title: Central venous catheter related bloodstream infections in adult patients on home parenteral nutrition: Prevalence, predictive factors, therapeutic outcome.
abstract: The prevalence of central venous catheter (CVC)-related blood-stream infections (CRBSI), infecting agents and the effectiveness of antibiotic therapy were evaluated in 172 adult patients on Home Parenteral Nutrition (HPN) at the Clinical Nutrition Outpatient Unit of Federico II University Hospital in Naples, Italy.
  
  
  
  The study population consisted of 127 oncological (74%) and 45 (26%) non-oncological patients, for a total of 53,818 (median 104; range 14-1080) CVC days.
  
  
  
  Ninety-four CRBSIs were diagnosed on 238 CVC (infection rate 1.74/1000 CVC days). Coagulase negative (CoNs) Staphylococci were the most frequently infecting agents (52.8% as single agent) with 17.1% Staphylococcus epidermidis infections. Eighty-three percent S. epidermidis were beta-lattamase producer (BLACT), 66.6% methicillin-resistant (MR) and 55.5% had a MIC for Vancomicin ≥1. Gram-negative bacteria represented 18.6% infections, fungi 7.1%, finally 15% infections were polymicrobial. Previous catheterizations and the presence of an enterocutaneous stoma were significantly related with a higher infection risk (p < 0.0001 in both cases).
  
  
  
  CRBSI and antibiotic resistance of infecting agents remain an important challenge in adult patients on HPN; an active research on strategies to counteract the phenomena is required.
authors.affiliation: Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. Electronic address: lidia.santarpia@unina.it.
authors.forename: Lidia
authors.initials: L
authors.lastname: Santarpia
authors.affiliation: Infectious Disease Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Buonomo
authors.affiliation: Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Pagano
authors.affiliation: Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Alfonsi
authors.affiliation: Infectious Disease Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Foggia
authors.affiliation: Department of Cardiac Surgery, Federico II University, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Mottola
authors.affiliation: Intensive Care Unit, Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Federico II University, Naples, Italy.
authors.forename: Geremia Zito
authors.initials: GZ
authors.lastname: Marinosci
authors.affiliation: Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Contaldo
authors.affiliation: Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Pasanisi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D055499:Catheter-Related Infections / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D062905:Central Venous Catheters / Q000009:adverse effects / Q000382:microbiology*; D003141:Communicable Diseases / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; Catheter related blood-stream infections; Central venous catheters; Home parenteral nutrition