Peripherally inserted central catheters have a protective role and the effect of fluctuation curve feature in the risk of bloodstream infection compared with central venous catheters: a propensity-adjusted analysis

Abstract

Background: The prevention of peripherally inserted central catheters (PICC)-associated BSI and central venous catheters (CVC)-associated BSI have been a topic of national importance in China. Therefore, we aimed to explore the epidemiological characteristics of central line-associated bloodstream infection (CLABSI), and to evaluate whether PICCs were associated with a protective effect for CLABSI.

Methods: A retrospective cohort study was conducted in teaching hospital in Western China. All adult patients received a CVC or PICC during their hospital stay were included from January 2017 to December 2020. Primary endpoint was CLABSI up to 30 days after CVC or PICC placement. Propensity scores with a 2:1 match was used to account for potential confounders, and restricted cubic spline was used to visualize the risk of CLABSI at different time points during the catheterization.

Results: A total of 224687 devices (180522 PICCs and 45965 CVCs) in 24879 patients were included. The overall incidence was 1.8 CLABSIs per 1000 catheter-days. The odds ratio (OR) value increased day by day after PICC insertion, reached a relatively high point on the 4th day, and decreased from days 5 through 8. From the 9th day of intubation the OR value began to gradually increase day by day again. After covariate adjustment using propensity scores, CVCs were associated with higher risk of CLABSI (adjHR = 3.27, 95% CI 2.38-4.49) compared with PICCs.

Conclusions: PICCs have a protective role and the effect of fluctuation curve feature in CLABSI when compared to CVCs, and the first 8 calendar days after CVC insertion are the acute stage of CVC-associated BSI.

Keywords: Bloodstream infection; Central venous catheter; Peripherally inserted central catheter; Propensity score matching; Restricted cubic spline regression.

Fig. 1

Cases selection algorithm for our study population. We excluded 774 patients younger than 18 years and 4495 patients who did not meet CLABSI diagnostic criteria, resulting in 4775 patients with CVC and 20,104 patients with PICC were included in the analysis

Fig. 2

Restricted cubic spline of CLABSI risk. A OR value increased rapidly in the first 8 calendar days after CVC insertion. However, after the 8th calendar day the OR value became stable. B In the first 4 calendar days after PICC insertion, the OR value increased day by day, reached a relatively high point on the 4th calendar day, and decreased from days 5 through 8. However, after the 8th calendar day the OR value began to increase day by day again

Fig. 3

Standardized mean differences before and after matching. PSM improved the balance on the investigated baseline characteristics with all SMD between groups decreasing to 0.1 or less except for the respiratory failure

Fig. 4

30-day CLABSI hazard before and after propensity score matching. A In the whole cohort, patients with CVC had a significantly higher 30-day CLABSI hazard compared with patients with PICC (HR = 6.76, 95% CI 5.53–8.27). B In the PSM cohort, patients with CVC also had a significantly higher 30-day CLABSI hazard compared with patients with PICC (adjHR = 3.27, 95% CI 2.38–4.49)