1162 infection control & hospital epidemiology october 2017, vol. 38, no. 10


table 2. Continued Category/Variable


Provider characteristics Documented indication for PICC placement Antibiotic therapy Chemotherapy


Difficult IV Access


Medications requiring central venous access Incompatible IV fluids/medications TPN


Other /Unknown


Location of PICC insertion Location of PICC insertion Placement attempts


Arm selected for insertion Vein selected for insertion Vein selected for insertion Vein selected for insertion


Device characteristics Gauge


PICC length Power PICC


Antimicrobial coated Antithrombotic coated Valved PICC


No. of PICC lumens


Comparator/Referent Group


Yes vs no Yes vs no Yes vs no Yes vs no Yes vs no Yes vs no Yes vs no


ICU vs general medical ward ER vs general medical ward >1 vs 1


Right vs left Other vs basilic


Cephalic vs basilic Brachial vs basilic


Per unit increase Per unit increase Yes vs no Yes vs no Yes vs no Yes vs no


Multiple vs single


(95% Confidence Interval) P Value Hazard Ratio


0.45 (0.31–0.64) 5.38 (3.50–8.25) 1.29 (0.93–1.80) 1.61 (1.05–2.46) 1.32 (0.43–3.99) 2.18 (1.62–2.93) 0.96 (0.69–1.35) 1.45 (0.94–2.24) 0.86 (0.36–2.04) 0.75 (0.53–1.08) 1.09 (0.84–1.41) 1.07 (0.71–1.60) 0.51 (0.22–1.19) 0.85 (0.40–1.81)


1.73 (1.37–2.17) 0.99 (0.96–1.02) 1.08 (0.65–1.81) 1.27 (0.96–1.68) 0.95 (0.32–2.83) 1.05 (0.70–1.57) 3.18 (2.20–4.59)


<.01 <.01 .13 .03 .63


<.01 .83


<.01 .12


.53 .67


<.01 .44 .77 .10 .93 .80


<.01


NOTE. COPD, chronic obstructive pulmonary disease; HIV, human immunodeficiency virus; AIDS, acquired immune deficiency syndrome; CLABSI, central line-associated bloodstream infection; DVT, deep-vein thrombosis; PE, pulmonary embolism; VTE, venous thromboembolism; CVA, cerebrovascular accident; TIA, transient ischemic attack; eGFR, esti- mated glomerular filtration rate; LOS, length of stay; CVC, central venous catheter; PICC, peripherally inserted central catheter; TPN, total parenteral nutrition; ICU, intensive care unit.


table 3. Michigan PICC-CLABSI (MPC) Risk Score for Infection Predictor Variable


Hematological cancer CLABSI history within 3 mo


Active cancer with receipt of chemotherapy Lumens


Presence of another CVC at time of PICC placement Receipt of TPN through the PICC


Status


Past/Present history vs none Yes vs no Yes vs no


Multiple vs single Yes vs no Yes vs no


Hazard Ratio (95% CI) Pointsa 3.77 (2.75–5.16)


2.84 (1.68–4.80) 2.39 (1.59–3.59) 2.09 (1.49–2.92) 1.98 (1.40–2.80) 1.82 (1.21–2.73)


ratio; PICC, peripherally inserted central catheter; CVC, central venous catheter. aPoints assigned to each predictor based on size of regression (ß) coefficient from the multivariable model.


3 months of PICC placement (2 points). The predicted prob- ability of CLABSI for PICC dwell times of 6 to 40 days ranged from 0.2% to 1.1% for patients with a risk score of 0, to 2.0% to 11.8% for patients with a risk score of 5 (Table 4). The areas under the time-dependent receiver-operating-characteristics curves ranged from 0.70 (95% CI, 0.64–0.76) to 0.80 (95% CI, 0.76–0.84) for PICC dwell times of 6 to 40 days, with the maximum AUC value occurring at 21 days indicating good model performance (Figure 2).


Optimized adjusted AUC values for the MPC score calcu-


lated using bootstrapped samples ranged from 0.67 to 0.77 for PICC dwell times of 6 to 40 days, with the maximum AUC value occurring at 21 days, indicating good model calibration. The performance of the MPC score was further assessed with events restricted to those meeting CRBSI definitions (n =184 of 249 cases). Using this more restrictive approach, the pre- dictive performance of the model was comparable to outcomes using the modified NHSN CLABSI definition, with AUC


3 2 2 1 1 1


P Value <.0001


<.0001 <.0001 <.0001 .0001


<.0001 NOTE. PICC-CLABSI, peripherally inserted central catheter central-line–associated bloodstream infection; CI, confidence interval; HR, hazard


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