title: Catheter-related infections associated with home parenteral nutrition and predictive factors for the need for catheter removal in their treatment.
abstract: The inpatient and outpatient records were reviewed for 527 patients, including 138 children, who were discharged on home total parenteral nutrition and followed by the University of California, Los Angeles, home total parenteral nutrition service for a minimum of 1 week between April 1973 and October 1991. The total follow-up time was 1154 patient years; the median follow-up time was 206 days (range 7 to 6344 days). Thirty-six patients were followed for more than 10 years (median 12.7 years). Three hundred fifteen adults (but only four children) were never infected. A total of 427 catheter-related infections occurred, giving an overall infection rate of 0.37 per patient year (0.51 per patient year in children and 0.28 per patient year in patients followed for more than 10 years). Seventy percent of the infections overall were sepsis (0.26 per patient year); of those, 17% were exit site (0.06 per patient year), and 2% were tunnel (0.01 per patient year) infections. In children, 67% of the infections were sepsis (0.37 per patient year) and 24% were exit site (0.13 per patient year). Fifty-four different organisms were responsible, and 12% of the infections were polymicrobial in origin. Sixty percent of sepsis in all patients was caused by Gram-negative organisms (44% of the catheters were removed). Forty-three percent of sepsis in children was caused by Gram-negative organisms. Twenty-six percent of sepsis in all patients was caused by Gram-positive organisms (40% of the catheters were removed). Thirty-six percent of sepsis in children was caused by Gram-positive organisms.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Section of Gastroenterology, Baylor College of Medicine, Houston, Texas 77030.
authors.forename: A L
authors.initials: AL
authors.lastname: Buchman
authors.forename: A
authors.initials: A
authors.lastname: Moukarzel
authors.forename: B
authors.initials: B
authors.lastname: Goodson
authors.forename: F
authors.initials: F
authors.lastname: Herzog
authors.forename: P
authors.initials: P
authors.lastname: Pollack
authors.forename: L
authors.initials: L
authors.lastname: Reyen
authors.forename: M
authors.initials: M
authors.lastname: Alvarez
authors.forename: M E
authors.initials: ME
authors.lastname: Ament
authors.forename: J
authors.initials: J
authors.lastname: Gornbein
mesh_terms: D002177:Candidiasis / Q000209:etiology; D002404:Catheterization / Q000009:adverse effects*; D004927:Escherichia coli Infections / Q000209:etiology; D006801:Humans; D007239:Infections / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D007710:Klebsiella Infections / Q000209:etiology; D016562:Parenteral Nutrition, Home Total / Q000009:adverse effects*; D018805:Sepsis / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000209:etiology