2094. Pulmonary Artery Catheter Epidemiology of Risk (PACER) Study. (26th November 2018) - Yetmar, Zachary
Abstract: Background: Central line-associated bloodstream infections (CLABSI) are a known complication of central venous access. Pulmonary artery catheters (PAC) are frequently used in status 1A pre-heart transplant patients, at the top of the heart transplant waiting list. These patients often have a PAC in place for extended periods of time and are thus at risk for CLABSI. Our institution's practice includes routine PAC exchange after 21 days of use. We sought to estimate the risk of CLABSI and determine whether factors influenced infection rate. Methods: We conducted a retrospective, descriptive study from January 2013 to December 2016 identifying characteristics of PAC use and infection rate in adult status 1A pre-heart transplant patients. Time to CLABSI was analyzed with Kaplan–Meier estimates. The effect of CLABSI on time to transplant and death were analyzed in time-dependent Cox models. Results: We identified 61 status 1A pre-heart transplant patients with PACs during this time period with 219 PACs and 2566 line-days. Median duration of PAC was 11 days. There were 14 CLABSIs for an infection rate of 5.46/1, 000 line-days (95% CI: 2.98–9.15), compared with 1.06/1, 000 line-days for our institution's intensive care unit rate. Causative organisms were coagulase-negative Staphylococcus (79%), Enterobacter (7%), E. coli (7%), and Klebsiella (7%). There was a trend toward higher infection rate per 1, 000 line-days with longer duration of PACs. Lines in place for 0–10 days resulted in an infection rate of 3.14 (1.02–7.32); 11–20 days with a rate of 8.70 (3.19–18.94); and >20 days with a rate of 32.61 (6.72–95.30). There was a trend toward higher infection rate with more concomitant non-PAC lines used (0 other lines, 4.57; 1 line, 6.21; 2 or more, 11.56). Median time to infection diagnosis from PAC placement was 29 days (23–49). Line infection was associated with shorter time to transplant (hazard ratio 2.49; P = 0.027), but no effect on mortality (hazard ratio 1.79; P = 0.355). Conclusion: Our study demonstrated a high rate of CLABSI with PAC, with a trend toward increased risk with longer use, and presence of concomitant lines. Infection was associated with a shorter time to transplant, though not with time to death. Prolonged PAC use in the status 1A population should be revisited. Disclosures: All authors: No reported disclosures.