Intensive Care and Nutrition Department, Fernandes Távora Hospital, Fortaleza, Brazil.
JPEN J Parenter Enteral Nutr. 2012 Sep;36(5):574-86. doi: 10.1177/0148607111427040. Epub 2012 Jan 23.
Parenteral nutrition (PN) is associated with an increased risk of developing bloodstream infections (BSIs) but the impact of the PN delivery system upon BSI rates remains unclear. This was an international, multicenter, prospective, randomized, open-label, controlled trial that investigated the differences of BSIs associated with 2 different PN systems.
Patients were randomly allocated in a 2:1:1 ratio to receive either PN delivered by a multichamber bag (MCB group), or by compounded PN made with olive oil (COM1 group) or with MCT/LCT (COM2 group). Blood cultures were performed to evaluate the incidence of BSIs, and catheter use data was collected to calculate CLAB and central venous catheter device use ratio (CVC-DUR). Secondary outcomes included the development of severe sepsis/septic shock, number of intensive care unit (ICU) and hospital days, and all-cause mortality at Day 28.
406 patients were included: 202 in the MCB group, 103 in the COM1 group, and 101 in the COM2 group. Baseline characteristics were well balanced between the 3 groups, BSIs were significantly higher in patients receiving compounded PN (46 BSIs for COM1+COM2 vs 34 BSIs for MCB; p = 0.03).CLAB was higher in patients receiving compounded PN (13.2 for COM1+COM2 vs 10.3 for MCB; p < 0.0001). No differences were observed for the secondary outcomes.
Compounded PN was associated with a higher incidence of BSIs and CLABs, suggesting that the use of MCB PN may play a role in reducing the incidence of BSIs in patients who receive PN.
NCT00798681.
肠外营养（PN）与发生血流感染（BSI）的风险增加相关，但 PN 输送系统对 BSI 发生率的影响尚不清楚。这是一项国际性、多中心、前瞻性、随机、开放标签、对照试验，旨在研究 2 种不同 PN 系统与 BSI 相关的差异。
患者以 2:1:1 的比例随机分配接受多腔袋（MCB 组）、橄榄油配制的 PN（COM1 组）或 MCT/LCT 配制的 PN（COM2 组）。进行血培养以评估 BSI 的发生率，并收集导管使用数据以计算 CLAB 和中心静脉导管装置使用比（CVC-DUR）。次要结局包括严重脓毒症/感染性休克的发生、重症监护病房（ICU）和住院天数以及第 28 天的全因死亡率。
共纳入 406 例患者：MCB 组 202 例，COM1 组 103 例，COM2 组 101 例。3 组间基线特征均衡，接受复合 PN 的患者 BSI 发生率明显更高（COM1+COM2 组 46 例，MCB 组 34 例；p=0.03）。接受复合 PN 的患者 CLAB 更高（COM1+COM2 组 13.2，MCB 组 10.3；p<0.0001）。次要结局无差异。
复合 PN 与 BSI 和 CLAB 的发生率较高相关，提示 MCB PN 的使用可能在降低接受 PN 的患者 BSI 发生率方面发挥作用。
NCT00798681。
