Influence of parenteral nutrition on central venous catheter-related bloodstream infections

Abstract

Background. Parenteral nutrition (PN) is necessary the critically ill with digestive tract dysfunction [1]. In 2016 A.S.P.E.N. guidelines claimed that PN improves outcomes of the critically ill, thus was called nutrition therapy [3]. Some reports state, that PN may induce the risk of catheter-related bloodstream infections (CRBSI) [4], others deny [5]. In this study we investigated if PN affects the incidence of CRBSI in the critically ill. Methods. A retrospective analysis of 85 case histories of critically ill patients with central venous catheters (CVC) was performed. Study group received total (TPN) or partial PN (PPN), control group – enteral nutrition. Differences in demographics, possitive CVC tip cultures, incidences of CRBSI were analyzed between groups. CRBSI criteria were: simultaneous positive CVC tip and blood culture of the same pathogen, symptoms of bloodstream infection, exclusion of other bacteriaemia sources. Impact of CVC location on CRS was analyzed between TPN and PPN groups. Statistical significance (p<0.05) was calculated with IBM SPSS statistics 23. Results. From 31 critically ill patients (18 males, 13 females) with mean age of 63.5 years (y.) 25 received PPN, 6 – TPN. 54 patients (26 males, 28 females) with mean age of 64.4 y. received EN. The location of CVC in TPN group was right (85.71 percent (pct.)) and left subclavian (14.29 pct.) veins. CVC location in PPN group was right (75 pct.), left (4 pct.) subclavian and right internal jugular (21 pct.) veins. In both groups 6 CVCs were removed after manifestation of inflammatory symptoms in the site of insertion following 4 positive CVC tip cultures (12.9 pct.) in study group and 2 positive CVC tip cultures (3.7 pct.) in control group. In all cases simultaniously drawn blood cultures were negative and only four had bloodstream infection symptoms, therefore no CRBSI were diagnosed. Presented data did not differ significantly between g[...].