Patient- and Device-Specific Risk Factors for Peripherally Inserted Central Venous Catheter—Related Bloodstream Infections

2013 ◽  
Vol 34 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Makhawadee Pongruangporn ◽  
M. Cristina Ajenjo ◽  
Anthony J. Russo ◽  
Kathleen M. McMullen ◽  
Catherine Robinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Adult Patients ◽  
Chronic Obstructive ◽  
Central Venous ◽  
Obstructive Pulmonary Disease ◽  
Specific Risk

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.Design.Nested case-control study.Setting.Barnes-Jewish Hospital, a 1,252-bed tertiary care teaching hospital.Patients.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 difficileinfection (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.

Early Onset versus Late Onset Peripherally Inserted Central Venous Catheter Infections: An Analysis of Risk Factors and Microbiology

2013 ◽  
Vol 34 (9) ◽  
pp. 980-983 ◽  
Author(s):  
Paul Chittick ◽  
Sobia Azhar ◽  
Kalyani Movva ◽  
Paula Keller ◽  
Judith A. Boura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Early Onset ◽  
Late Onset ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Catheter Infections ◽  
Central Catheters

The risks and microbiology for peripherally inserted central catheters (PICCs) are less well described than those for traditional central catheters, particularly as they pertain to duration of catheterization. We compared patients with early- and late-onset PICC bloodstream infections at our institution and found significant differences in microbiologic etiologies.

Risk factors for central venous catheter–related bloodstream infections after gastrointestinal surgery

2017 ◽  
Vol 45 (5) ◽  
pp. 549-550 ◽  
Author(s):  
Shenghai Wu ◽  
Shuhua Ren ◽  
Hongfeng Zhao ◽  
Huicheng Jin ◽  
Lihui Xv ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Gastrointestinal Surgery ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous

Clinical and financial implications of central venous catheters bloodstream infections in patients with multiple myeloma in the United States.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20033-e20033
Author(s):  
Pool Tobar ◽  
Luis F. Gonzalez Mosquera ◽  
Diana D. Cardenas Maldonado ◽  
Bernard Moscoso ◽  
Alida I. Podrumar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Weight Loss ◽  
Central Venous Catheter ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
The United States ◽  
Central Venous ◽  
Predictors Of Mortality ◽  
Poor Outcome

e20033 Background: Multiple Myeloma(MM) has an increased exposure to intravascular catheters due to the increased risk of severe infections and due to the route of treatment administration. Central Venous Catheter Bloodstream Infections(CVCBI) have significant mortality, imply a delay in treatment and increased cost as well. There is no prior report on the risk factors for poor outcome in MM patients that develop this complication. We aim to describe the predictors of mortality as well as the changes in cost that CVCBI implies. Methods: We retrieved adult patients with MM from the Nationwide Inpatient Sample database from 2016-2018. We used the ICD-10 codes to identify and compare patients who developed CVCBI with those that did not developed it. The main outcomes were hospital mortality and predictors of mortality. We computed the chi-squared test and the Mann-Whitney U-test. Mortality predictors are estimated using multivariate logistic regression and logistic fixed-effect methods to control for admission cohort and hospital time invariant characteristics. All analyses were performed using Stata Statistical Software version 14 (StataCorp, College Station, TX). Results: A total of 58,838 patients with MM were identified. The majority were white (63.5%), male (55.3%), with a median age of 70 (IQR 62-78). Most MM were not in remission (99.1%), followed by those in remission (1.3%) and relapse (0.3%). CVCBI was diagnosed in 264 (0.4%) of the MM patients. There was significantly higher mortality in the CVCBI group vs. the non-CVCBI group (8.7% vs. 5%; p < 0.01), longer LOS (10 vs. 5 days; p < 0.001), and higher median hospitalization cost (US$86,168 vs. US$43,511; p < 0.001). In the multivariable analysis, CVCBI was associated with higher mortality (OR: 1.69; CI 95%: 1.14-2.52; p < 0.001). Among patients with MM and CVCBI those that had achieved remission had a higher risk of death (OR: 2.87; CI 95%: 2.17-3.8; p < 0.001). Other variables associated with mortality were age > 65 (OR: 1.84; CI 95%: 1.59-2.15; p < 0.001), concomitant chronic heart failure (CHF) (OR: 1.46; CI 95%: 1.29-1.65; p < 0.001), chronic kidney disease (CKD) (OR: 1.43; CI 95%: 1.32-1.56; p < 0.001), and weight loss (OR: 2.31; CI 95%: 1.91-2.8; p < 0.001). When compared to medicare patients with higher mortality were more likely to be under medicaid(OR: 1.25; CI 95%: 1.02-1.55; p < 0.05) and private insurances(OR: 1.31; CI 95%: 1.15-1.49; p < 0.001). There was no significant association with sex, race/ethinicity or household income. Conclusions: In patients with Multiple Myeloma the development of Central Venous Catheter Bloodstream Infections was associated with a higher overall mortality, length of stay and cost of hospitalization. Age, CHF, CKD and weight loss were independent risk factors for poor outcome in this patient population. Further studies are required on developing strategies for the prevention of this complication.

