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Master Thesis

Mortalité attribuable aux PICC-lines dans quatre hôpitaux de l'Assistance-Publique Hôpitaux de Marseille

Abstract : Introduction: Peripherally inserted central catheters (PICC-line) are devices inserted through peripheral venous access. In our institution, this technology was quickly adopted by clinicians. Bacteremia on catheters remains an important public health issue in France. The mortality attributable to bacteremia on PICC-line remains poorly evaluated in France and in the literature in general. In our study we report an exhaustive inventory, over a period of 7 years on all the structures of our institution bacteremia on PICC-line and their mortality to 30 days. Material and methods: In retrospect from January 2010 to December 2016, we crossed Picc-line poses registers on all the Assistance-Publique Hôpitaux de Marseille (AP-HM) with the laboratory's positive and negative blood culture registers. bacteriology and data from the Information Systems Medicalization Program (PMSI). Result: 11334 PICC-lines were included over a period of 7 years and followed for the occurrence, in the same hospital stay, of bacteremia and / or death. There were 258 cases of PICC-line bacteremia on this same period, a prevalence of 2.27%. The hematology services: 20/324 (6.17%), oncology: 55/1375 (4%), and hepato-gastro-enterology: 42/1142 (3.66%) had the highest prevalence of bacteremia by PICC-line poses. The correlation analysis, when adjusted by exposure and year, showed that the service profile explained 72% of the variability in the rate of bacteremia with a p = 0.023. Bacteremia was early with 75% of bacteremia occurring within 21 days of insertion. The number of death among patients with bacteremia patients was 57/11 334 PICC-line poses retained, a rate of 0.50% at 30 days. The 30-day mortality of patients with PICC-line was 1369/11334 or 12.07%, the mortality of patients with bacteremia on PICC-line is 57/258 or 22.09%, the mortality of patients without bacteremia being 1311 / 11076 ie 11.83% (p <0.05, RR 2.066 [1.54-2.75]). The Kaplan-Meier survival analysis revealed a statistically significant excess mortality between patients with PICC-line complicated bacteremia and Picc-line carriers without bacteremia (p <0.0007, hazard ratio 1.89 [1307-2709]). Conclusion: PICC-line patients are frail patients with significant comorbidities for whom episodes of bacteremia represent a significant excess mortality. The setting of a PICC-line must remain a solution of last resort after careful evaluation of the risk-benefit ratio by a senior doctor.
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https://dumas.ccsd.cnrs.fr/dumas-01908308
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Submitted on : Tuesday, October 30, 2018 - 9:57:21 AM
Last modification on : Monday, July 6, 2020 - 4:46:25 PM
Long-term archiving on: : Thursday, January 31, 2019 - 1:30:16 PM

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Simon Bessis. Mortalité attribuable aux PICC-lines dans quatre hôpitaux de l'Assistance-Publique Hôpitaux de Marseille. Sciences du Vivant [q-bio]. 2017. ⟨dumas-01908308⟩

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