Spinal Infections Amongst Sufferers With Lengthy-Time period Central Venous Catheters for Dwelling Parenteral Diet.
Nutr Clin Pract. 2017 Feb;32(1):133-138
Authors: Topan R, Ambrose T, Small M, Lightman E, Nightingale J, Gabe SM
Spinal infections are a uncommon but severe metastatic complication of bacteremia amongst sufferers with long-term central venous catheters (CVCs) for which clinicians should stay vigilant. We carried out a retrospective overview of all instances of spinal an infection occurring within the context of a CVC for long-term parenteral diet (PN) managed in our division between January 2010 and October 2013, a cohort of 310 sufferers over this time interval. Six sufferers had been recognized (imply age, 65 years; 5 male). 100% of sufferers offered with spinal ache (5/6 cervical, 1/6 thoracic). Organisms had been cultured from the CVC in 5 of 6 sufferers. In all instances, the white blood cell depend was regular, and in 5 of 6, C-reactive protein was regular. All diagnoses had been confirmed on magnetic resonance imaging (MRI), and in three of 6 instances, an MRI was repeated (on the recommendation of neurosurgical colleagues) to verify decision of adjustments after a interval of antimicrobial remedy. There was no clear correlation between period of PN or variety of days following CVC insertion and onset of an infection. The CVC was changed in four of 6 sufferers on the time of prognosis, delayed elimination in 1 of 6, and salvaged within the remaining case. Though uncommon, a excessive index of suspicion is required in sufferers receiving long-term PN who current with spinal ache. Peripheral inflammatory markers is probably not elevated. MRI must be carried out and sufferers must be handled with antibiotics alongside involvement of native microbiology and neurosurgical groups. Multidisciplinary dialogue on CVC salvage in these instances is vital, particularly in instances of difficult vascular anatomy.
PMID: 27385770 [PubMed – indexed for MEDLINE]