Epidemiology of bloodstream infections in patients receiving long-term total parenteral nutrition
Data
2007-01-01
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Artigo
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Goals: To describe the epidemiology and microbiologic characteristics of bloodstream infections (BSIs) in patients receiving long-term total parenteral nutrition (TPN).Background: Home TPN therapy has been reported as a risk factor for BSI. However, little knowledge exists regarding the epidemiology of BSIs in this patient group.Study: A descriptive, observational epidemiologic study of patients receiving long-term TPN from January 1981 to July 2005 was performed. Variables analyzed include age, gender, time of follow-up, number of BSIs, microbiologic characteristics, underlying disease necessitating long-term TPN, catheter type, complications related to TPN, and clinical outcome.Results: Forty-seven patients receiving long-term TPN were evaluated. the most frequent indication for long-term TPN was ischemic bowel disease (25.5%). the mean duration of follow-up was 4.5 years. Thirty-eight patients (80.9%) developed 248 BSls while receiving TPN. More than 1 BSI episode occurred in 78.9% of these patients, and 23.8% of BSI episodes were polymicrobial. the most prevalent pathogen was coagulase negative staphylococci (33.5%). the most frequent complication among patients with BSI was central venous thrombosis (44.7%). Five patients were intravenous drug users. There were 11 deaths among the patients on long-term TPN, 4 of these were related to infection and 4 were related to intravenous drug use.Conclusions: the incidence of BSI is high, and a significant proportion of BSIs in long-term TPN patients are polymicrobial and due to multidrug-resistant bacteria and fungi. Careful management of the infusion line is required and interventions are needed to reduce the risk of catheter-related infections in this population.
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Journal of Clinical Gastroenterology. Philadelphia: Lippincott Williams & Wilkins, v. 41, n. 1, p. 19-28, 2007.