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  • Title: Bloodstream infections associated with parenteral nutrition preparation methods in the United States: a retrospective, large database analysis.
    Author: Turpin RS, Canada T, Rosenthal V, Nitzki-George D, Liu FX, Mercaldi CJ, Pontes-Arruda A, IMPROVE Study Group.
    Journal: JPEN J Parenter Enteral Nutr; 2012 Mar; 36(2):169-76. PubMed ID: 22002964.
    Abstract:
    BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Both the observed rate of BSI and adjusted probability of developing a BSI remained significantly lower for the MCB than the compounded PN group.
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