TY - JOUR

T1 - A multi-national survey of experience and attitudes towards managing catheter related blood stream infections for home parenteral nutrition

AU - Joly, Francisca

AU - Nuzzo, Alexandre

AU - Bozzetti, Federico

AU - Cuerda, Cristina

AU - Jeppesen, Palle B.

AU - Lal, Simon

AU - Lamprecht, Georg

AU - Mundi, Manpreet

AU - Szczepanek, Kinga

AU - Van Gossum, André

AU - Wanten, Geert

AU - Pironi, Loris

N1 - Publisher Copyright: © 2023

PY - 2023

Y1 - 2023

N2 - Background and aims: Catheter-related bloodstream infection (CRBSI) is the most common complication of home parenteral nutrition (HPN) in patients with chronic intestinal failure (CIF). The aim of this study was to assess the broad range of practices of international multi-disciplinary teams involved in the care of this complication occurring in CIF patients. Design: An online questionnaire was designed and distributed to members of the European Society for Clinical Nutrition and Metabolism (ESPEN) and distributed to colleagues involved in managing patients with CIF. Results: A total of 47 responses were included from centers across 21 countries. The centers had been delivering HPN for a median 21 years (IQR 11–35) and were actively following a median 58 patients (27–120) per center for benign CIF in 80% of cases (67–95). Tunneled catheters were the most common type of central venous catheters (CVC), representing 70% (47–86) of all CVC in use. For the management of CRBSI, written procedures were provided in 87% of centers. First measures included simultaneous central and peripheral blood cultures (90%), stopping HPN infusion (74%), and administrating an antibiotic lock and systemic antibiotics (44%). Immediate removal of the CVC was more likely in case of fungal infection (78%), Staphylococcus aureus (53%), or in case of PICC catheter (52%) (all p < 0.01). After the first CRBSI, 80% of centers used preventive CVC locks (taurolidine in 84% of cases, p < 0.001). We observed a large heterogeneity in practices regarding preparation, duration, reaspiration, and volume of CVC locks, and monitoring of CRBSI (timing of blood cultures, radiological work-up). Conclusion: In this international survey of HPN expert centers, we observed a significant consensus regarding the initial management of CRBSI and the use of secondary preventive CVC locks, while areas of variation exist. Management of CRBSI may be improved with clearer recommendations based on the micro-organism and the type of CVC, including PICC lines which are increasingly used yet insufficiently studied in HPN patients.

AB - Background and aims: Catheter-related bloodstream infection (CRBSI) is the most common complication of home parenteral nutrition (HPN) in patients with chronic intestinal failure (CIF). The aim of this study was to assess the broad range of practices of international multi-disciplinary teams involved in the care of this complication occurring in CIF patients. Design: An online questionnaire was designed and distributed to members of the European Society for Clinical Nutrition and Metabolism (ESPEN) and distributed to colleagues involved in managing patients with CIF. Results: A total of 47 responses were included from centers across 21 countries. The centers had been delivering HPN for a median 21 years (IQR 11–35) and were actively following a median 58 patients (27–120) per center for benign CIF in 80% of cases (67–95). Tunneled catheters were the most common type of central venous catheters (CVC), representing 70% (47–86) of all CVC in use. For the management of CRBSI, written procedures were provided in 87% of centers. First measures included simultaneous central and peripheral blood cultures (90%), stopping HPN infusion (74%), and administrating an antibiotic lock and systemic antibiotics (44%). Immediate removal of the CVC was more likely in case of fungal infection (78%), Staphylococcus aureus (53%), or in case of PICC catheter (52%) (all p < 0.01). After the first CRBSI, 80% of centers used preventive CVC locks (taurolidine in 84% of cases, p < 0.001). We observed a large heterogeneity in practices regarding preparation, duration, reaspiration, and volume of CVC locks, and monitoring of CRBSI (timing of blood cultures, radiological work-up). Conclusion: In this international survey of HPN expert centers, we observed a significant consensus regarding the initial management of CRBSI and the use of secondary preventive CVC locks, while areas of variation exist. Management of CRBSI may be improved with clearer recommendations based on the micro-organism and the type of CVC, including PICC lines which are increasingly used yet insufficiently studied in HPN patients.

KW - Central venous access

KW - Central venous catheter

KW - CRBSI

KW - HPN

KW - Intestinal failure

KW - Short bowel syndrome

U2 - 10.1016/j.clnesp.2023.06.032

DO - 10.1016/j.clnesp.2023.06.032

M3 - Journal article

C2 - 37739646

AN - SCOPUS:85163477010

VL - 57

SP - 126

EP - 130

JO - Clinical Nutrition ESPEN

JF - Clinical Nutrition ESPEN

SN - 2405-4577

ER -