Emory University School of Medicine, Atlanta, Georgia, USA.
JPEN J Parenter Enteral Nutr. 2011 Sep;35(5):581-7. doi: 10.1177/0148607111413597. Epub 2011 Jul 28.
Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter-associated bloodstream infections (CA-BSI) are common in hospitalized patients receiving parenteral nutrition (PN), but data evaluating CA-BSI in children receiving HPN are limited.
To determine the incidence and characteristics of CA-BSI in children receiving HPN.
Medical records of 44 children receiving HPN during a 3-year period were reviewed. End points were CA-BSI during the initial 6 months after discharge. CA-BSI was defined as isolation of pathogens from blood requiring antimicrobial therapy.
The primary indication for HPN was short bowel syndrome (46%), and 59 BSI were documented during the initial 6 months of HPN in 29 (66%) children. Of CA-BSI, polymicrobial infections accounted for 52%; gram-positive, 29%; gram-negative, 17%; and fungal, 2%. CA-BSI incidence per 1000 catheter-days was highest during the first month posthospital discharge (72 episodes; 95% confidence interval [CI], 45.4-109.6). CA-BSI incidence density ratio for children receiving HPN for >90 days compared with those receiving HPN for <30 days was 2.2 (P < .05). Logistic regression revealed that Medicaid insurance and age <1 year were associated with increased risk for CA-BSI (odds ratio [OR], 4.4 [95% CI, 1.13-16.99] and 6.6 [1.50-28.49], respectively; P < .05).
The incidence of CA-BSI in children receiving HPN is highest during the first month posthospital discharge. Strategies to address care in the immediate posthospital discharge period may reduce the burden of infectious complications of HPN.
家庭肠外营养（HPN）可挽救肠衰竭患儿的生命。接受肠外营养（PN）的住院患者中，导管相关血流感染（CA-BSI）很常见，但有关接受 HPN 患儿 CA-BSI 的数据有限。
确定接受 HPN 治疗的患儿中 CA-BSI 的发生率和特征。
回顾了 3 年内接受 HPN 治疗的 44 名儿童的病历。终点是出院后最初 6 个月内的 CA-BSI。CA-BSI 定义为需要抗菌治疗的血液中分离出病原体。
HPN 的主要适应证为短肠综合征（46%），29 名（66%）患儿在接受 HPN 的最初 6 个月中发生了 59 例 BSI。CA-BSI 中，混合感染占 52%；革兰阳性菌占 29%；革兰阴性菌占 17%；真菌占 2%。出院后第一个月 CA-BSI 的发病率最高（72 例；95%置信区间 [CI]，45.4-109.6）。与接受 HPN <30 天的患儿相比，接受 HPN >90 天的患儿 CA-BSI 的发病率密度比为 2.2（P <.05）。Logistic 回归显示，医疗补助保险和年龄 <1 岁与 CA-BSI 的风险增加相关（比值比 [OR]，4.4 [95%CI，1.13-16.99]和 6.6 [1.50-28.49]；P <.05）。
接受 HPN 治疗的患儿出院后第一个月 CA-BSI 的发生率最高。针对出院后即刻护理的策略可能会降低 HPN 感染性并发症的负担。
