302 - Peripheral IV catheters, a common source of healthcare-associated Staphylococcus aureus bacteremia

Background: Healthcare-associated S. aureus bacteremia (HA-SAB) has traditionally been attributed to surgical site infections (SSI) or central line-associated bloodstream infections. However, peripheral IV catheters (pIV) are increasingly recognized as cause of HA-SAB. This study evaluates risk factors for HA-SAB due to pIV.

Methods: This is a retrospective, case-control study of adult patients hospitalized at Denver Health Medical Center with HA-SAB (SAB presenting with hospital-onset [≥3 days after hospitalization] or community-onset attributed to recent hospitalization [discharge ≤7 days prior]). The time period ranged from Jan 1, 2016 to Nov 30, 2019. Cases were reviewed by an infectious diseases physician to determine the source of SAB. PIV-related SAB was defined as phlebitis, cellulitis, and/or drainage at the site of a previous pIV AND no other source or another less likely source based on progress notes and microbiology results. Three controls were matched to each pIV-related SAB case based on the age of the patient (±5 years) and the date the pIV was placed (±3 days). Patients who were admitted for elective procedures, to psychiatry, to obstetrics, and those who died within 2 days of pIV placement were excluded.

Results: There were 376 episodes of SAB during the study period; 313 were community-onset while 63 were HA-SAB (50 hospital-onset and 13 community-onset attributed to hospitalization). PIV was the most common cause of HA-SAB (n=20, 29.4%); other common causes were SSI (n=10, 15.9%), source present at admission (n=8, 12.7%), and pneumonia (n=7, 11.1%). The median age of patients with pIV-related SAB was 53 years (SD 15.6), and 85% were male. The median duration of pIV was 5 days (SD 2.8). Twenty percent was MRSA.
As compared to controls, pIV in immunocompromised individuals and those placed by emergency medical services (EMS) were more likely to develop SAB (OR 11.8, 95% CI 2.5-56.5 and OR 6.9, 95% CI 6.9-24.0, respectively). Age, gender, pIV location, and duration of pIV were not associated with development of SAB.

Conclusion: PIV placed by EMS are more likely to cause SAB than those placed in the hospital. Facilities should consider changing these pIV promptly upon admission to the hospital and work with EMS to improve pIV placement technique.