Prospective, observational cohort study.
SETTING: Cleveland, Ohio, and Toronto, Ontario, Canada.
PATIENTS: 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: