Catheter-related bloodstream infections in patients with intestinal failure receiving home parenteral support: risks related to a catheter-salvage strategy

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ABSTRACT

Background

In intestinal failure (IF) patients receiving home parenteral support (HPS), catheter-related bloodstream infections (CRBSIs) frequently result in replacement of their tunneled central venous catheters (CVCs), which may lead to future loss of central venous access.

Objective

This observational study investigated the consequences of a catheter-salvage strategy related to CRBSIs.

Design

All CRBSIs from 2002 to 2016 in the Copenhagen IF and microbiological databases were retrospectively analyzed. Catheter salvage was defined by successful antimicrobial therapy with a retained CVC at discharge. Re-occurrences of CRBSIs with the same microbial species and identical antibiogram were defined as a relapse (<30 d) or as a recurrent (30–100 d) infection. Cox regression analyses incorporated a frailty factor to account for recurrent events and overrepresentation by some patients. Cumulative incidence curves are presented with a competing risk model.

Results

There were 2006 tunneled CVCs inserted in 715 adult HPS patients covering 2014.3 CVC years, with a CRBSI incidence rate of 1.83/1000 (n = 1350) and a mortality rate of 0.007/1000 CVC days (n = 5). The mean ± SD salvage rate was 55.3% ± 5.5%, varying according to infection type [monoinfections (62.9% ± 4.4%) and polyinfections (58.6% ± 17.3%)] and causative microorganism [coagulase-negative Staphylococci (CoNS) (68.1% ± 9.4%), Staphylococcus aureus (42.6% ± 17.5%), and Enterobacteriaceae (54.3% ± 16.7%)]. The overall risk of CRBSI relapse was 7.5%, and the risk of CRBSI recurrence was 7.3%. The HR for a subsequent CRBSI was 14% lower in a replaced than in a retained CVC (95% CI: 0.74, 0.99). The HR for a new CRBSI after catheter salvage was 36% higher after polyinfections than after monoinfections (95% CI: 1.03, 1.79). Enterobacteriaceae entailed an increased risk of CRBSI recurrence compared with CoNS (2.26; 95% CI; 1.08, 4.75) and S. aureus (4.45; 95% CI: 1.28, 15.5).

Conclusions

High catheter-salvage rates related to CRBSIs were achievable and safe in HPS patients within a broad range of microorganisms but contributed to an increased risk of CRBSI relapse or recurrence.

Key Words

catheter-related bloodstream infections
central-line associated bloodstream infections
catheter salvage
intestinal failure
parenteral support
home parenteral nutrition
recurrent infections

Abbreviations

Co NS
coagulase-negative Staphylococci
CRBSI
catheter-related bloodstream infection
CRC
catheter-related complication
CVC
central venous catheter
GNB
gram-negative bacteremia
HPS
home parenteral support
IF
intestinal failure
MRSA
methicillin-resistant Staphylococcus aureus
MSSA
methicillin-sensitive Staphylococcus aureus

Cited by (0)

The authors reported no funding received for this study.

The Department of Medical Gastroenterology, University Hospital of Copenhagen Rigshospitalet, disclaims responsibility for any of the analyses, interpretations, or conclusions of this article.