Lower risk of bloodstream infections for peripherally inserted central catheters compared to central venous catheters in critically ill patients

Vassiliki Pitiriga; John Bakalis; Kalliopi Theodoridou; Petros Kanellopoulos; George Saroglou; Athanasios Tsakris

doi:10.1186/s13756-022-01180-1

Lower risk of bloodstream infections for peripherally inserted central catheters compared to central venous catheters in critically ill patients

Antimicrob Resist Infect Control. 2022 Nov 9;11(1):137. doi: 10.1186/s13756-022-01180-1.

Authors

Vassiliki Pitiriga¹, John Bakalis², Kalliopi Theodoridou¹, Petros Kanellopoulos², George Saroglou², Athanasios Tsakris³

Affiliations

¹ Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece.
² Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547, Athens, Greece.
³ Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece. atsakris@med.uoa.gr.

Abstract

Background: Peripherally inserted central venous catheters (PICCs) serve as an alternative to short-term central venous catheters (CVCs) for providing intravenous access in hospitalized patients. Although a number of studies suggest that PICCs are associated with a lower risk of central line-associated bloodstream infections (CLABSIs) than CVCs, recent data concerning specific patient groups support the contrary. In this regard, we are comparing CVC- and PICC-related CLABSI rates developed in a selected group of critically ill inpatients and evaluating the CLABSI microbiological distribution.

Methods: The study was conducted at a tertiary care hospital in Greece between May 2017 and May 2019. We performed a two-year retrospective analysis of the data collected from medical records of consecutive adult patients who underwent PICC or CVC placement.

Results: A total of 1187 CVCs placed for 9774 catheter-days and 639 PICCs placed for 11,110 catheter-days, were reported and analyzed during the study period. Among CVCs, a total of 59 (4.9%) CLABSIs were identified, while among PICCs, 18 (2.8%) cases presented CLABSI (p = 0.029). The CLABSI incidence rate per 1,000 catheter-days was 6.03 for CVC group and 1.62 for PICC group (p < 0.001). The CLABSI rate due to multidrug-resistant organisms (MDROs) among the two groups was 3.17 in CVC group and 0.36 in PICC group (p < 0.001). Within CLABSI-CVC group, the most common microorganism detected was MDR Acinetobacter baumannii (27.1%) followed by MDR Klebsiella pneumoniae (22%). In CLABSI-PICC group, the predominant microorganism was Candida spp. (33.3%) followed by non-MDR gram-negative pathogens (22.2%).

Conclusions: PICC lines were associated with significantly lower CLABSI rates comparing to CVC although they were in place longer than CVC lines. Given their longer time to the development of infection, PICCs may be a safer alternative for prolonged inpatient IV access. The high prevalence of CLABSI-MDROs depicts the local microbial ecology, emphasizing the need of public health awareness.

Keywords: Bloodstream infection; Catheterization; Central line-associated bloodstream infection; Central venous catheter; Colonization; Insertion site; Peripherally inserted central catheter; Sepsis.

MeSH terms

Adult
Catheter-Related Infections* / epidemiology
Catheter-Related Infections* / etiology
Catheterization, Central Venous* / adverse effects
Central Venous Catheters* / adverse effects
Critical Illness
Humans
Retrospective Studies
Risk Factors
Sepsis* / epidemiology