Parenteral nutrition-associated bloodstream infection in an Australian teaching hospital-an 8-year retrospective study of over 11,000 PN-days

Townell, Nicola, McDougall, David and Playford, E. Geoffrey (2014) Parenteral nutrition-associated bloodstream infection in an Australian teaching hospital-an 8-year retrospective study of over 11,000 PN-days. Scandinavian Journal of Infectious Diseases, 46 5: 361-367. doi:10.3109/00365548.2014.880185


Author Townell, Nicola
McDougall, David
Playford, E. Geoffrey
Title Parenteral nutrition-associated bloodstream infection in an Australian teaching hospital-an 8-year retrospective study of over 11,000 PN-days
Journal name Scandinavian Journal of Infectious Diseases   Check publisher's open access policy
ISSN 0036-5548
1651-1980
Publication date 2014-05-01
Year available 2014
Sub-type Article (original research)
DOI 10.3109/00365548.2014.880185
Open Access Status Not yet assessed
Volume 46
Issue 5
Start page 361
End page 367
Total pages 7
Place of publication Stockholm, Sweden
Publisher Informa Healthcare
Language eng
Abstract Background: Bloodstream infections (BSIs) are a well-recognized complication of parenteral nutrition (PN). However, their epidemiology and clinical consequences are incompletely described. Methods: A retrospective cohort study was performed, from 2002 to 2009, of all hospital inpatients who were administered PN, outside the intensive care setting, at a major tertiary hospital in Queensland, Australia. Results: In 780 episodes of PN administration, 120 BSIs occurred, giving an incidence of 10.0/1000 PN-days. The majority of PN-associated BSIs were classified as central line-associated (n = 98, 81.7%). Candida spp. were the most frequent pathogens. Observed BSI management revealed that over 8% of intravascular devices were inappropriately retained, over 30% of empirical antibiotic therapy was inappropriate, and 62% of antifungal therapy was delayed >= 48 h. All-cause hospital mortality was over 2-fold greater in patients with a PN-associated BSI compared to those without (17.9% vs 8.3%, crude odds ratio (OR) 2.4, 95% confidence interval (CI) 1.29-4.35, p = 0.002). BSI was identified as an independent risk factor for mortality (adjusted OR 3.54, 95% CI 1.76-7.12, p < 0.001). Low baseline albumin levels and a requirement for intravenous insulin infusion (a marker of sustained hyperglycaemia) were independent risk factors for the development of PN-associated BSIs. Conclusions: PN-associated BSI in hospital inpatients is common and is associated with mortality. The implementation of standardized evidence-based infection prevention strategies, particularly targeting IVD maintenance, is a priority. PN-associated BSI management pathways require optimization, with timely IVD removal and appropriate antimicrobial therapy. Depending on local epidemiology patterns, empirical antifungal therapy should be considered.
Formatted abstract
Background: Bloodstream infections (BSIs) are a well-recognized complication of parenteral nutrition (PN). However, their epidemiology and clinical consequences are incompletely described. Methods: A retrospective cohort study was performed, from 2002 to 2009, of all hospital inpatients who were administered PN, outside the intensive care setting, at a major tertiary hospital in Queensland, Australia. Results: In 780 episodes of PN administration, 120 BSIs occurred, giving an incidence of 10.0/1000 PN-days. The majority of PN-associated BSIs were classified as central line-associated (n = 98, 81.7%). Candida spp. were the most frequent pathogens. Observed BSI management revealed that over 8% of intravascular devices were inappropriately retained, over 30% of empirical antibiotic therapy was inappropriate, and 62% of antifungal therapy was delayed ≥ 48 h. All-cause hospital mortality was over 2-fold greater in patients with a PN-associated BSI compared to those without (17.9% vs 8.3%, crude odds ratio (OR) 2.4, 95% confidence interval (CI) 1.29–4.35, p = 0.002). BSI was identified as an independent risk factor for mortality (adjusted OR 3.54, 95% CI 1.76–7.12, p < 0.001). Low baseline albumin levels and a requirement for intravenous insulin infusion (a marker of sustained hyperglycaemia) were independent risk factors for the development of PN-associated BSIs. Conclusions: PN-associated BSI in hospital inpatients is common and is associated with mortality. The implementation of standardized evidence-based infection prevention strategies, particularly targeting IVD maintenance, is a priority. PN-associated BSI management pathways require optimization, with timely IVD removal and appropriate antimicrobial therapy. Depending on local epidemiology patterns, empirical antifungal therapy should be considered.



Keyword Bloodstream infection
Epidemiology
Mortality
Parenteral nutrition
Candidaemia
Catheter-related infection
Risk factors
Hyperglycemia
Complications
Guidelines
Management
Outcomes
Therapy
Society
Sepsis
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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