scholarly journals A clinical study of patients with central venous catheter associated bloodstream infections in a tertiary care hospital

2020 ◽  
Vol 9 (11) ◽  
pp. 1665
Author(s):  
R. Abisha Rezia ◽  
R. Vijendra ◽  
Anjana Gopi
Keyword(s):  
Staphylococcus Aureus ◽  
Central Venous Catheter ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Care Hospital ◽  
Central Venous ◽  
Enterococcus Spp ◽  
Acinetobacter Spp

Background: Central venous access puts the patients at risk of iatrogenic complications and is associated with bloodstream infections. Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus and Methicillin Resistant Staphylococcus aureus (MRSA) are responsible for at least two-thirds of the infections followed by Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Enterococcus spp and Acinetobacter spp. Due to the scarcity of Central Venous Catheter associated Blood Stream Infections (CVC-BSI) data, this study was taken up in our tertiary care hospital. Aims: This study is aimed to study the profile of organisms causing CVC-BSI, assess their antimicrobial susceptibility, the clinical course and outcome.Methods: All subjects whose central venous catheter samples (n=84) were sent for culture and sensitivity during the study period were included in this prospective observational study. The study was done in the Department of Microbiology from July 2019 to December 2019. The catheter tips were streaked onto blood agar plate using Roll plate technique. After biochemical identification of the organisms, antimicrobial susceptibility testing was performed by modified Kirby-Bauer disc diffusion method as per the Clinical Laboratory Standard Institute (CLSI) guidelines. Results: Growth of pathogens was seen in 64.3% (n=54). The common organisms were Coagulase Negative Staphylococcus aureus (CONS) in 27.78% (n=15), Enterococcus spp, Klebsiella pneumoniae in 14.8% each (n=8) and Acinetobacter spp in 11.1% (n=6). Resistance was seen with amoxicillin + clavulanic acid, cefepime, ciprofloxacin and cefoperazone. The organisms were sensitive to levofloxacin, tetracycline and vancomycin.Conclusion: Aseptic precautions taken by the healthcare personnel will bring down the infections and curb the spread of multi-drug resistant hospital acquired infections.

Peripherally Inserted Central Venous Catheter–Associated Bloodstream Infections in Hospitalized Adult Patients

2011 ◽  
Vol 32 (2) ◽  
pp. 125-130 ◽  
Author(s):  
M. Cristina Ajenjo ◽  
James C. Morley ◽  
Anthony J. Russo ◽  
Kathleen M. McMullen ◽  
Catherine Robinson ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Limited Data ◽  
Intravenous Therapy ◽  
Central Venous ◽  
Therapy Services ◽  
Jewish Hospital ◽  
Therapy Service

