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Characterization of post-hospital infections in adults requiring home parenteral nutrition
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Characterization of post-hospital infections in adults requiring home parenteral nutrition
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Journal Article
Characterization of post-hospital infections in adults requiring home parenteral nutrition
2013
Overview
Limited data are available on the incidence and risk factors for infection in patients requiring home parenteral nutrition (HPN).
A retrospective study was conducted in 101 consecutive adults (63 female, 38 male) discharged on HPN from the Emory University Hospital, Atlanta, GA. New bloodstream infections (BSIs) requiring rehospitalization and other infections were evaluated.
Most infections (75%) developed during the initial 6 mo after hospital discharge; rates of BSI were particularly high during the first 4 mo. Fifty-six patients (55.4%) developed 102 BSIs (11.5 BSIs/1000 catheter-days). Most BSIs were attributed to gram-positive organisms (46%), including coagulase-negative Staphylococcus, Staphylococcus aureus, Enterococcus species, and others, followed by Candida species (20%) and gram-negative organisms (13%). Twenty-one percent of BSIs were polymicrobial. The BSI incidence rate ratio was significantly increased for patients with mean prehospital discharge blood glucose concentrations in the highest quartile versus the lowest quartile (incidence rate ratio 2.4, P = 0.017). Patients with a peripherally inserted central catheter versus non-peripherally inserted central catheter central venous catheters had significantly higher rates of BSI (P = 0.018). Thirty-nine patients (38.6%) developed 81 non-BSIs, including pneumonia, urinary tract infections, and surgical site infections. Postdischarge PN dextrose, lipid, and total calorie doses were unrelated to BSI but were variably related to the rate of non-BSIs.
Adult patients on HPN exhibit a very high incidence of post-hospital infections. Higher mean blood glucose levels during predischarge hospitalization and the use of peripherally inserted central catheters at discharge are associated with an increased risk of BSI in the postdischarge home setting.
Publisher
Elsevier Inc,Elsevier,Elsevier Limited
Subject
/ adults
/ Aged
/ Biological and medical sciences
/ Blood
/ Candida
/ Catheter-Related Infections - epidemiology
/ Catheter-Related Infections - etiology
/ Catheter-Related Infections - microbiology
/ coagulase negative staphylococci
/ etiology
/ Female
/ females
/ Fundamental and applied biological sciences. Psychology
/ Gastroenterology and Hepatology
/ Georgia
/ glucose
/ Human infectious diseases. Experimental studies and models
/ Humans
/ lipids
/ Male
/ males
/ Parenteral Nutrition, Home - adverse effects
/ patients
/ Sepsis
/ Vertebrates: anatomy and physiology, studies on body, several organs or systems
