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Antibiotic therapy of catheter infections in patients receiving home parenteral nutrition
Author(s) -
Miller SJ,
Dickerson RN,
Graziani AA,
Muscari EA,
Mullen JL
Publication year - 1990
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607190014002143
Subject(s) - cefazolin , medicine , vancomycin , parenteral nutrition , antibiotics , catheter , sepsis , surgery , staphylococcus aureus , microbiology and biotechnology , bacteria , genetics , biology
Fifty‐eight episodes of catheter‐related sepsis in 21 patients receiving home parenteral nutrition were retrospectively studied. Of 81 organisms isolated from the blood, 59% were Gram‐positive cocci, 25% were Gram‐negative bacilli, and 16% were yeast. Attempts to treat bacterial infections at home with antibiotic therapy while the catheter remained in place were made; fungal isolation resulted in immediate hospitalization and catheter removal. Gram‐negative infections more often resulted in eventual hospitalization (92%) and catheter removal (50%) than Gram‐positive infections (57% hospitalization and 23% catheter removal). Empiric therapy with 1 g of cefazolin intravenously every 12 hr was successful in only 33% of episodes caused by coagulase‐negative staphylococci, whereas vancomycin was successful in 62%. Sensitivity testing was not a reliable guide for antibiotic choice for treatment of these infections. Cefazolin, 1 g, intravenously every 12 hr was successful in only 25% of Gram‐negative episodes treated empirically with this regimen. We conclude that our home parenteral nutrition patients should be hospitalized for a few days upon presentation with a catheter infection for clinical evaluation and aggressive antibiotic therapy. Vancomycin is the preferred drug for treatment of catheter‐related infections caused by coagulase‐negative staphylococcus.