Evde Parenteral Nütrisyon Alan Hastalarda Kateter İlişkili Kan Dolaşımı Enfeksiyonları

Abstract

Evde Parenteral Nütrisyon (EPN) tedavisi kısa bağırsak hastaları gibi özel tıbbi koşullara sahip hastalar için hayati bir tedavidir. EPN tedavisinde, santral kateterler (SVK) kritik rol oynamaktadır. Kateter ilişkili kan dolaşımı enfeksiyonu (KİKDE) EPN tedavisinde kateter ile ilişkili önemli morbidite ve mortaliteye yol açan bir komplikasyon olarak karşımıza çıkmaktadır. KİKDE endo-luminal (kateter içi) veya ekstra-luminal (kateter dışı) kaynaklı olabilir. KİKDE fizyopatolojisinde barsak translokasyonu (BT), bağışıklık sistemi yapısının bağırsakta bozulması, kateter yüzeylerinde gelişen biyofilm tabakası gibi mekanizmalar rol oynamaktadır. Kateter ile ilgili kan dolaşımı enfeksiyonları mono ve polimikrobiyal olabilir. Sıklık sırasına göre Gram pozitif bakteriler, Gram negatif bakteriler, mantarlar ve daha nadir enfeksiyonlar KİKDE etyolojisinde saptanan etkenlerdir. Koagülaz negatif stafilakoklar en yaygın nedensel patojendir. Ateş, spesifik olmamakla birlikte en yaygın klinik bulgudur. Sonuç olarak, EPN tedavisi uygulanan hastalarda, KİKDE açısından hasta yönetim planı yapılmalıdır.

Keywords

• kronik barsak yetmezliği
• Evde parenteral nütrisyon
• kateter ilişkili kan dolaşımı enfeksiyonu

Catheter-Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition

Abstract

Home Parenteral Nutrition (HPN) therapy is a vital treatment for patients with special medical conditions, such as Short Bowel Syndrome (SBS). Central venous catheters (CVC) play a critical role in the treatment of HPN. Catheter related bloodstream infection (CRBSI) is a complication in HPN treatment that causes significant catheter-related morbidity and mortality. CRBSI may be endo-luminal (inside the catheter) or extra-luminal (outside the catheter). Mechanisms such as bacterial translocation (BT), disruption of the immune system structure in the intestines, and biofilm layer developing on catheter surfaces play a role in the pathophysiology of CRBSI. CRBSI infections can be mono or polymicrobial. In order of frequency, Gram-positive bacteria, Gram-negative bacteria, fungi and rarer infections are the factors detected in the etiology of CRBSI. Coagulase-negative staphylococci is the most common causative pathogen. Fever, although nonspecific, is the most common clinical finding. As a result, in patients receiving HPN treatment, a patient management plan should be made in terms of CRBSI.

Keywords

• Home parenteral nutrition
• ; catheter related bloodstream infection
• chronic intestinal failure

References

1. Gompelman M, Causevic E, Bleeker-Rovers CP, Wanten GJA. Catheter-related bloodstream infection management in patients receiving home parenteral nutrition: An observational cohort study. Clin Nutr ESPEN. 2022; 50: 155-61.
2. https://www.klimud.org/public/uploads/content/files/KLIMUD%20Rehberleri_Kan%20Dolasimi_ver02.pdf.
3. Pironi L, Arends J, Bozzetti F, Cuerda C, Gillanders L, Jeppesen PB, et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr. 2016; 35: 247-307.
4. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009; 49 (1): 1-45.
5. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011; 39(4 Suppl): 1-34.
6. NHSN. 2023; published online March 16. https://www.cdc.gov/nhsn (accessed Aug 30, 2023).
7. Asensio AB, García-Urkia N, Aldazabal P, Bachiller P, García-Arenzana JM, Eizaguirre I. Incidence of bacterial translocation in four different models of experimental short bowel syndrome. Cir Pediatr. 2003; 16(1): 20-5.
8. Eizaguirre I, Aldazábal P, García N, Orgiles I, García-Arenzana JM, Ariz C. Bacterial translocation associated with short bowel: role of ileocecal valve and cecum. Cir Pediatr. 2001; 14(2): 57-60.

