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Intraarterial Catheter Use Is Associated With Increased Risk of Hospital Onset Bacteremia

A Retrospective Cohort Study
Published:January 22, 2021DOI:https://doi.org/10.1016/j.chest.2021.01.038
      The risk of iatrogenic infection from intraarterial catheters (IACs) is debated. Reported rates of bacteremia that are associated with IACs are higher than those associated peripheral lines but lower that those associated central venous catheters (CVC).
      • O’Horo J.C.
      • Maki D.G.
      • Krupp A.E.
      • Safdar N.
      Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis.
      The rate of bacteremia attributed to IAC use is dependent on the method of surveillance with the highest reported rates when all IACs are cultured compared with cultures collected only when the IAC was the suspected infection.
      • O’Horo J.C.
      • Maki D.G.
      • Krupp A.E.
      • Safdar N.
      Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis.
      IACs are not considered central lines for regulatory reporting of central line-associated bloodstream infections (CLABSI). However, bacteremia due to IAC use in the presence of a CVC generally would meet criteria for CLABSI and be attributed to the CVC. Additionally, there is wide variation in precautions used during their insertion compared with fairly standardized procedures for the insertion of CVCs.
      • Cohen D.M.
      • Carino G.P.
      • Heffernan D.S.
      • et al.
      Arterial catheter use in the ICU: a national survey of antiseptic technique and perceived infectious risk.
      ,
      • Safdar N.
      • O’Horo J.C.
      • Maki D.G.
      Arterial catheter-related bloodstream infection: incidence, pathogenesis, risk factors and prevention.
      Hospital onset bacteremia (HOB) is a novel metric defined as blood cultures positive >48 hours after hospitalization. It has been proposed as a composite measure of health care-associated infections and includes CLABSI, surgical site infections, urinary tract infections, contaminants, and nonpreventable infections. HOB can be extracted autonomously from medical records without manual adjudication, and change in the rate of HOB is associated with a change in the rate of CLABSI.
      • Rock C.
      • Thom K.A.
      • Harris A.D.
      • et al.
      A multicenter longitudinal study of hospital-onset bacteremia: time for a new quality outcome measure?.
      Many epidemiologists support reporting rates of HOB as a quality measure either in addition to or instead of CLABSI.
      • Dantes R.B.
      • Abbo L.M.
      • Anderson D.
      • et al.
      Hospital epidemiologists’ and infection preventionists’ opinions regarding hospital-onset bacteremia and fungemia as a potential healthcare-associated infection metric.
      We investigated if IAC use is associated with increased risk of HOB.
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