375. Descriptive Epidemiology of Patients with Chronic Home Parenteral Nutrition
Session: Poster Abstract Session: Epidemiology - Bacterial Infections
Friday, October 21, 2011
Room: Poster Hall B1
Background: Patients receiving home parenteral nutrition (HPN)are at risk for Catheter-related blood stream infections (CR-BSI).  Previous studies have reported rates between 2.45 and 4.58 infections per 1000 catheter days. Limited data are available on risk for HPN associated CR-BSI.

Methods: We conducted a retrospective study at Barnes-Jewish Hospital, a 1250-bed academic medical center. Patients who were discharged on HPN from 1/2007 to 12/2009 were included in the study. The medical records of these patients were reviewed until 10/2010. CR-BSI was defined as positive blood culture(s) in clinical setting of infection without another source of infection.  Univariate analysis was performed using chi-square analysis and backward stepwise logistic regression was used for multivariate analysis. A P-value of < 0.05 was considered significant.

Results: 

225 patients [mean age 53.91 +-14.2 (22-93)]were included in the study with  40,444  (mean 93.2 +-124.6; min 2, max 949) catheter days evaluated. 85/225 (37%) were eventually diagnosed with CR-BSI. The overall rate was 4.47 per 1000 catheter days. The most common pathogens isolated were: Coagulase-negative staphylococcus 59 (30.9%), Candida species 43 (22.5%),K. pneumoniae 29 (15.2%), Enterococcus species 25 (13.1%), and S. aureus 19 (9.9%). Multivariate analysis revealed that compared to other CVCs, PICCs were more likely to be associated with complications [aOR 2.3; 95% CI (2.7-3.9);P-value 0.005].

Conclusion: We found a similar bloodstream infection rate associated with home parenteral therapy as previously reported. The proportion of Gram-negative bacteria and candida species as the etiology for the bloodstream infection was higher among our cohort than previously reported. PICCs were associated with more complications than other types of CVCs.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Michael J Durkin, MD, Department of Medicine, Barnes-Jewish Hospital/Washington University School of Medicine, Saint Louis , MO, Dominic N Reeds, MD, Department of Medicine/Nutritional Science, Washington University School of Medicine, Saint Louis, MO, John E Mazuski, MD, PhD, Surgery/Division of General Surgery, Washington University School of Medicine, Saint Louis, MO and Bernard C. Camins, MD, MSCR, Department of Medicine, Washington University School of Medicine, St. Louis, MO

Disclosures:

M. J. Durkin, None

D. N. Reeds, None

J. E. Mazuski, None

B. C. Camins, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.