The Relationship Between Total Parenteral Nutrition and Central Line‐Associated Blood Stream Infections
Authors: Fonseca Ana Gabriela , Burgermaster Marissa , Larson Elaine , Seres David S. 
Published: November 2023

Background

Central line‐associated blood stream infections (CLABSI) prevalencehas decreased significantly over the past years in part due to hospital‐level infection control initiatives. However, a large number still occur every year. Total parenteral nutrition (TPN) is a CLABSI risk factor; in a previous study, Ippolito et al. described the risk of CLBSI among patients receiving TPN in our hospital from 2007–2008 (OR=4.33, CI=2.50–7.48). In this study we aimed to describe the risk of CLABSI associated with TPN after the never event policy implementation in our hospital.

Methods

We used the Health Information Technology to Reduce Healthcare‐Associated Infection (HIT‐HAI) dataset in conjunction with electronic medical to identify patients who were discharged between January 1,2013 and December 31, 2014 and had a central venous catheter (CVC) during their stay. Patients from this dataset who also received TPN were identified using electronic medical records and ICD‐9 code. Student's t‐test and chi‐square were used to identify variables of interest and a multivariable logistic regression model was developed to assess the influence of TPN on CLABSI risk.

Results

Among patients who received CVCs (n=12,868), 1253 received TPN, and 1106 patients developed CLABSI. Results from multivariable regression analysis show that TPN (OR, 2.20; 95% CI, 1.59–3.04) was a significant risk factor for CLABSI, controlling for Charlson index (score predicting risk of mortality based on comorbid conditions), diabetes, duration of catheterization, malignancy, HIV renal disease, surgical site infection, ICU stay, history of transplant and pneumonia.

Discussion

After significant reductions in CLABSIs due to infection control program implementation, TPN remains a significant risk factor for CLABSI in our hospital. Although the odds ratio is smaller than found by Ippolito et al in 2007–2008, patients with CVCs receiving TPN in 2013–2014 were 2.2 times more likely to have a CLABSI than patients with CVCs who did not receive TPN. Because TPN still remains a risk factor for CLABSI, the way that TPN is currently prescribed at our hospital may need to be changed.

Citation: Ippolito, P., Larson, E. L., Furuya, E. Y., Liu, J., & Seres, D. S. (2014). Utility of Electronic Medical Records to Assess the Relationship Between Parenteral Nutrition and Central Line–Associated Bloodstream Infections in Adult Hospitalized Patients. JPEN J Parenter Enteral Nutr. 2015 Nov;39(8):929–34

Support or Funding Information

This study was funded by National Institutes of Health/National Institute of Nursing Research Grant #R01NR010822 and Training Grant #HL007343

Significant Risk Factors Associated with CLABSI Multivariable analysis

Risk Factors
p‐value
OR
95% CI

TPN
<.0001
2.199
1.589–3.044

Charlson index
0.8431
0.997
0.963–1.032

Duration of catheterization
<.0001
1.024
1.020–1.028

Diabetes
0.7679
1.023
0.880–1.188

Malignancy
0.0003
1.403
1.165–1.688

HIV
0.0005
2.266
1.431–3.589

Renal disease
<.0001
2.881
2.480–3.348

Surgical site infection
0.0039
1.743
1.195–2.541

History of transplant
<.0001
0.241
0.155–0.376

ICU stay
<.0001
1.427
1.240–1.641

Pneumonia
0.1369
1.186
0.947–1.484

CLABSI, central line‐associated blood stream infection; HIV, human immunodeficiency virus; ICU, intensive care unit; TPN, total parenteral nutrition