Epidemiology of Bloodstream Infections in Patients Receiving Long-term Total Parenteral Nutrition

Marra, Alexandre R.; Opilla, Marianne; Edmond, Michael B.; Kirby, Donald F.

doi:10.1097/01.mcg.0000212606.13348.f7

Cited by 79 publications

(55 citation statements)

References 22 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…The most prevalent organism isolated from catheter blood cultures in our patients overall was CONS, a finding similar to that reported in several studies. 13,36 CONS have an affinity for biofilms, which sustain colonization that may persist following antimicrobial treatment and blood culture clearance. K pneumoniae was the most common gram-negative pathogen identified.…”

Section: Discussionmentioning

confidence: 99%

“…12 However, utilization of PN is associated with a high incidence of catheter-associated bloodstream infections (CA-BSI). [13][14][15] The incidence of 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.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…46 CVC-related sepsis rates have recently been variably reported as 0.14-0.83 episodes/patient-year. [47][48][49][50][51] As outlined above, maintaining low sepsis rates requires careful catheter care protocols, with multiple studies reiterating the importance of a multidisciplinary nutrition support team in reducing CVC-related sepsis. 45,[52][53][54] The patient is key to minimising CVC-related sepsis rates at home.…”

Section: Complications Of Long-term Pnmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

136

108

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SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

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“…TPN has historically been identified as a risk factor for PICC-related infections. In a study by Marra et al 4 of 47 patients receiving long-term TPN, 38 (80.9%) of patients developed a catheter-related blood- The data from this small study are quite limited but deserve further investigation, especially when considering hospital risk factors (Table 1). These risk factors have not been extensively evaluated in the literature.…”

Section: Retrospective Analysis Of Culture-positive Peripherally Insementioning

confidence: 98%

Retrospective Analysis of Culture-Positive Peripherally Inserted Central Catheter Infections at an Academic Medical Center

Liscynesky

Stevenson

2012

Infect. Control Hosp. Epidemiol.

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Epidemiology of Bloodstream Infections in Patients Receiving Long-term Total Parenteral Nutrition

Cited by 79 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

Review article: the management of long‐term parenteral nutrition

Retrospective Analysis of Culture-Positive Peripherally Inserted Central Catheter Infections at an Academic Medical Center

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