Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-30T20:20:27.576Z Has data issue: false hasContentIssue false
  • English
  • Français

Pulmonary artery catheter epidemiology of risk in pre–heart-transplant recipients

Published online by Cambridge University Press:  30 April 2019

Zachary A Yetmar Open the ORCID record for Zachary A Yetmar [Opens in a new window] ,
Brian Lahr ,
John O’Horo ,
Atta Behfar ,
Priya Sampathkumar  and
Elena Beam
Zachary A Yetmar
Affiliation:
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
Brian Lahr
Affiliation:
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
John O’Horo
Affiliation:
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota Division of Pulmonary and Critical Care Medicine, Rochester, Minnesota
Atta Behfar
Affiliation:
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
Priya Sampathkumar
Affiliation:
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Elena Beam*
Affiliation:
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
*
Author for correspondence: Elena Beam, Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Central-line–associated bloodstream infections (CLABSIs) are a known complication of central venous access. Pulmonary artery catheters (PAC) are frequently used in pre–heart-transplant patients, but the rate of CLABSI in this population is unknown. We sought to estimate the rate of CLABSI and identify factors associated with development of infection in patients actively listed for heart transplantation with a PAC.

Design:

Retrospective cohort study.

Setting:

This study was conducted in 3 intensive care units at an academic tertiary-care center in Minnesota.

Patients:

61 pre–heart-transplant patients in an intensive care unit with a PAC in place from January 2013 to December 2016, totaling 219 PACs.

Methods:

At-risk patients, pertinent risk factors, and demographic data were obtained using Mayo Clinic’s Unified Data Platform. CLABSIs were identified through internal infection prevention and control data. Characteristics of PAC use and infection rate were collected and analyzed using Kaplan-Meier estimates and time-dependent Cox models.

Results:

Among pre–heart-transplant patients with a PAC, there were 14 CLABSIs, for an infection rate of 5.46 of 1,000 PAC days (95% confidence interval [CI], 2.98–9.15). The most common causative organism was coagulase-negative Staphylococcus (79%). In unadjusted analyses, CLABSI was associated with shorter time to transplant (hazard ratio [HR], 2.49; P = .027), but not mortality (HR, 1.79; P = .355).

Conclusions:

The rate of CLABSI with PAC is high. Prolonged PAC use in the pre–heart-transplant population should be revisited.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 6 , June 2019 , pp. 632 - 638
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: These data were presented in part as an abstract (no. 2094) at the Infectious Diseases Society of America Annual Meeting on October 6, 2018, in San Francisco, California.

