Table 2.
Comparison of Demographics, Clinical Characteristics, and Outcomes of Patients Stratified by Peripherally Inserted Central Catheter Use
| Full Cohort | Propensity Score–Matched Cohorta | |||||||
|---|---|---|---|---|---|---|---|---|
| Characteristic | No PICC (n = 164) | PICC (n = 97) | P Value | Missing | No PICC (n = 65) | PICC (n = 71) | P Value | Missing |
| Demographics | ||||||||
| Age, median (IQR), y | 8.9 (4.0–11.8) | 10.2 (5.4–12.5) | .25 | … | 9.7 (6.0–11.6) | 9.2 (4.8–12.3) | .93 | … |
| Study site, HCH | 52 (32) | 81 (84) | < .001 | … | 19 (29) | 61 (86) | < .001 | … |
| Sex, female | 62 (38) | 40 (41) | .58 | … | 23 (35) | 29 (41) | .51 | … |
| Location of infectionb | ||||||||
| Upper extremity long bone | 15 (9) | 11 (11) | .57 | … | 8 (12) | 7 (10) | .65 | … |
| Lower extremity long bone | 78 (48) | 48 (50) | .76 | … | 35 (54) | 32 (45) | .31 | … |
| Pelvis or sacrum | 22 (13) | 27 (28) | .004 | … | 13 (20) | 21 (30) | .20 | … |
| Hands | 9 (6) | 4 (4) | .77 | … | 2 (3) | 4 (6) | .68 | … |
| Feet | 28 (17) | 8 (8) | .05 | … | 8 (12) | 7 (10) | .65 | … |
| Otherc | 4 (2) | 4 (4) | .48 | … | 3 (5) | 2 (3) | .58 | … |
| Multifocal infectiond | 3 (2) | 9 (9) | .01 | … | 3 (5) | 3 (4) | 1 | … |
| Markers of severity | ||||||||
| Admitted to ICU | 6 (4) | 10 (10) | .03 | … | 3 (5) | 6 (9) | .50 | … |
| Tmaxe, median (IQR), °C | 38.6 (37.6–39.6) | 39.3 (38.4–40.0) | < .001 | 1 | 39.3 (38.6–39.9) | 39.0 (38.1–39.9) | .39 | 1 |
| Fever after > 48 h of antibiotic therapy | 42 (26) | 48 (50) | < .001 | … | 30 (46) | 30 (42) | .65 | … |
| Admission WBC, median (IQR), ×1000 cells/mL | 10.4 (7.8–13.9) | 12.7 (8.3–16.0) | .02 | 19 | 11.4 (7.4–16.0) | 11.5 (8.3–15.7) | .68 | 10 |
| Admission ESR, median (IQR), mm/h | 40 (22–52) | 55 (43–70) | < .001 | 18 | 46 (27–52) | 53 (38–69) | .003 | 7 |
| Admission CRP, median (IQR), mg/L | 46 (24–129) | 88 (34–178) | .001 | 15 | 72 (36–201) | 75 (28–151) | .41 | 4 |
| Suppurative arthritisf | 28 (17) | 32 (33) | .003 | … | 14 (22) | 21 (30) | .28 | … |
| Disseminated infectiong | 11 (7) | 19 (20) | .002 | … | 6 (9) | 7 (10) | .90 | … |
| Bone abscess (any) | 59 (36) | 40 (41) | .43 | … | 26 (40) | 26 (37) | .69 | … |
| CRP ≥ 100 mg/L after 2–4 d of anti- biotics | 19 (13) | 32 (39) | < .001 | 32 | 17 (26) | 20 (29) | .71 | 2 |
| Severity of illness scoreh | 1 (0–3) | 2 (0–7) | < .001 | 30 | 2 (0–5) | 1 (0–6) | .43 | 9 |
| Bacteremia | 62 (38) | 56 (58) | .002 | … | 45 (69) | 40 (56) | .12 | … |
| MRSA recovered | 24 (15) | 21 (22) | .15 | … | 15 (23) | 13 (18) | .49 | … |
| Treatment course | ||||||||
| Surgical intervention (any) | 98 (60) | 67 (69) | .13 | … | 38 (59) | 46 (65) | .45 | … |
| Delayed source control | 9 (6) | 15 (16) | .01 | … | 2 (3) | 8 (11) | .10 | … |
| Bone debridement | 59 (36) | 43 (44) | .18 | … | 26 (40) | 27 (38) | .81 | … |
| Multiple debridements | 22 (13) | 15 (16) | .65 | … | 12 (19) | 4 (6) | .03 | … |
| Length of stay, median (IQR), d | 4.3 (3.1–5.8) | 6.5 (4.5–11.1) | < .001 | 4 | 4.9 (3.9–7.0) | 5.9 (4.1–8.9) | .059 | 3 |
| Time to normal ESR, median (IQR), d | 21 (11–31) | 30 (18–43) | < .001 | 76 | 26 (18–33) | 27 (16–39) | .75 | 41 |
| Time to normal CRP, median (IQR), d | 18 (10–25) | 18 (11–28) | .37 | 29 | 21 (14–28) | 17 (9–29) | .045 | 15 |
| Duration of IV antibiotics, median, d (IQR) | 4 (2–5) | 35 (21–46) | < .001 | 9 | 4 (3–7) | 34 (17–45) | < .001 | 4 |
| Duration of antibiotics, median, d (IQR) | 28 (24–30) | 20 (14–28) | < .001 | 62 | 28 (24–31) | 19 (14–28) | .001 | 43 |
