbor, Mich; The University of Michigan Health System, Ann Arbor, Mich. Electronic address: vineetc@umich.edu.
Vineet
V
Chopra
The Center for Clinical Management Research and The Patient Safety Enhancement Program, Ann Arbor, Mich; VA Ann Arbor Healthcare System, Ann Arbor, Mich.
David
D
Ratz
The Center for Clinical Management Research and The Patient Safety Enhancement Program, Ann Arbor, Mich; VA Ann Arbor Healthcare System, Ann Arbor, Mich.
Latoya
L
Kuhn
VA Ann Arbor Healthcare System, Ann Arbor, Mich.
Tracy
T
Lopus
The University of Michigan Health System, Ann Arbor, Mich.
Carol
C
Chenoweth
The Center for Clinical Management Research and The Patient Safety Enhancement Program, Ann Arbor, Mich; VA Ann Arbor Healthcare System, Ann Arbor, Mich; The University of Michigan Health System, Ann Arbor, Mich.
Sarah
S
Krein
D000368:Aged; D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002406:Catheterization, Peripheral; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies
BSI; Bloodstream infection; CLABSI; Infection; PICC; Peripherally inserted central catheter