Peripherally inserted central catheter-associated bloodstream infection: Risk factors and the role of antibiotic-impregnated catheters for prevention

Am J Infect Control. 2019 Feb;47(2):191-195. doi: 10.1016/j.ajic.2018.07.006. Epub 2018 Sep 1.


Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Bloodstream infection; Central line–associated bloodstream infection; Peripherally inserted central catheter.

MeSH terms

  • Case-Control Studies
  • Catheter-Related Infections / epidemiology*
  • Catheter-Related Infections / prevention & control
  • Catheterization, Central Venous / adverse effects*
  • Catheterization, Central Venous / methods*
  • Female
  • Humans
  • Infection Control / methods*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Sepsis / epidemiology*
  • Sepsis / prevention & control