A Model to Predict Central-Line–Associated Bloodstream Infection Among Patients With Peripherally Inserted Central Catheters: The MPC Score

Abstract

BACKGROUND Peripherally inserted central catheters (PICCs) are associated with central-line-associated bloodstream infections (CLABSIs). However, no tools to predict risk of PICC-CLABSI have been developed. OBJECTIVE To operationalize or prioritize CLABSI risk factors when making decisions regarding the use of PICCs using a risk model to estimate an individual's risk of PICC-CLABSI prior to device placement. METHODS Using data from the Michigan Hospital Medicine Safety consortium, patients that experienced PICC-CLABSI between January 2013 and October 2016 were identified. A Cox proportional hazards model with robust sandwich standard error estimates was then used to identify factors associated with PICC-CLABSI. Based on regression coefficients, points were assigned to each predictor and summed for each patient to create the Michigan PICC-CLABSI (MPC) score. The predictive performance of the score was assessed using time-dependent area-under-the-curve (AUC) values. RESULTS Of 23,088 patients that received PICCs during the study period, 249 patients (1.1%) developed a CLABSI. Significant risk factors associated with PICC-CLABSI included hematological cancer (3 points), CLABSI within 3 months of PICC insertion (2 points), multilumen PICC (2 points), solid cancers with ongoing chemotherapy (2 points), receipt of total parenteral nutrition (TPN) through the PICC (1 point), and presence of another central venous catheter (CVC) at the time of PICC placement (1 point). The MPC score was significantly associated with risk of CLABSI (P<.0001). For every point increase, the hazard ratio of CLABSI increased by 1.63 (95% confidence interval, 1.56-1.71). The area under the receiver-operating-characteristics curve was 0.67 to 0.77 for PICC dwell times of 6 to 40 days, which indicates good model calibration. CONCLUSION The MPC score offers a novel way to inform decisions regarding PICC use, surveillance of high-risk cohorts, and utility of blood cultures when PICC-CLABSI is suspected. Future studies validating the score are necessary. Infect Control Hosp Epidemiol 2017;38:1155-1166.

Mechanisms of Parenteral Nutrition–Associated Liver and Gut Injury

“…PN requires the use of peripherally inserted catheters, which can increase the probability for infection. PN therapy has been demonstrated to be a significant independent risk factor for central line–associated bloodstream infections . Studies have reported adult trauma patients receiving enteral feeding have fewer incidents of line sepsis, intra‐abdominal abscesses, pancreatitis, and other infections compared with patients receiving PN .…”

“…PN therapy has been demonstrated to be a significant independent risk factor for central line–associated bloodstream infections . Studies have reported adult trauma patients receiving enteral feeding have fewer incidents of line sepsis, intra‐abdominal abscesses, pancreatitis, and other infections compared with patients receiving PN . The lack of enteral feeding further contributes to intraluminal bacterial overgrowth (notably, gram‐negative Proteobacteria) due to decreased intestinal motility and change in nutrition availability .…”

Complications and Risk Factors of Peripherally Inserted Central Catheters: A Review

“…From the previous studies, the incidence of PICC-related complications was relatively high and the two most common complications were infection and catheter-related thrombosis in patients with hematological malignancies, however, we still could not conclude an accurate incidence range of complications due to the incidence of complications varies considerably with the number reported in each literature (from 3% to 61.67%). Hematopoietic cell transplantation (HCT) status [9], HM [17], type of disease [14], PICC type [9,17], sex [9], patient safety and hospital resources [17,18] were proved to be influencing factors. However, not all the literatures has reported the influencing factors, so we can't draw a conclusion.…”

Developing, Implementing, and Evaluating a Multimedia Patient Decision Aid Program to Reform the Informed Consent Process of a Peripherally Inserted Central Venous Catheter Procedure: Protocol for Quality Improvement (Preprint)

“…Third, we surveyed 30 patients who received the consent process for the PICC procedure The questionnaire used for knowledge recall and knowledge retention was created based on recent guidelines for PICC [22][23][24][25][26][27][28][29][30][31][32] and included 3 "select one-answer" multiple-choice questions, 4 "select all that apply" multiple-choice questions, and 12 true/false questions. The knowledge recall questionnaire was administered within 4 -8 hours after the discussion between the vascular access team nurse and the patient and obtaining the signed consent.…”