title: Central Venous Catheter Salvage in Home Parenteral Nutrition Catheter-Related Bloodstream Infections: Long-Term Safety and Efficacy Data.
abstract: Catheter-related bloodstream infections (CRBSIs) are a serious complication in the provision of home parenteral nutrition (HPN). Antibiotic salvage of central venous catheters (CVCs) in CRBSI is recommended; however, this is based on limited reports. We assessed the efficacy of antibiotic salvage of CRBSIs in HPN patients.
  
  
  
  All confirmed CRBSIs occurring in patients receiving HPN in a national intestinal failure unit (IFU), between 1993 and 2011, were analyzed. A standardized protocol involving antibiotic and urokinase CVC locks and systemic antibiotics was used.
  
  
  
  In total, 588 patients were identified with a total of 2134 HPN years, and 297 CRBSIs occurred in 137 patients (65 single and 72 multiple CRBSIs). The overall rate of CRBSI in all patients was 0.38 per 1000 catheter days. Most (87.9%) infections were attributable to a single microorganism. In total, 72.5% (180/248) of CRBSIs were salvaged when attempted (coagulase-negative staphylococcus, 79.8% [103/129], Staphylococcus aureus, 56.7% [17/30]; polymicrobial infections, 67.7% [21/30]; and miscellaneous, 66.1% [39/59]). CVC salvage was not attempted in 49 episodes because of life-threatening sepsis (n = 18), fungal infection (n = 7), catheter problems (n = 20), and CVC tunnel infection (n = 4). Overall, the CVC was removed in 33.7% (100/297) of cases. There were 5 deaths in patients admitted to the IFU for management of the CRBSI (2 severe sepsis at presentation, 3 metastatic infection).
  
  
  
  This is the largest reported series of catheter salvage in CRBSIs and demonstrates successful catheter salvage in most cases when using a standardized protocol.
authors.affiliation: Intestinal Failure Unit martyn.dibb@nhs.net.
authors.forename: Martyn J
authors.initials: MJ
authors.lastname: Dibb
authors.affiliation: Intestinal Failure Unit.
authors.forename: Arun
authors.initials: A
authors.lastname: Abraham
authors.affiliation: Microbiology Department, Salford Royal NHS Foundation Trust, Salford, England.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Chadwick
authors.affiliation: Intestinal Failure Unit.
authors.forename: Jon L
authors.initials: JL
authors.lastname: Shaffer
authors.affiliation: Intestinal Failure Unit.
authors.forename: Antje
authors.initials: A
authors.lastname: Teubner
authors.affiliation: Intestinal Failure Unit.
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Carlson
authors.affiliation: Intestinal Failure Unit.
authors.forename: Simon
authors.initials: S
authors.lastname: Lal
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000295:instrumentation; D062905:Central Venous Catheters; D006801:Humans; D016331:Parenteral Nutrition, Home; D013203:Staphylococcal Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: nutrition; nutrition support practice; nutrition support teams; outcomes research/quality; parenteral nutrition; research and diseases; sepsis; venous access