title: Epidemiology of bloodstream infections in patients receiving long-term total parenteral nutrition.
abstract: OBJECTIVE
  To describe the epidemiology and microbiologic characteristics of bloodstream infections (BSIs) in patients receiving long-term total parenteral nutrition (TPN).
  
  
  BACKGROUND
  Home TPN therapy has been reported as a risk factor for BSI. However, little knowledge exists regarding the epidemiology of BSIs in this patient group.
  
  
  METHODS
  A descriptive, observational epidemiologic study of patients receiving long-term TPN from January 1981 to July 2005 was performed. Variables analyzed include age, gender, time of follow-up, number of BSIs, microbiologic characteristics, underlying disease necessitating long-term TPN, catheter type, complications related to TPN, and clinical outcome.
  
  
  RESULTS
  Forty-seven patients receiving long-term TPN were evaluated. The most frequent indication for long-term TPN was ischemic bowel disease (25.5%). The mean duration of follow-up was 4.5 years. Thirty-eight patients (80.9%) developed 248 BSIs while receiving TPN. More than 1 BSI episode occurred in 78.9% of these patients, and 23.8% of BSI episodes were polymicrobial. The most prevalent pathogen was coagulase negative staphylococci (33.5%). The most frequent complication among patients with BSI was central venous thrombosis (44.7%). Five patients were intravenous drug users. There were 11 deaths among the patients on long-term TPN, 4 of these were related to infection and 4 were related to intravenous drug use.
  
  
  CONCLUSIONS
  The incidence of BSI is high, and a significant proportion of BSIs in long-term TPN patients are polymicrobial and due to multidrug-resistant bacteria and fungi. Careful management of the infusion line is required and interventions are needed to reduce the risk of catheter-related infections in this population.
authors.affiliation: Division of Infectious Diseases, Universidade Federal de São Paulo (UNIFESP-EPM)/Hospital São Paulo, Brazil.
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Marianne
authors.initials: M
authors.lastname: Opilla
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
authors.forename: Donald F
authors.initials: DF
authors.lastname: Kirby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016562:Parenteral Nutrition, Home Total / Q000009:adverse effects*; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000209:etiology; D013210:Staphylococcus / Q000302:isolation & purification; D015996:Survival Rate; D013997:Time Factors; D014768:Virginia / Q000453:epidemiology