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Vertebral osteomyelitis: an under-recognized infectious complication in patients on home parenteral nutrition
Genevieve Huard1, Mickael Bouin1, Michel Lemoyne1
1Gastroenterology and Nutrition Unit, Hopital Saint-Luc, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada.
Background:
Patients on home parenteral nutrition (HPN) are at high risk of central venous catheter sepsis (CVCS). CVCS can be associated with distant bacterial seeding. However, few cases of vertebral osteomyelitis (VO) related to HPN have been reported. For this reason, we made the hypothesis that the incidence of VO in patients on HPN is probably higher than what is reported. The goal of this study was to evaluate the incidence of infectious complications, and more specifically, the incidence of VO in patients on HPN.
Methods:
A retrospective study of all patients receiving HPN from 2001 to 2006 was conducted. Patients who received HPN for < 1 month were excluded. Infectious complications and, more specifically, cases of VO were searched.
Results:
Thirty-one patients received HPN and were included in the analysis. Forty-four infectious complications occurred (1.302/1,000 CVC-days). The most frequent infectious complication was urinary tract infection (25 cases; 0.740/1,000 CVC-days). Seven CVCS occurred in five different patients (0.207/1,000 CVC-days). In patients with CVCS, 42.9% (three cases) developed a secondary VO. No predictive factors for the development of VO could be identified in univariate analysis.
Conclusion:
We report a very low rate of infectious complications and an even lower rate of CVCS in patients on HPN. However, we report that 42.9% of our cases of CVCS developed a secondary VO. Consequently, VO must be part of the differential diagnosis among patients with HPN who complain of back pain.
Insights
Patients on home parenteral nutrition (HPN) face risks of catheter sepsis. A study found that nearly half of these sepsis cases led to vertebral osteomyelitis (VO), highlighting VO as a crucial differential diagnosis for back pain in HPN patients.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Clinical Medicine
Background:
- Home parenteral nutrition (HPN) patients are susceptible to central venous catheter sepsis (CVCS).
- Vertebral osteomyelitis (VO) is an uncommon but serious complication of CVCS.
- The incidence of VO in HPN patients is likely underestimated.
Purpose of the Study:
- To determine the incidence of infectious complications in HPN patients.
- To specifically evaluate the occurrence of VO in this population.
Main Methods:
- Retrospective analysis of HPN patients from 2001-2006.
- Exclusion of patients with HPN duration less than one month.
- Systematic search for infectious complications, with a focus on VO.
Main Results:
- Thirty-one patients were analyzed, experiencing 44 infectious complications.
- Urinary tract infections were most common, followed by CVCS in five patients.
- A significant 42.9% of CVCS cases resulted in secondary VO, with no identifiable predictive factors.
Conclusions:
- HPN patients exhibit low overall infectious complication and CVCS rates.
- A high proportion of CVCS cases in HPN patients develop secondary VO.
- VO should be considered in the differential diagnosis for HPN patients presenting with back pain.