CLABSI and home parenteral nutrition
Abstract:
Background: The risk of blood stream infections may be increased in hospitalized patients receiving ready-made multi-chamber parenteral nutrition bags (MCB) compared to customized parenteral nutrition (PN); however, as highlighted in recent international guidelines, there are no comparable data relating to home PN (HPN).
Methods: Data from a prospectively maintained database were analysed to compare incidence rates of catheter-related blood stream infections (CRBSI) between patients receiving customized HPN compared to MCB HPN at a national UK referral centre between May 2018 and August 2020.
Results: Sixty patients with chronic intestinal failure were commenced on MCB and 45 on customized HPN for a total of 5914 and 7641 catheter days respectively. No difference in CRBSI incidence was found (0.51/1000 catheter days for MCB, 0.39/1000 catheter days for customized HPN; incidence rate ratio 1.29, 95% CI 0.26-6.37). Eighteen patients were switched from customized HPN to MCB HPN. The study period covered 7401 catheter days on customized HPN and 4834 days on MCB. No significant change was noted in the CRBSI rates following this switch (0.27/1000 catheter days on customized HPN versus 0.21/1000 catheter days on MCB; incidence rate ratio 1.31, 95% CI 0.12-14.3).
Conclusion: The use of MCB for HPN patients is not associated with an increased risk of CRBSI. This study will inform international guidelines and provide reassurance for the continued, safe use of MCB HPN.
Reference:
Crooks B, Harrison S, Millward G, Hall K, Taylor M, Farrer K, Abraham A, Teubner A, Lal S. Catheter-related infection rates in patients on customized home parenteral nutrition compared to multi-chamber bags. JPEN J Parenter Enteral Nutr. 2021 Jul 20. doi: 10.1002/jpen.2225. Epub ahead of print. PMID: 34287965.