Epidemiology and risk factors for bloodstream infections in a home parenteral nutrition program.
BACKGROUND
An increasing number of patients with intestinal failure are receiving home parenteral nutrition (HPN). Associated complications include bloodstream infections (BSIs), but data on rates and risk factors for HPN-related BSIs are scarce.


METHODS
A retrospective review was conducted of patients enrolled in the regional HPN program between 2001 and 2008. Demographic information and data on indication for HPN, duration of PN therapy, type and date of insertion of central venous access device, and blood culture results were recorded.


RESULTS
In total, 155 patients (165 courses of HPN) were included for a total of 45,876 catheter days. The mean patient age was 49 years, and 105 (64%) patients were female. A total of 105 organisms were cultured from 93 distinct episodes of BSIs. The rate of BSI was found to be 2.0 per 1000 catheter days, but excluding BSIs with a single positive culture of coagulase-negative staphylococcus and diphtheroid bacilli, the rate of infection was 1.4 per 1000 catheter days. Male sex and underlying malignancy were significant predictors of BSI, with hazard ratios of 1.69 (95% confidence interval [CI], 1.14-2.60; P = .009) and 2.38 (95% CI, 1.53-3.50; P < .001).


CONCLUSIONS
In a large heterogeneous group of HPN patients, the BSI rate ranged between 1.4 and 2.0 infections per 1000 catheter days. Isolated organisms were similar to those found in hospitalized patients. Male sex and underlying malignancy were significant risk factors for BSI. These high-risk patients are likely to benefit from interventions aimed at reducing BSIs.
Gastroenterology and Clinician Investigator Programs, McMaster University Medical Centre, Hamilton, Ontario, Canada sam.elfassy@medportal.ca.
Sam
S
Elfassy
Gastroenterology Program, McMaster University Medical Centre, Hamilton, Ontario, Canada.
Zain
Z
Kassam
Internal Medicine Program, McMaster University Medical Centre, Hamilton, Ontario, Canada.
Faizan
F
Amin
Division of Gastroenterology, McMaster University Medical Centre, Hamilton, Ontario, Canada.
Khurram J
KJ
Khan
Division of Infectious Diseases, Department of Medicine, McMaster University Medical Centre, Hamilton, Ontario, Canada.
Shariq
S
Haider
Division of Gastroenterology, McMaster University Medical Centre, Hamilton, Ontario, Canada.
David
D
Armstrong
D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000097:blood*; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology*; D003352:Corynebacterium / Q000302:isolation & purification; D003354:Corynebacterium Infections / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D012737:Sex Factors; D013203:Staphylococcal Infections / Q000453:epidemiology; D013210:Staphylococcus / Q000302:isolation & purification; D013997:Time Factors
adult; bloodstream infections; enteral nutrition; home nutrition support