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A RETROSPECTIVE EXAMINATION OF RISK FACTORS FOR CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS IN HOME PARENTERAL NUTRITION PATIENTS FROM A QUEENSLAND TERTIARY HOSPITAL

Paris Hoey 1,2, Douglas Roche 1,2, Paul Chapman 3, Vishal Kaushik 1, Stacey Llewellyn 4, Niwansa Adris 1

Affiliations

1 Royal Brisbane and Women's Hospital, Brisbane, Australia

2 University of Queensland, Brisbane, Australia

3 Royal Brisbane and Women’s Hospital, Brisbane, Australia

4 QIMR Berghofer Medical Research Institute, Brisbane, Australia

Summary

AI Generated

A retrospective study of 34 Australian patients receiving home parenteral nutrition found regular opioid use associated with increased central line-associated bloodstream infection risk, with low catheter salvage rates and delayed effective antibiotic therapy.

Regular opioid use was associated with increased CLABSI risk (p=0.016), while geographical remoteness and tropical climate were not predictive of infection in first central venous catheters
The overall infection rate was 1.02 per 1000 catheter days, with Enterobacterales (22%) and coagulase-negative Staphylococcus (18%) the most common causative organisms
Only 50% of patients received empiric antimicrobials within the 3-hour sepsis timeframe, with just 25% receiving adequate pathogen coverage and median time to effective therapy of 22.7 hours
CVC salvage was attempted in only 8% of CLABSI episodes (3 of 39), all successful, representing potential missed opportunities for venous access preservation
The authors recommend an empiric regimen of vancomycin, cefepime and caspofungin for Australian intestinal failure units with similar antimicrobial patterns, expected to be effective in 84.6% of cases

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Abstract

Introduction

A central line-associated bloodstream infection (CLABSI) is a common and potentially life-threatening complication for patients with intestinal failure (IF) receiving home parenteral nutrition (HPN). In uncomplicated infections, The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines advocate for central venous access (CVC) salvage for venous access preservation (1). Existing knowledge regarding the risk factors of HPN-related CLABSIs have been extrapolated from European and North American studies (2-4), and the effects of tropical climates and its potentially higher support requirements on the incidence of infection has not yet been studied.

Aims & Methods

We sought to analyse the risk factors of developing HPN-related CLABSI, and assess CLABSI management, in a large Australian state with a highly dispersed population. A retrospective observational cohort study was conducted on 34 adult patients receiving HPN via a central venous catheter (CVC) at a Queensland tertiary referral centre, between 2016 and 2023. CLABSI was defined according to the criteria of the Australian Commission on Safety and Quality in Health Care (5). Patient charts were reviewed, and a univariate cox regression analysis model was used to identify predictors of CLABSI in the first CVC during the study period. Kaplan-Meier analysis was employed to build survival curves of time to CLABSI, and log-rank tests analysed survival between patient and CVC characteristics.

Results

Nineteen patients had ≥1 CLABSI(s) episode, accounting for a total of 39 episodes. Patients with ≥1 CLABSI(s) used regular opioids more than those who did not develop CLABSI (p=0.016) but did not differ by age, gender, body mass index, geography, aetiology of intestinal failure or catheter weeks. Fourteen patients (41%, n=14/34) developed a CLABSI in their first CVC. No patient or line characteristics, including geographical remoteness and tropical climate, were found to be predictive of CLABSI in their first CVC. The overall infection rate was 1.02 per 1000 catheter days. Most CLABSIs were caused by Enterobacterales (22%, n=12/55), followed by coagulase-negative Staphylococcus (18%, n=10/55). Administration of empiric antimicrobials within the standardised 3-hour sepsis timeframe was inadequate (50%, n=14/28), with only 25% (n=7/28) providing adequate cover of causative pathogens. The median time to effective antibiotic therapy was 22.7 hours (IQR 4.8-29.8). There were 3 CVC salvages (8%, n=3/39), all of which were successful.

Conclusion

In this cohort of patients, regular opioid use was associated with an increased risk of developing CLABSI which is consistent with international studies (2-4). We also found a low CVC salvage rate in our cohort, representing potential missed opportunities for venous access preservation. Based on our findings, an empiric antimicrobial regime of vancomycin, cefepime and caspofungin for all HPN-related CLABSI cases would be expected to be effective for 84.6%. We recommend that Australian IF units with a similar antimicrobial distribution and resistance pattern adopt this regime.

References

Pironi L, Boeykens K, Bozzetti F, Joly F, Klek S, Lal S, et al. ESPEN guideline on home parenteral nutrition. Clin Nutr. 2020;39(6):1645-66.

