OWE-025 Catheter related infections in type 2 intestinal failure patients admitted to a national centre

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Abstract

Introduction

Management of intestinal failure (IF) requires safe and sustained delivery of parenteral nutrition (PN). Thus, long term safe central venous catheter (CVC) access is vital, with meticulous catheter care and salvage of infected catheters being of prime importance since catheter related blood stream infection (CRBSI) and loss of intravenous access are leading causes of morbidity and mortality in chronic IF. There are, however, no published data on the occurrence and outcomes of CRBSIs in patients admitted with acute severe (type 2) IF.

Methods

This is a retrospective observational study conducted between Jan 2011 and July 2017. All new patients with type 2 IF admitted to a national IF Unit during these dates were included. A prospectively maintained database was used to record all confirmed CRBSI cases and clinical data. All new patients admitted with a CVC had paired central and peripheral cultures taken to identify CRBSI. Diagnosis of CRBSI was based on quantitative and qualitative analysis of paired central and peripheral blood cultures. The CVC was used only when CRBSI had been excluded or treated. A standardised 10 to 14 day catheter salvage treatment protocol involving CVC locks and systemic antibiotic administration was used to salvage infected catheters, as appropriate.

Results

Of the 509 patients with type 2 IF admitted from another hospital to our IFU during the study period, 341 (54% female; mean age 54.6 (range 16–86 years) had an indwelling CVC. PICC and tunnelled CVCs were the most common(81.5%). Surgical complications and mesenteric ischaemia were the most common underlying aetiology. Sixty-five (19.1%) of patients had a diagnosis of CRBSI on the initial screening set of blood cultures and pour plates; the CRBSI had not previously been identified in the referring hospital. A successful CVC salvage rate of 91% was achieved in this cohort. Over a total of 23 548 subsequent catheter days during the 341 patients’ stay in the IFU, there was only one CRBSI (0.042 per 1000 catheter days). There was no increased risk of future Home PN related CRBSI (p=0.09) or mortality (p=0.4) in those admitted with a CRBSI at admission, over a follow-up period of 216 944 catheter days.

Conclusion

All patients should have screening cultures of CVC on admission to an IFU. When CRBSI is present on admission, a high rate of catheter salvage is possible. Stringent CVC care and aseptic strategies in a dedicated IFU can achieve a very low CRBSI rate during the subsequent in-patient stay. CRBSI at index admission to the IFU does not increase risk of future HPN CRBSI or death after discharge

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