The Relationship Between Parenteral Nutrition and Central Line–Associated Bloodstream Infections: 2009–2014

Fonseca, Gabriela; Burgermaster, Marissa; Larson, Elaine; Seres, David S.

doi:10.1177/0148607116688437

Cited by 51 publications

(46 citation statements)

References 13 publications

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“…PN requires the use of peripherally inserted catheters, which can increase the probability for infection. PN therapy has been demonstrated to be a significant independent risk factor for central line–associated bloodstream infections . Studies have reported adult trauma patients receiving enteral feeding have fewer incidents of line sepsis, intra‐abdominal abscesses, pancreatitis, and other infections compared with patients receiving PN .…”

Section: Mucosal Atrophy Central Line Infection–driven Liver Injurymentioning

confidence: 99%

“…PN therapy has been demonstrated to be a significant independent risk factor for central line–associated bloodstream infections . Studies have reported adult trauma patients receiving enteral feeding have fewer incidents of line sepsis, intra‐abdominal abscesses, pancreatitis, and other infections compared with patients receiving PN . The lack of enteral feeding further contributes to intraluminal bacterial overgrowth (notably, gram‐negative Proteobacteria) due to decreased intestinal motility and change in nutrition availability .…”

Section: Mucosal Atrophy Central Line Infection–driven Liver Injurymentioning

confidence: 99%

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Mechanisms of Parenteral Nutrition–Associated Liver and Gut Injury

et al. 2019

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Parenteral nutrition (PN) has revolutionized the care of patients with intestinal failure by providing nutrition intravenously. Worldwide, PN remains a standard tool of nutrition delivery in neonatal, pediatric, and adult patients. Though the benefits are evident, patients receiving PN can suffer serious cholestasis due to lack of enteral feeding and sometimes have fatal complications from liver injury and gut atrophy, including PN-associated liver disease or intestinal failure-associated liver disease. Recent studies into gut-systemic cross talk via the bile acid-regulated farnesoid X receptor (FXR)-fibroblast growth factor 19 (FGF19) axis, gut microbial control of the TGR5-glucagon-like peptide (GLP) axis, sepsis, and role of prematurity of hepatobiliary receptors are greatly broadening our understanding of PN-associated injury. It has also been shown that the composition of ω-6/ω-3 polyunsaturated fatty acids given parenterally as lipid emulsions can variably drive damage to hepatocytes and cell integrity. This manuscript reviews the mechanisms for the multifactorial pathogenesis of liver disease and gut injury with PN and discusses novel ameliorative strategies. (Nutr Clin Pract. 2020;35:63-71)

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Section: Mucosal Atrophy Central Line Infection–driven Liver Injurymentioning

confidence: 99%

Section: Mucosal Atrophy Central Line Infection–driven Liver Injurymentioning

confidence: 99%

Mechanisms of Parenteral Nutrition–Associated Liver and Gut Injury

et al. 2019

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“…This delayed onset, with 66% of exit‐site infections arising 30 days after PICC insertion, rules out the possibility of infections because of insertion maneuvers but highlights the role of parenteral supportive treatments themselves. PN deserves particular attention as a growth factor for bacteria and fungi (Machado, Suen, Figueiredo, & Marchini, ) and an independent risk factor for catheter‐related bloodstream infections across different types of CVAD (Beghetto, Victorino, Teixeira, & de Azevedo, ; Buchman, Opilla, Kwasny, Diamantidis, & Okamoto, ; Fonseca, Burgermaster, Larson, & Seres, ; Touré et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…This delayed onset, with 66% of exit-site infections arising 30 days after PICC insertion, rules out the possibility of infections because of insertion maneuvers but highlights the role of parenteral supportive treatments themselves. PN deserves particular attention as a growth factor for bacteria and fungi (Machado, Suen, Figueiredo, & Marchini, 2009) and an independent risk factor for catheter-related bloodstream infections across different types of CVAD (Beghetto, Victorino, Teixeira, & de Azevedo, 2005;Buchman, Opilla, Kwasny, Diamantidis, & Okamoto, 2014;Fonseca, Burgermaster, Larson, & Seres, 2018;Touré et al, 2013). Our rate of removal because of symptomatic thrombosis was comparable to the rate of removal because of symptomatic thrombosis reported by Christensen et al (2014), but our median dwell-time before removal was much longer (55 days vs. 9.5 days), with 64% of PICC removals because of symptomatic thrombosis in our study taking place at least 30 days after PICC insertion.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of the safety of over 100,000 peripherally‐inserted central catheters days for parenteral supportive treatments

