Characterization of post-hospital infections in adults requiring home parenteral nutrition.
Characterization of post-hospital infections in adults requiring home parenteral nutrition.
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DOI：
10.1016/j.nut.2012.03.010
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发表时间：
2013-01
期刊：
影响因子：
--
通讯作者：
Ziegler TR
中科院分区：
文献类型：
--
作者：
Zhao VM;Griffith DP;Blumberg HM;Dave NJ;Battey CH;McNally TA;Easley KA;Galloway JR;Ziegler TR
关于需要家庭肠外营养（HPN）的患者感染的发生率和危险因素的数据有限。回顾性研究美国亚特兰大埃默里大学医院101例连续成人（63例女性，38例男性）因HPN出院。评估需要再次住院的新血流感染（BSI）和其他感染。大多数感染（75%）发生在出院后的最初6个月；头四个月的BSI率特别高。56例患者（55.4%）共发生102例BSI （11.5 BSI/1000导管天）。大多数bsi归因于革兰氏阳性菌（46%），包括凝固酶阴性葡萄球菌、金黄色葡萄球菌、肠球菌等，其次是念珠菌（20%）和革兰氏阴性菌（13%）。21%的bsi是多微生物性的。院前平均血糖（BG）浓度最高四分位数的患者与最低四分位数的患者相比，BSI发生率比（IRR）显著增加；IRR 2.4;P = 0.017)。置入外周中心静脉导管（PICC）的患者与未置入PICC中心静脉导管的患者相比，BSI发生率明显更高（p = 0.018）。39例（38.6%）患者出现81例非bsi感染，包括肺炎、尿路感染和手术部位感染。出院后PN葡萄糖、脂质和总热量剂量与BSI无关，但与非BSI发生率有不同的相关性。成年HPN患者院后感染的发生率非常高。出院前住院期间较高的平均BG水平和出院时使用PICCs与出院后家庭环境中BSI风险增加有关。
Limited data are available on the incidence and risk factors for infection among patients requiring home parenteral nutrition (HPN). Retrospective study of 101 consecutive adults (63 female, 38 male) discharged on HPN from Emory University Hospital, Atlanta, GA. New bloodstream infections (BSI) requiring re-hospitalization and other infections were evaluated. Most infections (75%) developed during the initial 6 months after hospital discharge; rates of BSI were particularly high during the first four months. A total of 56 patients (55.4%) developed a total of 102 BSIs (11.5 BSI/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 (IRR) was significantly increased for patients with mean pre-hospital discharge blood glucose (BG) concentrations in the highest quartile versus the lowest quartile; IRR 2.4; P = 0.017). Patients with a peripherally inserted central catheter (PICC) versus non-PICC central venous catheters had significantly higher rates of BSI (p = 0.018). Thirty-nine (38.6%) patients developed 81 non-BSI infections, including pneumonia, urinary tract infections, and surgical site infections. Post-discharge PN dextrose, lipid, and total calorie doses were unrelated to BSI but variably related to the rate of non-BSI. Adult HPN patients exhibit a very high incidence of post-hospital infections. Higher mean BG levels during pre-discharge hospitalization and use of PICCs at discharge are associated with an increased risk of BSI in the post-discharge home setting.
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