Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, the Netherlands.
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
Clin Nutr ESPEN. 2022 Aug;50:155-161. doi: 10.1016/j.clnesp.2022.06.003. Epub 2022 Jun 8.
Patients with intestinal failure receiving home parenteral nutrition (HPN) are susceptible to central-line associated bloodstream infections (CLABSIs), with crucial roles for adequate (empiric) antimicrobial therapy and effective catheter management strategies. Our aim was to link recent epidemiologic CLABSI data with clinical outcomes and to identify risk factors for therapeutic failure to decide on the safest and most accurate CLABSI management in patients receiving HPN.
A retrospective observational cohort study was conducted. All data on CLABSIs (period 2010-2020) in adult patients receiving HPN were retrieved. The efficacy of attempted catheter salvage and empiric antimicrobial treatment (β-lactam antibiotics) in our center, with a low prevalence of methicillin-resistant staphylococci, was investigated. Multivariate cox-regression analysis was performed to identify risk factors for recurrent CLABSI.
389 CLABSIs occurred in 149 patients. The overall infection rate was 0.64 per 1000 central venous catheter (CVC) days. Most CLABSIs were caused by Coagulase-negative staphylococci (37%). Attempted CVC salvage was successful in 70% of the cases. Empiric antimicrobial therapy was found to be adequate in only 47% of cases, mainly because of insufficient Coagulase-negative staphylococci coverage. According to the Cox model, patients with a replaced CVC had a 50% lower risk of a new CLABSI than patients with a retained (salvaged) CVC during follow-up (HR 0.50; 95% CI 0.35-0.72, P < 0.001).
CVC salvage can be achieved in most CLABSI cases but seems associated with a shorter CLABSI-free survival. Importantly, based on our findings, a glycopeptide containing antibiotic treatment regimen will increase the likelihood of adequate empiric coverage.
接受家庭肠外营养（HPN）的肠衰竭患者易发生中心静脉导管相关血流感染（CLABSI），充分（经验性）抗菌治疗和有效的导管管理策略至关重要。我们的目的是将最近的流行病学 CLABSI 数据与临床结果联系起来，并确定治疗失败的危险因素，以决定在接受 HPN 的患者中进行最安全和最准确的 CLABSI 管理。
进行了一项回顾性观察队列研究。检索了所有接受 HPN 的成年患者的 CLABSIs（2010-2020 年期间）的数据。研究了我们中心尝试保留导管和经验性抗菌治疗（β-内酰胺类抗生素）的疗效，我们中心耐甲氧西林葡萄球菌的患病率较低。采用多变量 Cox 回归分析确定 CLABSI 复发的危险因素。
149 名患者中发生了 389 例 CLABSI。总体感染率为每 1000 个中心静脉导管（CVC）天 0.64 例。大多数 CLABSI 由凝固酶阴性葡萄球菌引起（37%）。在 70%的情况下，尝试保留 CVC 是成功的。只有 47%的情况下经验性抗菌治疗被认为是充分的，主要是因为对凝固酶阴性葡萄球菌的覆盖不足。根据 Cox 模型，与保留（保留）CVC 的患者相比，在随访期间更换 CVC 的患者发生新 CLABSI 的风险降低了 50%（HR 0.50；95%CI 0.35-0.72，P<0.001）。
在大多数 CLABSI 病例中可以实现 CVC 保留，但似乎与较短的 CLABSI 无复发生存期相关。重要的是，根据我们的发现，包含糖肽的抗生素治疗方案将增加经验性覆盖的可能性。
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