9. Aprahamian CJ, Chen M, Yang Y, Lorenz RG, Harmon CM. Two-hit rat model of short bowel syndrome and sepsis: independent of total parenteral nutrition, short bowel syndrome is proinflammatory and injurious to the liver. J Pediatr Surg. 2007; 42(6): 992-7.
10. Aldazabal P, Eizaguirre I, Barrena MJ, Garcia-Arenzana JM, Ariz C, Cuadrado E. Bacterial translocation and T-lymphocyte populations in experimental short-bowel syndrome. Eur J Pediatr Surg. 1998; 8(4): 247-50.
11. Gutierrez IM, Kang KH, Calvert CE, Johnson VM, Zurakowski D, Kamin D, et al. Risk factors for small bowel bacterial overgrowth and diagnostic yield of duodenal aspirates in children with intestinal failure: a retrospective review. J Pediatr Surg. 2012; 47(6): 1150-4.
12. Sukhotnik I, Yakirevich E, Coran AG, Siplovich L, Krausz M, Sabo E, et al. Lipopolysaccharide endotoxemia reduces cell proliferation and decreases enterocyte apopotosis during intestinal adaptation in a rat model of short-bowel syndrome. Pediatr Surg Int. 2002; 18(7): 615-9.
13. Romond M-B, Colavizza M, Romond PC, Bezirtzoglou E. Selective decontamination by antimicrobials during long term treatment: perspectives for saving host indigenous microbiota. Anaerobe. 2011; 17(6): 468-73.
14. Bond A, Kopczynska M, Conley T, Teubner A, Taylor M, Abraham A, et al. Long-term survival following fungal catheter-related bloodstream infection for patients with intestinal failure receiving home parenteral support. JPEN J Parenter Enteral Nutr. 2023; 47(1): 159-64.
15. Pohju AK, Hakkarainen AI, Pakarinen MP, Sipponen TM. Longitudinal evolution of catheter-related bloodstream infections, kidney function and liver status in a nationwide adult intestinal failure cohort. Scand J Gastroenterol. 2022; 57(7): 763-7.
16. Xue Z, Coughlin R, Amorosa V, Quinn R, Schiavone P, Stoner N, et al. Factors Associated With Central Line-Associated Bloodstream Infections in a Cohort of Adult Home Parenteral Nutrition Patients. JPEN J Parenter Enteral Nutr. 2020; 44(8): 1388-96.
17. Bond A, Conley T, Teubner A, Taylor M, Abraham A, Salazar FR, et al. Management of home parenteral nutrition catheter-related bloodstream infections in hospitals outside of a specialized intestinal failure center. JPEN J Parenter Enteral Nutr. 2022; 46(7): 1731-5.
18. Saqui O, Fernandes G, Allard J. Central venous catheter infection in Canadian home parenteral nutrition patients: a 5-year multicenter retrospective study. Br J Nurs. 2020; 29(8): 34-42.
19. Crivelli A, Fabeiro M, Puga M, Dieguez N, Giunta L, Pochettino F, et al. Care of patients on home parenteral nutrition during the first year of the COVID-19 pandemic: Management of central line-associated bloodstream infections. Clin Nutr ESPEN. 2022; 52: 250-3.
20. Reitzel RA, Rosenblatt J, Chaftari A-M, Raad II. Epidemiology of Infectious and Noninfectious Catheter Complications in Patients Receiving Home Parenteral Nutrition: A Systematic Review and Meta-Analysis. JPEN J Parenter Enteral Nutr. 2019; 43(7): 832-51.
21. Messing B. Catheter-related sepsis during home parenteral nutrition. Clin Nutr. 1995; 14 (Suppl 1): 46-51.
22. Tourvieilhe L, Jandot E, Quessada T, Barreto C, Marotte S, Heissat S et al. Increase of recurrent central line-associated bloodstream infections in children with home parenteral nutrition in a rehabilitation care facility compared to home. Clin Nutr. 2022; 41(9): 1961-8.
23. Wozniak LJ, Bechtold HM, Reyen LE, Chan AP, Marcus EA, Vargas JH. Epidemiology and Risk Factors for Outpatient-Acquired Catheter-Related Bloodstream Infections in Children Receiving Home Parenteral Nutrition. JPEN J Parenter Enteral Nutr. 2018; 42(5): 942-8.
24. Trivić I, Mišak Z, Kerman V, Prlić H, Kolaček S, Hojsak I. Central Catheter-related Bloodstream Infection Rates in Children on Home Parenteral Nutrition. J Pediatr Gastroenterol Nutr. 2020; 70(3): e59-62.
25. Seddik TB, Tian L, Nespor C, Kerner J, Maldonado Y, Gans H. Risk Factors of Ambulatory Central Line-Associated Bloodstream Infection in Pediatric Short Bowel Syndrome. JPEN J Parenter Enteral Nutr. 2020; 44(3): 500-6.
