The impact of parenteral nutrition preparation on bloodstream infection risk and costs

• Published in: European journal of clinical nutrition 2014-08, Vol.68 (8), p.953-958
• Main Authors: Turpin, R S, Solem, C, Pontes-Arruda, A, Sanon, M, Mehta, S, Xiaoqing Liu, F, Botteman, M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Amino acids; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacteremia - economics; Bacteremia - etiology; Bacteremia - prevention & control; Biological and medical sciences; Blood diseases; Blood flow; Catheter-Related Infections - economics; Catheter-Related Infections - etiology; Catheter-Related Infections - prevention & control; Catheters; Clinical Nutrition; Confidence intervals; Cost analysis; Costs; Cross Infection - economics; Cross Infection - etiology; Cross Infection - prevention & control; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Epidemiology; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Generalized linear models; Germany; Health aspects; Health Care Costs; Health economics; Health risks; Hospitalization - economics; Humans; Infections; Intensive care medicine; Internal Medicine; Lipids; Male; Medical instruments; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Morbidity; Nosocomial infections; Nutrition; Nutrition research; original-article; Parenteral nutrition; Parenteral Nutrition - adverse effects; Parenteral Nutrition - economics; Parenteral Nutrition - methods; Parenteral Nutrition Solutions - economics; Patients; Proportional Hazards Models; Public Health; Retrospective Studies; Risk; Risk factors; Statistical models; Subgroups; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/ejcn.2014.34

Background: Catheter-related bloodstream infections (BSIs) are a serious problem leading to increased morbidity, longer hospital stay, and hence, additional costs. This study evaluated the risk of BSI and the cost of parenteral nutrition (PN) in Germany. Subjects/Methods: A retrospective observational chart review of patients hospitalized from October 2009 to April 2011 and receiving PN via ready-to-use three-chamber bag (MCB), single bottle (SB) or hospital compounded admixture (CPN) was conducted across Germany. Propensity score-adjusted models were used to evaluate the association between the type of PN, BSI (Cox Proportional Hazards) and hospitalization cost (generalized linear models) within a subgroup receiving all three macronutrients (lipids, amino acids, glucose). Results: Of the 1995 patient records reviewed (MCB=816; CPN=584; SB=595), 1457 patients received all three macronutrients. After adjustment, SB was associated with an increased hazard of BSI, vs MCB without additions (hazard ratio (HR) (95% confidence interval (CI))=2.53 (1.66–3.86)) in the total cohort. Adding supplements to MCB on the ward also increased the BSI risk in both total and subgroup analyses. In patients receiving all three macronutrients, adjusted total costs were MCB (no additions): €6,572 (95% CI: €6,896–6263); CPN: €6,869 (€7,283–6479); SB: €6,872 (€7,242–6521); MCB (ward additions): €7,402 (€7,878–6955); P