Great Ormond Street Hospital for Children, Department of Paediatric Gastroenterology, Division of Intestinal Failure and Nutritional Rehabilitation, London, UK.
Paediatric Hospital Regina Margherita, Dietetic and Clinical Nutrition Unit, University of Turin, Turin, Italy.
Clin Nutr. 2023 Nov;42(11):2241-2248. doi: 10.1016/j.clnu.2023.09.007. Epub 2023 Sep 26.
BACKGROUND & AIMS: Catheter-related bloodstream infection (CRBSI) is the most common, potentially life-threatening complication of long-term parenteral nutrition (PN). We prospectively assessed the incidence and risk factors for CRBSI in children receiving long-term home PN (HPN) for intestinal failure (IF) in a single IF rehabilitation center.
Data regarding episodes and potential risk factors for CRBSI in children on HPN were prospectively recorded.
Forty-one of 75 children were diagnosed with CRBSI. The overall CRBSI rate was 1.61 per 1000 catheter days. The indications for HPN were gastrointestinal motility disorders in 35%, short bowel syndrome (SBS) in 28% graft versus host disease (GvHD) post bone marrow transplant in 17%, congenital enteropathy in 15%, and severe neurodevelopmental impairment in 5%. Gastrointestinal motility disorders had significantly higher CRBSI rate compared to other groups (p < 0.0005; 2.74 in motility group vs 1.54 in GvHD group vs 0.52 in congenital enteropathies vs 0.36 in SBS group vs 0.67 in severe neurodevelopmental delay). Multivariate analysis revealed that enterocutaneous distal stoma (ileostomy or colostomy) (HR 3.35 [95% CI, 1.63-6.86]; p < 0.001), age <2 years (HR 0.28 [95% CI, 0.15-0.53]; p < 0.0001), male sex (HR 2.28 [95% CI, 1.51-3.43]; p < 0.0001), non-use of taurolidine citrate lock (HR 2.70 [95% CI, 1.72-4.11]; p < 0.0001) and gastrointestinal motility disorder (HR 3.02 [95% CI, 1.81-4.91]; p < 0.001) were independent risk factors for developing CRBSI.
Extra care in managing PN connections and disconnections should be taken in children with an underlying gastrointestinal motility disorder, distal enterocutaneous stoma, male sex and those aged <2 years since they are at a significantly higher risk of CRBSI. Early introduction of taurolidine lock should be considered.
导管相关血流感染（CRBSI）是长期肠外营养（PN）最常见且可能危及生命的并发症。我们前瞻性评估了单一肠衰竭（IF）康复中心接受长期家庭 PN（HPN）治疗的儿童中 CRBSI 的发生率和危险因素。
前瞻性记录了接受 HPN 的儿童发生 CRBSI 的发作和潜在危险因素的数据。
75 名儿童中有 41 名被诊断为 CRBSI。总的 CRBSI 发生率为每 1000 个导管日 1.61 次。HPN 的适应证为胃肠道动力障碍占 35%，短肠综合征（SBS）占 28%，骨髓移植后移植物抗宿主病（GvHD）占 17%，先天性肠病占 15%，严重神经发育障碍占 5%。与其他组相比，胃肠道动力障碍组的 CRBSI 发生率显著更高（p<0.0005；动力组为 2.74，GvHD 组为 1.54，先天性肠病为 0.52，SBS 组为 0.36，严重神经发育延迟组为 0.67）。多变量分析显示，肠外切口径路的末端造口（回肠造口或结肠造口）（HR 3.35 [95%CI，1.63-6.86]；p<0.001）、年龄<2 岁（HR 0.28 [95%CI，0.15-0.53]；p<0.0001）、男性（HR 2.28 [95%CI，1.51-3.43]；p<0.0001）、不使用柠檬酸三羟甲胺锁（HR 2.70 [95%CI，1.72-4.11]；p<0.0001）和胃肠道动力障碍（HR 3.02 [95%CI，1.81-4.91]；p<0.001）是发生 CRBSI 的独立危险因素。
对于存在胃肠道动力障碍、末端肠外切口径路、男性和年龄<2 岁的儿童，应特别注意管理 PN 连接和断开，因为他们发生 CRBSI 的风险显著增加。应考虑早期引入柠檬酸三羟甲胺锁。
