Bloodstream Infections Associated With Parenteral Nutrition Preparation Methods in the United States A Retrospective, Large Database Analysis

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 36; no. 2; pp. 169 - 176
• Main Authors: Turpin, Robin S., Canada, Todd, Rosenthal, Victor D., Nitzki-George, Diane, Liu, Frank Xiaoqing, Mercaldi, Catherine J., Pontes-Arruda, Alessandro
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-03-2012; Sage Publications
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacteremia - epidemiology; Bacteremia - etiology; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Commerce; Cross Infection - epidemiology; Cross Infection - etiology; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Female; Humans; Incidence; Intensive care medicine; Logistic Models; Male; Medical sciences; Middle Aged; Parenteral Nutrition - adverse effects; Parenteral Nutrition Solutions; Pharmaceutical Services; Pharmacy Service, Hospital; Sepsis - epidemiology; Sepsis - etiology; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; United States - epidemiology; United States; North America; America; compounding; bloodstream; infection; multichamber bag; parenteral nutrition; Infection; Database; Nutrition; Enteral administration; Parenteral administration; Feeding
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607111414714

Background: The incidence of bloodstream infection (BSI) among patients receiving parenteral nutrition (PN) is reported to vary widely from 1.3%−39%. BSI rates in a large inpatient population were compared in this study to determine if PN prepared by different methods was associated with BSI. Methods: Data from Premier Perspective, the largest inpatient cost-based clinical and financial claims database in the United States, were analyzed. Included were all hospitalized patients age ≥18 years who received any PN from January 1, 2005, to December 31, 2007. BSI rates, the primary dependent variable, were defined as the occurrence ICD-9 codes of 038.x (septicemia), 995.91 (sepsis), 995.92 (severe sepsis), and 790.7 (bacteremia). The exposure cohort received PN in a commercial multichamber bag (MCB) (n = 4669), whereas the comparator group received PN prepared by a pharmacy (either hospital compounded or outsourced; n = 64,315). Observed data were adjusted using multivariate logistic regression for baseline differences, risk factors, and potential confounders, with propensity score matching as a sensitivity analysis. Results: The observed and adjusted BSI rates indicate that MCB is associated with fewer infections than pharmacy-prepared PN (observed 17.5% vs 26.6%; adjusted 19.6% vs 25.9%, both P < .001). Propensity-matched scores found similar results with observed BSI rates of 18.9% in patients receiving MCB and 24.6% in patients receiving a compounded PN. Conclusion: Both the observed rate of BSI and adjusted probability of developing a BSI remained significantly lower for the MCB than the compounded PN group.