SLR - May 2012 - Kyle Johnson
Reference: Daneman, N., Downing, M., Zagorski, B. How Long Should Peripherally Inserted Central Catheterization be Delayed in the Context of Recently Documented Bloodstream Infection? J Vasc Interv Radiol 2012; 23:123-125
Scientific Literature Review
Reviewed by: Kyle Johnson, DPM
Residency Program: Yale-New Haven Hospital/DVA
Podiatric Relevance:
Peripherally inserted central catheterization (PICC) is commonly used for the administration of long-term antibiotic therapy in healthy patients without renal disease. However, PICCs have been associated with bloodstream infection rates ranging from 1.5-5.6 percent. The purpose of this study was to evaluate the time delay between date of blood culture collection and PICC re-insertion following documented bacteremia, and to further assess the risk of relapsing bactermia after PICC re-insertion.
Methods:
This retrospective cohort study consisted of 348 patients undergoing PICC insertion within 40 days (ranging 1-40 days) of a positive blood culture result. If multiple blood cultures were positive during the initial episode of bacteremia, the collection date of the positive culture most closely preceding PICC insertion was used as the index bacteremia date. A Fisher exact test was used to compare the risk of relapse with early (< 2 day) versus late (> 3 day) PICC insertion after documented bacteremia.
Results:
The 10 most common pathogens implicated in the index bacteremia included: S. aureus (21.2 percent), coag-negative Staph species (14.1 percent), E. coli (10.9 percent), Enterococcus faecalis (10.6 percent), Pseudomonas aeruginosa (7.5 percent), Klebsiella peumoniae (6.3 percent), Enterobacter cloacae (4.6 percent), Serratia marcescens (3.7 percent), Klebsiella oxytoca (2.6 percent), Acinetobacter baumannii (1.7 percent), and other species (16.4 percent).
The average time lapse between positive blood culture and PICC insertion was 12 +/- 7 days. 8.9 percent of PICCs were inserted within two days of documented bacteremia, 42.2 percent inserted within one week, and 71.8 percent within two weeks. Ninety-eight percent of patients received antibiotic therapy between the date of bacteremia and PICC insertion, and 83 percent were still receiving antibiotic treatment on the date of PICC re-insertion.
Recurrent bacteremia within 30 days of PICC insertion was 9.5 percent (only 0.9percent of patients had a relapse with the same organism of index). The risk of relapse was higher when PICCs were inserted within two days (6.5 percent) versus more than three days (0.3 percent) after documented bacteremia (P = 0.02).
Conclusions:
This study provides evidence that there may be some benefit in delaying PICC insertion until three days after collection of a positive blood culture, although true bacteremia relapses are very uncommon.