Adolescent eating disorder with catheter‐related bloodstream infection

• Published in: Pediatrics international Vol. 63; no. 6; pp. 678 - 684
• Main Authors: Tamura, Akira, Minami, Koichi, Tsuda, Yuko, Mizumoto, Kazuhiro, Suzuki, Hiroyuki
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-06-2021
• Subjects: adolescent eating disorder; Appetite; Candida parapsilosis; Catheters; catheter‐related bloodstream infection; central venous hyperalimentation; Eating disorders; Hyperalimentation; Infections; Nutrition therapy; Nutritional status; nutritional therapy; Pediatrics; Risk factors; catheter-related bloodstream infection; central venous hyperalimentation; nutritional therapy; Candida parapsilosis; adolescent eating disorder
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1111/ped.14511

Background
Treatment of adolescent eating disorder requires early improvement of nutritional status. Central venous hyperalimentation is used but catheter‐related bloodstream infection (CRBSI) is a complication. There have been no reports examining risk factors for CRSBI in eating disorders.
Methods
The subjects were 51 patients who received nutritional therapy with the use of a peripherally inserted central catheter (PICC) from January 2012 to December 2019. The courses of weight and white blood cell (WBC) count were examined retrospectively during nutritional therapy. Onset factors for CRBSI were determined and a case series of CRBSI caused by Candida parapsilosis is presented.
Results
The day of minimum weight occurred on or before day 7 in 37 of the 51 patients, and this day was preceded by the day with the lowest WBC at a significant rate. The minimum weight day was significantly delayed in CRSBI cases compared with non‐CRBSI cases (P = 0.02). In the case series of CRBSI caused by C. parapsilosis, the median WBC count before CRBSI decreased to 2,570 (1,680–3,270)/μL at a median of day (12–90) 36. Catheter‐related bloodstream infection developed at a median of day (26–133) 38. The PICC was immediately removed and an antifungal drug was started, leading to cure with no after effects in all subjects.
Conclusions
In patients with an eating disorder treated with nutritional therapy using a PICC, prolonged resistance to weight gain became a risk factor for developing CRBSI. White blood cell counts recover after weight gain, which suggests that there is a risk of developing CRBSI, even with improved appetite and weight gain.