title: Impact of prompt catheter withdrawal and adequate antimicrobial therapy on the prognosis of hospital-acquired parenteral nutrition catheter-related bacteraemia.
abstract: Catheter-related bacteraemia (CRB) is a cause of death in hospitalized patients, and parenteral nutrition (PN) is a risk factor. We aim to describe the prognosis of PN-CRB and the impact of catheter extraction within 48 h from bacteraemia. All consecutive hospitalized adult patients with CRB (2007-2012) were prospectively enrolled. Factors associated with 30-day mortality were determined by logistic regression analysis. Among 847 episodes of CRB identified, 291 (34%) episodes were associated with short-term catheter use for PN. Cure was achieved in 236 (81%) episodes, 42 (14.5%) patients died within the first 30 days, 7 (2.5%) relapsed, and 6 (2%) had re-infection. On multivariate analysis, previous immunosuppressive therapy (OR 5.62; 95% CI 1.69-18.68; p 0.0048) and patient age (OR 1.05; 95% CI 1.02-1.07; p 0.0009) were predictors of 30-day mortality, whereas catheter removal within 48 h of bacteraemia onset (OR 0.26; 95% CI 0.12-0.58; p 0.0010) and adequate empirical antibiotic treatment (OR 0.36; 95% CI 0.17-0.77; p 0.0081) were protective factors. Incidence of PN-CRB decreased from 5.36 episodes/1000 days of PN in 2007 to 2.9 in 2012, yielding a 46.1% rate reduction (95% CI 15.7-65.5%), which may be attributable to implementation of a multifaceted prevention strategy. In conclusion, short-term PN-CRB accounted for one-third of all episodes of CRB in our setting, and 14.5% of patients died within 30 days following bacteraemia. Our findings suggest that prompt catheter removal and adequate empirical antibiotic treatment could be protective factors for 30-day mortality. Concomitantly with implementation of a multifaceted prevention strategy, PN-CRB incidence was reduced by half.
authors.affiliation: Infectious Diseases Division, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Rodríguez-Pardo
authors.forename: B
authors.initials: B
authors.lastname: Almirante
authors.forename: N
authors.initials: N
authors.lastname: Fernández-Hidalgo
authors.forename: C
authors.initials: C
authors.lastname: Pigrau
authors.forename: C
authors.initials: C
authors.lastname: Ferrer
authors.forename: A M
authors.initials: AM
authors.lastname: Planes
authors.forename: R
authors.initials: R
authors.lastname: Alcaraz
authors.forename: R
authors.initials: R
authors.lastname: Burgos
authors.forename: A
authors.initials: A
authors.lastname: Pahissa
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000401:mortality / Q000473:pathology*; D055499:Catheter-Related Infections / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D003428:Cross Infection / Q000401:mortality / Q000473:pathology*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D000900:Anti-Bacterial Agents
keywords: Catheter-related bacteraemia; epidemiology; outcome; parenteral nutrition; prevention