Background.Limited data on the risk of peripherally inserted central venous catheter-associated bloodstream infections (PICC BSIs) in hospitalized patients are available. In 2007, dedicated intravenous therapy nurses were no longer available to place difficult peripheral intravenous catheters or provide PICC care Barnes-Jewish Hospital.Objectives.To determine the hospital-wide incidence of PICC BSIs and to assess the effect of discontinuing intravenous therapy service on PICC use and PICC BSI rates.Setting.A 1,252-bed tertiary care teaching hospital.Methods.A 31-month retrospective cohort study was performed. PICC BSIs were defined using National Healthcare Safety Network criteria.Results.In total, 163 PICC BSIs were identified (3.13 BSIs per 1,000 catheter-days). PICC use was higher in intensive care units (ICUs) than non-ICU areas (PICC utilization ratio, 0.109 vs 0.059 catheter-days per patient-day for ICU vs non-ICU; rate ratio [RR], 1.84 [95% confidence interval {CI}, 1.78-1.91]). PICC BSI rates were higher in ICUs (4.79 vs 2.79 episodes per 1,000 catheter-days; RR, 1.7 [95% CI, 1.10-2.61]). PICC use increased hospital-wide after the intravenous therapy service was discontinued (0.049 vs 0.097 catheter-days per patient-day; P = .01), but PICC BSI rates did not change (2.68 vs 3.63 episodes per 1,000 catheter-days; P = .06). Of PICC BSIs, 73% occurred in non-ICU patients.Conclusions.PICC use and PICC BSI rates were higher in ICUs; however, most of the PICC BSIs occurred in non-ICU areas. Reduction in intravenous therapy services was associated with increased PICC use across the hospital, but PICC BSI rates did not increase.

scholarly journals 1694. Predictors of Septic Shock in Adult Patients with Candidemia: A Single-Center Experience Over 13 Years

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S620-S620
Author(s):  
Jin Woong Suh ◽  
Jeong Yeon Kim ◽  
You Seung Chung ◽  
Hojin Lee ◽  
Sun Bean Kim ◽  
...  
Keyword(s):  
Septic Shock ◽  
Central Venous Catheter ◽  
Candida Species ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Venous Catheter ◽  
Adult Patients ◽  
Central Venous ◽  
Shock Presentation ◽  
Factors Associated

Abstract Background Although the incidence of candidemia has been increased recently, factors associated with septic shock in adult patients with candidemia have not been well defined. We performed a study to identify septic shock risk factors. Methods This retrospective study was conducted among adult patients ≥19 years of age with candidemia who were diagnosed from 2006 to 2018 at a single tertiary care medical center. Clinical data were collected. Patients were excluded if they were noted to have concomitant bacteremia or to have received antifungal treatment <5 days. Results After application of the exclusion criteria, 46 patients (25.1%) were classified as having septic shock presentation out of 183 patients. Between the septic shock and non-septic shock patients, there were no differences regarding comorbidities. Variables associated with septic shock in the univariate analysis were non-remission of candidemia [23/46 (67.6%) vs. 100/137 (83.3%) P = 0.044], central venous catheter [41/46 (89.1%) vs. 98/137 (67.9) P = 0.005], hemodialysis [12/46 (26.1%) vs. 15/137 (10.9%) P = 0.012], neutropenia [10/46 (21.7%) vs. 14/137 (10.2%) P = 0.045], and previous hospitalization to the intensive care unit (ICU) [24/46 (52.2%) vs. 47/137 (34.3%) P = 0.031]. The group of other Candida species consisting of [C. guilliermondii, C. haemulonii, C. famata, C. lusitaniae, and unknown] was more common in the septic shock patients (10.9%) than in the non-septic shock patients (1.5%), P = 0.004. The mortality of patients with septic shock was significantly higher than that of patients without septic shock [37/46 (80.4%) vs. 59/137 (43.1%) P < 0.001]. Multivariate analysis showed central venous catheter (odds ratio [OR] 4.00, 95% confidence interval [CI] 1.12 – 14.30, P = 0.033) and abnormal aspartate aminotransferase [AST] (OR 2.76, 95% CI 1.06 – 7.16, P = 0.024) were significantly associated with septic shock. Presence of other Candida species (OR 6.78, 95% CI 0.87 – 53.03, P = 0.068) showed borderline significance. Conclusion Our findings suggest that venous catheter and abnormal AST were significant factors associated with septic shock in adult patients with candidemia. Also, candidemia caused by other Candida species may need to be monitored closely for the development of septic shock presentation. Disclosures All authors: No reported disclosures.

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