Risk factors of peripherally inserted central catheter-related bloodstream infection in patients with hematological malignancy / 中国感染与化疗杂志

ABSTRACT

Objective To investigate the morbidity and risk factors of peripherally inserted central catheter (PICC) related bloodstream infection and the distribution and antimicrobial susceptibility of pathogens in patients with hematological malignancy for better prevention and management of such infections. Methods The relevant data were collected from the patients with hematologic malignancy and PICC in hematology department from July 2013 to November 2016. The risk factors of PICC related bloodstream infection were analyzed. Blood samples and catheter-related blood samples were taken for culture of pathogens. The pathogens were identified on VITEK-32. Antimicrobial susceptibility was tested by using Kirby-Bauer method. Results A total of 10 213 patients with PICC were included in this study. PICC related bloodstream infection was identified in 280 (2.74％) patients, about 0.55 per 1 000 PICC days. The main risk factors of PICC related bloodstream infection were type of hematological malignancy (P＜0.001) and days of indwelling PICC (P＜0.001). A total of 322 strains of pathogenic bacteria were isolated, including gam-negative bacteria (73.91％), gam positive bacteria (22.05％) and fungus (4.04％). The gram-negative species isolated from bloodstream were mainly Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. E. coli and K. pneumoniae isolates were relatively sensitive to piperacillin-tazobactam, cefepime, cefoperazone-sulbactam, imipenem, gentamicin and amikacin. S. maltophilia isolates were relatively sensitive to piperacillin-tazobactam, ceftazidime, cefoperazone sulbactam and ciprofloxacin, while P. aeruginosa strains were relatively sensitive to the commonly used anti-Pseudomonas antibiotics. The gram-positive isolates including Staphylococcus epidermidis, Staphylococcus hominis and Staphylococcus haemolyticus were all susceptible to vancomycin, linezolid, and teicoplanin. The most frequently identified fungal species was Candida tropicalis. Conclusions Prolonged duration of PICC may increase the risk of central line-associated bloodstream infection (CLABSI). The incidence of CLABSI is associated with the type of hematological malignancy. CLABSI pathogens are mainly gram-negative microorganisms with various levels of antibiotic resistance. Clinicians should adhere to standard operating procedures, strengthen surveillance of patients with PICC, evaluate the risk dynamically, and remove PICC as early as possible.