Sepsis severity in chronic intestinal failure patients presenting with catheter related blood stream infection

The occurrence of catheter related blood stream infection (CRBSI) is a leading cause of morbidity and mortality for patients receiving home parenteral support (HPS) via a central venous catheter (CVC), as part of their chronic intestinal failure (CIF) care.

This was a retrospective cohort study of CRBSI events in patients receiving HPS for underlying CIF, cared for at a national IF Reference Centre between 2012 and 2022.

Overall, there were 153 CRBSI episodes recorded in 102 patients, over 418,252 catheter days, corresponding to CRBSI rate of 0.37 per 1000 catheter days. Among all episodes of CRBSI, 79 (51.6 %) had SIRS ≥ 2, 55 (35.9 %) had SOFA ≥ 2, 35 (22.9 %) had Red Flag sepsis and 28 (18.3 %) fulfilled NICE high-risk criteria. Of note, substantial proportion of episodes (35.3 %) did not fulfil any of the criteria. The median score for SIRS criteria was 2 (IQR 0-3) and for SOFA was 1 (IQR 0-2). The median white cell count was 8.3 × 10⁹/L (IQR 6.2-14.0 ×10⁹/L), median C-reactive protein was 44.0 mg/L (IQR 14.0-90.0 mg/L). There were no CRBSI-related deaths recorded among the study population. Eight (5.2 %) CRBSI episodes led to multi-organ dysfunction and in 10 (6.5 %) episodes patients required ICU admission.

We have demonstrated that the majority of HPS-dependent patients who present with CRBSI do so in a subtle manner. Awareness of this is vital, particularly for healthcare professionals who do not routinely care for patients with CIF.