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Guglielmi FW, Diamanti A, Gandullia P, Aimasso U, Arrigo S, Capriati T, Elia D, Guidetti M, Lezo A, Madeo A, Mazzuoli S, Merlo FD, Regano N, Sasdelli AS, Pironi L, De Francesco A. Non-interventional, 5-year retrospective data of home parenteral nutrition in patients with benign chronic intestinal failure: Analysis of an Italian nurse registry (SERECARE II). Nutrition 2024; 120:112257. [PMID: 38335907 DOI: 10.1016/j.nut.2023.112257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/17/2023] [Accepted: 10/01/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE This study is an assessment of home parenteral nutrition service performance and safety and efficacy outcomes in patients with benign chronic intestinal failure. METHODS This is a retrospective, non-interventional, and multicenter study. Data were collected by trained nurses and recorded in a dedicated registry (SERECARE). RESULTS From January 1, 2013 to June 30, 2018, data from a total of 683 patients with benign chronic intestinal failure were entered in the registry. Patients included 208 pediatric (53.8% male; median age = 4.0 y) and 475 adult (47.6% male; median age = 59.0 y) participants. On average, patients were visited 5.4 ± 4.5 times and received 1.4 ± 0.8 training sessions. Retraining was not common and mostly due to change of therapy or change of caregiver. Of 939 complications, 40.9% were related to the central venous catheter and were mostly infectious (n = 182) and mechanical (n = 187). The rate of infectious and mechanical complications per 1000 catheter days decreased over 5 y (0.30-0.15 and 0.33 -0.19, respectively). The rate of complications per 1000 catheter days and the mean complications per patient were higher in pediatric than in adult patients. The hospitalization rate was 1.01 per patient throughout the study period. These data were similar to those registered in a previous study period (2002-2011) (n = 1.53 per patient). Changes over time in the efficacy variables were mostly small and non-significant. CONCLUSIONS This study confirms the importance of setting up and maintaining structured registries to monitor and improve home parenteral nutrition care. Safety outcomes have improved over the years, most likely due to the underlying efficient nursing service.
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Affiliation(s)
| | | | | | - Umberto Aimasso
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Antonella Lezo
- Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienzadi Torino, Turin, Italy
| | | | | | | | - Nunzia Regano
- Ospedale Monsignor Raffaele Dimiccoli, Barletta, Italy
| | | | - Loris Pironi
- Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Natale R, Nasti C, Morena A, Pasanisi F, Santarpia L. Haematogenous Pneumonia Caused by Kocuria Kristinae in a Patient with a Central Venous Catheter. Eur J Case Rep Intern Med 2024; 11:004314. [PMID: 38584898 PMCID: PMC10997385 DOI: 10.12890/2024_004314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 04/09/2024] Open
Abstract
Kocuria kristinae is a Gram-positive commensal bacterium, rarely responsible for infection in immunocompromised patients. A 29-year-old woman affected by intestinal pseudo-obstruction and requiring home parenteral nutrition, was hospitalised for fever and shivering during the infusion through a long-term central venous catheter (CVC). Blood cultures were positive for K. kristinae infection. At a chest CT scan, two partially cavitated nodular lesions were evidenced. Meropenem antibiotic therapy was used locally and systemically, resulting in catheter use restoration. A chest CT scan two months later at follow-up showed two centimetric, fibrotic and disventilatory areas replacing the previous nodular thickenings. Kokuria kristinae was responsible for haematogenous pulmonary involvement with excavated nodules, requiring a differential diagnosis. Moreover, in the case of a CVC infection, in addition to the risk of right endocarditis, haematogenous pneumonia must also be considered. LEARNING POINTS Kocuria kristinae is a Gram-positive commensal bacterium, potentially responsible for infection.In the case of central venous catheter infection, in addition to the risk of right endocarditis, haematogenous pneumonia must also be considered.A differential diagnosis between bacterial and fungal infection is necessary (less, but to be suspected, neoplastic metastases).
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Affiliation(s)
- Raffaele Natale
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Clelia Nasti
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Annadora Morena
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Lidia Santarpia
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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Gundogan K, Dave NJ, Griffith DP, Zhao VM, McNally TA, Easley KA, Haack CI, Galloway JR, Ziegler TR. Ethanol Lock Therapy Markedly Reduces Catheter-Related Blood Stream Infections in Adults Requiring Home Parenteral Nutrition: A Retrospective Study From a Tertiary Medical Center. JPEN J Parenter Enteral Nutr 2019; 44:661-667. [PMID: 31456260 DOI: 10.1002/jpen.1698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/16/2019] [Accepted: 08/03/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND The use of central venous catheter (CVC) access for home parenteral nutrition (HPN) is associated with catheter-related bloodstream infections (CRBSIs). There are limited data on the use of ethanol lock therapy (ELT) to prevent CRBSI in adult HPN patients. Our aim was to determine whether the routine institution of ELT decreased the incidence of CRBSI compared with historic controls at Emory University Hospital (EUH) in Atlanta, Georgia, USA. METHODS EUH medical records of adult HPN patients discharged with a tunneled, silicone CVC on ELT were retrospectively studied during a pre-hoc determined 14-month observation period (n = 87; 13,386 catheter days) and compared with clinically similar HPN patients from the same institution before institution of the ELT protocol for all appropriate patients. The ELT protocol involved instilling 2 mL of 70% ethanol into each catheter lumen daily after the HPN cycle, following initial flushing with normal saline. RESULTS Only 5 of 87 patients (5.7%) who received ELT were diagnosed with a CRBSI (0.45/1000 catheter days) during observation. We compared these data with our previously published clinically matched patient population from EUH (n = 22) receiving HPN via a silicone CVC without ELT. Of these historical controls, 45.5% were diagnosed with 1 or more CRBSIs (8.7/1000 catheter days) during observation (P < .001 vs the current ELT cohort). CONCLUSIONS In this retrospective study with historical controls from the same academic center, institution of ELT in adults requiring HPN via a silicone CVC was associated with a marked (19-fold) reduction in CRBSI.
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Affiliation(s)
- Kursat Gundogan
- Division of Medical Intensive Care, Department of Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Nisha J Dave
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Daniel P Griffith
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Vivian M Zhao
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Pharmaceutical Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Therese A McNally
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Nursing Services, Emory University Hospital, Atlanta, Georgia, USA
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Carla I Haack
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John R Galloway
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA
| | - Thomas R Ziegler
- Nutrition and Metabolic Support Service, Emory University Hospital, Atlanta, Georgia, USA.,Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Center for Clinical and Molecular Nutrition, Emory University, Atlanta, Georgia, USA.,Section of Endocrinology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
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