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Background: Intravenous therapy in the outpatient and home setting 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. Settings: Cleveland, Ohio, and Toronto, Ontario, Canada. Patients: Patients receiving home infusion therapy through a central or midline catheter.
Measurements: Primary laboratory-confirmed blood-stream infection.
Results: Among 827 patients (998 catheters), the most common diagnosis 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%) percent. Sixty-nine bloodstream infection occurred during 69 532-catheter days (0.99 infections per 1000 days). In a Cox regression model with time-depressant coveriates, 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 parental nutrition (hazard ratio, 4.1 [CI, 2.3 to 7.2]), receipt of therapy outside the home (for example, in an outpatient Chinook or physicians 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. , 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, parental nutrition, infusion therapy in a hospital clinic or physician's office, and use of multilumen catheters. Compared with implanted ports or peripherally insured catheters, centrally inserted venous catheters may confer greater risk for bloodstream infection.
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