Abstract:
Background: Treatment of adolescent eating disorder requires early improvement of nutritional status. Central venous hyperalimentation is used, but catheter-related bloodstream infection (CRBSI) is a complication. There have been no reports examining risk factors for CRSBI in eating disorders.
Methods: The subjects were 51 patients who received nutritional therapy with use of a peripherally inserted central catheter (PICC) from January 2012 to December 2019. The courses of weight and white blood cell (WBC) count were examined retrospectively during nutritional therapy. Onset factors for CRBSI were determined and a case-series of CRBSI caused by Candida parapsilosis is presented.
Results: The day of minimum weight occurred on or before day 7 in 37 of the 51 patients, and this day was preceded by the day with the lowest WBC at a significant rate. The minimum weight day was significantly delayed in CRSBI cases compared to non-CRBSI cases (P=0.02). In the case-series of CRBSI caused by Candida parapsilosis, the median WBC count before CRBSI decreased to 2,570 (1,680-3,270) /µL at a median of day (12-90) 36. CRBSI developed at a median of day (26-133) 38. The PICC was immediately removed and an antifungal drug was started, leading to cure with no aftereffects in all subjects.
Conclusion: In patients with eating disorder treated with nutritional therapy using a PICC, prolonged resistance to weight gain became a risk factor for developing CRBSI. WBC counts recover after weight gain, which suggests that there is a risk of developing CRBSI, even with improved appetite and weight gain.
Reference:
Tamura A, Minami K, Tsuda Y, Mizumoto K, Suzuki H. Adolescent eating disorder with catheter-related bloodstream infection. Pediatr Int. 2020 Oct 14. doi: 10.1111/ped.14511. Epub ahead of print. PMID: 33053266.