title: Catheter Salvage After Catheter-Related Bloodstream Infection During Home Parenteral Nutrition.
abstract: Catheter-related bloodstream infection (CRBSI) is a common complication in patients receiving home parenteral nutrition (HPN). Data regarding catheter salvage after a CRBSI episode are limited. We aimed to determine the incidence of CRBSI and rates of catheter salvage in adult patients receiving HPN.
  
  
  
  We retrospectively searched our prospectively maintained HPN database for the records of all adult patients receiving HPN from January 1, 1990, to December 31, 2013, at our tertiary referral center. Data abstracted from the medical records included demographics, diseases, treatments, and outcomes. The incidence of CRBSI and rates of catheter salvage were determined.
  
  
  
  Of 1040 patients identified, 620 (59.6%) were men. The median total duration on HPN was 124.5 days (interquartile range, 49.0-345.5 days). Mean (SD) age at HPN initiation was 53.3 (15.3) years. During the study period, 465 CRBSIs developed in 187 patients (18%). The rate of CRBSI was 0.64/1000 catheter days. Overall, 70% of catheters were salvaged (retained despite CRBSI) during the study period: 78% of infections with coagulase-negative staphylococci, 87% with methicillin-sensitive Staphylococcus aureus, and 27% with methicillin-resistant S aureus. The percentage of catheters salvaged was 63% from 1990 to 1994, 63% from 1995 to 1999, 61% from 2000 to 2004, 72% from 2005 to 2009, and 76% from 2010 to 2013.
  
  
  
  Catheter salvage is possible after a CRBSI episode. Since most episodes of CRBSI are caused by skin commensals, effective treatment without removal of the central venous catheter is possible in most cases.
authors.affiliation: 1 Division of General Internal Medicine.|2 Second Department of Internal Medicine, Charles University Faculty of Medicine, Hradec Kralove, Czech Republic.
authors.forename: Jithinraj
authors.initials: J
authors.lastname: Edakkanambeth Varayil
authors.affiliation: 1 Division of General Internal Medicine.|3 Division of Infectious Diseases.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Whitaker
authors.affiliation: 1 Division of General Internal Medicine.
authors.forename: Akiko
authors.initials: A
authors.lastname: Okano
authors.affiliation: 1 Division of General Internal Medicine.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Carnell
authors.affiliation: 1 Division of General Internal Medicine.
authors.forename: Jacob B
authors.initials: JB
authors.lastname: Davidson
authors.affiliation: 3 Division of Infectious Diseases.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Enzler
authors.affiliation: 4 Division of Gastroenterology and Hepatology.
authors.forename: Darlene G
authors.initials: DG
authors.lastname: Kelly
authors.affiliation: 5 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Manpreet S
authors.initials: MS
authors.lastname: Mundi
authors.affiliation: 1 Division of General Internal Medicine.|4 Division of Gastroenterology and Hepatology.|5 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.|6 Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Kentucky, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Hurt
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000453:epidemiology*; D002175:Candida / Q000302:isolation & purification; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D062905:Central Venous Catheters / Q000009:adverse effects / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D016331:Parenteral Nutrition, Home; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D062606:Tertiary Care Centers
keywords: catheter salvage; catheter-related bloodstream infection; coagulase-negative staphylococci; home parenteral nutrition