Risk Factors and Outcomes Associated With Hospital-Onset Peripheral Intravenous Catheter-Associated Staphylococcus aureus Bacteremia

Background: Peripheral venous catheters (PVCs) are common in hospitals, but the literature surrounding PVC-associated bacteremia is lacking. We describe incidence rates, risk factors, and outcomes related to PVC-associated Staphylococcus aureus bacteremia (SAB), a common cause of hospital-onset (HO) SAB.

Methods: This is a retrospective case-control study conducted at a 537-bed teaching community hospital during 2015-2016. Cases were adult inpatients with HO SAB with infectious diseases documentation of the PVC as the only source of bacteremia. Cases were matched 1:2 with controls on approximate PVC insertion date, age, mortality prediction score, and insurance type. Odds ratios (ORs) were estimated using conditional logistic regression. PVC utilization was estimated by a point-prevalence survey from July 2017.

Results: Of 205 SAB episodes, 160 were community-onset and 45 were HO; 16 (36%) HO cases were PVC-associated. Cases (n = 16) were more likely than controls (n = 32) to have a PVC placed in the antecubital area (odds ratio [OR], 11.9; 95% confidence interval [CI], 1.5-95.7; P = .02) and PVC duration ≥4 days (OR, 4.0; 95% CI, 1.1-15.2; P = .04). The point prevalence of at least 1 PVC in adult inpatients was 86%, and the incidence density of HO PVC-associated SAB was 0.15 per 1000 PVC-days. The mean length of stay for cases was 13.2 days. All cases successfully completed parenteral antibiotics with a mean treatment length of 23.6 days.

Conclusions: PVC-associated SAB is a common cause of HO SAB that results in significant morbidity. PVC placement in the antecubital area and line duration should be minimized to reduce HO SAB.