Epidemiology Research Today is a free monthly online journal that collates and summarizes the latest research about Epidemiology, including details on twin studies, statistics, environmental and genetic factors.

Epidemiology of bloodstream infections in patients receiving long-term total parenteral nutrition.

Marra AR, Opilla M, Edmond MB, Kirby DF

Division of Infectious Diseases, Universidade Federal de São Paulo (UNIFESP-EPM)/Hospital São Paulo, Brazil.

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 BSIs 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.

Published 1 January 2007 in J Clin Gastroenterol, 41(1): 19-28.
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