重症监护病房和非重症监护病房患者肠外营养相关感染并发症。
Infectious complications associated with parenteral nutrition in intensive care unit and non-intensive care unit patients.
机构信息
Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil.
Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, RS, Brazil.
出版信息
Braz J Infect Dis. 2020 Mar-Apr;24(2):137-143. doi: 10.1016/j.bjid.2020.02.002. Epub 2020 Mar 20.
INTRODUCTION
Malnutrition is associated with an increased risk of complications in hospitalized patients, and parenteral nutrition (PN) is used when oral or enteral feeding is not possible. This study aimed at analyzing associations between PN characteristics and infectious complications in hospitalized patients.
MATERIAL AND METHODS
This was a retrospective cohort study conducted in a tertiarycare university hospital. Data from consecutive adult patients submitted to PN (January 2016 to December 2017; ICU and ward) were reviewed by means of an electronic database. Patient's clinical characteristics, PN prescription and catheter insertion procedure data were extracted and analyzed. The main outcome was the development of central line-associated bloodstream infection (CLABSI). The secondary outcomes were other infectious complications and mortality, as well as factors associated with CLABSI.
RESULTS
We analyzed 165 patients and 247 catheters used for parenteral nutrition infusion. The CLABSI rate was 6.47 per 1000 catheter-days. In the univariable analysis, CLABSI was associated with longer hospitalization time, longer PN time, longer catheter time, catheter insertion performed by a surgeon or a surgical resident, and procedures performed outside the ICU. In an extended time-dependent Cox regression, no variable was associated with a higher risk of CLABSI, and additional PN days did not increase the rate of CLABSI. The overall mortality rate was 24.8%. Only the patients' comorbidity index was associated with death in the multivariable analysis.
DISCUSSION
In our study, patients who needed PN had an overall CLABSI rate of 6.47 per 1000 catheter-days. These outcomes were not associated with PN and catheter characteristics studied after adjustment for catheter time. The overall mortality rate was 24.8% and it was not associated with PN in multivariable analyses, only with Charlson comorbidity index.
简介
营养不良与住院患者并发症风险增加有关，当无法进行口服或肠内喂养时，会使用肠外营养（PN）。本研究旨在分析住院患者 PN 特征与感染并发症之间的关系。
材料和方法
这是一项在三级保健大学医院进行的回顾性队列研究。通过电子数据库回顾了 2016 年 1 月至 2017 年 12 月连续接受 PN（ICU 和病房）的成年患者的数据。提取并分析了患者的临床特征、PN 处方和导管插入程序数据。主要结果是发生中心静脉导管相关血流感染（CLABSI）。次要结果是其他感染并发症和死亡率，以及与 CLABSI 相关的因素。
结果
我们分析了 165 名患者和 247 根用于肠外营养输注的导管。CLABSI 的发生率为每 1000 个导管日 6.47 例。在单变量分析中，CLABSI 与住院时间延长、PN 时间延长、导管时间延长、由外科医生或外科住院医师进行的导管插入术以及在 ICU 外进行的操作有关。在扩展的时间依赖性 Cox 回归中，没有变量与更高的 CLABSI 风险相关，并且额外的 PN 天数不会增加 CLABSI 的发生率。总死亡率为 24.8%。只有患者的合并症指数与多变量分析中的死亡相关。
讨论
在我们的研究中，需要 PN 的患者的总体 CLABSI 发生率为每 1000 个导管日 6.47 例。在调整导管时间后，这些结果与研究的 PN 和导管特征无关。总死亡率为 24.8%，在多变量分析中与 PN 无关，仅与 Charlson 合并症指数相关。
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