Campagna

Gonella

Berchialla

et al. 2019

Research in Nursing & Health

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The type of central vascular access device providers chosen for providing parenteral supportive treatments has evolved over the past years, going from routinely used centrally inserted catheters to a more recent trend of peripherally‐inserted central catheters (PICCs) when expected treatment duration is less than 6 months. This multicenter retrospective study aimed to provide a comprehensive assessment of the safety of PICCs in administering parenteral supportive treatments. All adult inpatients and outpatients who had a PICC inserted for the administration of parenteral supportive treatments (i.e., parenteral nutrition, intravenous fluids, blood products, or antibiotics) between September 2007 and December 2014 in four public Italian hospitals were included. The primary outcome was PICC removal because of an adverse event (AE, defined as occlusion, exit‐site infection, or symptomatic thrombosis). Among the 1,250 included patients, 178 PICC‐related removals because of AEs (14.2%; 1.62 AEs per 1,000 PICC days) were reported. Rates of PICC removal because of occlusion, exit‐site infection, and symptomatic thrombosis were 1.08, 0.32, and 0.23 per 1,000 PICC days, respectively. The median dwell‐time between PICC insertion and its removal because of an AE was 67 days (interquartile range 28–180 days). Risk of PICC removal due to AE was higher with open‐system PICCs [hazard ratio = 2.75, 95% confidence interval 1.52–4.96]. In this study, we found preliminary evidence that PICCs can be safely used to administer parenteral supportive treatments lasting up to 6 months. PICCs may be a relevant alternative to centrally inserted catheters for medium‐term parenteral supportive treatments.

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“…Despite this necessity, PN is associated with complications including central line-associated bloodstream infections (CLABSI) 1. The increased infectious risk associated with PN has been linked to the increased calories delivered in critically ill patients 2 3.…”

Section: Introductionmentioning

confidence: 99%

Quality improvement initiative to reduce adverse effects associated with parenteral nutrition overfeeding

Franck

2018

Frontline Gastroenterol

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ObjectiveParenteral nutrition (PN) overfeeding is a potential risk factor in the development of infections and other complications including hyperglycaemia, refeeding syndrome and liver dysfunction. This study was conducted to evaluate the impact of a quality improvement initiative to reduce PN overfeeding.DesignRetrospective cohort study of a quality improvement initiative.SettingA health system comprised of two US Department of Veterans Affairs medical centres.PatientsPatients receiving PN.InterventionsMethods to reduce overfeeding included the use of standardised PN products with lower dextrose to amino acid ratios, reduced use of intravenous lipid emulsion (ILE), and use of adjusted body weights or guideline-recommended predictive equations for energy requirements.Main outcome measuresThe primary outcome measures were the doses of kilocalories, amino acids and ILE in each cohort. The proportions of patients developing complications before and after the intervention were evaluated.ResultsThe mean maximum total daily kilocalorie dose was 30.2 kcal/kg/day in the preintervention group (n=86) vs 23.4 kcal/kg/day in the postintervention group (n=62) (p<0.001). More patients in the postintervention group received reduced ILE during the first week of PN therapy compared with the preintervention group (p<0.001). The mean maximum total daily amino acid dose in each group was not significantly different. Significantly fewer cases of central line-associated bloodstream infections, hyperglycaemia and liver dysfunction were observed in the postintervention group.ConclusionsA quality improvement initiative to reduce PN overfeeding was effective in reducing kilocalorie and ILE doses while maintaining similar amino acid doses. Observed complications were reduced following the intervention.

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The Relationship Between Parenteral Nutrition and Central Line–Associated Bloodstream Infections: 2009–2014

Abstract: PN remains a significant risk factor for CLABSIs; further work is needed to identify effective strategies to reduce rates of CLABSI among patients receiving PN.

Cited by 51 publications

References 13 publications

Mechanisms of Parenteral Nutrition–Associated Liver and Gut Injury

Mechanisms of Parenteral Nutrition–Associated Liver and Gut Injury

A retrospective study of the safety of over 100,000 peripherally‐inserted central catheters days for parenteral supportive treatments

Quality improvement initiative to reduce adverse effects associated with parenteral nutrition overfeeding

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