Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK.
Department of Gastroenterology, University Hospital, Madrid, Spain.
JPEN J Parenter Enteral Nutr. 2022 Sep;46(7):1731-1735. doi: 10.1002/jpen.2396. Epub 2022 May 28.
Catheter-related bloodstream infections (CRBSIs) remain the commonest complication associated with home parenteral nutrition (HPN). Although the management outcomes of CRBSIs have been extensively reported by specialized intestinal failure (IF) centers, there are minimal data reporting CRBSI outcomes for HPN-dependent patients admitted to nonspecialized hospitals.
This was an observational study from a prospectively maintained database of CRBSIs in HPN-dependent patients managed outside of a specialized IF center.
Three hundred and six patients from a total cohort of 1066 HPN-dependent patients suffered from 489 CRBSI events from 2003 to 2021; after 2017, 71 of these events were managed at the patient's local, nonspecialized hospital and the remainder at the specialized IF center. From 2017 to 2021, salvage of the central venous catheter (CVC) with antimicrobial therapy was attempted in 32 out of 71 (45.1%) patients admitted to the nonspecialized hospital, with successful salvage recorded in 23 (71.8%) cases. Notably, CVC salvage was attempted more commonly (77 out of 103 [74.8%]; P = 0.004 vs nonspecialized hospital), with a better salvage success rate (64 out of 77 [83.1%] P = 0.01 vs nonspecialized hospital) in patients who were admitted to the specialized IF center.
In some instances, CRBSIs can be effectively managed when patients presenting to a nonspecialized hospital; however, overall salvage is more likely to be successful in the specialized setting. Further development of clinical and educational networks between IF centers and patients' local hospitals aimed at standardizing care may lead to improved CRBSI outcomes.
导管相关血流感染（CRBSI）仍然是与家庭肠外营养（HPN）相关的最常见并发症。尽管专门的肠衰竭（IF）中心已经广泛报道了 CRBSI 的管理结果，但在非专门医院收治的依赖 HPN 的患者中，报告 CRBSI 结果的数据很少。
这是一项在专门的 IF 中心之外管理的依赖 HPN 的患者的 CRBSI 前瞻性维护数据库中的观察性研究。
在 2003 年至 2021 年期间，共有 1066 例依赖 HPN 的患者，其中 306 例患者发生了 489 例 CRBSI 事件；2017 年后，这 71 例事件中的 71 例在患者当地的非专门医院进行管理，其余的在专门的 IF 中心进行管理。在 2017 年至 2021 年期间，在非专门医院收治的 71 例患者中，尝试用抗菌药物治疗来保留中心静脉导管（CVC），32 例（45.1%）成功保留了 CVC。值得注意的是，在专门的 IF 中心收治的患者中，尝试保留 CVC 的情况更为常见（103 例中有 77 例[74.8%]；P = 0.004 与非专门医院相比），并且保留成功率更高（77 例中有 64 例[83.1%]；P = 0.01 与非专门医院相比）。
在某些情况下，当患者在非专门医院就诊时，可以有效地管理 CRBSI；然而，在专门的环境中，整体保留成功率更高。IF 中心和患者当地医院之间进一步发展临床和教育网络，旨在规范护理，可能会改善 CRBSI 结果。
