title: Central venous catheter infections in home parenteral nutrition patients: Outcomes from Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care.
abstract: Home parenteral nutrition (HPN) is a high-cost, complex nutrition support therapy that requires the use of central venous catheters. Central line-associated bloodstream infections (CLABSIs) are among the most serious risks of this therapy. Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care (Sustain registry) provides the most current and comprehensive data for studying CLABSI among a national cohort of HPN patients in the United States. This is the first Sustain registry report detailing longitudinal data on CLABSI among HPN patients.
  
  
  
  To describe CLABSI rates for HPN patients followed in the Sustain registry from 2011-2014.
  
  
  
  Descriptive, χ2, and t tests were used to analyze data from the Sustain registry.
  
  
  
  Of the 1,046 HPN patients from 29 sites across the United States, 112 (10.7%) experienced 194 CLABSI events during 223,493 days of HPN exposure, for an overall CLABSI rate of 0.87 episodes/1,000 parenteral nutrition-days. Although the majority of patients were female (59%), adult (87%), white (75%), and with private insurance or Medicare (69%), CLABSI episodes per 1,000 parenteral nutrition-days were higher for men (0.69 vs 0.38), children (1.17 vs 0.35), blacks (0.91 vs 0.41), and Medicaid recipients (1.0 vs 0.38 or 0.39). Patients with implanted ports or double-lumen catheters also had more CLABSIs than those with peripherally inserted or central catheters or single-lumen catheters. Staphylococci were the most commonly reported pathogens. These data support findings of smaller studies about CLABSI risk for children and by catheter type and identify new potential risk factors, including gender, race, and insurance type.
  
  
  
  Additional studies are needed to determine effective interventions that will reduce HPN-associated CLABSI.
authors.affiliation: American Society for Parenteral and Enteral Nutrition, Silver Spring, MD.
authors.forename: Vicki M
authors.initials: VM
authors.lastname: Ross
authors.affiliation: American Society for Parenteral and Enteral Nutrition, Silver Spring, MD. Electronic address: peggig@nutritioncare.org.
authors.forename: Peggi
authors.initials: P
authors.lastname: Guenter
authors.affiliation: American Society for Parenteral and Enteral Nutrition, Silver Spring, MD.
authors.forename: Mandy L
authors.initials: ML
authors.lastname: Corrigan
authors.affiliation: University of Michigan Home Care Services, University of Michigan, Ann Arbor, MI.
authors.forename: Debra
authors.initials: D
authors.lastname: Kovacevich
authors.affiliation: Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI.
authors.forename: Marion F
authors.initials: MF
authors.lastname: Winkler
authors.affiliation: Silver Spring, MD.
authors.forename: Helaine E
authors.initials: HE
authors.lastname: Resnick
authors.affiliation: Silver Spring, MD.
authors.forename: Tina L
authors.initials: TL
authors.lastname: Norris
authors.affiliation: Collierville, TN.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Robinson
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Ezra
authors.initials: E
authors.lastname: Steiger
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000453:epidemiology*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D015995:Prevalence; D018805:Sepsis / Q000453:epidemiology*; D012737:Sex Factors; D012958:Societies, Scientific; D014481:United States; D055815:Young Adult
keywords: CLABSI; Database