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The impact of parenteral nutrition preparation on bloodstream infection risk and costs
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 observation...
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| Published in: | European journal of clinical nutrition 2014-08, Vol.68 (8), p.953-958 |
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| container_issue | 8 |
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| container_title | European journal of clinical nutrition |
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| creator | Turpin, R S Solem, C Pontes-Arruda, A Sanon, M Mehta, S Xiaoqing Liu, F Botteman, M |
| description | 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 |
| doi_str_mv | 10.1038/ejcn.2014.34 |
| format | article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1644472853</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A377778560</galeid><sourcerecordid>A377778560</sourcerecordid><originalsourceid>FETCH-LOGICAL-c725t-4e2ed52f76c252921ba058af12ed147f9bce4c74654ca3e7479bb60d38587b733</originalsourceid><addsrcrecordid>eNqN0s1v0zAUAPAIgVg3uHFGkRCIAyn-tnOcJgZIk7gMrpbjvLQpiR1s57D_HmcrrEMVEEey9fyznTy_oniB0Rojqt7Dzro1QZitKXtUrDCTouKCocfFCtWcVRQheVKcxrhDGUlJnhYnhAkhJVOr4tv1Fsp-nIxNpe_KyQRwCYIZSjen0Kfeu3IKkOPmdpzfZvC-jSmAGcvedWBvJ0Ifv5fGtaX1McVnxZPODBGe7_uz4uvlh-uLT9XVl4-fL86vKisJTxUDAi0nnRSWcFIT3BjElelwDudv7erGArOSCc6soSCZrJtGoJYqrmQjKT0r3t7tOwX_Y4aY9NhHC8NgHPg5aiwYY5Io_j-UEIGRkPjflHOscE0VyfTVH3Tn5-DyP2siGFGUkpr_TS170RrVlN6rjRlA59T6FIxdjtbnVOZHcYGyqo6oDbjl1ryDrs_hB359xOfWwtjbowveHCzYghnSNvphXq45PoTv7qANPsYAnZ5CP5pwozHSS23qpTb1Upuassxf7pMwNyO0v_GvYszg9R6YaM3QBeNsH--dEoLW8iADMU-5DYSDbB47-CekovZg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1551390933</pqid></control><display><type>article</type><title>The impact of parenteral nutrition preparation on bloodstream infection risk and costs</title><source>Free E-Journal (出版社公開部分のみ）</source><creator>Turpin, R S ; Solem, C ; Pontes-Arruda, A ; Sanon, M ; Mehta, S ; Xiaoqing Liu, F ; Botteman, M</creator><creatorcontrib>Turpin, R S ; Solem, C ; Pontes-Arruda, A ; Sanon, M ; Mehta, S ; Xiaoqing Liu, F ; Botteman, M</creatorcontrib><description>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
<0.001;
P
<0.001.
Conclusion:
Use of MCB does not appear to increase treatment costs, possibly by reducing the risk of infection. This study identified several PN preparation methods associated with a significantly increased hazard for BSI; definitive CPN findings are limited by our inability to distinguish automated from manual pharmacy compounding.</description><identifier>ISSN: 0954-3007</identifier><identifier>EISSN: 1476-5640</identifier><identifier>DOI: 10.1038/ejcn.2014.34</identifier><identifier>PMID: 24667748</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>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</subject><ispartof>European journal of clinical nutrition, 2014-08, Vol.68 (8), p.953-958</ispartof><rights>Macmillan Publishers Limited 2014</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2014 Nature Publishing Group</rights><rights>Copyright Nature Publishing Group Aug 2014</rights><rights>Macmillan Publishers Limited 2014.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c725t-4e2ed52f76c252921ba058af12ed147f9bce4c74654ca3e7479bb60d38587b733</citedby><cites>FETCH-LOGICAL-c725t-4e2ed52f76c252921ba058af12ed147f9bce4c74654ca3e7479bb60d38587b733</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28663970$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24667748$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Turpin, R S</creatorcontrib><creatorcontrib>Solem, C</creatorcontrib><creatorcontrib>Pontes-Arruda, A</creatorcontrib><creatorcontrib>Sanon, M</creatorcontrib><creatorcontrib>Mehta, S</creatorcontrib><creatorcontrib>Xiaoqing Liu, F</creatorcontrib><creatorcontrib>Botteman, M</creatorcontrib><title>The impact of parenteral nutrition preparation on bloodstream infection risk and costs</title><title>European journal of clinical nutrition</title><addtitle>Eur J Clin Nutr</addtitle><addtitle>Eur J Clin Nutr</addtitle><description>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
<0.001;
P
<0.001.
