Incidence of Bloodstream Infection with the Use of Parental Nutrition

Author(s):
Alexandra Wiegand; Sara Parli; Barbara Magnuson Woodward

Background:

Parental nutrition (PN) is used in several patient populations for the provision of nutrition support while hospitalized if compelling indications are present. A primary concern of TPN includes increased risk of bacterial and fungal bloodstream infections (BSIs), which may lead to significant morbidity and mortality. While rates of infection with PN have declined over the past 10 years due to improvements in standard of care, the risk of infection remains. A medication use evaluation was conducted to examine the incidence of BSIs while receiving PN at a quaternary care academic medical center.

Hypothesis:

The use of PN increases the incidence of BSIs in hospitalized patients.

Methods:

This was a retrospective review of adult patients ≥ 18 years old admitted to University of Kentucky HealthCare from January 1st, 2020 to July 31st, 2021 who received PN at any point during their hospital admission. Patients were excluded if they were admitted with an infection from their home PN. Clinical data was collected utilizing Vizient data and completed using retrospective chart review. The primary outcome of this review was incidence of BSI after initiation of PN. Secondary outcomes examined included PN duration and type of bacterial or fungal organism.

Results:

A total of 378 adult patients received inpatient PN, of which 67 (17.7%) patients had PN stopped for concern for infection. In the patients whom PN was stopped for infection, the most common indications for PN were ileus, short bowel syndrome, and anastomotic leak. Incidence of positive blood cultures occurred in 30 patients (7.9%), with a total of 32 occurrences due to two patients with multiple occurrences during their admission. In patients whom PN was stopped for infection, patients with positive blood cultures had longer mean TPN duration compared to those with negative blood cultures (12.4 days vs 7.4 days). The incidence of gram positive and gram negative organisms were similar and occurred more frequently than fungemia. There were seven occurrences of multi-organism blood cultures.

Conclusions:

In 1.5 years of PN use at a quaternary care center with high adherence to ASPEN guidelines for PN use, 7.9% of patients developed a BSI after PN was initiated during their hospitalization. While rates of infection with PN have decreased over the years, PN may still contribute to development of BSIs. For this reason, providers should ensure appropriate indications are present prior to initiation of PN, and infection prevention should continue to be addressed in all patients receiving PN.