家庭肠外营养患者静脉注射脂肪乳液的中心导管相关血流感染发生率

　　实施家庭肠外营养（HPN）的患者，静脉输注脂肪乳剂（IVFE）是血流感染（BSI）的高风险因素。美国罗格斯大学从美国肠外肠内营养学会（ASPEN）登记入组的病例库中选取自2011年8月～2014年8月接受HPN的患者共772例，进行回顾分析发现中心管道相关血流感染（CLABSI）率与每周接受IVFE的天数呈正相关关系。相对于没有接受IVFE输入的患者，每周1天输注IVFE的CLABSI率提高至1.6倍，每周7天全部接受IVFE输注的患者CLABSI率提高至2.2倍。

JPEN J Parenter Enteral Nutr. 2017;41(2):270-271.

The incidence of central line-associated bloodstream infections with intravenous fat emulsion infusion in patients on home parenteral nutrition.

Mireille Hamdan; Rebecca Brody; Andrea Marcus.

Nutritional Science, School of Health Professions, Rutgers University, Newark, New Jersey, USA.

PURPOSE: Patients receiving home parenteral nutrition (HPN) with intravenous fat emulsion (IVFE) infusion are at a higher risk of bloodstream infections (BSIs). The effect of the number of days of IVFE infusion on the incidence rate of BSIs is controversial. We studied the incidence rates of central line-associated bloodstream infections (CLABSIs) when grouped by the number of days per week of IVFE infusion received.

METHODS: The American Society for Parenteral and Enteral Nutrition (ASPEN) maintains a National Patient Registry called the Sustain Registry database. A secondary analysis of data obtained from the Sustain Registry database of adult participants (N = 772) who received HPN between August 2011 and August 2014 was conducted. Participants on fish oil-based IVFE or who were less than 18 or greater than 90 years of age were excluded. Descriptive statistics were used to summarize the clinical and demographic characteristics. Incidence rates of CLABSIs and rate ratios with 95% confidence intervals (CIs) were calculated to assess the rate of CLABSIs among 4 groups of IVFE infusion: 0 days of IVFE, 1 day of IVFE, 2-6 days of IVFE, and 7 days of IVFE.

RESULTS: Registrants' mean age was 51 years (SD = 15.2, range: 18-88). Among the 772 participants, 60.6% were female. The most frequently reported reasons for HPN were gastrointestinal obstruction (19.9%), short bowel syndrome (15.7%), and gastrointestinal fistula (14.6%). The incidence rate of CLABSIs per 1000 PN days was the lowest in those with zero days of IVFE (0.4; 95% CI = 0.2-0.5) and highest in those with daily IVFE infusion (0.9; 95% CI = 0.4-1.6). The incidence rates for those with 1 day of IVFE infusion (0.6; 95% CI = 0.4-0.9) and 2-6 days of IVFE (0.5; 95% CI = 0.3-0.8) were higher when compared with participants in the reference group with no days of IVFE. Rate ratios with confidence intervals indicate that the infection rate for those receiving 1 day of IVFE is 1.6 times higher (95% CI = 0.9-2.8) and 2.2 times higher (95% CI = 1.0-4.6) for those receiving daily IVFE infusion compared with the reference group with no days of IVFE.

CONCLUSIONS: Incidence rates of CLABSIs among groups receiving IVFE infusion increased when compared with the reference group with 0 days of IVFE infusion, even though the CIs indicate no significant statistical differences. Understanding the relationship between the incidence rates of BSIs and the number of days of IVFE infusion may inform decision making around safe HPN practices with regards to IVFE administration.

FINANCIAL SUPPORT: Department of Nutritional Sciences, School of Health Professions, Rutgers University.

DOI: 10.1177/0148607116686023