Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition

Abstract

Catheter-related bloodstream infections (CRBSIs) commonly arise from a parenteral nutrition catheter hub. A target for a Nutrition Support Team is to have a CRBSI rate of less than 1 per 1000. The diagnosis of CRBSI is suspected clinically by a temperature shortly after setting up a feed, general malaise or raised blood inflammatory markers. It is confirmed by qualitative and quantitative blood cultures from the catheter and peripherally. Treatment of inpatients may involve central venous catheter removal and antibiotics for patients needing short-term parenteral nutrition, but catheter salvage is generally recommended for patients needing long-term parenteral nutrition, where appropriate.

Catheter-related bloodstream infection management in patients receiving home parenteral nutrition: An observational cohort study

“…Last, we used the CLABSI definition proposed by the CDC [17], which differs from the more strict CRBSI definition that is used by the Infectious Diseases Society of America [39]. Some authors argue that the CLABSI definition could easily lead to an overestimation of the true central line sepsis incidence [15,40].…”

Systematic review with meta‐analysis: effects of implementing a nutrition support team for in‐hospital parenteral nutrition

“…Consequently, precautions should be taken when interpreting and comparing CRI rates because definition differences may result in discrepancies and comparability difficulties 21,58 . While dedicated intestinal failure units may achieve extremely low CRI rates, the corresponding rates in general wards may be higher 59 . Under NST supervision, quality improvement initiatives aimed to unify insertion and catheter care may significantly reduce CRI rates in these wards 7,59,60 .…”

“… 21 , 58 While dedicated intestinal failure units may achieve extremely low CRI rates, the corresponding rates in general wards may be higher. 59 Under NST supervision, quality improvement initiatives aimed to unify insertion and catheter care may significantly reduce CRI rates in these wards. 7 , 59 , 60 It has been proposed that NSTs may aim for an in‐patient CRI target of <1 episode per 1000 catheter days both in dedicated units and general wards.…”

“… 7 , 59 , 60 It has been proposed that NSTs may aim for an in‐patient CRI target of <1 episode per 1000 catheter days both in dedicated units and general wards. 59 , 61 …”

Bacterial Spectrum and Antimicrobial Pattern of Blood Stream Infections Associated With Non-Tunneled Double Lumen Catheter in Hemodialysis Patients

“…Catheter related blood stream infections (CRBSI) can be defined as "positive culture of the catheter (on removal), or paired blood cultures from a peripheral vein and the catheter (when left in place) with isolation of identical organisms (both species and antibiograms) from cultures of catheter segments and blood drawn from a peripheral vein in a patient with clinical symptoms of sepsis and the absence of another source of infection" 1 . Non-tunneled hemodialysis catheter is a fast and easily accessible method to initiate dialysis in most patients.…”