Recurrent sepsis in home parenteral nutrition patients: an analysis of risk factors.
Septicemia is the major cause of morbidity in home parenteral nutrition patients, accounting for approximately 70% of rehospitalizations. To identify risk factors, the incidence of infection was examined in 41 current home parenteral nutrition patients, 30 with short-bowel syndrome (including 16 with inflammatory bowel disease and 11 with bowel infarction) and 11 with chronic obstructive disorders. Management, which was followed for a mean duration of 78.6 months (range, 1 to 15 1/2 years), was standardized by protocol. Ten patients never experienced infection during the average follow-up of 61 months (range, 14 to 174 months), whereas seven patients experienced frequent infections during the mean follow-up of 77 months (range, 24 to 180 months). Significant distinguishing features in the frequent-infection group were younger age (45 +/- 12 vs 66.9 +/- 14.3 years, p < .05), Crohn's disease (in five of seven vs zero of 10 subjects, p < .05), jejunostomies (in seven of seven vs one of 10 subjects, p < .0005), and central vein thrombosis (in five of seven vs zero of 10 subjects, p < .05). A greater proportion of the frequent-infection group had poor catheter-care technique and more were smokers. One hundred fifty septicemias were confirmed by blood culture, giving an average infection rate of one every 31 months, 52% caused by Gram-positive organisms (chiefly coagulase-negative staphylococci and Staphylococcus aureus), 30% caused by Gram-negative organisms, and 16% caused by fungus (chiefly Candida albicans).(ABSTRACT TRUNCATED AT 250 WORDS)
O'Keefe
S J
SJ
Division of Gastroenterology and Infectious Diseases, Mayo Clinic, Rochester, Minnesota.
Burnes
J U
JU
Thompson
R L
RL
D000293:Adolescent; D000328:Adult; D000368:Aged; D002177:Candidiasis; D002404:Catheterization / Q000009:adverse effects; D003424:Crohn Disease / Q000628:therapy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D012008:Recurrence; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology; D012778:Short Bowel Syndrome / Q000628:therapy; D013203:Staphylococcal Infections; D013997:Time Factors