Incidence of and factors associated with catheter-related bloodstream infection in patients with advanced solid tumors on home parenteral nutrition managed using a standardized catheter care protocol

Abstract

BackgroundCatheter-related bloodstream infections (CRBSIs) are associated with high morbidity and mortality as well as increased medical costs. Cancer patients, who are often immunocompromised, are susceptible to CRBSI while receiving home parenteral nutrition (HPN). We evaluated the incidence of and factors associated with CRBSIs in cancer patients undergoing HPN managed using a standardized catheter care protocol.MethodsThis is a retrospective cohort study of 335 cancer patients receiving HPN between January 2012 and July 2015. The primary outcome of interest was the incidence of CRBSI expressed as events per 1000 HPN days. HPN days were calculated from the start date with the home infusion provider until the discontinuation of HPN, or the removal of the venous access device (VAD), or the death of the patient. The VADs used were either peripherally inserted central catheters (PICCs) or a subcutaneous implanted port or tunneled central catheters (TCCs). Univariate Poisson regression analyses were used to determine the variables associated with CRBSIs.ResultsOf 335 patients, 193 were females and 142 were males. The most common cancer types were colorectal, pancreatic, ovarian and stomach. A total of 408 VADs in 335 patients were studied, covering a total of 29,403 HPN days. Of 408 VADs, 206 (50.5%) were ports, 191 (46.8%) were PICCs, and 7 (2.7%) were TCCs. The median duration of HPN was 54 days. A total of 16 CRBSI episodes were recorded (8 in ports, 7 in PICCs and 1 in TCCs). The median duration from the start of HPN to the development of CRBSI episodes was 43.5 days. The overall incidence of CRBSI per 1000 HPN days was 0.54 (95% confidence interval: 0.32–0.86). Upon univariate analysis, no variables were found to be statistically significantly associated with CRBSI incidence.ConclusionsWe found a low rate of CRBSI following a standardized catheter maintenance protocol in a high-risk oncology population undergoing HPN.

Infectious Complications in Home Parenteral Nutrition: A Systematic Review and Meta-Analysis Comparing Peripherally-Inserted Central Catheters with Other Central Catheters

“…After reading the selected articles, only three prospective studies that included appropriate data for both PICCs and other CVCs were considered for the final analysis [7,17,18]. We discarded eight articles with retrospective, pediatric, or inpatient data [9,10,19,20,21,22,23,24], two articles with duplicated series of patients [25,26], and seven articles with inappropriately reported infection rates for adequate extraction [27,28,29,30,31,32,33], whereas other reasons for the exclusion of full text articles (such as including several of the above reasons and others, such as different types of reported outcomes apart from catheter-related infections, the use of locks as preventive measures, the type of lipid emulsions, and other unrelated outcomes) are given in Figure 1 (references are listed in the Supplementary material).…”

ESPEN guideline on home parenteral nutrition

“…Previous guidelines and standards recommend that prescription, implementation and monitoring of an individualized HPN program shall be managed by a NST in centers with HPN management expertise [3,10,51,64e74]. Patients managed by such a dedicated patient-centered NST have better outcomes and possible lower overall costs of care [22,64].…”

“…To assure optimal outcomes, the team should develop an individualized training and treatment plans based on standardized protocols. Notably, CRBSI rates, which are considered a proxy for the quality of HPN support, even in high-risk patients such as those with cancer, are the lowest in expert referral centers [64,65].…”

Home transfusion: three decades of practice at a tertiary care hospital

“…Some costs of care (surveillance, room cleaning, utilities, personal hygiene, and nutrition) are reduced or shouldered by the patient. This approach can also improve patient safety by avoiding nosocomial infectious agents, frequentation of emergency departments, and reduction in readmission rates and mortality . Major health care providers, like Johns Hopkins Hospital or Presbyterian Healthcare offer HH as part of their portfolio for a wide range of conditions, from chronic diseases to terminally ill patients.…”