Evaluation of Peripherally Inserted Central Catheter (PICC) Complications in Patients Requiring Outpatient Parenteral Antimicrobial Therapy (OPAT)

Abstract

Background. OPAT enables prompt discharge of selected patients ( pts) requiring long-term intravenous antimicrobial (AM) therapy.We report a cohort of pts in which PICC was used for OPAT in Argentina. Methods. We review data of 514 PICC inserted between 2003 and 2016 based on pharmacy records. Pts followed until PICC removal were included. Since 2006 patient's files were prospectively recorded in a database, thus 359 PICC were eligible. Each PICC insertion was considered an event; some pts received several PICC. Variables for which p value was 20.2 were entered in multivariate logistical regression model. Serial Med- Calca v11.6.1.0 was used for analysis. Results. We review 359 episodes of PICC inserted in 283 pts. Mean age was 51.5 years (16-94). Mean PICC time was 45.7 ds (1-313), total of 15,823 PICC-d (Figure 1). Twenty-five percent of pts had cancer (83.3% progressive). Osteomyelitis was the most frequent indication (67.7%), followed by abdominal infection (12%) and endocarditis (IE) (5.3%). beta-lactams (36%) and glycopeptides (12.5%) were the most used AM. Poor hygiene was observed in 9.2% pts. Complication was seen in 25.3% of pts (50.5% infectious; 49.5% non-infectious). Infectious complications (IC) were exit site infection (ESI) 69.6%; bloodstream infection (BSI) 15.2%; PICC colonization (PC) 15.2%. IC rate was 3.03, BSI 0.51, ESI 2.02 and CC 0.51/1000 PICC-d, respectively. Potentially fatal complications were 9 (2.5%) corresponding to 8 BSI and 1 arterial malposition. Causes for PICC removal were 78.3% end of treatment; 12% IC; 3.1% poor hygiene; 1.9% AM adverse event; 1.9% death for other causes; 1.4% thrombosis; 0.3% pts decision, 0.9% other (Figure 2). Conclusion. We report 359 PICC placed in 230 pts. BSI rate was 0.51/1000 PICCd. No patient died from PICC-related complications. Total IC were 13.37% (rate 3.03/ 1000 PICC-d). After multivariate analysis IE as OPAT indication, progressive malignancy and poor hygiene were significantly associated with IC. (Figure Presented).