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"We investigated potential predictors of CLABSI to determine a predictive model in a cohort of adult HPN patients" Xue et al (2020).

Abstract:

PURPOSE: Central line-associated bloodstream infection (CLABSI) is a potentially life-threatening complication in home parenteral nutrition (HPN) patients. We investigated potential predictors of CLABSI to determine a predictive model in a cohort of adult HPN patients.

METHODS: Patients managed by the HPN service at the Hospital of University of Pennsylvania on 1/1/2018 were included and followed through 6/30/2019, using existing medical records to collect demographic and clinical data. CLABSI were adjudicated prospectively by infectious disease experts. Variables with p≤0.2 when comparing patients with CLABSI to those without were included in logistic regression models.

RESULTS: In the 114 patients, mean age was 54 ± 16 years, 68% was female and BMI was 25 ± 5.6. Median experience with HPN was 516 days (range 15-10,281) and 26% had history of CLABSI. The catheter types were PICC (72.6%), tunneled (23.9%), and implanted (3.5%). The incidence of CLABSI was 0.89/1000 catheter days. One multivariate model identified ostomy/wound (OR 22.0, 95%CI = 4.8-101.7), tunneled/implanted catheter (OR = 4.4; 95%CI = 1.4-13.9), and BMI < 18.5 (OR = 5.9; 95%CI = 1.4-24.2) as predictors of CLABSI. A second model identified patients with 2 potential predictors (OR 22.9, 95% CI = 5.6-93.5) and tunneled/implanted catheter (OR = 6.7; 95% = CI 2.1-21.8) at high risk of CLABSI.

CONCLUSION: In adult HPN patients, the presence of ostomy or wound, use of tunneled or implanted catheter, and low BMI were associated with CLABSI. Whether CLABSI rates might be reduced by more intense training (in wound or catheter care) especially for those with multiple predictors, different type of catheter, or malnutrition will require further study.

Reference:

Xue, Z., Coughlin, R., Amorosa, V., Quinn, R., Schiavone, P., Stoner, N., Kinosian, B. and Compher, C. (2020) Factors Associated with Central Line-Associated Bloodstream Infections in a Cohort of Adult Home Parenteral Nutrition Patients. JPEN. Journal of Parenteral and Enteral Nutrition. May 9th. doi: 10.1002/jpen.1876. (Epub ahead of print).