Global Health Economics, Baxter Healthcare, Deerfield, Illinois 60015, USA.
JPEN J Parenter Enteral Nutr. 2012 Mar;36(2):169-76. doi: 10.1177/0148607111414714. Epub 2011 Oct 14.
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.
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.
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.
Both the observed rate of BSI and adjusted probability of developing a BSI remained significantly lower for the MCB than the compounded PN group.
接受肠外营养（PN）的患者血流感染（BSI）的发生率据报道差异很大，为 1.3%-39%。本研究比较了大型住院患者人群中的 BSI 发生率，以确定不同方法制备的 PN 是否与 BSI 相关。
分析了美国最大的基于住院费用的临床和财务索赔数据库 Premier Perspective 的数据。纳入标准为 2005 年 1 月 1 日至 2007 年 12 月 31 日期间接受任何 PN 的年龄≥18 岁的所有住院患者。主要因变量为 BSI 发生率，定义为 ICD-9 代码 038.x（败血症）、995.91（败血症）、995.92（严重败血症）和 790.7（菌血症）的发生。暴露队列在商业多腔袋（MCB）中接受 PN（n=4669），而对照组在药房中接受 PN（医院配制或外包；n=64315）。采用多变量逻辑回归对基线差异、危险因素和潜在混杂因素进行观察数据调整，并采用倾向评分匹配进行敏感性分析。
观察到和调整后的 BSI 发生率表明，MCB 与感染率低于药房配制的 PN（观察发生率为 17.5%比 26.6%；调整发生率为 19.6%比 25.9%，均 P<.001）。匹配后的倾向评分发现，接受 MCB 的患者的观察 BSI 发生率为 18.9%，接受复合 PN 的患者的 BSI 发生率为 24.6%，结果相似。
与复合 PN 组相比，MCB 的 BSI 发生率和调整后的 BSI 发生概率均显著降低。
