ABSTRACT
Sepsis is one of the most frequent and serious complications of centrally infused parenteral nutrition (PN) in adults and children [1]. In fact, of the greater than 150 million intravenous catheters placed in the United States each year, approximately 80,000 central venous catheter (CVC)-associated infections develop [2]. Worldwide it is estimated that 250,000-500,000 cases of CVC-associated bloodstream infections (BSI) occur annually. The estimated cost to the healthcare system ranges from 12,000 to 56,000 U.S. dollars per episode, with an estimated total cost of approximately $2.3 billion annually in the United States [3-5]. Care includes a mean length of stay of up to 6 days in an intensive care unit, and up to 21 days at the hospital [5,6]. The mortality associated with major CVC-associated infection is estimated between 12% and 35% per infection [5]. Additionally, the Center for Medicare and Medicaid Services 2008 reimbursement guidelines consider infections which are the result of a vascular catheter to be a preventable hospital-acquired condition which will no longer be reimbursed [7]. Interestingly, those patients with intestinal failure (IF) are at the highest risk in developing CVC-associated infections [8]. Additionally, of those patients with IF on home parenteral nutrition (HPN), half of all hospitalizations were due to proven CVC-associated infections [8]. Most series report an incidence of 0.5-2.0 infections per 1000 catheter-days for a nonimmunosuppressed patient with a CVC [9,10]. For immunosuppressed patients (e.g., hematology or oncology patients), a rate of 2-3 infections per 1000 catheter-days is generally reported [11,12]. A considerably higher rate of infection is found in children with the short-bowel syndrome with rates ranging from 2.1 to 9 infections per 1000 catheter-days [8,13-17]. The mean rate of CVC infections in adult IF patients may be lower, with one group reporting a rate of 0.48 infections/1000 catheter-days [18].
