A comparison of two methods of treatment for catheter-related bloodstream infections in patients on home parenteral nutrition

2015 ◽  
Vol 34 (5) ◽  
pp. 918-922 ◽  
Author(s):  
Michał Ławiński ◽  
Krystyna Majewska ◽  
Łukasz Gradowski ◽  
Iwona Fołtyn ◽  
Pierre Singer
Keyword(s):  
Parenteral Nutrition ◽  
Bloodstream Infections ◽  
Home Parenteral Nutrition ◽  
Methods Of Treatment

scholarly journals Incidence and Outcomes of Home Parenteral Nutrition in Patients With Crohn Disease in Olmsted County, Minnesota

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Zeinab Bakhshi ◽  
Siddhant Yadav ◽  
Bradley R Salonen ◽  
Sara L Bonnes ◽  
Jithinraj Edakkanambeth Varayil ◽  
...  
Keyword(s):  
Weight Loss ◽  
Parenteral Nutrition ◽  
Short Bowel Syndrome ◽  
Crohn Disease ◽  
Severe Disease ◽  
Bloodstream Infections ◽  
Home Parenteral Nutrition ◽  
Average Weight ◽  
Olmsted County ◽  
Short Bowel

Abstract Background We sought to estimate the incidence of home parenteral nutrition (HPN) use in a population-based cohort of patients with Crohn disease (CD), and to assess clinical outcomes and complications associated with HPN. Methods We used the Rochester Epidemiology Project (REP) to identify residents of Olmsted County, who were diagnosed with CD between 1970 and 2011, and required HPN. Results Fourteen out of 429 patients (3.3%) with CD received HPN (86% female). Eleven patients (79%) had moderate–severe CD and 12 patients (86%) had fistulizing disease. Thirteen patients (93%) underwent surgery, primarily due to obstruction. Among CD incidence cases, the cumulative incidence of HPN from the date of CD diagnosis was 0% at 1 year, 0.5% at 5 years, 0.8% at 10 years, and 2.4% at 20 years. Indications for HPN included short bowel syndrome in 64%, malnutrition in 29%, and bowel rest in 21%. The median duration of HPN was 2.5 years. There was an average weight gain of 1.2 kg at 6 months, an average weight loss of 1.4 kg at 1 year, and a further weight loss of 2.2 kg at 2 years from the start of HPN. Patients were hospitalized a mean of 5 times after the start of HPN, mainly due to catheter-related bloodstream infections and thrombosis. Conclusions Less than 4% of patients with CD need HPN. Most have moderate to severe disease with short bowel syndrome or malnutrition. Possible reasons for the patients’ weight loss could be noncompliance, and increased metabolic needs because of active disease.

scholarly journals A comparison of two methods of treatment for central catheter tunnel phlegmon in home parenteral nutrition patients

2016 ◽  
Vol 3 ◽  
pp. 170-175
Author(s):  
Michał Ławiński ◽  
Karol Forysiński ◽  
Agnieszka Bzikowska ◽  
Justyna Z. Kostro ◽  
Aleksandra Gradowska ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Home Parenteral Nutrition ◽  
Central Catheter ◽  
Methods Of Treatment

Ethanol Lock Therapy in Reducing Catheter-Related Bloodstream Infections in Adult Home Parenteral Nutrition Patients

2011 ◽  
Vol 36 (5) ◽  
pp. 603-610 ◽  
Author(s):  
Bijo K. John ◽  
Maqsood A. Khan ◽  
Rex Speerhas ◽  
Kristen Rhoda ◽  
Cindy Hamilton ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Bloodstream Infections ◽  
Home Parenteral Nutrition ◽  
Lock Therapy ◽  
Ethanol Lock

scholarly journals Home Parenteral Nutrition in Patients with Intestinal Failure: Possible Undetected Complications

