Management of home parenteral nutrition CLABSI
Introduction: Catheter-related blood stream infections (CRBSIs) remain the commonest complication associated with home parenteral nutrition (HPN). While the management outcomes of CRBSIs have been extensively reported by specialised intestinal failure (IF) centres, there are minimal data reporting CRBSI outcomes for HPN-dependent patients admitted to non-specialised hospitals.
Method: Observational study from a prospectively-maintained database of CRBSIs in HPN-dependent patients managed outside of a specialised IF centre.
Results: Three-hundred and six patients from a total cohort of 1066 HPN-dependent patients suffered from 489 CRBSI events from 2003-2021; after 2017, 71 of these events were managed at the patient’s local, non-specialised hospital and the remainder at the specialised IF centre. From 2017 to 2021, salvage of the central venous catheter (CVC) with antimicrobial therapy was attempted in 32/71 (45.1%) patients admitted to the non-specialised hospital, with successful salvage recorded in 23 (71.8%) cases. Notably, CVC salvage was attempted more commonly (77/103 (74.8%); p=0.004 vs. non-specialised hospital), with a better salvage success rate (64/77 (83.1%) p=0.01 vs. non-specialised hospital) in patients who were admitted to the specialised IF centre.
Conclusion: In some instances CRBSIs can be effectively managed when patients presenting to anon-specialised hospital, however overall salvage is more likely to be successful in the specialised setting. Further development of clinical and educational networks between IF centres and patients’ local hospitals aimed at standardising care may lead to improved CRBSI outcomes.
Bond A, Conley T, Teubner A, Taylor M, Abraham A, Romero Salazar F, Mallawaarachchi P, Lal S. Management of home parenteral nutrition catheter related blood stream infections in hospitals outside of a specialised intestinal failure centre. JPEN J Parenter Enteral Nutr. 2022 May 11. doi: 10.1002/jpen.2396. Epub ahead of print. PMID: 35543532.