Year: 2024
Type: article
Abstract: Background and Aim:A central line-associated bloodstream infection (CLABSI) is a common and potentially life-threatening complication for patients with intestinal failure (IF) receiving home parenteral nutrition (HPN).In uncomplicated infections, The European Society for Clinical Nutrition and Metabolism guidelines advocate for central venous access (CVC) salvage for venous access preservation.Existing knowledge regarding the risk factors of HPN-related CLABSIs have been extrapolated from European and North American studies, and the effects of tropical climates and its potentially higher support requirements on the incidence of infection has not yet been studied.We sought to analyse the risk factors of developing HPN-related CLABSI, and assess CLABSI management, in a large Australian state with a highly dispersed population.Methods: A retrospective observational cohort study was conducted on 34 adult patients receiving HPN via a CVC at a Queensland tertiary referral centre, between 2016 and 2023.Patient charts were reviewed, and a univariate cox regression analysis model was used to identify predictors of CLABSI in the first CVC.Kaplan-Meier analysis was employed to build survival curves of time to CLABSI, and log-rank tests analysed survival between characteristics.Results: Nineteen patients had ≥1 CLABSI(s), accounting for a total of 39 episodes.Patients with ≥1 CLABSI(s) used regular opioids more than those who did not develop CLABSI (p=0.016).Fourteen patients (41%, n=14/34) developed a CLABSI in their first CVC.No patient or line characteristics, including tropical climate, were found to be predictive of CLABSI in their first CVC.The overall infection rate was 1.02 per 1000 catheter days.Most CLABSIs were caused by Enterobacterales (22%, n=12/55), followed by coagulase-negative Staphylococcus (18%, n=10/ 55).Administration of empiric antimicrobials within the standardised 3-hour sepsis timeframe was inadequate (50%, n=14/28), with only 25% (n=7/28) providing adequate cover of causative pathogens.The median time to effective antibiotic therapy was 22.7 hours (IQR 4.8-29.8).There were 3 CVC salvages (8%, n=3/39), all of which were successful.Conclusion: In this cohort of patients, regular opioid use was associated with an increased risk of developing CLABSI which is consistent with international studies.We also found a low CVC salvage rate in our cohort, representing potential missed opportunities for venous access preservation.Based on our findings, an empiric antimicrobial regime of vancomycin, cefepime and caspofungin for all HPN-related CLABSI cases would be expected to be effective for 84.6%.We recommend that Australian IF units with a similar antimicrobial distribution and resistance pattern adopt this regime.
DOI: 10.1111/jgh.16706
Language: English
Subfield: Emergency Medical Services
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4402514564