Home parenteral nutrition: The Quebec patient profile and systematic review of antimicrobial locks in the prevention of catheter related blood stream infections
Bibliographic record
Abstract
Background: Home parenteral nutrition (HPN) is a life-sustaining treatment for patients with chronic intestinal failure. Chronic intestinal failure is a rare condition with an estimated prevalence of 5 to 20 per million population (1). Patients with intestinal failure have insufficient bowel function to meet their nutritional needs with sole oral or enteral intake. On HPN, patients self-administer nutrients and fluids intravenously via central venous access, a complex process that is costly and puts patients at risk for several complications. One major complication is catheter related blood stream infection (CRBSI), which is associated with significant morbidity and mortality. No data currently exist on HPN patients in Quebec with little information available on local complications such as CRBSI and hospitalization rates.Objectives: Our objectives were to establish a patient cohort to define the profile of HPN patients in Quebec and to review CRBSI in HPN. We aimed to evaluate CRBSI associated risk factors and prevention methods, namely antimicrobial lock use as prophylaxis. Methods: We conducted a prospective cohort study enrolling active HPN patients in Quebec as part of the Canadian HPN Registry. We collected data on demographics, comorbidities, PN prescription and complication rates. After reviewing risk factors for CRBSI, we performed a systematic review on the use of antimicrobial locks as prophylaxis for catheter infection in the HPN population.Results: The prevalence and incidence of HPN is 13 per million and 0.6 per million population in 2016 in Quebec. Demographics were comparable with the rest of Canada with the exception of greater proportion of short bowel syndrome and motility disorders in the PN population. Hospitalization rate was 1.05 ± 1.21 (range 0-6) per patient per year and mean CRBSI rate was 0.65 per 1000 catheter-year. Antimicrobial locks were not routinely used in Quebec. Our systematic review on the topic retrieved 23 studies (3 randomized controlled trials (RCT) and 20 observational studies) featuring important clinical and methodological heterogeneity and limited by moderate to high risk of bias. Our results are insufficient to establish the benefits of antimicrobial lock use.Conclusion: HPN is rare in Quebec where there was a higher prevalence of short bowel syndrome and motility disorders, the latter driven by the presence of regional genetic dysmotility condition. Local CRBSI rate was low and comparable to national and international reports. While our systematic review was inconclusive, we identified key methodological and study design characteristics useful to inform future studies on antimicrobial locks.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.012 | 0.020 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".