title: Environmental Risk Factors for Developing Catheter-Related Bloodstream Infection in Home Parenteral Nutrition Patients: A 6-Year Follow-up Study.
abstract: Tunneled, cuffed, central venous catheters, including Hickman catheters and peripherally inserted central venous catheters (PICCs), are the most commonly used venous access for home parenteral nutrition (HPN) therapy. Catheter-related bloodstream infection is the most prevalent and severe complication. This study investigated whether environmental risk factors, including smoking, catheter management by a home care nurse, colectomy with stoma, number of infusion days per week, and C-reactive protein at catheter insertion day, influenced the time to first catheter-related bloodstream infection (CRBSI).
  
  
  
  In this 6-year (2008-2014) observational cohort study, adult patients with intestinal failure receiving HPN through either Hickman catheters or PICCs were included. Data were obtained by reviewing medical records, and the environmental risk factors were analyzed with the Cox proportional hazards model.
  
  
  
  A total of 295 catheters (Hickman catheters: n = 169 and PICCs: n = 126) inserted into 136 patients were registered. Using the PICCs, 1 additional infusion day per week showed to significantly decrease the time to first CRBSI by a factor of 2.47. Hickman catheters managed by a home care nurse had a significantly increased mean (SD) incidence of CRBSI of 1.45 (0.68) per 1000 catheter days. Hickman catheters not managed by a home care nurse had a mean (SD) incidence of 0.56 (0.24).
  
  
  
  Using the PICC, 1 additional infusion day per week decreased the time to first CRBSI, while having the Hickman catheter managed by a home care nurse increased the mean CRBSI incidence. No other risk factors were found.
authors: Department of Health Science and Technology, Aalborg University, Aalborg, Denmark laurafbech@hotmail.com.
authors: Laura Fuglsang
authors: LF
authors: Bech
authors: Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors: Lotte
authors: L
authors: Drustrup
authors: Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors: Louis
authors: L
authors: Nygaard
authors: Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors: Anders
authors: A
authors: Skallerup
authors: Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
authors: Line Dahlstrøm
authors: LD
authors: Christensen
authors: Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
authors: Lars
authors: L
authors: Vinter-Jensen
authors: Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
authors: Henrik Højgaard
authors: HH
authors: Rasmussen
authors: Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
authors: Mette
authors: M
authors: Holst
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D002097:C-Reactive Protein / Q000378:metabolism; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology; D002406:Catheterization, Peripheral / Q000009:adverse effects; D062905:Central Venous Catheters / Q000009:adverse effects / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002097:C-Reactive Protein
keywords: Hickman catheter; catheter-related bloodstream infection; catheter-related sepsis; central venous catheters; environmental risk factors; home parenteral nutrition; intestinal failure; peripherally inserted venous catheter