Factors Associated With Central Line–Associated Bloodstream Infections in a Cohort of Adult Home Parenteral Nutrition Patients
- 9 May 2020
- journal article
- research article
- Published by Wiley in Journal of Parenteral and Enteral Nutrition
- Vol. 44 (8), 1388-1396
- https://doi.org/10.1002/jpen.1876
Abstract
Purpose Central line‐associated bloodstream infection (CLABSI) is a potentially life‐threatening complication in home parenteral nutrition (HPN) patients. We investigated potential predictors of CLABSI to determine a predictive model in a cohort of adult HPN patients. Methods Patients managed by the HPN service at the Hospital of University of Pennsylvania on 1/1/2018 were included and followed through 6/30/2019, using existing medical records to collect demographic and clinical data. CLABSI were adjudicated prospectively by infectious disease experts. Variables with p≤0.2 when comparing patients with CLABSI to those without were included in logistic regression models. Results In the 114 patients, mean age was 54 ± 16 years, 68% was female and BMI was 25 ± 5.6. Median experience with HPN was 516 days (range 15‐10,281) and 26% had history of CLABSI. The catheter types were PICC (72.6%), tunneled (23.9%), and implanted (3.5%). The incidence of CLABSI was 0.89/1000 catheter days. One multivariate model identified ostomy/wound (OR 22.0, 95%CI = 4.8‐101.7), tunneled/implanted catheter (OR = 4.4; 95%CI = 1.4‐13.9), and BMI < 18.5 (OR = 5.9; 95%CI = 1.4‐24.2) as predictors of CLABSI. A second model identified patients with 2 potential predictors (OR 22.9, 95% CI = 5.6‐93.5) and tunneled/implanted catheter (OR = 6.7; 95% = CI 2.1‐21.8) at high risk of CLABSI. Conclusion In adult HPN patients, the presence of ostomy or wound, use of tunneled or implanted catheter, and low BMI were associated with CLABSI. Whether CLABSI rates might be reduced by more intense training (in wound or catheter care) especially for those with multiple predictors, different type of catheter, or malnutrition will require further study. This article is protected by copyright. All rights reservedKeywords
This publication has 31 references indexed in Scilit:
- Risk Factors for the Development of Catheter‐Related Bloodstream Infections in Patients Receiving Home Parenteral NutritionJournal of Parenteral and Enteral Nutrition, 2013
- Consensus Statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral NutritionJournal of Parenteral and Enteral Nutrition, 2012
- Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral NutritionJournal of Parenteral and Enteral Nutrition, 2011
- Guidelines for the Prevention of Intravascular Catheter-related InfectionsClinical Infectious Diseases, 2011
- Racial and Geographic Disparities in the Use of Parenteral Nutrition Among Inflammatory Bowel Disease Inpatients Diagnosed With Malnutrition in the United StatesJournal of Parenteral and Enteral Nutrition, 2009
- Review article: psychological aspects of home parenteral nutrition, abnormal illness behaviour and risk of self‐harm in patients with central venous cathetersAlimentary Pharmacology & Therapeutics, 2008
- MALNUTRITION AND INFECTION: AN UPDATEBritish Journal of Nutrition, 2007
- The impact of home parenteral nutrition on daily life—A reviewClinical Nutrition, 2007
- Home parenteral nutrition registry: A five-year retrospective evaluation of outcomes of patients receiving home parenteral nutrition supportNutrition, 2005
- Can Intravenous Feeding as the Sole Means of Nutrition Support Growth in the Child and Restore Weight Loss in an Adult?Annals of Surgery, 1969