| Total duration of antibiotics, median, d (IQR) | 31 (28–35) | 42 (33–58) | < .001 | 14 | 31 (28–36) | 41 (31–51) | < .001 | 9 |
| Therapy-related AEs | ||||||||
| Gastrointestinal | 20 (13) | 16 (17) | .33 | 9 | 6 (10) | 12 (18) | .18 | 7 |
| Rash or allergy | 5 (3) | 11 (12) | .006 | 9 | 1 (2) | 7 (10) | .06 | 7 |
| Minor PICC-relatedi | … | 40 (43) | 9 | … | 30 (45) | 7 | ||
| Major PICC-relatedj | … | 2 (2) | 9 | … | 1 (2) | 7 | ||
| PICC removed due to AE | … | 19 (20) | 9 | … | 14 (21) | 7 | ||
| Severe neutropeniak | 1 (1) | 4 (4) | .06 | 9 | 0 (0) | 3 (5) | .25 | 7 |
| Nephrotoxicityl | 1 (1) | 3 (3) | .14 | 9 | 0 (0) | 3 (5) | .25 | 7 |
| Liver toxicitym | 0 (0) | 1 (1) | .37 | 9 | 0 (0) | 1 (1) | 1 | 7 |
| Antibiotic changed due to AE | 6 (4) | 17 (18) | < .001 | 9 | 1 (2) | 11 (16) | .01 | 7 |
| ED visit due to AE | 2 (1) | 27 (28) | < .001 | 1 | 1 (2) | 21 (30) | < .001 | 1 |
| ED visit specifically due to PICC AE | … | 16 (17) | 1 | … | 13 (19) | 1 | ||
| ED visit due to recurrence of infection symptoms | 12 (7) | 7 (7) | > .99 | 1 | 3 (5) | 2 (3) | .67 | 1 |
| Readmitted due to AE | 3 (2) | 14 (15) | < .001 | 1 | 1 (2) | 9 (13) | .02 | 1 |
| Readmitted specifically due to PICC AE | … | 5 (5) | 1 | … | 3 (4) | 1 | ||
| Readmitted due to recurrence of in- fection symptoms | 13 (8) | 13 (14) | .15 | 1 | 3 (5) | 7 (10) | .33 | 1 |
| Adherence to therapy | ||||||||
| Medication adherence issuesn | 10 (6) | 4 (4) | .58 | 3 | 3 (5) | 2 (3) | .67 | 3 |
| Lost to follow-upo | 26 (16) | 5 (5) | .01 | 4 | 9 (14) | 4 (6) | .14 | 4 |
| Outcomes | ||||||||
| Acute complicated coursep | 28 (17) | 34 (36) | .001 | 5 | 12 (19) | 16 (24) | .50 | 4 |
| Chronic morbidityp | 12 (8) | 15 (16) | .03 | 8 | 1 (2) | 8 (12) | .04 | 8 |
Data are presented as no. (%) unless otherwise indicated. Bold values indicate significant results.
Abbreviations: AE, adverse event (therapy-related only); CRP, C-reactive protein; ED, emergency department; ESR, erythrocyte sedimentation rate; HCH, Hasbro Children’s Hospital; ICU, intensive care unit; IQR, interquartile range; IV, intravenous; MRSA, methicillin-resistant Staphylococcus aureus; PICC, peripherally inserted central catheter; Tmax, maximum temperature; WBC, white blood cell.
aPropensity scores were estimated using binary logistic regression with the following covariates: fever > 48 hours after antibiotics, suppurative arthritis, disseminated infection, bone abscess, CRP ≥ 100 mg/L after 2–4 days of antibiotics, delayed source control, bone debridement.
bTotal > 100% secondary to multifocal infections.
cClavicle, scapula, sternum, or patella.
dTwo or more noncontiguous bones.
eIn the first 48 hours from presentation.
fSynovial fluid with positive culture, positive Gram stain for bacteria, nucleated cell count ≥ 10 000 cells/mL, or moderate-many neutrophils if nucleated cell count not done (4 cases).
gMultifocal infection, pneumonia, septic pulmonary embolism, deep vein thrombosis, or endocarditis.
hAs described by Athey et al [30].
iTreatment with tissue plasminogen activator dislodgement, dermatitis, local infection.
jCentral line–associated bloodstream infection or thrombus demonstrated by imaging.
kAbsolute neutrophil count < 500 cells/mL.
lIncrease in the serum creatinine concentration > 150% of the baseline value.
mAlanine aminotransferase > 150 IU/L.
nReceived ≤80% of the prescribed antibiotic doses.
oPatient did not return to clinic despite continued documented need.
pDefined in Methods section.