Clinical factors associated with peripherally inserted central catheters (PICC) related bloodstream infections: a single centre retrospective cohort

Abstract

Background Despite their spread in daily practice, few data is available on clinical factors associated with peripherally inserted central catheter (PICC)-related bloodstream infections (PR-BSI). We aimed to assess the PR-BSI incidence, microbiology, and factors associated with PR-BSI with a focus on clinical symptoms. Methods We conducted a retrospective cohort study in a French university hospital. We screened all PICC insertions performed from April 1st, 2018, to April 1st, 2019, and included PICC insertions in adult patients. We assessed the PR-BSI incidence, the factors associated with PR-BSI using a Cox model, and negative and positive predictive values (NPVs and PPVs) of each clinical sign for PR-BSI. Results Of the 901 PICCs inserted in 783 patients (38,320 catheters days), 214 PICCs (24%) presented with a complication. The most prevalent complication was PR-BSI (1.9 per 1000 catheter days; 8.1% of inserted PICCs ). Enterobacterales (N = 27, 37%) and coagulase negative Staphylococci (N = 24, 33%), were the main microorganisms responsible for PR-BSI. Factors independently associated with occurrence of PR-BSI were fever (hazard ratio 13.21, 95% confidence interval 6.00–29.11, p < 0.001) and chills (HR 3.66, 95%CI 1.92–6.99, p < 0.001). All clinical signs and a duration of PICC maintenance ≥ 28 days, had a low PPVs (≤ 67.1%) but high NPVs (≥ 92.5%) for PR-BSI. Conclusions Monitoring of clinical signs, especially fever and chills, with caution and limitation of device maintenance duration, could improve PICC management.

Peripherally Inserted Central Venous Catheter (PICC) Related Bloodstream Infection in Cancer Patients Treated with Chemotherapy Compared with Noncancer Patients: A Propensity-Score-Matched Analysis

“…Peripherally inserted central catheters (PICCs), also known as PICC lines, are venous catheters inserted into a peripheral vein in the upper arm, the distal tip of which is located in the territory of the superior vena cava [ 1 , 2 ]. They are easier to place and less prone to complications at the time of insertion than other central venous catheters (CVC) [ 1 , 2 ]. PICCs are mainly used for the administration of parenteral nutrition, prolonged antimicrobial therapy, or chemotherapy [ 1 , 2 ].…”

“…They are easier to place and less prone to complications at the time of insertion than other central venous catheters (CVC) [ 1 , 2 ]. PICCs are mainly used for the administration of parenteral nutrition, prolonged antimicrobial therapy, or chemotherapy [ 1 , 2 ]. In some patients requiring simultaneous administration of these drugs, devices with two lumens (two separate tubings in the same catheter) can be inserted [ 3 ].…”

“…In some patients requiring simultaneous administration of these drugs, devices with two lumens (two separate tubings in the same catheter) can be inserted [ 3 ]. The different types of PICCs can be used for durations of up to 6 months and even longer [ 1 , 2 ].…”

“…Over the past decade, the use of PICCs has become more widespread in daily practice, leading at the same time to an increase in the number of PICC-related complications [ 1 , 4 ]. Complications include mechanical complications such as catheter dysfunction or accidental removal [ 5 ], thrombotic complications [ 6 ], and infectious complications [ 1 , 7 ]. PICC-related infections (PICCRIs) and, in particular, PICC-related bloodstream infections (PICCR-BSIs) are the most frequent complications [ 1 , 7 ].…”

“…Complications include mechanical complications such as catheter dysfunction or accidental removal [ 5 ], thrombotic complications [ 6 ], and infectious complications [ 1 , 7 ]. PICC-related infections (PICCRIs) and, in particular, PICC-related bloodstream infections (PICCR-BSIs) are the most frequent complications [ 1 , 7 ]. However, PICCs would have a potential advantage over other central venous catheters since they would reduce the risk of catheter-related bloodstream infections compared to other CVCs [ 8 , 9 , 10 ].…”