Implication of a distant septic focus in parenteral nutrition catheter colonization.
During a 4-year period, 244 surgical patients receiving total parenteral nutrition (TPN) were studied with emphasis on the relationship between TPN catheter colonization and a preexisting distant septic focus (DSF). A colonized catheter was defined as a catheter with a positive semiquantitative culture of the catheter tip (greater than or equal to 15 colonies on the plate). Catheter-related sepsis (CRS) was defined as a catheter with either the same organisms cultured from the catheter tip and from blood or with defervescence following catheter removal. Two hundred sixty-nine catheters were inserted for TPN for a total of 4433 patient days, with a mean length of stay of 16.5 days. Forty-two of the 269 catheters (15.6%) were colonized and more than half (57.1%) of the organisms cultured were Gram-negative bacilli or enterococci. Nineteen of the 42 colonized catheters were associated with CRS with a CRS rate of 7.1% among the 269 catheters. A DSF was present in 165 of the 244 patients or in 188 of the 269 catheters (69.9%). The colonization rate of 19.1% (36/188) in those catheters with DSF was significantly higher than that of 7.4% (6/81) in those without DSF (p less than 0.05). Those patients with DSF or with a colonized catheter were associated with a high mortality (p less than 0.001). Sepsis was responsible for 33 of the 48 patients (68.8%) who died. The data stress the important contribution of DSF to the colonization of TPN catheters and to the mortality of these critically ill surgical patients.
Chuang
J H
JH
Nutrition Support Service Team, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Chuang
S F
SF
D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D004755:Enterobacteriaceae / Q000302:isolation & purification; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006801:Humans; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D018805:Sepsis / Q000382:microbiology* / Q000401:mortality; D014552:Urinary Tract Infections / Q000382:microbiology