ArticleFrontiers in pharmacology2026
Immune-inflammatory prediction of PICC-related bloodstream infection in oldest-old adults with exploratory berberine biofilm-inflammation experiments.
Article in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Adults aged 80 years or older frequently require peripherally inserted central catheter (PICC) placement for prolonged intravenous therapy, nutritional support, and difficult vascular access. In this oldest-old population, PICC-related bloodstream infection (PICC-CRBSI) risk may be shaped by catheter factors, frailty, nutritional depletion, immune-inflammatory imbalance, and competing events such as death or non-infectious catheter removal. This study developed and internally validated a competing-risk model for 60-day definite PICC-CRBSI in patients aged ≥80 years and separately explored the antibiofilm and anti-inflammatory activity of berberine Methods: Consecutive patients aged ≥80 years who underwent PICC placement at a single tertiary teaching hospital between January 2019 and December 2025 were included in a retrospective cohort. The prediction landmark was 24 h after PICC insertion. Definite PICC-CRBSI within 60 days was analyzed with death and non-infectious PICC removal treated as competing events. Clinical, biomarker, and combined models were developed using L2-penalized Fine-Gray regression and internally validated with 1,000 patient-level bootstrap resamples. After model locking, a separate exploratory substudy evaluated berberine effects on Results: A total of 386 patients were analyzed, and 46 developed definite PICC-CRBSI over 19,528 catheter-days, corresponding to an incidence density of 2.36 per 1,000 catheter-days. Patients with definite PICC-CRBSI had greater frailty, longer catheter dwell time, lower lymphocyte and albumin levels, and higher systemic immune-inflammation index (SII) and C-reactive protein-to-albumin ratio (CAR) than those without definite infection. The combined model showed an apparent 60-day time-dependent area under the curve (AUC) of 0.758 and a bootstrap-corrected AUC of 0.731, indicating moderate internally validated discrimination. The Aalen-Johansen 60-day cumulative incidence of PICC-CRBSI was 3.2%, 8.5%, and 28.1% in the low-, intermediate-, and high-risk groups, respectively. Conclusion: A single-center competing-risk model combining catheter-related variables with routine immune-inflammatory biomarkers provided preliminary internal risk stratification for 60-day PICC-CRBSI in patients aged ≥80 years. The berberine substudy suggested antibiofilm and anti-inflammatory activity
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