Objective: To assess infectious and thrombotic complications of peripherally inserted central catheters (PICCs) in adults. Design: A 5-year prospective cohort study. Setting: Tertiary-care teaching hospital in Seville, Spain. Patients: Adult patients undergoing PICC insertion. Methods: Catheter-associated bloodstream infection (CABSI) including catheter-related bloodstream infection (CRBSI), primary bacteremia (PB), and upper extremity deep vein thrombosis (UEDVT) were recorded. Independent predictors of complications were assessed by multivariate analysis. Results: In total, 1,142 PICCs were inserted, with 153,191 catheter days (median, 79). Complications included 66 cases of CABSI (5.78%; 0.43‰ catheter days), 38 cases of CRBSI (3.33%; 0.25‰ catheter days), 28 cases of PB (2.45%; 0.18‰ catheter days), and 23 cases of UEDVT (2.01%; 0.15‰ catheter days). The median times to infection were 24, 41, and 60 days for CRBSI, PB, and UEDVT, respectively. Parenteral nutrition (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.77–6.52) and admission to the hematology ward (OR, 4.90; 95% CI, 2.25–10.71) were independently associated with CRBSI and PB, respectively. Admission to the hematology ward (OR, 12.46; 95% CI, 2.49–62.50) or to the oncology ward (OR, 7.89; 95% CI, 1.77–35.16) was independently associated with UEDVT. The crude mortality rate was 24.8%. Only 2 patients died of complications. Conclusions: PICCs showed a low rate of thrombotic and infectious complications. Compared to PB, CRBSI showed significantly different risk factors, a higher incidence density per catheter days, and a shorter median time to infection. Separate analyses of CRBSI and PB are more specific and clinically useful when analyzing infectious complications.

Los autores declaran no tener ningún tipo de interés económico o comercial. ReSuMeNLos Tumores de Koënen son manifestaciones cutáneas de la Esclerosis Tuberosa, que es de afectación sistémica y en ocasiones con localización en el pie. El conocimiento de este tipo de afecciones dermatológicas es muy importante para un tratamiento correcto y por este motivo un enfoque interdisciplinario es esencial para que el diagnóstico sea preciso y precoz. En la Historia Clínica es importante realizar una valoración de los antecedentes familiares, realizar una exploración de la piel y un estudio neurológico. Se presenta un caso con clínica compatible con la presencia de Tumor de Koënen. El diagnostico diferencial es esencial para plantear el tratamiento y conseguir un buen pronóstico y pronta curación. Conclusiones. Se plantea el tratamiento quirúrgico como técnica de elección pese a la elevada tasa de recidivas que presenta dicho tratamiento. La resección quirúrgica de la lesión permite el diagnóstico anatomopatologico. Palabras clave: esclerosis tuberosa; tumor de koënen; tratamiento podológico; tratamiento quirúrgico. ABStRACtThe Koenen tumors are cutaneous manifestations of tuberous sclerosis, which is of systemic involvement and sometimes with location in the foot. The knowledge of this type of dermatological is very important for proper treatment and for this reason an interdisciplinary approach is essential for the accurate and early diagnosis. In the clinical history is important to make an assessment of family history, perform a scan of the skin and a neurological study. We report a case with symptoms consistent with the presence of tumor Koenen. The differential diagnosis is essential for planning treatment and get a good outcome and speedy recovery. Conclusions. Surgical treatment is proposed as a technique of choice despite the high rate of recurrence presents such treatment. Surgical resection of the lesion allows the pathological diagnosis.

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