Association between parenteral nutrition–containing intravenous lipid emulsion and bloodstream infections in patients with single‐lumen central venous access: A secondary analysis of a randomized trial

Abstract

AbstractBackgroundDistinguishing primary bloodstream infections (BSIs) related to central venous access devices (CVADs) from those that occur through other mechanisms, such as a damaged mucosal barrier, is difficult.MethodsSecondary analysis was conducted on data from patients with CVADs that were collected for a large, randomized trial. Patients were divided into two groups: those who received parenteral nutrition (PN)–containing intravenous lipid emulsion (ILE) and those who did not have PN‐containing ILE. This study investigated the influence of PN‐containing ILE (ILE PN) on primary BSIs in patients with a CVAD.ResultsOf the 807 patients, 180 (22%) received ILE PN. Most (627/807; 73%) were recruited from the hematology and hematopoietic stem cell transplant unit, followed by surgical (90/807; 11%), trauma and burns (61/807; 8%), medical (44/807; 5%), and oncology (23/807; 3%). When primary BSI was differentiated as a central line‐associated BSI (CLABSI) or mucosal barrier injury laboratory‐confirmed BSI (MBI‐LCBI), the incidence of CLABSI was similar in the ILE PN and non–ILE PN groups (15/180 [8%] vs 57/627 [9%]; P = 0.88) and the incidence of MBI‐LCBI was significantly different between groups (31/180 [17%] ILE PN vs 41/627 [7%] non–ILE PN; P < 0.01).ConclusionOur data indicate that twice as many primary BSIs in ILE PN patients are due to MBIs than CVADs. It is important to consider the MBI‐LCBI classification, as some CLABSI prevention efforts aimed at CVADs for the ILE PN population may be better directed to gastrointestinal tract protection interventions.