References

Connors, A, Speroff, T, Dawson, N, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 1996; 276:889–897.CrossRefGoogle ScholarPubMed
Rajaram, S, Desai, N, Kalra, A, et al. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database Syst Rev 2013;2:CD003408.Google Scholar
Marschall, J, Mermel, LA, Fakih, M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:753–771.CrossRefGoogle ScholarPubMed
McGee, DC, Gould, MK. Preventing complications of central venous catheterization. N Engl J Med 2003;348:1123–1133.CrossRefGoogle ScholarPubMed
O’Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52(9):e162–e193.CrossRefGoogle ScholarPubMed
Schiffer, CA, Mangu, PB, Wade, JC, et al. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2013;31:1357–1370.CrossRefGoogle ScholarPubMed
Yokoe, DS, Anderson, DJ, Berenholtz, SM, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect Control Hosp Epidemiol 2014;35:967–977.CrossRefGoogle ScholarPubMed
O’Horo, JC, Maki, DG, Krupp, AE, Safdar, N. Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis. Crit Care Med 2014;42:1334–1339.CrossRefGoogle ScholarPubMed
Raad, I, Umphrey, J, Khan, A, Truett, LJ, Bodey, GP. The duration of placement as a predictor of peripheral and pulmonary arterial catheter infections. J Hosp Infect 1993;23:17–26.CrossRefGoogle ScholarPubMed
Mermel, LA, McCormick, RD, Springman, SR, Maki, DG. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med 1991;91(3B):197S–205S.CrossRefGoogle ScholarPubMed
Hassan, EA, Elsherbiny, NM, El-Rehim, ASA, Soliman, AMA, Ahmed, AO. Health care-associated infections in pre-transplant liver intensive care unit: perspectives and challenges. J Infect Public Health 2018;11:398–404.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. CDC/NHSH bloodstream infection event (central line-associated bloodstream infection and non–central-line-associated bloodstream infection). Centers Dis Control Prev Natl Healthc Saf Network. 2015;January:1–45.Google Scholar
Chen, YY, Yen, DH, Yang, YG, Liu, CY, Wang, FD, Chou, P. Comparison between replacement at 4 days and 7 days of the infection rate for pulmonary artery catheters in an intensive care unit. Crit Care Med 2003;31:1353–1358.CrossRefGoogle Scholar
Kac, G, Durain, E, Amrein, C, Herisson, E, Fiemeyer, A, Buu-Hoi, A. Colonization and infection of pulmonary artery catheter in cardiac surgery patients: epidemiology and multivariate analysis of risk factors. Crit Care Med 2001;29:971–975.CrossRefGoogle ScholarPubMed
Deshpande, KS, Hatem, C, Ulrich, HL, et al. The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 2005;33:13–15.CrossRefGoogle Scholar
See, I, Lessa, FC, ElAta, OA, et al. Incidence and pathogen distribution of healthcare-associated infections in pilot hospitals in Egypt. Infect Control Hosp Epidemiol 2013;34:1281–1288.CrossRefGoogle ScholarPubMed
Cook, D, Randolph, A, Kernerman, P, et al. Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med 1997;25:1417–1424.CrossRefGoogle ScholarPubMed
Weiner, LM, Webb, AK, Limbago, B, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National healthcare safety network at the centers for disease control and prevention, 2011–2014. Infect Control Hosp Epidemiol 2016;37:1288–1301.CrossRefGoogle ScholarPubMed
Pawar, M, Mehta, Y, Kapoor, P, Sharma, J, Gupta, A, Trehan, N. Central venous catheter-related blood stream infections: incidence, risk factors, outcome, and associated pathogens. J Cardiothorac Vasc Anesth. 2004;18:304–308.CrossRefGoogle ScholarPubMed
Dezfulian, C, Lavelle, J, Nallamothu, BK, Kaufman, SR, Saint, S. Rates of infection for single-lumen versus multilumen central venous catheters: a meta-analysis. Crit Care Med 2003;31:2385–2390.CrossRefGoogle ScholarPubMed
Templeton, A, Schlegel, M, Fleisch, F, et al. Multilumen central venous catheters increase risk for catheter-related bloodstream infection: prospective surveillance study. Infection 2008;36:322.CrossRefGoogle ScholarPubMed
Chopra, V, Ratz, D, Kuhn, L, Lopus, T, Chenoweth, C, Krein, S. PICC-associated bloodstream infections: prevalence, patterns, and predictors. Am J Med 2014;127:319–328.CrossRefGoogle ScholarPubMed
Valbousquet, SL, Duron, S, Arnaud, FX, et al. Evaluation of PICC complications in orthopedic inpatients with bone infection for long-term intravenous antibiotics therapy. J Vasc Access 2015;16:299–308.Google Scholar
Baxi, SM, Shuman, EK, Scipione, CA, et al. Impact of postplacement adjustment of peripherally inserted central catheters on the risk of bloodstream infection and venous thrombus formation. Infect Control Hosp Epidemiol 2013;34:785–792.CrossRefGoogle ScholarPubMed
Haglund, NA, Cox, ZL, Lee, JT, et al. Are peripherally inserted central catheters associated with increased risk of adverse events in status 1B patients awaiting transplantation on continuous intravenous milrinone? J Card Fail 2014;20:630–637.CrossRefGoogle ScholarPubMed
Ziegler, MJ, Pellegrini, DC, Safdar, N. Attributable mortality of central-line–associated bloodstream infection: systematic review and meta-analysis. Infection 2015;43:29–36.CrossRefGoogle ScholarPubMed
Nelson, RE, Geiger, K, Brown, J, Concannon, C, Dumyati, G, Stevens, V. Inpatient costs, mortality and 30-day re-admission in patients with central-line–associated bloodstream infections. Clin Microbiol Infect 2014;20:O318–O324.Google Scholar
Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US healthcare system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle Scholar