P322 Complications to parenteral therapy in patients with intestinal failure because of inflammatory bowel disease: A retrospective cohort study
R. Lorentsen, L. K. Munck, S. Wildt*
Køge University Hospital, and Faculty of Health Sciences, University of Copenhagen, Section of Gastroenterology, Medical Department, Køge, Denmark
Intestinal failure (IF) is a rare complication in inflammatory bowel disease (IBD) and often due to repeated resections or complications to surgery. Parenteral therapy (PT) is the established treatment for patients with IF. The aim of this study was to compare treatment and complication rates of PT in IBD patients with the non-IBD patients in our IF unit.
All patients receiving PT because of IF in a regional Gastroenterology Department with IF service in the period 2005–2014 were included retrospectively. Comparison of demographics, type, and frequency of PT, catheter type, catheter dwell time, and complications was made amongst those with and without IBD. Non-parametric tests were applied.
In total, 146 patients with IF were identified (87 F and 59 M). The cause of IF was IBD in 24 (16%). The non-IBD patients had IF because of obstructions and surgical complications (41%), cancer (21%), radiation enteritis (10%), mesenteric vascular disease (9%), and other causes (3%). Age (median and range) at start of PT was 54 (38–76) years in the IBD group and 66 (21–87) years in the non-IBD group. 29 patients (6 IBD) were treated with fluid and electrolytes via a peripheral venous access on a weekly basis. Further, 117 of 146 (80%) patients (18 IBD) had a central venous access for the infusion of PT. Treatment period (median and range) was 856 days (18–3 651) in IBD compared with 235 days (163–650) in the non-IBD group (p = 0.04). The dwell time (median and range) for non-tunnelled catheter (n = 328) and tunnelled catheter (n = 142) was 39 (15–11) and 163 (32–819) days, respectively. The incidence of catheter-related blood stream infection (CRBSI) in tunnelled catheters were 0.96 episodes per 1 000 catheter days in IBD and 1.97 in non-IBD patients respectively. Further, 45 % of patients in the non-IBD group never had a CRBSI and 11% of patients accounted for 49% of all CRBSIs. In patients with IBD, 50% never had a CRBSI, and 1 patient had 7 (33%) of all CRBSIs. Gram positive bacteria were the most common pathogen in the IBD group (73%) compared with the non-IBD group (44%) (p = 0.01). The incidence of thrombosis in tunnelled catheters was 0.14 episodes per 1 000 catheter days in non-IBD patients, whereas no thrombosis occurred in patients with IBD.
The duration of IF and need of PT was significantly longer in the IBD than non-IBD patients. CRBSI was one of the most common complications in patients with IF treated with PT, and overall incidence did not differ compared with other centres. However, the incidence of both CRBSI and thrombosis was lower in the IBD than in the non-IBD group, probably reflecting that the IBD patients were younger, had less co-morbidity, and, hence, better capability of aseptic catheter handling.