230 Patient years of experience with home long-term parenteral nutrition in childhood: Natural history and life of central venous catheters

Moukarzel, Adib; Haddad, Imad Y.; Ament, Marvin E.; Buchman, Alan L.; Reyen, Laurie; Maggioni, Andrea; Baron, Howard; Vargas, Jorge

doi:10.1016/0022-3468(94)90107-4

Cited by 119 publications

(62 citation statements)

References 22 publications

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“…Prompt diagnosis and management of infection and removal of catheters infected with organisms deemed to be difficult to treat by antimicrobial administration alone, such as in fungal infections, may also reduce complications associated with central venous catheter usage. [24][25][26][27][28] Furthermore, our group showed a significant association between higher mean blood glucose levels during hospitalization and increased risk for posthospital BSI in adults on HPN (unpublished study). The purpose of this study was to assess the incidence, manifestations, and etiology of CA-BSI in children receiving HPN in a major metropolitan area of the southeastern United States.…”

Section: Introductionmentioning

confidence: 72%

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

Mohammed

Zhao

Shane

et al. 2011

J Parenter Enteral Nutr

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Background: Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter‐associated bloodstream infections (CA‐BSI) are common in hospitalized patients receiving parenteral nutrition (PN), but data evaluating CA‐BSI in children receiving HPN are limited. Objective: To determine the incidence and characteristics of CA‐BSI in children receiving HPN. Methods: Medical records of 44 children receiving HPN during a 3‐year period were reviewed. End points were CA‐BSI during the initial 6 months after discharge. CA‐BSI was defined as isolation of pathogens from blood requiring antimicrobial therapy. Results: The primary indication for HPN was short bowel syndrome (46%), and 59 BSI were documented during the initial 6 months of HPN in 29 (66%) children. Of CA‐BSI, polymicrobial infections accounted for 52%; gram‐positive, 29%; gram‐negative, 17%; and fungal, 2%. CA‐BSI incidence per 1000 catheter‐days was highest during the first month posthospital discharge (72 episodes; 95% confidence interval [CI], 45.4–109.6). CA‐BSI incidence density ratio for children receiving HPN for >90 days compared with those receiving HPN for <30 days was 2.2 (P < .05). Logistic regression revealed that Medicaid insurance and age <1 year were associated with increased risk for CA‐BSI (odds ratio [OR], 4.4 [95% CI, 1.13–16.99] and 6.6 [1.50–28.49], respectively; P < .05). Conclusions: The incidence of CA‐BSI in children receiving HPN is highest during the first month posthospital discharge. Strategies to address care in the immediate posthospital discharge period may reduce the burden of infectious complications of HPN.

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Section: Introductionmentioning

confidence: 72%

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

Mohammed

Zhao

Shane

et al. 2011

J Parenter Enteral Nutr

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“…For example, pediatric patients with short gut syndrome, who are dependent upon parenteral nutrition, are at high risk for recurrent central line infections and thus may have higher cumulative antibiotic exposure than even some critical care and oncology patients. [34][35][36][37] For such patients, pathogens causing CLABSIs may be more likely to be antibiotic resistant. Other potential explanations include differences in infection control practices or opportunities for transmission in pediatric ward locations compared to critical care or oncology locations.…”

Section: Discussionmentioning

confidence: 99%

Pathogen Distribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011–2014

Lake

Weiner

Milstone

et al. 2017

Infect. Control Hosp. Epidemiol.

135

103

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OBJECTIVETo describe pathogen distribution and antimicrobial resistance patterns for healthcare-associated infections (HAIs) reported to the National Healthcare Safety Network (NHSN) from pediatric locations during 2011–2014.METHODSDevice-associated infection data were analyzed for central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonia (VAP), and surgical site infection (SSI). Pooled mean percentage resistance was calculated for a variety of pathogen-antimicrobial resistance pattern combinations and was stratified by location for device-associated infections (neonatal intensive care units [NICUs], pediatric intensive care units [PICUs], pediatric oncology and pediatric wards) and by surgery type for SSIs.RESULTSFrom 2011 to 2014, 1,003 hospitals reported 20,390 pediatric HAIs and 22,323 associated pathogens to the NHSN. Among all HAIs, the following pathogens accounted for more than 60% of those reported: Staphylococcus aureus (17%), coagulase-negative staphylococci (17%), Escherichia coli (11%), Klebsiella pneumoniae and/or oxytoca (9%), and Enterococcus faecalis (8%). Among device-associated infections, resistance was generally lower in NICUs than in other locations. For several pathogens, resistance was greater in pediatric wards than in PICUs. The proportion of organisms resistant to carbapenems was low overall but reached approximately 20% for Pseudomonas aeruginosa from CLABSIs and CAUTIs in some locations. Among SSIs, antimicrobial resistance patterns were similar across surgical procedure types for most pathogens.CONCLUSIONThis report is the first pediatric-specific description of antimicrobial resistance data reported to the NHSN. Reporting of pediatric-specific HAIs and antimicrobial resistance data will help identify priority targets for infection control and antimicrobial stewardship activities in facilities that provide care for children.Infect Control Hosp Epidemiol 2018;39:1–11

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“…Because of constant diarrhea and/or the need to maintain stomas and/or enteral tubes, SBS patients must be especially meticulous in their technique to avoid contamination of their CVCs with enteral organisms. Although their CVCs are susceptible to infection in the best of circumstances, 15 they are even more likely to become infected as their clinical status deteriorates and their ability to provide meticulous CVC maintenance deteriorates. For the same reasons, the risk of urinary tract infections caused by contamination with enteral organisms is increased.…”

Section: Discussionmentioning

confidence: 99%

Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants

Fryer

Pellar

Ormond³

et al. 2003

Liver Transplantation

141

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The United Network for Organ Sharing (UNOS) reports indicate that mortality on the intestine transplant waiting list is higher than on other transplant waiting lists. The goals of this study were (1) to determine whether most of the intestinal transplant candidate deaths have occurred in those who also need liver transplants, and (2) to compare the waiting list mortality in the liver-intestine candidate subset with the overall liver transplant candidate population. We found that 90% of intestine transplant waiting list deaths have occurred in candidates who also needed liver transplants. Since 1994, annual mortality has been higher in liver-intestine transplant candidates than in the overall liver transplant candidate population, and these differences have been statistically significant since 1996. These mortality differences applied to all age groups. Also, status 2B, 3, and 7 candidate mortality was significantly higher in liver-intestine candidates than in the overall liver transplant candidate population. Because there were so few liver-intestine transplant candidates listed as status 1 or 2A, a meaningful comparison was not possible in these statuses. These data indicate that liverintestine transplant candidates are a unique subset of liver transplant candidates with a significantly higher risk of dying on the waiting list. Recent changes in UNOS liver allocation policy that gives higher priority to liver-intestine candidates may help to reduce this discrepancy. However, further research into the etiology of liver disease in patients on long-term parenteral nutrition and earlier referral of high-risk short bowel syndrome patients to centers with special expertise in their management are needed for an ultimate solution to this problem. (Liver Transpl 2003;9:748-753.)

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230 Patient years of experience with home long-term parenteral nutrition in childhood: Natural history and life of central venous catheters

Cited by 119 publications

References 22 publications

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

Pathogen Distribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011–2014

Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants

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