Clinical Characteristics and Outcomes of S. Aureus Bacteremia in Patients Receiving Total Parenteral Nutrition

Abstract

Background: Patients on total parenteral nutrition (TPN) are at risk of developing central line-associated infections. Specifically, Staphylococcus aureus bacteremia (SAB) is feared for its high complication rates. This prospective cohort study compares characteristics, clinical course and outcome of SAB in patients with and without TPN support. Methods: Clinical and microbiological data from all patients with positive blood cultures for S. aureus from two facilities, including our referral center for TPN support, were retrieved (period 2013–2020). Primary outcome was overall mortality, and included survival analysis using a multivariate Cox regression model. Secondary outcomes comprised a comparison of clinical characteristics and outcomes between both patient groups and analysis of factors associated with complicated outcome (e.g., endocarditis, deep-seated foci, relapse and death) in patients on TPN specifically. Results: A total of 620 SAB cases were analyzed, of which 53 cases received TPN at the moment the blood culture was taken. Patients in the TPN group were more frequently female, younger and had less comorbidity (p < 0.001). In-hospital death and overall mortality were significantly lower in TPN patients (4% vs. 18%, p = 0.004 and 10% vs. 34%, p < 0.001, respectively). Positive follow-up blood cultures, delayed onset of therapy and previous catheter problems were associated with a higher incidence of complicated SAB outcome in patients on TPN. Conclusion: Our data show that patients on TPN have a milder course of SAB with lower mortality rates compared to non-TPN SAB patients.

Catheter salvage or removal in catheter‐related bloodstream infections with Staphylococcus aureus in children with chronic intestinal failure receiving home parenteral nutrition and the use of prophylactic taurolidine catheter lock solution: A descriptive cohort study

“…Furthermore, immunocompromised patients are known to be at higher risk of complications, recurrent infections, and mortality compared with controls in case of S aureus bacteremia 36 . Interestingly, pediatric and adult patients with chronic IF receiving HPN seem to have a milder course of S aureus CRBSI, lower occurrence of complications (such as endocarditis and osteoarticular infection), and lower mortality rate compared with patients not receiving PN 12,18 . The mild clinical course in these patients with IF receiving HPN could be explained by the knowledge and experience of the parents and (adolescent) patients because they are all well educated in expertise centers about recognition of early signs (eg, fever) of potential serious complications.…”

“…Starting antimicrobial therapy immediately might have contributed to our high success rate because delayed treatment onset is proven to be associated with a complicated outcome in S aureus bacteremia. 12 In light of the high successful treatment rate, this strict antimicrobial protocol in our center for children with IF receiving HPN seems to be an effective method. Additionally, catheter salvage rates in aforementioned studies were notably higher (varying between 75% and 85%) than our 44% salvage rate.…”

“…36 Interestingly, pediatric and adult patients with chronic IF receiving HPN seem to have a milder course of S aureus CRBSI, lower occurrence of complications (such as endocarditis and osteoarticular infection), and lower mortality rate compared with patients not receiving PN. 12,18 The mild clinical course in these patients with IF receiving HPN could be explained by the knowledge and experience of the parents and (adolescent) patients because they are all well educated in expertise centers about recognition of early signs (eg, fever) of potential serious complications. The long duration of the HPN may indeed result in a lot of experience in patients and caregivers to notice subtle early signs of an infection.…”

“…CRBSI with S aureus has a high mortality rate, varying between 9.4% and 34% in adults, and a high risk of complications, including metastatic infection, such as endocarditis, arthritis, and osteomyelitis. [11][12][13] The Infectious Diseases Society of America (IDSA) and Surviving Sepsis Campaign guidelines provide strong recommendations on the removal of the catheter in the setting of CRBSI with S aureus, based on adult data only. 14,15 The committee of the Dutch Working Party on Antibiotic Policy (Stichting Werkgroep Antibiotica Beleid [SWAB]) cited the literature used by the IDSA and agreed on the recommendation to remove the catheter in case S aureus bacteria is detected in blood cultures in adults.…”

“…The management concerning removal of catheters in case of a CRBSI with particular pathogens remains controversial, especially with Staphylococcus aureus . CRBSI with S aureus has a high mortality rate, varying between 9.4% and 34% in adults, and a high risk of complications, including metastatic infection, such as endocarditis, arthritis, and osteomyelitis 11–13 . The Infectious Diseases Society of America (IDSA) and Surviving Sepsis Campaign guidelines provide strong recommendations on the removal of the catheter in the setting of CRBSI with S aureus , based on adult data only 14,15 .…”