Catheter‐related bloodstream infections, infective endocarditis, and vertebral osteomyelitis in adults receiving home parenteral nutrition: A descriptive cohort study

BACKGROUND: Intestinal failure patients receiving home parenteral nutrition are at risk of catheter-related bloodstream infection. Metastatic infections include infective endocarditis and vertebral osteomyelitis. We aimed to investigate the incidences of catheter-related bloodstream infection, infective endocarditis, and vertebral osteomyelitis in type 3 intestinal failure patients. METHODS: This was a cohort study conducted in a Danish referral intestinal failure center. All data on catheter-related bloodstream infections, infective endocarditis, and vertebral osteomyelitis were retrieved from medical records on patients receiving home parenteral nutrition through tunneled cuffed central venous access devices or peripherally inserted central catheters from 01 January 2019 to 31 December 2023. RESULTS: A total of 323 patients (209 females) were included, totaling 913 catheters and 293,650 catheter days. The catheter-related bloodstream infection incidence was 0.93 per 1,000 catheter days (95% CI: 0.82-1.03) over the 5-year period, with a statistically significantly higher incidence for tunneled cuffed central venous access devices than for peripherally inserted central catheters (1.10 [95% CI: 0.95-1.26] vs. 0.66 [95% CI: 0.52-0.81] per 1,000 catheter days, respectively). Thirteen cases of infective endocarditis (0.04 per 1,000 catheter days [95% CI: 0.02-0.07]) and ten cases of vertebral osteomyelitis (0.03 per 1000 [95% CI: 0.01-0.06]) were identified. CONCLUSION: The catheter-related bloodstream infection incidence is within the acceptable range recommended by current guidelines. The incidence of infective endocarditis is higher, and that of vertebral osteomyelitis is similar to those in other studies. Catheter-related bloodstream infection is a serious complication that may lead to infective endocarditis or vertebral osteomyelitis, underscoring the need for timely detection and management.