Conclusion:
Use of MCB does not appear to increase treatment costs, possibly by reducing the risk of infection. This study identified several PN preparation methods associated with a significantly increased hazard for BSI; definitive CPN findings are limited by our inability to distinguish automated from manual pharmacy compounding.</description><subject>Adult</subject><subject>Aged</subject><subject>Amino acids</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Bacteremia - economics</subject><subject>Bacteremia - etiology</subject><subject>Bacteremia - prevention & control</subject><subject>Biological and medical sciences</subject><subject>Blood diseases</subject><subject>Blood flow</subject><subject>Catheter-Related Infections - economics</subject><subject>Catheter-Related Infections - etiology</subject><subject>Catheter-Related Infections - prevention & control</subject><subject>Catheters</subject><subject>Clinical Nutrition</subject><subject>Confidence intervals</subject><subject>Cost analysis</subject><subject>Costs</subject><subject>Cross Infection - economics</subject><subject>Cross Infection - etiology</subject><subject>Cross Infection - prevention & control</subject><subject>Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition</subject><subject>Epidemiology</subject><subject>Feeding. Feeding behavior</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Generalized linear models</subject><subject>Germany</subject><subject>Health aspects</subject><subject>Health Care Costs</subject><subject>Health economics</subject><subject>Health risks</subject><subject>Hospitalization - economics</subject><subject>Humans</subject><subject>Infections</subject><subject>Intensive care medicine</subject><subject>Internal Medicine</subject><subject>Lipids</subject><subject>Male</subject><subject>Medical instruments</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Nosocomial infections</subject><subject>Nutrition</subject><subject>Nutrition research</subject><subject>original-article</subject><subject>Parenteral nutrition</subject><subject>Parenteral Nutrition - adverse effects</subject><subject>Parenteral Nutrition - economics</subject><subject>Parenteral Nutrition - methods</subject><subject>Parenteral Nutrition Solutions - economics</subject><subject>Patients</subject><subject>Proportional Hazards Models</subject><subject>Public Health</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Risk factors</subject><subject>Statistical models</subject><subject>Subgroups</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><issn>0954-3007</issn><issn>1476-5640</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNqN0s1v0zAUAPAIgVg3uHFGkRCIAyn-tnOcJgZIk7gMrpbjvLQpiR1s57D_HmcrrEMVEEey9fyznTy_oniB0Rojqt7Dzro1QZitKXtUrDCTouKCocfFCtWcVRQheVKcxrhDGUlJnhYnhAkhJVOr4tv1Fsp-nIxNpe_KyQRwCYIZSjen0Kfeu3IKkOPmdpzfZvC-jSmAGcvedWBvJ0Ifv5fGtaX1McVnxZPODBGe7_uz4uvlh-uLT9XVl4-fL86vKisJTxUDAi0nnRSWcFIT3BjElelwDudv7erGArOSCc6soSCZrJtGoJYqrmQjKT0r3t7tOwX_Y4aY9NhHC8NgHPg5aiwYY5Io_j-UEIGRkPjflHOscE0VyfTVH3Tn5-DyP2siGFGUkpr_TS170RrVlN6rjRlA59T6FIxdjtbnVOZHcYGyqo6oDbjl1ryDrs_hB359xOfWwtjbowveHCzYghnSNvphXq45PoTv7qANPsYAnZ5CP5pwozHSS23qpTb1Upuassxf7pMwNyO0v_GvYszg9R6YaM3QBeNsH--dEoLW8iADMU-5DYSDbB47-CekovZg</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Turpin, R S</creator><creator>Solem, C</creator><creator>Pontes-Arruda, A</creator><creator>Sanon, M</creator><creator>Mehta, S</creator><creator>Xiaoqing Liu, F</creator><creator>Botteman, M</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope></search><sort><creationdate>20140801</creationdate><title>The impact of parenteral nutrition preparation on bloodstream infection risk and costs</title><author>Turpin, R S ; Solem, C ; Pontes-Arruda, A ; Sanon, M ; Mehta, S ; Xiaoqing Liu, F ; Botteman, M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c725t-4e2ed52f76c252921ba058af12ed147f9bce4c74654ca3e7479bb60d38587b733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Amino acids</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Bacteremia - economics</topic><topic>Bacteremia - etiology</topic><topic>Bacteremia - prevention & control</topic><topic>Biological and medical sciences</topic><topic>Blood diseases</topic><topic>Blood flow</topic><topic>Catheter-Related Infections - economics</topic><topic>Catheter-Related Infections - etiology</topic><topic>Catheter-Related Infections - prevention & control</topic><topic>Catheters</topic><topic>Clinical Nutrition</topic><topic>Confidence intervals</topic><topic>Cost