Catheter‐Related Bloodstream Infections in Adults Receiving Home Parenteral Nutrition: Substantial Differences in Incidence Comparing a Strict Microbiological to a Clinically Based Diagnosis

Tribler, Siri; Brandt, Claus; Hvistendahl, Mark; Staun, Michael; Brøbech, Per; Moser, Claus; Jeppesen, Palle Bekker

doi:10.1177/0148607116686290

Cited by 35 publications

(9 citation statements)

References 38 publications

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“…The CVAD salvage rate of 60% in patients with a CRBSI was similar in both arms and is comparable to rates observed in previous studies (55%‐80%) . With regard to the microbial pathogens leading to CRBSIs, several cohort studies reported a preponderance of infections caused by Gram‐positive (60%‐80%) over Gram‐negative bacteria (20%‐40%) . One meta‐analysis showed that the use of taurolidine significantly decreased CRBSIs caused by Gram‐negative bacteria, whereas CRBSIs from Gram‐positive organisms did not change .…”

Section: Discussionsupporting

confidence: 73%

Randomised clinical trial: 2% taurolidine versus 0.9% saline locking in patients on home parenteral nutrition

Wouters

Theilla

Singer

et al. 2018

Aliment Pharmacol Ther

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SummaryBackgroundThe catheter lock solutions 2% taurolidine and 0.9% saline are both used to prevent catheter‐related bloodstream infections (CRBSIs) in home parenteral nutrition patients.AimsTo compare the effectiveness and safety of taurolidine and saline.MethodsThis multicentre double‐blinded trial randomly assigned home parenteral nutrition patients to use either 2% taurolidine or 0.9% saline for 1 year. Patients were stratified in a new catheter group and a pre‐existing catheter group. Primary outcome was the rate of CRBSIs/1000 catheter days in the new catheter group and pre‐existing catheter group, separately.ResultsWe randomised 105 patients, of which 102 were analysed as modified intention‐to‐treat population. In the new catheter group, rates of CRBSIs/1000 catheter days were 0.29 and 1.49 in the taurolidine and saline arm respectively (relative risk, 0.20; 95% CI, 0.04‐0.71; P = 0.009). In the pre‐existing catheter group, rates of CRBSIs/1000 catheter days were 0.39 and 1.32 in the taurolidine and saline arm respectively (relative risk, 0.30; 95% CI, 0.03‐1.82; P = 0.25). Excluding one outlier patient in the taurolidine arm, mean costs per patient were $1865 for taurolidine and $4454 for saline (P = 0.03). Drug‐related adverse events were rare and generally mild.ConclusionsIn the new catheter group, taurolidine showed a clear decrease in CRBSI rate. In the pre‐existing catheter group, no superiority of taurolidine could be demonstrated, most likely due to underpowering. Overall, taurolidine reduced the risk for CRBSIs by more than four times. Given its favourable safety and cost profile, taurolidine locking should be considered as an additional strategy to prevent CRBSIs. Trial registration: Clinicaltrials.gov, identifier: NCT01826526.

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Section: Discussionsupporting

confidence: 73%

Randomised clinical trial: 2% taurolidine versus 0.9% saline locking in patients on home parenteral nutrition

Wouters

Theilla

Singer

et al. 2018

Aliment Pharmacol Ther

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“…3,4 The most common complications related to HPS are catheter-related bloodstream infections (CRBSIs), which occur at a rate between 0.35 and 2.5 per 1000 CVC days depending on CRBSI definition, healthcare providers' experience, and patient-related factors. [5][6][7][8] The presence of a CVC also entails a risk of mechanical problems (0.3-0.8 per 1000 CVC days) and the rarer, but feared and access-limiting, catheter-related thrombosis (0.01-0.06 per 1000 CVC days). 6,8 Furthermore, IF patients are susceptible to metabolic instability and fluid and electrolyte derangement.…”

