Peripheral Intravenous Catheter Placement Is an Underrecognized Source of Staphylococcus aureus Bloodstream Infection

Austin, Eloise D.; Sullivan, Sean B.; Whittier, Susan; Lowy, Franklin D.; Uhlemann, Anne‐Catrin

doi:10.1093/ofid/ofw072

Cited by 53 publications

(35 citation statements)

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“…However, some studies in Japan showed more frequent isolation of Candida spp. among PLABSI (8.1% to 14.7%) [15–19]. This result might reflect the difference in practice of using peripheral lines, not CVCs, to administer parenteral solutions in Japan.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology of Blood Stream Infection due to Candida Species in a Tertiary Care Hospital in Japan over 12 Years: Importance of Peripheral Line-Associated Candidemia

et al. 2016

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BackgroundCandidemia is an important cause of mortality in healthcare settings. Peripheral lines are a source of candidemia, yet few studies have reported on the clinico-epidemiological features of candidemia due to peripheral-line associated blood stream infection (PLABSI).MethodsWe conducted a single-centre retrospective cohort study of all patients with candidemia between 2002 and 2013. PLABSI was defined as the presence of at least one of the following: the presence of phlebitis or the resolution of clinical symptoms after peripheral-line withdrawal, with careful exclusion of an alternative explanation for bacteraemia. We described the epidemiology of candidemia and assessed predictive factors of PLABSI due to Candida spp., peripheral line-associated candidemia (PLAC), compared with non-PLAC.ResultsA total of 301 episodes of candidemia, including 37 of PLAC, were diagnosed during the study period. Central-line associated blood stream infection, intra-abdominal infection, and infection of unknown source accounted for the remaining 233, 14, and 17 cases, respectively. The overall incidence rate of candidemia was 0.11/1000 patient-days. In multivariate analysis, cephalosporin exposure (odds ratio [OR] = 2.22, 95% CI 1.04–4.77), polymicrobial bacteraemia/fungaemia (OR = 2.87, 95% CI 1.02–8.10), and ID specialist consultation (OR = 2.40, 95% CI 1.13–5.13) were identified as independent predictors of PLAC. Although non-PLAC had a higher mortality, the length of hospital stay after candidemia was similar between the two groups and candidemia duration was longer in the PLAC group.ConclusionPLACs are an important cause of candidemia in hospitalized patients. Appropriate identification and management of PLAC are crucial.

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Section: Discussionmentioning

confidence: 99%

“…The proportion of PLABSI secondary to Candida spp. is reported to range from 8.1% (5/62) to 14.7% (20/136) in Japan [15–19] and 0.2% to 1.1% in England [20]. Worldwide, there is a paucity of data on detailed clinical and epidemiological features of PLABSI, such as predictive factors.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Blood Stream Infection due to Candida Species in a Tertiary Care Hospital in Japan over 12 Years: Importance of Peripheral Line-Associated Candidemia

et al. 2016

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“…The bloodstream infections were categorized as community onset (CO) if the initial culture was collected within 72 h of admission and hospital-onset (HO) if collected greater than 72 h after admission. Data on primary site of infection were collected (34). The primary site of infection was defined based on reported symptoms prior to bacteremia, coupled with diagnostic studies.…”

Section: Methodsmentioning

confidence: 99%

Reduced Vancomycin Susceptibility of Methicillin-Susceptible Staphylococcus aureus Has No Significant Impact on Mortality but Results in an Increase in Complicated Infection

Sullivan

Austin

Stump

et al. 2017

Antimicrob Agents Chemother

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Methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSIs) often lead to severe complications despite the availability of effective antibiotics. It remains unclear whether elevated vancomycin MICs are associated with worse outcomes. We conducted a 2-year retrospective cohort study (n ϭ 252) of patients with MSSA BSIs at a tertiary care hospital. We defined reduced vancomycin susceptibility (RVS) as a Microscan MIC of 2 mg/liter. All strains were genotyped (spa) and assessed for agr functionality. Multivariable logistic regression models were used to examine the impact of RVS phenotype and strain genotype on 30-day allcause mortality and complicated bacteremia (metastatic spread, endovascular infection, or duration Ն3 days). One-third of patients (84/252) were infected with RVS isolates. RVS Infections were more frequently associated with metastatic or embolic sites of infection (36% versus 17%, P Ͻ 0.001), and endovascular infection (26% versus 12%, P ϭ 0.004). These infections occurred more often in patients with fewer underlying comorbidities (Charlson comorbidity index of Ն3 [73% versus 88%, P ϭ 0.002]). Genotyping identified 127 spa-types and 14 Spa-clonal complexes (Spa-CCs). Spa-CC002 and Spa-CC008 were more likely to exhibit the RVS phenotype versus other Spa-CCs (OR ϭ 2.2, P Ͻ 0.01). The RVS phenotype was not significantly associated with 30-day mortality; however, it was associated with complicated bacteremia (adjusted odds ratio of 2.35 [range, 1.26 to 4.37]; P ϭ 0.007) in adjusted analyses. The association of RVS strains with complicated infection and fewer underlying comorbidities suggests the phenotype as a potential marker of strain virulence in MSSA BSIs. The RVS phenotype itself was not a significant predictor of mortality in this patient cohort. Further studies are necessary to explore this host-pathogen relationship.KEYWORDS MSSA bacteremia, reduced vancomycin susceptibility S taphylococcus aureus is a dynamic pathogen causing a broad range of clinical syndromes, from localized skin-and-soft tissue infections to invasive disease (1). S. aureus bloodstream infections (SAB) often result in endovascular seeding and are frequently associated with poor outcomes, including 30-day mortality estimated at 20 to 40% (2-6). While bloodstream infections (BSIs) caused by methicillin-resistant S. aureus (MRSA) have historically attracted the most attention, methicillin-sensitive S. aureus (MSSA) is responsible for the majority of S. aureus BSIs (7,8).Morbidity and mortality in patients with S. aureus BSI are due to a complex interplay between timely and effective treatment, host-pathogen interactions, underlying pa-

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“…The most serious complication of PIVC placement is infection with Staphylococcus aureus bacteremia (SAB). PIVC‐related SAB represents as much as 25% of all health care–associated SAB episodes …”

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confidence: 99%

Peripheral Intravenous Cannula Insertion and Use in the Emergency Department: An Intervention Study

Hawkins

Greenslade

Suna

et al. 2017

Academic Emergency Medicine

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Peripheral Intravenous Catheter Placement Is an Underrecognized Source of Staphylococcus aureus Bloodstream Infection

Cited by 53 publications

References 12 publications

Epidemiology of Blood Stream Infection due to Candida Species in a Tertiary Care Hospital in Japan over 12 Years: Importance of Peripheral Line-Associated Candidemia

Epidemiology of Blood Stream Infection due to Candida Species in a Tertiary Care Hospital in Japan over 12 Years: Importance of Peripheral Line-Associated Candidemia

Reduced Vancomycin Susceptibility of Methicillin-Susceptible Staphylococcus aureus Has No Significant Impact on Mortality but Results in an Increase in Complicated Infection

Peripheral Intravenous Cannula Insertion and Use in the Emergency Department: An Intervention Study

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