A Model to Predict Central-Line-Associated Bloodstream Infection Among Patients With Peripherally Inserted Central Catheters: The MPC Score

BACKGROUND Peripherally inserted central catheters (PICCs) are associated with central-line-associated bloodstream infections (CLABSIs). However, no tools to predict risk of PICC-CLABSI have been developed. OBJECTIVE To operationalize or prioritize CLABSI risk factors when making decisions regarding...

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Bibliographic Details
Published in:Infection control and hospital epidemiology 2017-10, Vol.38 (10), p.1155-1166
Main Authors: Herc, Erica, Patel, Payal, Washer, Laraine L, Conlon, Anna, Flanders, Scott A, Chopra, Vineet
Format: Article
Language:English
Subjects:
Aged
Bacteremia - epidemiology
Blood
Catheter-Related Infections - epidemiology
Catheter-Related Infections - microbiology
Catheterization, Central Venous - adverse effects
Catheterization, Peripheral - adverse effects
Catheters
Central Venous Catheters - microbiology
Chemotherapy
Cohort analysis
Comorbidity
Consortia
Data collection
Databases, Factual
Decision Making
Female
Hospitalization
Hospitals
Humans
Male
Medical instruments
Medical laboratories
Medical records
Michigan - epidemiology
Middle Aged
Missing data
Nosocomial infections
Nursing
Parenteral nutrition
Patient safety
Proportional Hazards Models
Risk Assessment - methods
Risk Factors
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Summary:BACKGROUND Peripherally inserted central catheters (PICCs) are associated with central-line-associated bloodstream infections (CLABSIs). However, no tools to predict risk of PICC-CLABSI have been developed. OBJECTIVE To operationalize or prioritize CLABSI risk factors when making decisions regarding the use of PICCs using a risk model to estimate an individual's risk of PICC-CLABSI prior to device placement. METHODS Using data from the Michigan Hospital Medicine Safety consortium, patients that experienced PICC-CLABSI between January 2013 and October 2016 were identified. A Cox proportional hazards model with robust sandwich standard error estimates was then used to identify factors associated with PICC-CLABSI. Based on regression coefficients, points were assigned to each predictor and summed for each patient to create the Michigan PICC-CLABSI (MPC) score. The predictive performance of the score was assessed using time-dependent area-under-the-curve (AUC) values. RESULTS Of 23,088 patients that received PICCs during the study period, 249 patients (1.1%) developed a CLABSI. Significant risk factors associated with PICC-CLABSI included hematological cancer (3 points), CLABSI within 3 months of PICC insertion (2 points), multilumen PICC (2 points), solid cancers with ongoing chemotherapy (2 points), receipt of total parenteral nutrition (TPN) through the PICC (1 point), and presence of another central venous catheter (CVC) at the time of PICC placement (1 point). The MPC score was significantly associated with risk of CLABSI (P
ISSN:0899-823X
1559-6834
DOI:10.1017/ice.2017.167