Ross Vicki M, Guenter Peggi, Corrigan Mandy L, Kovacevich Debra, Winkler Marion F, Resnick Helaine E, Norris Tina L, Robinson Lawrence, Steiger Ezra
American Society for Parenteral and Enteral Nutrition, Silver Spring, MD.
American Society for Parenteral and Enteral Nutrition, Silver Spring, MD.
Am J Infect Control. 2016 Dec 1;44(12):1462-1468. doi: 10.1016/j.ajic.2016.06.028.
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, χ, 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.
家庭肠外营养（HPN）是一种高成本、复杂的营养支持疗法，需要使用中心静脉导管。中心静脉导管相关血流感染（CLABSI）是该疗法最严重的风险之一。“维持”：美国肠外与肠内营养学会的全国营养护理患者登记处（“维持”登记处）提供了美国全国HPN患者队列中有关CLABSI研究的最新和全面数据。这是首份详细介绍HPN患者CLABSI纵向数据的“维持”登记处报告。
描述2011年至2014年在“维持”登记处随访的HPN患者的CLABSI发生率。
使用描述性、χ检验和t检验分析“维持”登记处的数据。
在美国29个地点的1046例HPN患者中，112例（10.7%）在223493天的HPN暴露期间发生了194次CLABSI事件，总体CLABSI发生率为0.87次/1000肠外营养日。尽管大多数患者为女性（59%）、成年人（87%）、白人（75%），且拥有私人保险或医疗保险（69%），但每1000肠外营养日的CLABSI事件发生率男性（0.69对0.38）、儿童（1.17对0.35）、黑人（0.91对0.41）以及医疗补助接受者（1.0对0.38或0.39）更高。植入式端口或双腔导管的患者发生CLABSI的次数也比外周插入导管或中心导管或单腔导管的患者更多。葡萄球菌是最常报告的病原体。这些数据支持了关于儿童CLABSI风险以及导管类型的小型研究结果，并确定了新的潜在风险因素，包括性别、种族和保险类型。
需要进一步研究以确定能降低HPN相关CLABSI的有效干预措施。
