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Peripherally inserted central venous catheters decrease central line-associated bloodstream infections and change microbiological epidemiology in adult hematology unit: a propensity score-adjusted analysis

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Abstract

Peripherally inserted central venous catheters (PICCs) have a potential advantage in preventing central line-associated bloodstream infection (CLABSI) compared with the centrally inserted ones (CICCs). However, due to a limited number of studies with insufficient statistical evaluation, the superiority of PICCs is difficult to be generalized in adult hematology unit. We conducted a single-center retrospective study and compared the risk of CLABSI between 472 CICCs and 557 PICCs inserted in adult patients with hematological disorders through conventional multivariate models and a propensity score-adjusted analysis. The overall CLABSI incidence in CICCs and PICCs was 5.11 and 3.29 per 1000 catheter days (P = 0.024). The multivariate Cox regression analysis (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.31–0.75; P = 0.001) and Fine-Gray subdistribution analysis (HR: 0.59; 95% CI: 0.37–0.93; P = 0.023) demonstrated that PICC was independently associated with a reduced risk of CLABSI. Moreover, the stabilized inverse probability of treatment weighting analysis, which further reduced the selection bias between CICCs and PICCs, showed that PICCs significantly prevented CLABSI (HR: 0.58; 95% CI: 0.35–0.94; P = 0.029). Microbiologically, PICCs showed a significant decrease in gram-positive cocci (P = 0.001) and an increase in gram-positive bacilli (P = 0.002) because of a remarkable reduction in Staphylococci and increase in Corynebacterium species responsible for CLABSI. Our study confirmed that PICC was a superior alternative to CICC in preventing CLABSI in the adult hematology unit, while it posed a microbiological shift in local epidemiology.

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The dataset analyzed in the current study is available from the corresponding authors on reasonable request.

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Author notes

  1. Yosuke Nakaya and Mika Imasaki contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan

    Yosuke Nakaya, Katsujun Shimizu, Naoko Yagi, Minako Tsutsumi, Masahiro Yoshida, Takuro Yoshimura, Yoshiki Hayashi, Takafumi Nakao & Takahisa Yamane

  2. Department of Infectious Diseases, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan

    Mika Imasaki & Michinori Shirano

  3. Department of Hematology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan

    Yosuke Nakaya & Minako Tsutsumi

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Contributions

YN and MI analyzed the clinical data and drafted the manuscript, figures, and tables. MI and MS formed an infection control team with specific qualifications for central line management and collected clinical, microbiological, and CLABSI data. KS, NY, MT, MY, TY, YH, TN, and TY interpreted data and revised the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Michinori Shirano.

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The Ethics Committee of Osaka City General Hospital approved the protocol of this study (protocol file number: 2009096). All procedures were followed in accordance with the ethical standards of the responsible committee and the Helsinki Declaration.

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Informed consent from participants was obtained in the form of opt-outs on the institutional website because this study was retrospective and used anonymized data.

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The original version of this article was revised: This article was originally published with an incorrect table presentation in table 3.

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Nakaya, Y., Imasaki, M., Shirano, M. et al. Peripherally inserted central venous catheters decrease central line-associated bloodstream infections and change microbiological epidemiology in adult hematology unit: a propensity score-adjusted analysis. Ann Hematol 101, 2069–2077 (2022). https://doi.org/10.1007/s00277-022-04908-6

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