Nutrients ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 581 ◽  
Author(s):  
Lidia Santarpia ◽  
Giulio Viceconte ◽  
Maria Foggia ◽  
Lucia Alfonsi ◽  
Grazia Tosone ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Intestinal Failure ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Home Parenteral Nutrition ◽  
Central Venous ◽  
Radiological Features ◽  
Oncological Patients ◽  
Septic Pulmonary Embolism ◽  
Lung Infections

Background: Septic pulmonary embolism (SPE) may be a frequently undetected complication of central venous catheter (CVC)-related bloodstream infections (CRBSIs). Materials and Methods: The incidence of SPE was evaluated in a cohort of non-oncological patients on home parenteral nutrition (HPN) who were hospitalized for a CRBSI from January 2013 to December 2017. The main clinical, microbiological, and radiological features and the therapeutic approach were also described. Results: Twenty-three infections over 51,563 days of HPN therapy were observed, corresponding to an infection rate of 0.45/1000. In 10 out of the 23 cases (43.5%), pulmonary lesions compatible with SPE were identified. Conclusion: Our results demonstrated that a CRBSI can produce asymptomatic SPE with lung infiltrates in 43.5% of the cases, suggesting the need to check for secondary lung infections to choose the most appropriate antimicrobial therapy.

P10 Evaluation of existing line-locking practice in central venous catheters of paediatric patients on home parenteral nutrition

2018 ◽  
Vol 103 (2) ◽  
pp. e1.14-e1
Author(s):  
Tustin Amy ◽  
Hartley Karen ◽  
Derry David ◽  
Thomas Julian
Keyword(s):  
Parenteral Nutrition ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Venous Catheters ◽  
Home Parenteral Nutrition ◽  
List Type ◽  
Central Venous ◽  
Paediatric Patients

AimTo review current line-locking practice of central venous catheters (CVCs) to reduce catheter related blood stream infections (CRBSIs) and preserve line integrity in paediatric patients on home parenteral nutrition (HPN), with the secondary aim of producing a concise, evidence-based guideline for use in this cohort and inpatient PN patients as well.MethodAll 19 paediatric HPN patients were reviewed retrospectively over 6 months (January–June 2017). Data was collected from clinic letters, HPN prescriptions and blood cultures. Information gathered per patient:Line lock(s)Infective episode(s)CVC replacement(s)Establishment of current practice: All patients use TaurolockTM first-line. If CVC is stiff or stops bleeding back switch to TauroLockTM-Hep100. Should problems persist introduce alcohol 70% on alternate days or alone if recurrent infections occur on TaurolockTM. Blocked CVCs are instilled with urokinase or alteplase and CVC replaced if unsuccessful.Results18/19 patients were prescribed line locks as per above practice. One patient is prescribed heparin 10units/ml – due to a documented TauroLockTM allergy – and remained infection- free throughout. 7 infections occurred overall in 6 patients with 13 patients infection-free. 2.2 infections/1000 catheter days occurred in patients on TauroLockTM with 2 patients requiring CVC changes due to infection and broken CVC respectively.1 infection/1000 catheter days occurred on TauroLockTM- Hep100 with 2 CVC changes required due to occlusion. 11 infections/1000 catheter days occurred in 1 patient on daily alcohol 70%, although result validity is uncertain due to potential contamination of blood culture specimen from skin organisms during sampling. No infections occurred in 248 catheter days in patients alternating TauroLockTM-Hep100 and alcohol 70% with one line change required as CVC moved position.ConclusionCRBSIs pose a serious problem in paediatric HPN patients.1,2 Taurolidine has proven efficacy at preventing CRBSIs and proven superiority to heparin.3 The effectiveness of alcohol at reducing CRBSI rates and preventing CVC replacement has been proven when compared to heparin4 however, due to adverse effects (thrombosis and CVC degradation)4 use is limited to ensure benefits outweigh risks. These studies, although limited, and results in our patient cohort support the continued use of these line locks as per existing practice. Future work includes need to formalise written guideline and discuss clear pathway if patients have multiple CRBSIs on their existing line lock as presently information is unclear.ReferencesKoletzko B, Agostoni C, Ball P, et al. ESPEN/ESPGHAN guidelines on paediatric parenteral nutrition. Journal of Paediatric Gastroenterology and Nutrition2005;41:S76–S84.Candusso M, Faraguna D, Sperli D, et al. Outcome and quality of life in paediatric home parenteral nutrition. Current Opinion in Clinical Nutrition and Metabolic Care2005;5:309–14.Chu HP, Brind J, Tomar R, et al. Significant reduction in central venous catheter-related bloodstream infections in children on HPN after starting treatment with taurolidine line lock. J Pediatr Gastroenterol Nutr2012;55:403–7.Oliveira C, Nasr A, Brindle M, et al. Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: A meta-analysis. Paediatrics2012;129:318–329.

