Antibiotic therapy of catheter infections in patients receiving home parenteral nutrition

Abstract

Fifty-eight episodes of catheter-related sepsis in 21 patients receiving home parenteral nutrition were retrospectively studied. Of 81 organisms isolated from the blood, 59% were Gram-positive cocci, 25% were Gram-negative bacilli, and 16% were yeast. Attempts to treat bacterial infections at home with antibiotic therapy while the catheter remained in place were made; fungal isolation resulted in immediate hospitalization and catheter removal. Gram-negative infections more often resulted in eventual hospitalization (92%) and catheter removal (50%) than Gram-positive infections (57% hospitalization and 23% catheter removal). Empiric therapy with 1 g of cefazolin intravenously every 12 hr was successful in only 33% of episodes caused by coagulase-negative staphylococci, whereas vancomycin was successful in 62%. Sensitivity testing was not a reliable guide for antibiotic choice for treatment of these infections. Cefazolin, 1 g, intravenously every 12 hr was successful in only 25% of Gram-negative episodes treated empirically with this regimen. We conclude that our home parenteral nutrition patients should be hospitalized for a few days upon presentation with a catheter infection for clinical evaluation and aggressive antibiotic therapy. Vancomycin is the preferred drug for treatment of catheter-related infections caused by coagulase-negative staphylococcus.

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

“…29,37 The prevalence of fungal infections was low in our cohort of patients similar to that reported in several studies. 13,38 This study is unique in that our cohort is one of the largest evaluations of CA-BSI in children on HPN in the acute posthospital phase. Although retrospective, our findings suggest that the elevated rates of CA-BSI may be reduced by interventions focused on the immediate hospital discharge period with reinforcement provided before the sixth month of HPN receipt.…”

Comparing success rates in central venous catheter salvage for catheter-related bloodstream infections in adult patients on home parenteral nutrition: a systematic review and meta-analysis

“…The majority of the 28 included studies were conducted in Europe ( n = 21) ( 15 , 16 , 24 , 31–34 , 36–39 , 41–45 , 48 , 50–53 ) and the United States ( n = 6) ( 17 , 35 , 40 , 46 , 47 , 54 ) ( Supplemental Figure 2 ). Twenty-five studies were carried out in tertiary hospitals and/or specialized IF units ( 15–17 , 24 , 33–35 , 37–54 ) and 2 studies were multicenter ( 31 , 32 ).…”

“…Most studies defined CRBSIs according to the CDC ( 17 , 35 , 39 , 43–45 , 52 ) or IDSA ( 15 , 16 , 31 , 32 , 36 , 50 ) guidelines; the other studies used either nonstandard definitions or did not report the definition used ( 33 , 34 , 37 , 41 , 48 , 49 , 51 , 53 , 54 ). Two studies reported a slightly modified definition, but were still considered as appropriate and were counted as using the CDC definition ( 24 , 38 ).…”

“…Two studies reported a slightly modified definition, but were still considered as appropriate and were counted as using the CDC definition ( 24 , 38 ). Reported salvage rates differed widely among studies: 9 studies reported overall salvage rates ( 17 , 24 , 34 , 38 , 40 , 47 , 49 , 52 , 54 ), whereas 18 studies reported successful salvage rates (e.g., exclusion of S. aureus for salvage) ( 15 , 16 , 31–33 , 35–37 , 41 , 42–46 , 48 , 50 , 51 , 53 ) ( Supplemental Table 2 ). One study did not mention the method of salvage ( 39 ).…”

In vitro Experiments on Catheter-Related Infections Due to Gram-Negative Rods

“…However multiple complications can arise from the use of these catheters, the most com mon and feared being an infection of the cath eter itself potentially leading to life-threaten ing catheter sepsis [3,8], Until recently, since a complete chemotherapeutic restitution of in fected polymer was considered impossible, the treatment of choice was the removal of the contaminated catheter [5,8]. Lately, however, attempts have been made more and more fre quently to maintain the last available central venous line of severely ill patients with anti biotics [9][10][11][12], This manner of treatment is rather controversial and many ambiguities re main concerning appropriate modes of treat ment to eliminate the various bacteria which can cause catheter infection [10,12]. Until now, gram-positive agents such as Staphylococcus epidermidis and Staphylococcus aureus have been considered as the primary cause of this infectious complication [4,13,14], Hence, sci entific interest has focused mainly on both these causative agents.…”