The Risk Factors Of PICC-related Infections In Adults

Objective To analyze the risk factors of PICC-related infections in adults and recognize the pathogens in order to guide the use of empirical antibiotics.Method The survey was conducted from January 2013 to May 2016 at First Hospital Affiliated of Soochow University by investigating the number of PICC.And collect the first PICC-related infection in adult as the case group;The case with PICC in place with similar catheterization time,gender,age who were uninfected as control group,using a 1:3 proportion.And investigate the information of two groups,a retrospective analysis of catheter-related infection risk factors of PICC-related infection in adults was performed.Continuous variables were compared by T test.Qualitative variables were comparedc~2 test.The analysis was performed with logistic-regression model of the SPSS software package version 19.0.Results?.Incidence:The incidence of PICC-related infection was 3.49%.The incidence of hematological malignancies,non-tumor,solid tumors was 8.97%,0.89%,0.24%,respectively.?.The median dwell time of PICC-related infection:The median time of PICC-related local infections was 23 days,the median dwell time of PICC-related bloodstream infection was 18 days,P=0.028.?.Analysis of risk factors of PICC-related infections with hematological malignancies1.Univariate analysis:1.1.Disease factors:The types of hematological malignancies were different between two groups,P<0.01,acute leukemia accounted for a higher proportion in the case group(69.54%vs.52.43%),P<0.01.The duration of neutropenia of the case group was(14.01±10.94)days,while the control was(8.74±8.78)days,P<0.01.The value of lowest albumin of the case group was(31.67±4.67)g/L,while the control was(34.74±5.59)g/L,P<0.01.1.2.Complicated with infected disease:The incidence of pulmonary infection,perineal infection were higher compared with the control,P<0.01.1.3.Organs function:the incidence of heart failure was higher compared with the control,P<0.01.1.4.PICC-related factors:the times of indwelling catheter of case group was(1.34±0.59)times,while the control was(1.14±0.37)times,P<0.01.2.Multivariate analysis:Acute leukemia(P=0.019,OR=2.019 95%CI(1.121,3.637)),the times of indwelling catheter(P<0.01,OR=1.884 95%CI(1.559,2.277)),the duration of neutropenia(P=0.001,OR=1.023 95%CI(1.010,1.036)),the value of lowest albumin(P<0.01,OR=0.935,95%CI(0.915,0.955))were risk factors of PICC-related infections.?.The pathogens of PICC-related infection of hematological malignanciesThe pathogens of PICC-related local infection was mainly caused by G~+bacteria,the proportion of G~+bacteria,G~—bacteria and fungi accounted for 78.4%,20.4%,1.2%,respectively.The pathogens of PICC-related bloodstream infections was mainly by G~—bacteria,G~+bacteria,G~—bacteria,fungi accounted for 12.93%,78.23%,8.84%.For patients with hematopoietic stem cell transplantation,the pathogens of PICC-related local infection was mainly by G~+bacteria,G~—bacteria,fungi accounted for 51.16%,44.19%,4.65%;the pathogens of PICC-related bloodstream infection was mainly by G~—bacteria,G~+bacteria,G~—bacteria and fungi for catheter-related bloodstream infections were 6.82%,86.36%,6.82%.Conclusion?.The incidence of PICC-related infection in patients with hematological malignancies is higher than other diseases.?.Acute leukemia,the times of indwelling catheter,the duration of neutropenia,the value of lowest albumin are the independent risk factors of PICC-related infection.?.PICC-related bloodstream infections in patients with hematological malignancies especially with hematopoietic stem cell transplantation should be covered with Gram-negative bacteria and fungi.