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

Nicole C Gavin; Emily Larsen; Naomi Runnegar; Gabor Mihala; Samantha Keogh; David McMillan; Gillian Ray-Barruel; Claire M Rickard

doi:10.1002/jpen.2530

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

Journal article

Open access

Peer reviewed

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

Nicole C Gavin, Emily Larsen, Naomi Runnegar, Gabor Mihala, Samantha Keogh, David McMillan, Gillian Ray-Barruel and Claire M Rickard

Journal of Parenteral and Enteral Nutrition, Vol.47(6), pp.783-795

2023

DOI: https://doi.org/10.1002/jpen.2530

PMCID: PMC10946626

PMID: 37288612

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Abstract

Administration

Intravenous

Catheterization

Central Venous

Catheter-Related Infections

Central Venous Catheters

Clinical Nursing Research

Fat Emulsion

mucosal barrier injury laboratory-confirmed bloodstream infection

Parenteral nutrition < Nutrition

Vascular Access Devices

Background: Distinguishing 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. Methods: Secondary analysis was conducted on data from patients with CVADs, 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. Results: Of 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 bloodstream infection (CLABSI) or mucosal barrier injury laboratory-confirmed bloodstream infection (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). Conclusion: Our data indicates that twice as many primary BSIs in ILE PN patients are due to mucosal barrier injuries 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.

Details

Title: Association between parenteral nutrition containing intravenous lipid emulsions and bloodstream infections in patients with single-lumen central venous access: A secondary analysis of a randomized trial
Authors: Nicole C Gavin (Corresponding Author) - The University of Queensland
Emily Larsen (Author) - Griffith University
Naomi Runnegar (Author) - The University of Queensland
Gabor Mihala (Author) - Griffith University
Samantha Keogh (Author) - Queensland University of Technology
David McMillan (Author) - University of the Sunshine Coast, Queensland, School of Science, Technology and Engineering
Gillian Ray-Barruel (Author) - Griffith University
Claire M Rickard (Author) - Griffith University
Publication details: Journal of Parenteral and Enteral Nutrition, Vol.47(6), pp.783-795
Publisher: John Wiley & Sons Ltd.
Date published: 2023
DOI: 10.1002/jpen.2530
ISSN: 1941-2444
PMID: 37288612; PMC10946626
Copyright note: This is the peer reviewed version of the following article: Gavin, N.C., Larsen, E., Runnegar, N., Mihala, G., Keogh, S., McMillan, D., Ray-Barruel, G. and Rickard, C.M. (2023), Association between parenteral nutrition containing intravenous lipid emulsions and bloodstream infections in patients with single-lumen central venous access: A secondary analysis of a randomized trial.. J Parenter Enteral Nutr.. Accepted Author Manuscript. https://doi.org/10.1002/jpen.2530, which has been published in final form at https://doi.org/10.1002/jpen.2530. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Grants: Intravascular device administration sets: Replacement after Standard Versus Prolonged use (The RSVP Trial), 1008428, National Health and Medical Research Council (Australia, Canberra) - NHMRC
Australian Government Research Training Program (RTP) Scholarship, RTP, Department of Education (Australia, Canberra)
Organisation Unit: School of Science, Technology and Engineering; Centre for Bioinnovation
Language: English
Record Identifier: 99735297702621
Output Type: Journal article

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