Leeds Teaching Hospital, Beckett St, Leeds, LS9 7TF, United Kingdom.
Clin Nutr ESPEN. 2020 Apr;36:146-149. doi: 10.1016/j.clnesp.2020.01.001. Epub 2020 Jan 23.
BACKGROUND & AIMS: Parenteral nutrition (PN) is a valuable and life-saving treatment for patients with intestinal failure. While its use is increasing, it has been demonstrated to be a risk factor for intravenous catheter-related blood stream infection (CRBSI) - a significant, serious and potentially fatal complication of PN use. CRBSI can have serious secondary consequences for patients, though, there is a paucity of literature describing these. The aim of this study is to audit the incidence of, and evaluate the consequences of, complications associated with CRBSI.
Medical records were examined for all parenterally fed patients diagnosed with a CRBSI from 01/01/16 to 31/12/17 in a UK tertiary referral centre for patients requiring intravenous nutritional support. Patients were identified prospectively; data relating to the infection and complications was collected retrospectively.
114 episodes of CRBSI were recorded in 80 patients. 57 occurred during an inpatient admission, 57 occurred in the community and resulted in admission. 21 different adverse events occurred as a result of the CRBSI. The complications identified were varied with the most common being acute kidney injury, deranged electrolytes and urinary tract infections. Other significant complications included DVT, pulmonary abscess and infective endocarditis. 35% of episodes resulted in delayed discharge and 12% required escalation to a critical care bed. The financial impact is estimated at over £800,000 per annum.
The findings demonstrate a plethora of complications which can arise following CRBSI, which pose a significant health risk to parenterally fed patients who already have reduced physiological reserve. Moreover, these findings represent additional financial and resource burden to the health service. The adverse events resulting from CRBSIs should, therefore, be audited to improve outcomes: well-resourced specialist centres are best placed to provide this service.
肠衰竭患者的肠外营养（PN）是一种有价值且救生的治疗方法。虽然它的使用正在增加，但它已被证明是与静脉导管相关的血流感染（CRBSI）的一个危险因素 - 这是 PN 使用的一个严重且潜在致命的并发症。然而，CRBSI 可能会给患者带来严重的继发性后果，但描述这些后果的文献却很少。本研究旨在审查与 CRBSI 相关并发症的发生率，并评估其后果。
在英国一家三级转诊中心对所有接受静脉营养支持的患者进行了回顾性研究，该中心对 2016 年 1 月 1 日至 2017 年 12 月 31 日期间诊断为 CRBSI 的所有接受肠外喂养的患者的病历进行了检查。前瞻性地识别患者；收集与感染和并发症相关的数据。
在 80 名患者中记录了 114 例 CRBSI 发作。57 例发生在住院期间，57 例发生在社区，导致住院。21 种不同的不良事件是由 CRBSI 引起的。确定的并发症多种多样，最常见的是急性肾损伤、电解质紊乱和尿路感染。其他严重的并发症包括深静脉血栓形成、肺脓肿和感染性心内膜炎。35%的病例导致延迟出院，12%需要升级到重症监护病床。估计每年的财务影响超过 80 万英镑。
这些发现表明，CRBSI 后可能会出现多种并发症，这对已经生理储备减少的肠外喂养患者构成了重大健康风险。此外，这些发现代表了对卫生服务的额外财务和资源负担。因此，应审查 CRBSI 引起的不良事件，以改善结果：资源充足的专科中心最适合提供这项服务。
