Inpatients With COVID-19 More Likely to Develop CABSIs

Rates of catheter-associated bloodstream infection were high among inpatients with COVID-19 infection, with similar rates observed between those with midline catheters vs peripherally inserted central catheters.



Results of a study published in the American Journal of Infection Control indicate that inpatients with COVID-19 infection are at increased risk for catheter-associated bloodstream infections (CABSIs).

Previous studies assessing whether COVID-19 infection is a predictor for CABSIs have shown conflicting results. To better understand CABSI risk in patients with COVID-19 infection, researchers conducted an observational, prospective study at a University Hospital in Italy between October 2020 and May 2021. Patients (N=227) with COVID-19 infection in nonintensive care unit (ICU) wards who required a peripherally inserted central catheter (PICC) or midline catheter (MC) in were evaluated for the occurrence of CABSIs.

Among patients included in the analysis, the mean (SD) age was 78.08 (13.49) years, 58.1% were women, 61.6% had cardiovascular disease, 53.3% had hypertension, 23.3% had previous lung disease, and 22.4% had BMIs greater than 30 kg/m2.

The patients received either a MC (69.6%) or PICC (30.4%). Among 227 total venous access devices inserted, 70.1% were inserted on the right side and 29.9% on the left side. Of PICCs, the majority were single-lumen devices (n=58).

[W]e are not surprised by our data which show, for the first time and clearly, that MCs are as prone to infection as PICCs, at least in COVID patients.

The overall rate of CABSI was 4.4% or 3.5 episodes per 1,000 catheter-days. The most common causative infectious organism was Staphylococcus aureus (50%), followed by Candida parapsilosis (30%), C glabrata (10%), and C albicans (10%).

Stratified by catheter type, the rate of CABSI was numerically higher for patients with PICCs (5.8%) than those with MCs (3.8%), or 4.5 and 3.2 episodes per 1,000 catheter-days, respectively. The time between insertion and infection onset was similar between patients with PICCs vs MCs (mean, 13.17 vs 14.25 days).

Among 10 patients who developed CABSIs, 5 had BMIs greater than 30 kg/m2.

There were 11 instances of dislodgement, 6 of which were unintentional dislodgements by hospital staff. Symptomatic catheter-associated thrombosis occurred among 2 (1.3%) MC recipients.

This study may have been limited by the single-center design, the exclusion of ICU patients and recipients of centrally or femorally inserted central catheters, and the lack of patients with severe COVID-19 infection.

According to the researchers, “[W]e are not surprised by our data which show, for the first time and clearly, that MCs are as prone to infection as PICCs, at least in COVID patients.”



Frondizi F, Dolcetti L, Pittiruti M, et al. Complications associated with the use of peripherally inserted central catheters and midline catheters in COVID-19 patients: an observational prospective study. Am J Infect Control. Published online May 7, 2023. doi:10.1016/j.ajic.2023.05.002