Section: Introductionmentioning

confidence: 99%

Hospitalizations in Patients With Nonmalignant Short‐Bowel Syndrome Receiving Home Parenteral Support

et al. 2020

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Background The objective of this retrospective cohort study was to assess the frequency, duration, and causes of hospitalizations in patients receiving home parenteral support (HPS) due to short‐bowel syndrome (SBS) of nonmalignant causes. Furthermore, we aimed to investigate potential risk factors and hypothesized that patients with the shortest remnant, functional, small bowel—hence, the highest need for HPS—would have the highest incidence of hospitalizations. Methods Patients with nonmalignant SBS who initiated HPS in the period from 1970 to 2016 from the Department of Gastroenterology, Rigshospitalet, Copenhagen, Denmark, were included. Information about demography, hospitalizations at the department, and duration of HPS was obtained from the Copenhagen intestinal failure database. Results Patients (n = 331) received HPS for a total of 1409.9 years in the period. Hospitalizations accounted for 6.6% of the time registered as HPS‐dependent. The average patient was hospitalized for 5.7% (range 0%–82%) of the registered HPS days. The incidence of admissions was 2.5 per HPS year. The median length of stay was 7 days (range; 0–387). Catheter‐related complications were the most frequently registered causes of admissions (35.2%), subsequently accounting for 31.3% of the total admission time. A Cox regression of admissions showed no significant influence of the remnant‐bowel anatomy but identified the ability to administer HPS unaided as associated with a significantly reduced hazard. Conclusions This retrospective study illustrated that 6.6% of the provided HPS days were, in fact, spent hospitalized. Since admissions elsewhere were not accounted for, this may be an underestimation.

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“…The wide range in reported CRBSI rates between centres noted above1 2 5–12 likely pertains to wide variation in patient cohorts included in studies, methods of CRBSI diagnosis and training protocols for CVC care. However, differences in catheter care protocols between centres are likely the most significant factor accounting for the extremes in CRBSI rates.…”

Section: Diagnosismentioning

confidence: 99%

“…Currently, there is no guidance that includes the consideration of ‘probable’ CRBSI, with this approach best avoided in order to prevent inappropriate therapy or line removal. Tribler et al demonstrated that a clinically based approach to diagnose CRBSI, that is, clinical features and positive cultures, rather than qualitative±quantitative analysis, may lead to significant overdiagnosis by 46% 12. CVC tip culture is of limited clinical value given that salvage of infected CVCs is advised wherever possible 21 61.…”

Section: Diagnosismentioning

confidence: 99%

“…A recent publication from the UK reported an extremely low inpatient CRBSI rate on a dedicated IFU over a 7-year period of 0.04 per 1000 catheter days, over a total of 23 548 inpatient catheter days 9. For patients at home, CRBSI rates vary greatly between institutions both nationally and internationally, with reported rates between 0.22 and 11.5 episodes/1000 catheter days 1 2 5–12. Variables that have been shown to influence CRBSI rates include education and training in CVC care,11 experience of the MDT,13 person responsible for primary CVC care,11 duration of HPN, nature of underlying disease, patient age14 15 intestinal anatomy and opiate dependency 3 5 11 16–18…”

Section: Introductionmentioning

confidence: 99%

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

Bond

Chadwick

Smith

et al. 2019

Frontline Gastroenterol

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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.

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Catheter‐Related Bloodstream Infections in Adults Receiving Home Parenteral Nutrition: Substantial Differences in Incidence Comparing a Strict Microbiological to a Clinically Based Diagnosis

Cited by 35 publications

References 38 publications

Randomised clinical trial: 2% taurolidine versus 0.9% saline locking in patients on home parenteral nutrition

Randomised clinical trial: 2% taurolidine versus 0.9% saline locking in patients on home parenteral nutrition

Hospitalizations in Patients With Nonmalignant Short‐Bowel Syndrome Receiving Home Parenteral Support

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

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