title: Characterization of posthospital bloodstream infections in children requiring home parenteral nutrition.
abstract: BACKGROUND
  Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter-associated bloodstream infections (CA-BSI) are common in hospitalized patients receiving parenteral nutrition (PN), but data evaluating CA-BSI in children receiving HPN are limited.
  
  
  OBJECTIVE
  To determine the incidence and characteristics of CA-BSI in children receiving HPN.
  
  
  METHODS
  Medical records of 44 children receiving HPN during a 3-year period were reviewed. End points were CA-BSI during the initial 6 months after discharge. CA-BSI was defined as isolation of pathogens from blood requiring antimicrobial therapy.
  
  
  RESULTS
  The primary indication for HPN was short bowel syndrome (46%), and 59 BSI were documented during the initial 6 months of HPN in 29 (66%) children. Of CA-BSI, polymicrobial infections accounted for 52%; gram-positive, 29%; gram-negative, 17%; and fungal, 2%. CA-BSI incidence per 1000 catheter-days was highest during the first month posthospital discharge (72 episodes; 95% confidence interval [CI], 45.4-109.6). CA-BSI incidence density ratio for children receiving HPN for >90 days compared with those receiving HPN for <30 days was 2.2 (P < .05). Logistic regression revealed that Medicaid insurance and age <1 year were associated with increased risk for CA-BSI (odds ratio [OR], 4.4 [95% CI, 1.13-16.99] and 6.6 [1.50-28.49], respectively; P < .05).
  
  
  CONCLUSIONS
  The incidence of CA-BSI in children receiving HPN is highest during the first month posthospital discharge. Strategies to address care in the immediate posthospital discharge period may reduce the burden of infectious complications of HPN.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Aminu
authors.initials: A
authors.lastname: Mohammed
authors.forename: Frederick K
authors.initials: FK
authors.lastname: Grant
authors.forename: Vivian M
authors.initials: VM
authors.lastname: Zhao
authors.forename: Andi L
authors.initials: AL
authors.lastname: Shane
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Ziegler
authors.forename: Conrad R
authors.initials: CR
authors.lastname: Cole
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002675:Child, Preschool; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D016331:Parenteral Nutrition, Home; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology; D012778:Short Bowel Syndrome / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D015144:Southeastern United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose