Hospital-acquired parenteral nutrition catheter-related bacteraemia

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“We aim to describe the prognosis of PN-CRB and the impact of catheter extraction within 48h from bacteraemia.” Rodríguez-Pardo et al (2014).

Reference:

Rodríguez-Pardo, D., Almirante, B., Fernández-Hidalgo, N., Pigrau, C., Ferrer, C., Planes, A.M., Alcaraz, R., Burgos, R. and Pahissa, A. (2014) Impact of Prompt Catheter Withdrawal and Adequate Antimicrobial Therapy on the Prognosis of Hospital-Acquired Parenteral Nutrition Catheter-Related Bacteraemia. Clinical Microbiology and Infection. June 2nd. [epub ahead of print].

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 48h 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 CRBs 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 reinfection. On multivariate analysis, prior 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 48h 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. PN-CRB incidence 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 CRBs 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 to implementation of a multifaceted prevention strategy, PN-CRB incidence was reduced by half.

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