Central venous catheter infections and antibiotic therapy during long-term home parenteral nutrition: an 11-year follow-up study.
BACKGROUND
Catheter-related bloodstream infections are a serious and common complication in patients receiving home parenteral nutrition (HPN).


METHODS
Prevalence of infections, type of agents, and effectiveness of antibiotic therapy were evaluated in 296 patients (133 males, 163 females; mean age 58.2 +/- 13.5 years) receiving HPN for at least 3 months, from January 1995 to December 2006. Patients underwent 99,969 (331 +/- 552; minimum 91, maximum 4353) days of catheterization, corresponding to 93,236 (311 +/- 489; minimum 52, maximum 4353) days of HPN.


RESULTS
Fifty-two patients (24 males and 28 females; 35 oncological and 17 nononcological) were diagnosed with 169 infections. The overall corresponding infection rate was 2.0 per 1000 days of catheterization, with a progressive, regular decrease with time. In 30 cases, immediate central venous catheter removal was necessary. Infections were eradicated in 103 of 139 (74%) cases. As to the most common causative agent, 86 (51%) infections were due to Staphylococcus epidermidis. Of these, 64 were treated from 1995 to 2004, 57 of them (89%) successfully; 22 were treated from 2005 onward, only 7 of them (32%) successfully.


CONCLUSIONS
Although the global infection rate has progressively decreased over the years, S epidermidis has shown an alarming increase in resistance to antibiotic treatment in the last 2 years, suggesting the need for strategies to prevent central venous catheter infection.
Santarpia
Lidia
L
Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy. nad2005@unina.it
Alfonsi
Lucia
L
Tiseo
Domenico
D
Creti
Roberta
R
Baldassarri
Lucilla
L
Pasanisi
Fabrizio
F
Contaldo
Franco
F
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D015995:Prevalence; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology; D013212:Staphylococcus epidermidis
D000900:Anti-Bacterial Agents