Abstract
Background: Patients on total parenteral nutrition (TPN) are at risk of developing central line-associated infections. Specifically, Staphylococcus aureus bacteremia (SAB) is feared for its high complication rates. This prospective cohort study compares characteristics, clinical course and outcome of SAB in patients with and without TPN support. Methods: Clinical and microbiological data from all patients with positive blood cultures for S. aureus from two facilities, including our referral center for TPN support, were retrieved (period 2013–2020). Primary outcome was overall mortality, and included survival analysis using a multivariate Cox regression model. Secondary outcomes comprised a comparison of clinical characteristics and outcomes between both patient groups and analysis of factors associated with complicated outcome (e.g., endocarditis, deep-seated foci, relapse and death) in patients on TPN specifically. Results: A total of 620 SAB cases were analyzed, of which 53 cases received TPN at the moment the blood culture was taken. Patients in the TPN group were more frequently female, younger and had less comorbidity (p < 0.001). In-hospital death and overall mortality were significantly lower in TPN patients (4% vs. 18%, p = 0.004 and 10% vs. 34%, p < 0.001, respectively). Positive follow-up blood cultures, delayed onset of therapy and previous catheter problems were associated with a higher incidence of complicated SAB outcome in patients on TPN. Conclusion: Our data show that patients on TPN have a milder course of SAB with lower mortality rates compared to non-TPN SAB patients.
Highlights
Central line-associated bloodstream infections (CLABSIs) are the most common and serious complications for patients with intestinal failure receiving total parenteral nutrition (TPN) [1,2,3].The overall incidence of Central Line Associated Blood Stream Infection (CLABSI) in patients receiving TPN ranges from 0.38 to 4.58 episodes per 1000 catheter days and account for nearly 70% of all hospital admissions [4,5,6]
Sensitivity analysis was done for three specific variables to examine whether these influenced our data and outcomes, namely (1) patients treated in other hospitals with a significant amount of missing data, (2) cases with missing data on primary outcome and (3) short-term parenteral nutrition (e.g.,
We conducted the first study of S. aureus bacteremia in chronic TPN patients, resulting in an extensive and robust data analysis with >90% complete follow-up data
Summary
Central line-associated bloodstream infections (CLABSIs) are the most common and serious complications for patients with intestinal failure receiving total parenteral nutrition (TPN) [1,2,3].The overall incidence of CLABSIs in patients receiving TPN ranges from 0.38 to 4.58 episodes per 1000 catheter days and account for nearly 70% of all hospital admissions [4,5,6]. Central line-associated bloodstream infections (CLABSIs) are the most common and serious complications for patients with intestinal failure receiving total parenteral nutrition (TPN) [1,2,3]. S. aureus bacteremia (SAB) presents as a life-threatening infection that is associated with an all-cause mortality ranging from 20 to 30%. Staphylococcus aureus bacteremia (SAB) is feared for its high complication rates. This prospective cohort study compares characteristics, clinical course and outcome of SAB in patients with and without TPN support. Positive follow-up blood cultures, delayed onset of therapy and previous catheter problems were associated with a higher incidence of complicated SAB outcome in patients on TPN. Conclusion: Our data show that patients on TPN have a milder course of SAB with lower mortality rates compared to non-TPN SAB patients
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