26. Zhao VM, Griffith DP, Blumberg HM, Dave NJ, Battey CH, McNally TA, et al. Characterization of post-hospital infections in adults requiring home parenteral nutrition. Nutrition. 2013; 29(1): 52-9.
27. Vashi PG, Virginkar N, Popiel B, Edwin P, Gupta D. Incidence of and factors associated with catheter-related bloodstream infection in patients with advanced solid tumors on home parenteral nutrition managed using a standardized catheter care protocol. BMC Infect Dis. 2017; 17(1): 372.
28. Lowell JA, Bothe A Jr. Venous access. Preoperative, operative, and postoperative dilemmas. Surg Clin North Am. 1991; 71(6): 1231-46.
29. Bonnes SL, Mundi MS, Hurt RT, Salonen BR. To Pull or Not to Pull: Salvaging Central Line Catheters in Home Parenteral Nutrition. Curr Nutr Rep. 2018; 7(4): 324-8.
30. Phua AI-H, Hon KY, Holt A, O’Callaghan M, Bihari S. Candida catheter-related bloodstream infection in patients on home parenteral nutrition- Rates, risk factors, outcomes, and management. Clin Nutr ESPEN. 2019; 31: 1-9.
31. Yang J, Sun H, Wan S, Mamtawla G, Gao X, Zhang L, et al. Prolonged Parenteral Nutrition Is One of the Most Significant Risk Factors for Nosocomial Infections in Adult Patients With Intestinal Failure. Nutr Clin Pract. 2020; 35(5): 903-10.
32. Bech LF, Drustrup L, Nygaard L, Skallerup A, Christensen LD, Jensen LV, et al. Environmental Risk Factors for Developing Catheter-Related Bloodstream Infection in Home Parenteral Nutrition Patients: A 6-Year Follow-up Study. JPEN J Parenter Enteral Nutr. 2016; 40(7): 989-94.
33. Al-Tawil ES, Almuhareb AM, Amin HM. Catheter-related blood stream infection in patients receiving long-term home parenteral nutrition: Tertiary care hospital experience in Saudi Arabia. Saudi J Gastroenterol. 2016; 22(4): 304-8.
34. Raphael BP, Fournier G, McLaughlin SR, Puder M, Jones S, Flett KB. Antibiotic Susceptibility and Therapy in Central Line Infections in Pediatric Home Parenteral Nutrition Patients. J Pediatr Gastroenterol Nutr. 2020; 70(1): 59-63.
35. Grant J. Recognition, prevention, and treatment of home total parenteral nutrition central venous access complications. JPEN J Parenter Enteral Nutr. 2002; 26(5 Suppl): 21-8.
36. McIntyre AS, Gertner DJ, Wood S, Phillips RK, Lennard-Jones JE. Long-term parenteral nutrition: problems with venous access. J R Soc Med. 1990; 83(6): 371-2.
37. Huisman-de Waal G, Versleijen M, van Achterberg T, Jansen JB, Sauerwein H, Schoonhovenet L, et al. Psychosocial complaints are associated with venous access-device related complications in patients on home parenteral nutrition. JPEN J Parenter Enteral Nutr. 2011; 35(5): 588-95.
38. Wing VK, Song Y, Xiang C, Liu X, Macaulay D, Ponsillo M, et al. Incidence of catheter-related complications among Japanese patients with central venous catheters as well as patients with short bowel syndrome. Clin Exp Gastroenterol. 2018; 11: 439-45.
39. Williams N, Scott NA, Irving MH. Catheter-related morbidity in patients on home parenteral nutrition: implications for small bowel transplantation. Ann R Coll Surg Engl 1994; 76(6): 384-6.
40. Dibb M, Lal S. Home Parenteral Nutrition: Vascular Access and Related Complications. Nutr Clin Pract. 2017; 32(6): 769-76.
41. Allan P, Stevens P, Chadwick P, Teubner A, Abraham A, Carlson G, et al. Osteomyelitis in adult patients on long-term parenteral nutrition: 2745 patient-years of experience in a national referral centre. Clin Nutr. 2016; 35: 1135-9.
42. Topan R, Ambrose T, Small M, Lightman E, Nightingale J, Gabe SM. Spinal Infections Among Patients With Long-Term Central Venous Catheters for Home Parenteral Nutrition: A Descriptive Case Series. Nutr Clin Pract. 2017; 32(1): 133-8.
43. Yared G, Seidner DL, Steiger E, Hall PM, Nally JV. Tunneled right atrial catheter infection presenting as renal failure. JPEN J Parenter Enteral Nutr. 1999; 23(6): 363-65.
44. Vidal M, Genillon JP, Forestier E, Trouiller S, Pereira B, Mrozek N, et al. Outcome of totally implantable venous-access port-related infections. Med Mal Infect. 2016; 46(1): 32-8.
45. Clare A, Teubner A, Shaffer JL. What information should lead to a suspicion of catheter sepsis in HPN? Clin Nutr. 2008; 27: 552-6.