title: Risk factors for the development of catheter-related bloodstream infections in patients receiving home parenteral nutrition.
abstract: BACKGROUND
  Risk factors for development of catheter-related bloodstream infections (CRBSI) were studied in 125 adults and 18 children who received home parenteral nutrition (HPN).
  
  
  METHODS
  Medical records from a national home care pharmacy were reviewed for all patients that had HPN infused at least twice weekly for a minimum of two years from January 1, 2006-December 31, 2011. Infection and risk factor data were collected during this time period on all patients although those patients who received HPN for a longer period had data collected since initiation of HPN.
  
  
  RESULTS
  In adults, 331 central venous catheters (CVCs) were placed. Total catheter years were 1157. Median CVC dwell time was 730 days. In children, there were 53 CVCs placed. Total catheter years were 113.1. Median CVC dwell time was 515 days. There were 147 CRBSIs (0.13/catheter year;0.35/1000 catheter days). In children there were 33 CRBSIs (0.29/catheter year;0.80/1000 days; P < .001 versus adults). In adults, univariate analysis showed use of subcutaneous infusion ports instead of tunneled catheters (P = .001), multiple lumen catheters (P = .001), increased frequency of lipid emulsion infusion (P = .001), obtaining blood from the CVC (P < 0.001), and infusion of non-PN medications via the CVC (P < .001) were significant risk factors for CRBSI. Increased PN frequency was associated with increased risk of CRBSI (P = .001) in children, but not in adults. Catheter disinfection with povidone-iodine was more effective than isopropyl alcohol alone. There were insufficient patients to evaluate chlorhexidine-containing regimens.
  
  
  CONCLUSIONS
  Numerous risk factors for CRBSI were identified for which simple and current countermeasures already exist.
authors.affiliation: Glencoe, Illinois a.buchman@hotmail.com.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Buchman
authors.affiliation: Nutrishare, Elk Grove, California.
authors.forename: Marianne
authors.initials: M
authors.lastname: Opilla
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Mary
authors.initials: M
authors.lastname: Kwasny
authors.affiliation: Nutrishare, Elk Grove, California.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Diamantidis
authors.affiliation: Nutrishare, Elk Grove, California.
authors.forename: Rodney
authors.initials: R
authors.lastname: Okamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000097:blood*; D055499:Catheter-Related Infections / Q000097:blood* / Q000175:diagnosis; D057785:Catheters / Q000382:microbiology; D062905:Central Venous Catheters / Q000009:adverse effects / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: catheter-related bloodstream infection; home nutrition support; nutrition support practice; outcomes research/quality; parenteral nutrition; sepsis; venous access