Treatment of home parenteral nutrition related catheter infections with catheter retention

Introduction: Home parenteral nutrition (HPN) is a life-saving treatment of patients with permanent bowel disorders. HPN-associated bloodstream infection is one of the serious complications of HPN, a determining factor of mortality. Between 2010 and 2011 seven patients were treated in our own centre and during 1000 days of care we encountered 0.51 catheter infections. Between 2012 and 2014 we had 11 patients, the infection rate was 1.58. As the infection rate was increasing we compiled a catheter reservation protocol in line with the literature to facilitate long term central vein integrity preservation and to reduce the rate of recurrent catheter infection. Patients, method: Between 2012 and 2014 we treated 11 patients. We set up a catheter retention protocol: (1) immediate catheter removal upon infections caused by fungi, Pseudomonas, MRSA or other resistant pathogens; (2) in the event of repeated and proven catheter infections: use of the infected catheter is prohibited; (3) 3 × catheter closing with 70 per cent ethanol; (4) the catheter is reused upon the normalization of white blood cell count and CRP; (5) thereafter the central catheter is closed with Tauroloc-Hepa on every second day of nutrition. We examined the retention time of the catheter and the complications of the infection. Results: There were three patients with repeated catheter infections, two of them had a jejunostomy and one had a tumour. Average age: 51 years. Patient 1: 3 × E. coli infections, after the third instance the catheter was replaced, there were no complications. Catheter retention: 112 days. Patient 2: 1 × Staph. coag. neg., catheter retention: 65 days; Patient 3: Enterococcus fecalis, Klebsiella pneumonia, later on Staph. caog. neg. Catheter retention: 179 days. Infection rate with this group: 3.95 Summary: Catheter infection occurred with older (> 60ys) male patients and longer (> 450 days) nutrition periods. In two of the three cases reviewed there were no complications; catheter replacement times could be prolonged by 118.7 days on average. After the third recurring infection of the patient with a tumour and a jejunostomy endocarditis occurred as a complication. Conclusion: Male gender and > 450 days of HPN pose increased risk, as described in the literature. We changed our protocol and now remove the central catheter if a second proven recurring catheter infection occurs.