Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC.
Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC.
Am J Infect Control. 2019 Feb;47(2):191-195. doi: 10.1016/j.ajic.2018.07.006. Epub 2018 Sep 1.
Antimicrobial-impregnated (AIP) peripherally inserted central catheters (PICCs) may lower risk of central line-associated bloodstream infection (CLABSI) compared with nonantimicrobial-impregnated (NAIP) catheters. We sought to assess risk factors for CLABSI with a focus on the effect of AIP PICCs.
CLABSI rate was determined among patients who received PICCs from July 2009 through June 2012 using a retrospective study design. A nested case-control study matched for operators (interventional radiology [IR], infectious diseases [IDs], and the nurse venous access team [VAT]) was conducted to assess risks for PICC CLABSI.
Eighty-nine PICC CLABSIs (1.66%) occurred among 5,372 PICC placements a mean of 32 days after placement. Higher infection risk (1.75) was observed for IR-placed PICCs compared with ID-placed PICCs (P = .02). In addition, higher infection risk (4.22) was observed for IR-placed PICCS compared with VAT-placed PICCs (P = .0008). IR-placed NAIP catheters, as indicated by multivariate analysis, revealed a 5.45-fold greater CLABSI risk compared with AIP catheters (P < .0005). Other risk factors included chemotherapy, placement of a tunneled catheter, leukemia, and AIDS.
PICC CLABSIs were highest among patients receiving NAIP catheters in this large study. Highest risk occurred with placement of a tunneled catheter, AIDS, leukemia, and if the indication for PICC was chemotherapy. Our study suggests that the AIP PICC should be considered in all patients receiving PICCs.
与非抗菌浸渍（NAIP）导管相比，抗菌浸渍（AIP）外周中心静脉导管（PICC）可能降低中心静脉相关血流感染（CLABSI）的风险。我们旨在评估 CLABSI 的危险因素，重点关注 AIP PICC 的作用。
采用回顾性研究设计，于 2009 年 7 月至 2012 年 6 月期间，对接受 PICC 的患者进行 CLABSI 发生率的评估。对操作人员（介入放射科[IR]、传染病科[IDs]和静脉接入团队[VAT]）进行嵌套病例对照研究，以评估 PICC CLABSI 的风险。
在 5372 例 PICC 置管中，有 89 例（1.66%）发生了 PICC CLABSI，在置管后平均 32 天发生。与 ID 置管相比，IR 置管的感染风险更高（1.75）（P=0.02）。此外，与 VAT 置管相比，IR 置管的感染风险更高（4.22）（P=0.0008）。多变量分析显示，与 AIP 导管相比，IR 置管的 NAIP 导管的 CLABSI 风险高 5.45 倍（P<0.0005）。其他危险因素包括化疗、隧道式导管的放置、白血病和艾滋病。
在这项大型研究中，接受 NAIP 导管的患者的 PICC CLABSI 发生率最高。风险最高的是放置隧道式导管、艾滋病、白血病，如果 PICC 的适应证是化疗。我们的研究表明，所有接受 PICC 的患者都应考虑使用 AIP PICC。
