title: Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: a systematic review.
abstract: OBJECTIVE
  Catheter-related infection (CRI) is the most common and serious complication for adult patients receiving home parenteral nutrition (HPN). Our aim is to provide epidemiological data on infection incidence, infecting pathogens and contributing risk factors.
  
  
  METHODS
  Four electronic databases (Embase, Medline, IPA, CINAHL) were screened for eligible studies published between 1970 and March 2012. Methodological quality was evaluated and terminology/definitions were re-categorized.
  
  
  RESULTS
  Thirty-nine studies were included. Extensive variability was observed in terminology/definitions as well as in expression of CRI rate. After correct interpretation of definitions, overall catheter-related bloodstream infection rate (CRBSI) ranged between 0.38 and 4.58 episodes/1000 catheter days (median 1.31). Gram-positive bacteria of human skin flora caused more than half of infections. An analysis of the reported risk factors showed that the origin of a CRBSI is often multifactorial. The risk factors were related to the patient, the venous access device, the education, HPN therapy and follow-up.
  
  
  CONCLUSIONS
  This review on CRI in adult HPN patients revealed that included studies are of low quality and used poorly described risk factors and different definitions. The human skin flora caused most of infections; therefore, hand hygiene and training remain essential.
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, Research Centre for Clinical Pharmacy, University Hospitals Leuven, Leuven, Belgium. mira.dreesen@uzleuven.be
authors.forename: Mira
authors.initials: M
authors.lastname: Dreesen
authors.forename: Veerle
authors.initials: V
authors.lastname: Foulon
authors.forename: Isabel
authors.initials: I
authors.lastname: Spriet
authors.forename: Godelieve Alice
authors.initials: GA
authors.lastname: Goossens
authors.forename: Martin
authors.initials: M
authors.lastname: Hiele
authors.forename: Lutgart
authors.initials: L
authors.lastname: De Pourcq
authors.forename: Ludo
authors.initials: L
authors.lastname: Willems
mesh_terms: D000328:Adult; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D006801:Humans; D015994:Incidence; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D012307:Risk Factors; D012867:Skin / Q000382:microbiology