Impact of prompt catheter withdrawal and adequate antimicrobial therapy on the prognosis of hospital-acquired parenteral nutrition catheter-related bacteraemia

Abstract

Catheter-related bacteraemia (CRB) is a cause of death in hospitalized patients, and parenteral nutrition (PN) is a risk factor. We aim to describe the prognosis of PN-CRB and the impact of catheter extraction within 48 h from bacteraemia. All consecutive hospitalized adult patients with CRB (2007-2012) were prospectively enrolled. Factors associated with 30-day mortality were determined by logistic regression analysis. Among 847 episodes of CRB identified, 291 (34%) episodes were associated with short-term catheter use for PN. Cure was achieved in 236 (81%) episodes, 42 (14.5%) patients died within the first 30 days, 7 (2.5%) relapsed, and 6 (2%) had re-infection. On multivariate analysis, previous immunosuppressive therapy (OR 5.62; 95% CI 1.69-18.68; p 0.0048) and patient age (OR 1.05; 95% CI 1.02-1.07; p 0.0009) were predictors of 30-day mortality, whereas catheter removal within 48 h of bacteraemia onset (OR 0.26; 95% CI 0.12-0.58; p 0.0010) and adequate empirical antibiotic treatment (OR 0.36; 95% CI 0.17-0.77; p 0.0081) were protective factors. Incidence of PN-CRB decreased from 5.36 episodes/1000 days of PN in 2007 to 2.9 in 2012, yielding a 46.1% rate reduction (95% CI 15.7-65.5%), which may be attributable to implementation of a multifaceted prevention strategy. In conclusion, short-term PN-CRB accounted for one-third of all episodes of CRB in our setting, and 14.5% of patients died within 30 days following bacteraemia. Our findings suggest that prompt catheter removal and adequate empirical antibiotic treatment could be protective factors for 30-day mortality. Concomitantly with implementation of a multifaceted prevention strategy, PN-CRB incidence was reduced by half.

Does Parenteral Nutrition Increase the Risk of Catheter‐Related Bloodstream Infection? A Systematic Literature Review

“…Twenty‐one full‐text articles were retrieved. Ten 23 – 32 were excluded as they did not meet the inclusion criteria (see Figure 1). Eleven studies were included in the analysis.…”

“…This supports the theory that the administration of PN alone may not inherently hold additional risk for the development of CRBSIs. Alonso‐Echanove et al 45 and Rodriguez‐Pardo et al 32 found that the distribution of pathogens was influenced by PN. Fungi and yeasts were isolated more frequently when PN was prescribed (16% vs 6%; P = .01).…”

Performance of differential time to positivity as a routine diagnostic test for catheter-related bloodstream infections: a single-centre experience

“…Therefore, experts agree that, as a general rule, the catheter should be removed whenever these microorganisms are involved, limiting attempts salvage the catheter to patients with selected difficult circumstances [1,2,10]. In the case of CoNS, although retaining the catheter is also associated with a higher incidence of persistent bacteraemia and relapse [24,25], removing an involved central venous catheter in patients without intravascular hardware is less compelling as the response rate to systemic antibiotics alone in adults is 80% [26] and the frequency of complications and attributable mortality is very low [27].…”

“…In catheter-bearing patients with bacteraemia without an obvious focus, pre-test probabilities of the catheter being the source of infection are probably high enough to consider the removal of the device in all cases. Prevalence of CRBSI in patients with S. aureus or enterococcal bacteraemia who carry a catheter or acquire the infection in the hospital is expected to be at least onethird [13,23,28] and figures not lower than 25% are also expected for Gram-negative bacilli, Candida and CoNS [21,24,25]. Therefore, a test allowing CRBSI to be ruled out with a high degree of confidence would be particularly valuable.…”