analysis</topic><topic>Costs</topic><topic>Cross Infection - economics</topic><topic>Cross Infection - etiology</topic><topic>Cross Infection - prevention & control</topic><topic>Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition</topic><topic>Epidemiology</topic><topic>Feeding. Feeding behavior</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Generalized linear models</topic><topic>Germany</topic><topic>Health aspects</topic><topic>Health Care Costs</topic><topic>Health economics</topic><topic>Health risks</topic><topic>Hospitalization - economics</topic><topic>Humans</topic><topic>Infections</topic><topic>Intensive care medicine</topic><topic>Internal Medicine</topic><topic>Lipids</topic><topic>Male</topic><topic>Medical instruments</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Nosocomial infections</topic><topic>Nutrition</topic><topic>Nutrition research</topic><topic>original-article</topic><topic>Parenteral nutrition</topic><topic>Parenteral Nutrition - adverse effects</topic><topic>Parenteral Nutrition - economics</topic><topic>Parenteral Nutrition - methods</topic><topic>Parenteral Nutrition Solutions - economics</topic><topic>Patients</topic><topic>Proportional Hazards Models</topic><topic>Public Health</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Risk factors</topic><topic>Statistical models</topic><topic>Subgroups</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Turpin, R S</creatorcontrib><creatorcontrib>Solem, C</creatorcontrib><creatorcontrib>Pontes-Arruda, A</creatorcontrib><creatorcontrib>Sanon, M</creatorcontrib><creatorcontrib>Mehta, S</creatorcontrib><creatorcontrib>Xiaoqing Liu, F</creatorcontrib><creatorcontrib>Botteman, M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Neurosciences Abstracts</collection><collection>Agricultural Science Collection</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>British Nursing Database</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Agriculture Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest research library</collection><collection>ProQuest Biological Science Journals</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><jtitle>European journal of clinical nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Turpin, R S</au><au>Solem, C</au><au>Pontes-Arruda, A</au><au>Sanon, M</au><au>Mehta, S</au><au>Xiaoqing Liu, F</au><au>Botteman, M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of parenteral nutrition preparation on bloodstream infection risk and costs</atitle><jtitle>European journal of clinical nutrition</jtitle><stitle>Eur J Clin Nutr</stitle><addtitle>Eur J Clin Nutr</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>68</volume><issue>8</issue><spage>953</spage><epage>958</epage><pages>953-958</pages><issn>0954-3007</issn><eissn>1476-5640</eissn><abstract>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
<0.001;
P
<0.001.
Conclusion:
Use of MCB does not appear to increase treatment costs, possibly by reducing the risk of infection. This study identified several PN preparation methods associated with a significantly increased hazard for BSI; definitive CPN findings are limited by our inability to distinguish automated from manual pharmacy compounding.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>24667748</pmid><doi>10.1038/ejcn.2014.34</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0954-3007 |
| ispartof | European journal of clinical nutrition, 2014-08, Vol.68 (8), p.953-958 |
| issn | 0954-3007 1476-5640 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1644472853 |
| source | Free E-Journal (出版社公開部分のみ） |
| 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 |
| title | The impact of parenteral nutrition preparation on bloodstream infection risk and costs |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-26T03%3A26%3A34IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20impact%20of%20parenteral%20nutrition%20preparation%20on%20bloodstream%20infection%20risk%20and%20costs&rft.jtitle=European%20journal%20of%20clinical%20nutrition&rft.au=Turpin,%20R%20S&rft.date=2014-08-01&rft.volume=68&rft.issue=8&rft.spage=953&rft.epage=958&rft.pages=953-958&rft.issn=0954-3007&rft.eissn=1476-5640&rft_id=info:doi/10.1038/ejcn.2014.34&rft_dat=%3Cgale_proqu%3EA377778560%3C/gale_proqu%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c725t-4e2ed52f76c252921ba058af12ed147f9bce4c74654ca3e7479bb60d38587b733%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1551390933&rft_id=info:pmid/24667748&rft_galeid=A377778560&rfr_iscdi=true |