Alvira-Arill Gustavo R, Yarbrough April, Tansmore Jessica, Sierra Caroline M, Bashqoy Ferras, Herrera Oscar R, Peters Brian M, Stultz Jeremy S
Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville and Memphis, Tennessee, USA.
Pharmacotherapy. 2025 Aug;45(8):486-494. doi: 10.1002/phar.70037. Epub 2025 Jul 1.
Compared to soybean-oil and fish-oil formulations, the use of mixed-oil lipid injectable emulsion is associated with reduced catheter-related bloodstream infection rates in pediatric patients receiving parenteral nutrition. The objective of this study was to compare clinical outcomes of fungal catheter-related bloodstream infections in pediatric patients following receipt of parenteral nutrition with mixed-oil (SMOFlipid) lipid injectable emulsion or other formulations (soybean-oil [Intralipid] or fish-oil [Omegaven]).
A retrospective cohort study of pediatric patients with fungal catheter-related bloodstream infections following administration of parenteral nutrition and injectable lipid emulsion from five pediatric hospitals in the United States during a 5-year period was conducted. Differences in a composite outcome of 30-day mortality from first positive blood culture and/or infection persistence based on type of lipid injectable emulsion received prior to infection were assessed through generalized linear mixed models with binomial distribution.
One-hundred twelve fungal catheter-related bloodstream infections were assessed from 104 patients who received mixed-oil lipid injectable emulsion (n = 43) or other formulations (n = 69) prior to infection. Thirty-nine infections met the composite outcome (32 with persistent infection, three with 30-day mortality, and four with both). On multivariable analysis, receipt of mixed-oil lipid injectable emulsion demonstrated a non-statistically significant increase in the composite outcome (odds ratio [OR] [95% confidence interval {CI}]: 1.80 [0.75-4.34]; p = 0.19). Factors independently associated with the composite outcome include receipt of systemic antifungal prophylaxis (OR [95% CI]: 5.72 [1.33-24.7]; p = 0.019) and delay in central venous catheter removal (OR [95% CI]: 1.09 [1.01-1.19]; p = 0.03). Notable factors not associated with the composite outcome included continued receipt of lipid injectable emulsion, empiric antifungal choice, time to antifungal administration, and gastrointestinal surgery within 90 days prior to infection.
Use of mixed-oil lipid injectable emulsion compared to other formulations (soybean-oil or fish-oil) demonstrated a non-statistically significant increase in 30-day mortality and/or infection persistence from fungal catheter-related bloodstream infections in pediatric patients receiving parenteral nutrition.
与大豆油和鱼油制剂相比，在接受肠外营养的儿科患者中，使用混合油脂肪乳剂可降低导管相关血流感染率。本研究的目的是比较接受肠外营养的儿科患者在使用混合油（SMOFlipid）脂肪乳剂或其他制剂（大豆油[英脱利匹特]或鱼油[ω-3鱼油脂肪乳]）后发生真菌导管相关血流感染的临床结局。
对美国五家儿科医院5年间接受肠外营养和脂肪乳剂注射后发生真菌导管相关血流感染的儿科患者进行回顾性队列研究。根据感染前接受的脂肪乳剂类型，通过具有二项分布的广义线性混合模型评估首次血培养30天死亡率和/或感染持续存在这一复合结局的差异。
对104例在感染前接受混合油脂肪乳剂（n = 43）或其他制剂（n = 69）的患者的112例真菌导管相关血流感染进行了评估。39例感染符合复合结局（32例持续感染，3例30天死亡率，4例两者兼有）。多变量分析显示，使用混合油脂肪乳剂使复合结局有非统计学意义的增加（比值比[OR][95%置信区间{CI}]：1.80[0.75 - 4.34]；p = 0.19）。与复合结局独立相关的因素包括接受全身性抗真菌预防（OR[95%CI]：5.72[1.33 - 24.7]；p = 0.019）和延迟拔除中心静脉导管（OR[95%CI]：1.09[1.01 - 1.19]；p = 0.03）。与复合结局无关的显著因素包括继续使用脂肪乳剂注射、经验性抗真菌药物选择、抗真菌药物给药时间以及感染前90天内的胃肠道手术。
与其他制剂（大豆油或鱼油）相比，在接受肠外营养的儿科患者中，使用混合油脂肪乳剂使真菌导管相关血流感染导致的30天死亡率和/或感染持续存在有非统计学意义的增加。
