Townell Nicola, McDougall David, Playford E Geoffrey
From the 1 Infection Management Services, Princess Alexandra Hospital , Woolloongabba, Brisbane.
Scand J Infect Dis. 2014 May;46(5):361-7. doi: 10.3109/00365548.2014.880185. Epub 2014 Mar 3.
Bloodstream infections (BSIs) are a well-recognized complication of parenteral nutrition (PN). However, their epidemiology and clinical consequences are incompletely described.
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.
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.
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.
血流感染（BSIs）是肠外营养（PN）一种公认的并发症。然而，其流行病学和临床后果尚未得到充分描述。
对2002年至2009年期间在澳大利亚昆士兰州一家大型三级医院接受非重症监护环境下PN治疗的所有住院患者进行了一项回顾性队列研究。
在780次PN给药过程中，发生了120例BSIs，发生率为10.0/1000 PN日。大多数与PN相关的BSIs被归类为中心静脉导管相关（n = 98，81.7%）。念珠菌属是最常见的病原体。观察到的BSIs管理情况显示，超过8%的血管内装置保留不当，超过30%的经验性抗生素治疗不当，62%的抗真菌治疗延迟≥48小时。与无PN相关BSIs的患者相比，有PN相关BSIs的患者全因住院死亡率高出2倍多（17.9%对8.3%，粗比值比（OR）2.4，95%置信区间（CI）1.29 - 4.35，p = 0.002）。BSIs被确定为死亡的独立危险因素（调整后OR 3.54，95% CI 1.76 - 7.12，p < 0.001）。低基线白蛋白水平和静脉输注胰岛素的需求（持续性高血糖的一个指标）是发生PN相关BSIs的独立危险因素。
住院患者中PN相关BSIs很常见且与死亡率相关。实施标准化的循证感染预防策略，特别是针对血管内装置维护的策略，是当务之急。PN相关BSIs的管理途径需要优化，包括及时移除血管内装置和适当的抗菌治疗。根据当地的流行病学模式应考虑经验性抗真菌治疗。
