COMMUNITY-ACQUIRED BACTEREMIAS FROM TUNNELED CENTRAL INTRAVENOUS LINES - RESULTS FROM STUDIES OF A SINGLE VENDOR

Tunneled central intravenous catheters are a common method for renderi ng prolonged outpatient intravenous therapy. Their safety, however, ha s not been well studied. We conducted a retrospective evaluation of ba cteremias associated with tunneled central intravenous catheters manag ed by a single home health care vendor during a 1-year period. All cat heters were inserted in the operating room under sterile conditions. T o calculate total line days, the dates of catheter insertion and remov al were obtained from either the hospital operating room or the home h ealth care agency. Catheter care was conducted according to written pr otocols. Total line days were calculated. Community-acquired bacteremi a (defined as bacteremia occurring more than 6 days after the patients ' discharge from the hospital) was determined from records available i n the infection control department. Sixty-eight patients received intr avenous therapy from the vendor during the 1-year study period. Total line days were 5548 (median 52 days/patient). Eleven episodes of bacte remia occurred in five patients, providing an incidence density rate o f 2.0 infections/1000 catheter days. The most frequent bacteria encoun tered were Staphylococcus epidermidis (five), Klebsiella pneumoniae (t wo), and Acinetobacter calcoaceticus var anitratus (two). Median time to bacteremia was 103 days. Two patients, both younger than 4 years, a ccounted for seven of the infections; both had short-bowel syndrome. O n the basis of historical comparisons, outpatient intravenous therapy appears to be associated with a lower risk of bacteremia than in-hospi tal therapy. These data can provide quality improvement information an d may be a means for comparing home infusion therapy vendors.