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An evidence-based surveillance tool to identify and report catheter/cannula bloodstream infection in patients receiving parenteral nutrition

An evidence-based surveillance tool to identify and report catheter/cannula bloodstream infection in patients receiving parenteral nutrition
An evidence-based surveillance tool to identify and report catheter/cannula bloodstream infection in patients receiving parenteral nutrition

Objective: catheter/cannula-bloodstream infection (CBI) has been proposed as a marker of the quality of care provided to patients receiving parenteral nutrition (PN). However, surveillance criteria for CBI are variable, inconsistent, and sometimes confusing and impractical. Surveillance criteria were developed to simply and accurately demonstrate the presence or absence of CBI. The aim of this study was to establish a simple and valid surveillance tool, with consideration of changes in vital signs, to identify CBI in patients receiving PN. 

Methods: adult (≥18 y) inpatients prescribed PN at a single large teaching hospital were recruited between October 11, 2017 and November 16, 2018. Common clinical and laboratory criteria, including blood culture, associated with 100 consecutive PN episodes associated with suspected CBI were examined for potential predictive markers of CBI. Using binary logistic regression, criteria were incorporated into an instrument that was validated against a reference classification of CBI established by an expert multidisciplinary group. 

Results: the reference classification comprised 12 PN episodes with CBI and 88 without. Abnormal vital signs did not significantly predict CBI, but resolution of fever (≥38°C) and low systolic blood pressure (<100 mm Hg) in response to a specific treatment for CBI (line removal/antibiotics) did. Two other criteria were also significant predictors: positive blood culture; and absence of an alternative source that could explain the septic episode other than the catheter/cannula supplying PN. These two criteria together with a positive response to treatment (temperature and/or blood pressure, incorporated into a single binary variable), resulted in 100% correct CBI classification (100% sensitivity, 100% specificity, and 1.000 area under the curve in receiver operating characteristic analysis). All criteria could be retrospectively extracted from the medical records of all PN episodes. 

Conclusion: a CBI tool shows promise as a surveillance instrument for benchmarking and interinstitutional comparisons of the care received by hospitalized patients given PN.

Bloodstream infection, Catheter, Diagnosis, Parenteral nutrition, Sepsis, Surveillance
0899-9007
Austin, Peter David
69eb539b-307c-44f9-8e1e-7f0de841c220
Hand, Kieran Sean
ddc13961-28ef-43ff-9cfa-e62e1dee06ab
Macnaughtan, Jane
0f2d978f-29ee-4493-9624-db36525d0232
Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Harding, Susan Diane
7a89b946-4c8b-45ed-9c4d-8a71050b22ca
Smith, Caroline
c53cf3b5-c529-48a9-aa7a-f983b28c8ce8
Elia, Marinos
964bf436-e623-46d6-bc3f-5dd04c9ef4c1
Austin, Peter David
69eb539b-307c-44f9-8e1e-7f0de841c220
Hand, Kieran Sean
ddc13961-28ef-43ff-9cfa-e62e1dee06ab
Macnaughtan, Jane
0f2d978f-29ee-4493-9624-db36525d0232
Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Harding, Susan Diane
7a89b946-4c8b-45ed-9c4d-8a71050b22ca
Smith, Caroline
c53cf3b5-c529-48a9-aa7a-f983b28c8ce8
Elia, Marinos
964bf436-e623-46d6-bc3f-5dd04c9ef4c1

Austin, Peter David, Hand, Kieran Sean, Macnaughtan, Jane, Saeed, Kordo, Harding, Susan Diane, Smith, Caroline and Elia, Marinos (2022) An evidence-based surveillance tool to identify and report catheter/cannula bloodstream infection in patients receiving parenteral nutrition. Nutrition, 98, [111639]. (doi:10.1016/j.nut.2022.111639).

Record type: Article

Abstract

Objective: catheter/cannula-bloodstream infection (CBI) has been proposed as a marker of the quality of care provided to patients receiving parenteral nutrition (PN). However, surveillance criteria for CBI are variable, inconsistent, and sometimes confusing and impractical. Surveillance criteria were developed to simply and accurately demonstrate the presence or absence of CBI. The aim of this study was to establish a simple and valid surveillance tool, with consideration of changes in vital signs, to identify CBI in patients receiving PN. 

Methods: adult (≥18 y) inpatients prescribed PN at a single large teaching hospital were recruited between October 11, 2017 and November 16, 2018. Common clinical and laboratory criteria, including blood culture, associated with 100 consecutive PN episodes associated with suspected CBI were examined for potential predictive markers of CBI. Using binary logistic regression, criteria were incorporated into an instrument that was validated against a reference classification of CBI established by an expert multidisciplinary group. 

Results: the reference classification comprised 12 PN episodes with CBI and 88 without. Abnormal vital signs did not significantly predict CBI, but resolution of fever (≥38°C) and low systolic blood pressure (<100 mm Hg) in response to a specific treatment for CBI (line removal/antibiotics) did. Two other criteria were also significant predictors: positive blood culture; and absence of an alternative source that could explain the septic episode other than the catheter/cannula supplying PN. These two criteria together with a positive response to treatment (temperature and/or blood pressure, incorporated into a single binary variable), resulted in 100% correct CBI classification (100% sensitivity, 100% specificity, and 1.000 area under the curve in receiver operating characteristic analysis). All criteria could be retrospectively extracted from the medical records of all PN episodes. 

Conclusion: a CBI tool shows promise as a surveillance instrument for benchmarking and interinstitutional comparisons of the care received by hospitalized patients given PN.

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More information

Accepted/In Press date: 15 February 2022
e-pub ahead of print date: 5 March 2022
Published date: 8 April 2022
Additional Information: Funding Information: PDA acknowledges PINNT, a UK patient support and advocacy charity for those on home artificial nutrition support, for their general support and advice throughout his HEE/NIHR Clinical Lectureship. P.D.A., Clinical Lecturer (ICA-CL-2016-02-016), received funding from the Health Education England (HEE)/National Institute for Health Research (NIHR) for this research project. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, HEE, NHS, or the UK Department of Health and Social Care. P.D.A. was responsible for the conceptualization, methodology, funding acquisition, investigation, resources, data curation, validation, formal analysis, writing of the original draft, visualization, review and editing of the draft, and project administration. K.S.H., J.M., K.S., S.D.H., and C.S. were responsible for the investigation, review and editing of the draft. M.E. was responsible for the conceptualization, methodology, investigation, formal analysis, validation, review and editing of the draft, and supervision. The authors have no conflicts of interest to declare.
Keywords: Bloodstream infection, Catheter, Diagnosis, Parenteral nutrition, Sepsis, Surveillance

Identifiers

Local EPrints ID: 457898
URI: http://eprints.soton.ac.uk/id/eprint/457898
ISSN: 0899-9007
PURE UUID: 5b5f8895-2cee-464c-9951-7e697f607113
ORCID for Kordo Saeed: ORCID iD orcid.org/0000-0003-0123-0302

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Date deposited: 21 Jun 2022 18:15
Last modified: 19 Oct 2022 01:58

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Contributors

Author: Peter David Austin
Author: Kieran Sean Hand
Author: Jane Macnaughtan
Author: Kordo Saeed ORCID iD
Author: Susan Diane Harding
Author: Caroline Smith
Author: Marinos Elia

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