Prospective Evaluation of Risk Factors for Bloodstream Infection in Patients Receiving Home Infusion Therapy

7 September 1999 | Volume 131 Issue 5 | Pages 340-347

Background: Intravenous therapy in the outpatient and home settings is commonplace for many diseases and nutritional disorders. Few data are available on the rate of and risk factors for bloodstream infection among patients receiving such therapy.

Objective: To determine rates of and risk factors for bloodstream infection among patients receiving home infusion therapy.

Design: Prospective, observational cohort study.

Setting: Cleveland, Ohio, and Toronto, Ontario, Canada.

Patients: Patients receiving home infusion therapy through a central or midline catheter.

Measurements: Primary laboratory-confirmed bloodstream infection.

Results: Among 827 patients (988 catheters), the most common diagnoses were infections other than HIV (67%), cancer (24%), nutritional and digestive disease (17%), heart disease (14%), receipt of bone marrow or solid organ transplants (11%), and HIV infection (7%). Sixty-nine bloodstream infections occurred during 69 532 catheter-days (0.99 infections per 1000 days). In a Cox regression model with time-dependent covariates, independent risk factors for bloodstream infection were recent receipt of a bone marrow transplant (hazard ratio, 5.8 [95% CI, 3.0 to 11.3]), receipt of total parenteral nutrition (hazard ratio, 4.1 [CI, 2.3 to 7.2]), receipt of therapy outside the home (for example, in an outpatient clinic or physician's office) (hazard ratio, 3.6 [CI, 2.2 to 5.9]), use of a multilumen catheter (hazard ratio, 2.8 [CI, 1.7 to 4.7]), and previous bloodstream infection (hazard ratio, 2.5 [CI, 1.5 to 4.2]). Rates of bloodstream infection per 1000 catheter-days varied from 0.16 for patients with none of these 5 risk factors to 6.77 for patients with 3 or more risk factors. Centrally inserted venous catheters were associated with a higher risk than implanted ports were, but the difference was not statistically significant.

Conclusion: Bloodstream infections seem to be infrequent among outpatients receiving infusions through central and midline catheters. However, the rate of infection increases with bone marrow transplantation, parenteral nutrition, infusion therapy in a hospital clinic or physician's office, and use of multilumen catheters. Compared with implanted ports or peripherally inserted catheters, centrally inserted venous catheters may confer greater risk for bloodstream infection.

Author and Article Information

From the Centers for Disease Control and Prevention, Atlanta, Georgia; Mount Sinai/Princess Margaret Hospitals, Toronto, Ontario, Canada; and The Cleveland Clinic Foundation, Cleveland, Ohio.

Acknowledgments: The authors thank Demie Lyons, RN, PNP, of PharMark Corp., Arlington, Virginia, and Thomas Westrich, RPh, of Coram Healthcare, Inc., for helping to design the project; and Barbara Godfrey, RN, Mount Sinai/Princess Margaret Hospitals, Toronto, Canada, for assistance in data collection.

Requests for Reprints: Jerome I. Tokars, MD, MPH, Hospital Infections Program, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-69, Atlanta, GA 30333

Current Author Addresses: Drs. Tokars and Jarvis: Hospital Infections Program, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-69, Atlanta, GA 30333.

Dr. Cookson: Centers for Disease Control and Prevention, 1600 Clifton Road, E-03, Atlanta, GA 30333.

Ms. McArthur and Dr. McGeer: Department of Microbiology, Room 1460, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.

Ms. Boyer: 2339 Clague Road, Westlake, OH 44145.