Prevention of Subsequent Catheter-Related Bloodstream Infection Using Catheter Locks in High-Risk Patients Receiving Home Parenteral Nutrition.
Catheter-related bloodstream infection (CRBSI) is a serious complication in patients receiving home parenteral nutrition (HPN). Antibiotic lock therapy (ALT) and ethanol lock therapy (ELT) can be used to prevent CRBSI episodes in high-risk patients.



Following institutional review board approval, all patients enrolled in the Mayo Clinic HPN program from January 1, 2006, to December 31, 2013, with catheter locking were eligible to be included. Patients without research authorization and <18 years old at the initiation of HPN were excluded. Total number of infections before and after ALT or ELT were estimated in all patients.



A total of 63 patients were enrolled during the study period. Of 59 eligible patients, 29 (49%) were female, and 30 (51%) were male. The median duration of HPN was 3.66 (interquartile range, 0.75-8.19) years. The mean age ± SD at initiation of HPN was 49.89 ± 14.07 years. A total of 51 patients were instilled with ALT, and 8 patients were instilled with ELT during their course of HPN. A total of 313 CRBSI episodes occurred in these patients, 264 before locking and 49 after locking ( P < .001). Rate of infection per 1000 catheter days was 10.97 ± 25.92 before locking and 1.09 ± 2.53 after locking ( P < .001).



The major findings of the present study reveal that ALT or ELT can reduce the overall rate of infections per 1000 catheter days. ALT or ELT can be used in appropriate clinical setting for patients receiving HPN.
1 Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Jacob B
JB
Davidson
1 Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.|2 Department of Family and Community Medicine, University of Illinois College of Medicine at Rockford, Rockford, Illinois.
Jithinraj
J
Edakkanambeth Varayil
1 Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Akiko
A
Okano
3 Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota.
Jennifer A
JA
Whitaker
1 Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Sara L
SL
Bonnes
4 Emeritus Member, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Darlene G
DG
Kelly
5 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota.
Manpreet S
MS
Mundi
1 Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.|5 Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota.|6 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.|7 Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Kentucky.
Ryan T
RT
Hurt
D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000097:blood / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000097:blood / Q000382:microbiology / Q000517:prevention & control*; D000431:Ethanol / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000295:instrumentation*; D011446:Prospective Studies; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D000431:Ethanol
adult; home nutrition support; long-term care; parenteral nutrition; sepsis