The Efficacy of Alcohol-Antibiotic Lock Therapy for Treatment of Catheter Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition

2015 ◽  
Vol 86 (12) ◽  
Author(s):  
Michał ławiński ◽  
Krystyna Majewska ◽  
Iwona Fołtyn ◽  
Aleksandra Gradowska
Keyword(s):  
Gastrointestinal Tract ◽  
Parenteral Nutrition ◽  
Bloodstream Infection ◽  
Bloodstream Infections ◽  
Home Parenteral Nutrition ◽  
First Episode ◽  
High Concentration ◽  
Lock Therapy ◽  
Antibiotic Lock ◽  
Catheter Replacement

AbstractIn patients with chronic gastrointestinal tract failure, requiring access to the venous system, the subsequent catheter re-insertion are leading to large veins thrombosis impeding or preventing the insertion of another catheter and exposing patients to the risk of complications. Understanding the pathophysiology of catheter-related infections, enabled to use methods allowing to eradicate the source of infection without removal and replacement of central catheter with a new one. In our center, for many years we have been using an alternative method involving implementation of the alcohol-antibiotic lock in the treatment of infections. This method is based on the assumption that the destruction of biofilm with concentrated alcohol will enable antibiotic penetration and killing other microorganisms. Treatment with alcohol-antibiotic lock lasts from 8 to 10 days and involves filling the catheter with 96% alcohol followed by a solution of the antibiotic of high concentration.of the study was to evaluate the efficacy of treatment of catheter-related bloodstream infections with two methods (catheter replacement with a new one and the alcohol-antibiotic lock therapy) in patients receiving home parenteral nutrition (HPN).. 428 HPN in the period from 1 January 2005 to 31 December 2010. Among which 240 (56%) of women with an average age of 56.5±16 years and 188 (44%) of men with an average age of 54±17 years. The indications to HPN were as follows: short bowel syndrome in 298 (70%) patients, multilevel obstruction of the gastrointestinal tract in 52 (12%), postoperative gastrointestinal fistulas in 48 (11.2%), malabsorption syndrome in 17 (4%), motility disorders in 6, cachexia in 4 and radiation enteritis in 3 patients.. In 247 (57.5%) from 428 patients, no episode of catheter-related bloodstream infection was found, while 181 were diagnosed with 352 episodes of catheter-related bloodstream infections. In 40 (9.4%) from 428 patients, 168 (47.8%) episodes have been found - almost a half. The mean duration of treatment of patients receiving home parenteral nutrition, starting from the first episode of catheterrelated bloodstream infection, in 48 patients treated with the lock was equal to 1053+748 days, and in 133 patients treated with catheter replacement was equal to 952+709 days (t-test p = 0.62).. The survival time of patients treated with alcohol-antibiotic lock is the same as in patients treated with the catheter removal and insertion of the new one. The use of alcohol-antibiotic lock to treat catheter-related bloodstream infections in order to eradicate selected microorganisms that colonize the lumen and cause an infection, is as effective as catheter replacement with a new one.

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