Complications of Peripheral Venous Cathether-Related BSIs Are Frequent and Severe

Results of a study published in the Journal of Hospital Infection show that despite a low risk for occurrence, complications among patients with peripheral venous catheter (PVC)-related bloodstream infection (BSI) are often severe and associated with increased risk of mortality.

This retrospective study was conducted at Poitiers University hospital in France between 2018 and 2020. Researchers aimed to assess the incidence, complications, and costs associated with PCV-related BSIs. The analysis included patients with PVC-related BSI and a matched cohort of patients without PVC-related BSI (controls) who were admitted to the emergency department (ED). Patients were matched by hospital admission via the ED, age, comorbidities, admission to the same medical ward, year and duration of hospitalization, and medical- vs surgical-related hospitalization.

Among 113,068 patients admitted to the ED during the study period, 9833 (9%) were hospitalized in a medical ward following PVC placement. Of 581 patients with positive blood cultures, 0.2% had PVC-related BSIs, 4.4% had other BSIs, and 1.3% had contaminated blood cultures.

Of 25 patients with PVC-related BSIs, the median age was 73 (IQR, 52-88) years, 72% were men, and the median Charlson comorbidity index score was 3 (IQR, 2-5). Hospital admission was most commonly due to cardiac- (24%), neurologic- (20%), gastrointestinal- (16%), kidney- (12%), and infection-related (12%) cause. Overall, the median length of hospitalization was 21 (IQR, 16-34) days.

The median time from admission to PVC-related BSI onset was 7 (IQR, 4-12) days, and the majority of BSIs were caused by Staphylococcus aureus (64%) and S epidermidis (24%) pathogens.

Overall, patients with PVC-related BSI received antibiotics for a median of 14 (IQR, 7-20) days. The most common initial antibiotics were cefazolin (n=28) and vancomycin (n=24), and the most common second-line therapy was cefazolin (n=16).

The researchers noted that some patients with PVC-related BSI required exploratory testing, including cardiac ultrasonography (48%) and whole-body computed tomography (CT) and/or positron-emission tomography scanning (16%).

There was 1 patient with PVC-related BSI required intensive care unit admission due to the development of spondylodiscitis and sepsis. Other complications among patients with PVC-related BSI included mitral valve endocarditis (n=1) and deep presacral abscess (n=1). Of note, mortality occurred among 6 patients with PVC-related BSI.

Further analysis was performed between 22 patients with PVC-related BSI and 204 matched control patients to evaluate the associated costs of PVC-related BSI. Overall, median health care-associated costs were higher among patients with PVC-related BSI (11,597€ [IQR, 8479€-23,759€]) compared with matched control patients (6789€ [IQR, 4019€-10,764€]). Stratified by specific costs, patients with PVC-related BSI vs matched control patients incurred the greatest cost differences for laboratory-related costs (difference, 225€) and medical consumables (difference, 190€).

Limitations of this study include its single-center setting and retrospective design.

“[E]ven though the risk of developing PVC-related BSI in patients admitted to medical wards may seem low, it must be weighed against the number of PVCs used worldwide,” the researchers noted. In addition, “[t]hey increase health care costs and may be conducive to the selection of antibiotic-resistant bacteria,” the researchers concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.