Marra Alexandre R, Opilla Marianne, Edmond Michael B, Kirby Donald F
Division of Infectious Diseases, Universidade Federal de São Paulo (UNIFESP-EPM)/Hospital São Paulo, Brazil.
J Clin Gastroenterol. 2007 Jan;41(1):19-28. doi: 10.1097/01.mcg.0000212606.13348.f7.
To describe the epidemiology and microbiologic characteristics of bloodstream infections (BSIs) in patients receiving long-term total parenteral nutrition (TPN).
Home TPN therapy has been reported as a risk factor for BSI. However, little knowledge exists regarding the epidemiology of BSIs in this patient group.
A descriptive, observational epidemiologic study of patients receiving long-term TPN from January 1981 to July 2005 was performed. Variables analyzed include age, gender, time of follow-up, number of BSIs, microbiologic characteristics, underlying disease necessitating long-term TPN, catheter type, complications related to TPN, and clinical outcome.
Forty-seven patients receiving long-term TPN were evaluated. The most frequent indication for long-term TPN was ischemic bowel disease (25.5%). The mean duration of follow-up was 4.5 years. Thirty-eight patients (80.9%) developed 248 BSIs while receiving TPN. More than 1 BSI episode occurred in 78.9% of these patients, and 23.8% of BSI episodes were polymicrobial. The most prevalent pathogen was coagulase negative staphylococci (33.5%). The most frequent complication among patients with BSI was central venous thrombosis (44.7%). Five patients were intravenous drug users. There were 11 deaths among the patients on long-term TPN, 4 of these were related to infection and 4 were related to intravenous drug use.
The incidence of BSI is high, and a significant proportion of BSIs in long-term TPN patients are polymicrobial and due to multidrug-resistant bacteria and fungi. Careful management of the infusion line is required and interventions are needed to reduce the risk of catheter-related infections in this population.
描述接受长期全胃肠外营养（TPN）患者血流感染（BSI）的流行病学及微生物学特征。
家庭TPN治疗已被报道为BSI的一个危险因素。然而，关于该患者群体中BSI的流行病学情况知之甚少。
对1981年1月至2005年7月接受长期TPN治疗的患者进行了一项描述性观察性流行病学研究。分析的变量包括年龄、性别、随访时间、BSI次数、微生物学特征、需要长期TPN的基础疾病、导管类型、与TPN相关的并发症以及临床结局。
对47例接受长期TPN治疗的患者进行了评估。长期TPN最常见的指征是缺血性肠病（25.5%）。平均随访时间为4.5年。38例患者（80.9%）在接受TPN治疗期间发生了248次BSI。这些患者中78.9%发生了不止1次BSI发作，23.8%的BSI发作是多微生物感染。最常见的病原体是凝固酶阴性葡萄球菌（33.5%）。BSI患者中最常见的并发症是中心静脉血栓形成（44.7%）。5例患者为静脉吸毒者。长期TPN患者中有11例死亡，其中4例与感染有关，4例与静脉吸毒有关。
BSI的发生率很高，长期TPN患者中相当一部分BSI是多微生物感染，且由多重耐药细菌和真菌引起。需要仔细管理输液管路，并采取干预措施以降低该人群中导管相关感染的风险。
