title: Spinal Infections Among Patients With Long-Term Central Venous Catheters for Home Parenteral Nutrition.
abstract: Spinal infections are a rare yet serious metastatic complication of bacteremia among patients with long-term central venous catheters (CVCs) for which clinicians must remain vigilant. We performed a retrospective review of all cases of spinal infection occurring in the context of a CVC for long-term parenteral nutrition (PN) managed in our department between January 2010 and October 2013, a cohort of 310 patients over this time period. Six patients were identified (mean age, 65 years; 5 male). One hundred percent of patients presented with spinal pain (5/6 cervical, 1/6 thoracic). Organisms were cultured from the CVC in 5 of 6 patients. In all cases, the white blood cell count was normal, and in 5 of 6, C-reactive protein was normal. All diagnoses were confirmed on magnetic resonance imaging (MRI), and in 3 of 6 cases, an MRI was repeated (on the advice of neurosurgical colleagues) to confirm resolution of changes after a period of antimicrobial therapy. There was no clear correlation between duration of PN or number of days following CVC insertion and onset of infection. The CVC was replaced in 4 of 6 patients at the time of diagnosis, delayed removal in 1 of 6, and salvaged in the remaining case. Although rare, a high index of suspicion is needed in patients receiving long-term PN who present with spinal pain. Peripheral inflammatory markers may not be elevated. MRI should be performed and patients should be treated with antibiotics alongside involvement of local microbiology and neurosurgical teams. Multidisciplinary discussion on CVC salvage in these cases is important, especially in cases of challenging vascular anatomy.
authors.affiliation: 1 Lennard Jones Intestinal Failure Unit, St Mark's Hospital, London North West Healthcare NHS Trust, Harrow, London, UK.
authors.forename: Rabia
authors.initials: R
authors.lastname: Topan
authors.affiliation: 1 Lennard Jones Intestinal Failure Unit, St Mark's Hospital, London North West Healthcare NHS Trust, Harrow, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Ambrose
authors.affiliation: 1 Lennard Jones Intestinal Failure Unit, St Mark's Hospital, London North West Healthcare NHS Trust, Harrow, London, UK.
authors.forename: Mia
authors.initials: M
authors.lastname: Small
authors.affiliation: 1 Lennard Jones Intestinal Failure Unit, St Mark's Hospital, London North West Healthcare NHS Trust, Harrow, London, UK.
authors.forename: Elewys
authors.initials: E
authors.lastname: Lightman
authors.affiliation: 1 Lennard Jones Intestinal Failure Unit, St Mark's Hospital, London North West Healthcare NHS Trust, Harrow, London, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Nightingale
authors.affiliation: 1 Lennard Jones Intestinal Failure Unit, St Mark's Hospital, London North West Healthcare NHS Trust, Harrow, London, UK.
authors.forename: Simon M
authors.initials: SM
authors.lastname: Gabe
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001416:Back Pain / Q000209:etiology* / Q000517:prevention & control; D016470:Bacteremia / Q000097:blood / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D055499:Catheter-Related Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008131:London; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D012189:Retrospective Studies; D013131:Spine / Q000000981:diagnostic imaging / Q000382:microbiology; D013166:Spondylitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents
keywords: home parenteral nutrition; infection; parenteral nutrition; venous access devices