Gompelman M, Causevic E, Bleeker-Rovers CP, Wanten GJA. Catheter-related bloodstream infection management in patients receiving home parenteral nutrition: An observational cohort study. Clin. Nutr. ESPEN. 2022;50:155-61.

Adgey C, Raine T, Lawrence H, Sharkey LM, Woodward JM, Massey DCO. ADWE-10 Risk factors for line infections in a cambridge HPN cohort. Gut. 2018;67(1):A7.

Ashley B, Paul C, Trevor RS, Jeremy MDN, Simon L. Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition. Frontline Gastroenterol. 2020;11(1):48.

Australian Commission on Safety and Quality in Health Care. Surveillance of Central Line-Associated Bloodstream Infection. [Internet]. Sydney: Australian Commission on Safety and Quality in Health Care; July 2019. Available from: https://www.safetyandquality.gov.au/sites/default/files/2019-08/implementation-guide-for-surveillance-of-central-line-associated-blood-stream-infection-2019-final.pdf.

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

NUTRITION (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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OBEXELIMAB, A B CELL INHIBITOR, IN IGG4-RELATED DISEASE, INCLUDING PATIENTS WITH PANCREATOBILIARY INVOLVEMENT: RESULTS FROM THE PHASE 3 INDIGO TRIAL

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OBEXELIMAB, A B CELL INHIBITOR, IN IGG4-RELATED DISEASE, INCLUDING PATIENTS WITH PANCREATOBILIARY INVOLVEMENT: RESULTS FROM THE PHASE 3 INDIGO TRIAL

Emma Culver 1, Matthew C. Baker 2, Wen Zhang 3, Cory A. Perugino 4, Guy Katz 4, Yoshiya Tanaka 5, Arezou Khosroshahi 6, Alexander Kleger 7, nicolas schleinitz 8, Fernando Martinez-Valle 9, Hendrik Schulze-Koops 10, Shingo Nakayamada 11, Vinciane Rebours 12, Kazuichi Okazaki 13, Lingli Dong 14, Mollie Carruthers 15, Luke Y. C. Chen 16, Luca Frulloni 17, Alireza Meysami 18, Hiroki Takahashi 19, Mitsuhiro Kawano 20, Yanying Liu 21, Takako Saeki 22, Mikael Ebbo 8, Tobias Alexander 23, Andrés González-García 24, Omer Karadag 25, Maria Maslinska 26, Shauna Quinn 27, Allen Poma 27, Audrey Wells 27, Thomas J. Greene 27, John Stone 4, Emanuel della Torre 28

Affiliations

1 John Radcliffe Hospital, Oxford, Oxford, United Kingdom

2 Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Palo Alto, CA, United States

3 Peking Union Medical College Hospital, Beijing, China

4 Division of Rheumatology, Inflammation, and Immunity, Massachusetts General Hospital, Boston, MA, United States

5 University of Occupational and Environmental Health, Miyagi, Japan

6 Emory University School of Medicine, Georgia, United States

7 Institute of Molecular Oncology and Stem Cell Biology, Ulm University Hospital, Ulm, Germany

8 Hôpital de La Timone, Internal Medicine Department, Marseille, France

9 Hospital Universitario Vall d’Hebron, Barcelona, Spain

10 Klinikum der Universität München, Munich, Germany

11 University of Occupational and Environmental Health, Kitakyushu, Japan

12 Hopital Beaujon, Clichy, France

13 Kansai Medical University Kori Hospital, Hirakata, Japan

14 Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

15 Arthritis Research Canada, Vancouver, British Columbia, Canada

16 Dalhousie Medical School, Nova Scotia, Canada

17 Department of Medicine, the Pancreas Center, University of Verona, Verona, Italy

18 Henry Ford Health System, Michigan, USA; Wayne State University, Michigan, USA; Michigan State University, Michigan, United States

19 Sapporo Medical University, Sapporo, Japan

20 Kanazawa Medical University, Ishikawa, Japan

21 Beijing Friendship Hospital, Capital Medical University – PPDS, Beijing, China

22 Nagaoka Red Cross Hospital, Nagaoka, Japan

23 Charité – Universitätsmedizin Berlin, Department of Rheumatology and Clinical Immunology, German Rheumatism Research Center (DRFZ), Berlin, Germany

24 Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain

25 Hacettepe University, Department of Internal Medicine, Division of Rheumatology, Vasculitis Research Centre, Ankara, Türkiye

26 National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland

27 Zenas BioPharma, Waltham, MA, United States

28 Università Vita-Salute San Raffaele, Milano, Italy