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

Francisca Joly; Alexandre Nuzzo; Federico Bozzetti; Cristina Cuerda; Palle B Jeppesen; Simon Lal; Georg Lamprecht; Manpreet Mundi; Kinga Szczepanek; André Van Gossum; Geert Wanten; Loris Pironi

doi:10.1016/j.clnesp.2023.06.032

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

Clin Nutr ESPEN. 2023 Oct:57:126-130. doi: 10.1016/j.clnesp.2023.06.032. Epub 2023 Jun 28.

Authors

Affiliations

¹ Department of Gastroenterology and Nutritional Support, Center for Intestinal Failure, Reference Centre of Rare Disease MarDI, AP-HP Beaujon Hospital, University Paris Cité, Inserm UMR, Paris 1149, France. Electronic address: francisca.joly@aphp.fr.
² Department of Gastroenterology and Nutritional Support, Center for Intestinal Failure, Reference Centre of Rare Disease MarDI, AP-HP Beaujon Hospital, University Paris Cité, Inserm UMR, Paris 1149, France.
³ Faculty of Medicine, University of Milan, Milan, Italy.
⁴ Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
⁵ Department of Intestinal Failure and Liver Diseases, Rigshospitalet, Inge Lehmanns Vej 5 Opgang 3, 12. Og 16, Sal 2100, København Ø, Denmark.
⁶ Gastroenterology, Salford Royal & University of Manchester, UK.
⁷ Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University, Medical Center, Rostock, Germany.
⁸ Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA.
⁹ General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland.
¹⁰ Department of Gastroenterology and Clinical Nutrition, Hopital Erasme/Institut Bordet Brussels, Belgium.
¹¹ Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen 6500 HB, the Netherlands.
¹² Alma Mater Studiorum -University of Bologna, Department of Medical and Surgical Sciences, Italy IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Italy.

PMID: 37739646
DOI: 10.1016/j.clnesp.2023.06.032

Abstract

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.

Keywords: CRBSI; Central venous access; Central venous catheter; HPN; Intestinal failure; Short bowel syndrome.

MeSH terms

Anti-Bacterial Agents*
Attitude
Catheters
Consensus
Humans
Parenteral Nutrition, Home* / adverse effects

Substances

Anti-Bacterial Agents