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An analysis of 90-day emergency department visits after peripherally inserted central catheter (PICC) placement for prosthetic joint infection

Published online by Cambridge University Press:  07 March 2022

Lefko T. Charalambous Open the ORCID record for Lefko T. Charalambous [Opens in a new window] ,
Zoe Hinton ,
Billy I. Kim Open the ORCID record for Billy I. Kim [Opens in a new window] ,
Ayden Case ,
Meredith Brown ,
William Jiranek ,
Jessica Seidelman Open the ORCID record for Jessica Seidelman [Opens in a new window] ,
Michael P. Bolognesi  and
Thorsten M. Seyler
Lefko T. Charalambous*
Affiliation:
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
Zoe Hinton
Affiliation:
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
Billy I. Kim
Affiliation:
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
Ayden Case
Affiliation:
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
Meredith Brown
Affiliation:
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
William Jiranek
Affiliation:
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
Jessica Seidelman
Affiliation:
Division of Infectious Disease, Department of Medicine, Duke University School of Medicine, North Carolina
Michael P. Bolognesi
Affiliation:
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
Thorsten M. Seyler
Affiliation:
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
*
Author for correspondence: Lefko T. Charalambous, E-mail: [email protected]
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Abstract

Objective:

Research on complications with peripherally inserted central catheter (PICC) lines that are placed for the treatment of prosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is scarce. We investigated the timing, frequency, and risk factors for PICC complications during treatment of PJI after THA and TKA.

Methods:

We retrospectively queried an institutional database for THA and TKA patients from January 2015 through December 2020 that developed a PJI and required PICC placement at an academic, tertiary-care referral center.

Results:

The study included 889 patients (48.3% female) with a mean age of 64.6 years (range, 18.7–95.2) who underwent 435 THAs and 454 TKAs that were revised for PJI. The cohort had 275 90-day ED visits (30.9%), and 51 (18.5%) were PICC related. The average time from discharge to PICC ED visit was 26.2 days (range, 0.3–89.4). The most common reasons for a 90-day ED visit were issues related to the joint replacement or wound site (musculoskeletal or MSK; n = 116, 42.2%) and PICC complaints (n = 51, 18.5%). A multivariable logistic regression demonstrated that non-White race (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.24–4.04; P = .007) and younger age (OR, 0.98; 95% CI, 0.95–1.00; P = .035) were associated with PICC-related ED visits. Malposition/readjustment (41.2%) and occlusion (35.3%) were the most common PICC complications leading to ED presentation.

Conclusions:

PICC complications are common after PJI treatment, accounting for nearly 20% of 90-day ED visits.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 12 , December 2022 , pp. 1853 - 1858
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

a

Authors of equal contribution.

PREVIOUS PRESENTATION. These data were presented at The American Association of Hip and Knee Surgeons Annual Meeting in Dallas, Texas, on November 11–14, 2021, and at IDWeek 2021 from September 29–October 3, 2021, held virtually.

References

Osmon, DR, Berbari, EF, Berendt, AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013;56:e1–e25.CrossRefGoogle ScholarPubMed
Li, HK, Rombach, I, Zambellas, R, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med 2019;380:425–436.CrossRefGoogle ScholarPubMed
Underwood, J, Marks, M, Collins, S, Logan, S, Pollara, G. Intravenous catheter-related adverse events exceed drug-related adverse events in outpatient parenteral antimicrobial therapy. J Antimicrob Chemother 2019;74:787–790.CrossRefGoogle ScholarPubMed
Leroyer, C, Lashéras, A, Marie, V, et al. Prospective follow-up of complications related to peripherally inserted central catheters. Med Mal Infect 2013;43:350–355.CrossRefGoogle ScholarPubMed
Grau, D, Clarivet, B, Lotthe, A, Bommart, S, Parer, S. Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrob Resist Infect Control 2017;6:18.CrossRefGoogle ScholarPubMed
Jumani, K, Advani, S, Reich, NG, Gosey, L, Milstone, AM. Risk factors for peripherally inserted central venous catheter complications in children. JAMA Pediatr 2013;167:429–435.CrossRefGoogle ScholarPubMed
Kovacich, A, Tamma, PD, Advani, S, et al. Peripherally inserted central venous catheter complications in children receiving outpatient parenteral antibiotic therapy (OPAT). Infect Control Hosp Epidemiol 2016;37:420–424.CrossRefGoogle ScholarPubMed
Valbousquet Schneider, L Jr, Duron, S, Arnaud, FX, et al. Evaluation of PICC complications in orthopedic inpatients with bone infection for long-term intravenous antibiotics therapy. J Vasc Access 2015;16:299–308.CrossRefGoogle ScholarPubMed
Plate, JF, Ryan, SP, Bergen, MA, et al. Patient risk profile for unplanned 90-day emergency department visits differs between total hip and total knee arthroplasty. Orthopedics 2020;43:295–302.CrossRefGoogle ScholarPubMed
Wiley, MR, Carreon, LY, Djurasovic, M, et al. Economic analysis of 90-day return to the emergency room and readmission after elective lumbar spine surgery: a single-center analysis of 5444 patients. J Neurosurg Spine 2020. doi: 10.3171/2020.6.SPINE191477.CrossRefGoogle Scholar
Bocle, H, Lavigne, JP, Cellier, N, et al. Effectiveness of early switching from intravenous to oral antibiotic therapy in Staphylococcus aureus prosthetic bone and joint or orthopedic metalware-associated infections. BMC Musculoskelet Disord 2021;22:315.CrossRefGoogle ScholarPubMed