Comparison of catheter-related bloodstream infection rates in pediatric patients receiving parenteral nutrition with soybean oil-based intravenous fat emulsion versus a mixed oil fat emulsion.
Comparison of catheter-related bloodstream infection rates in pediatric patients receiving parenteral nutrition with soybean oil-based intravenous fat emulsion versus a mixed oil fat emulsion.
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比较接受大豆油静脉脂肪乳 (SO-IFE) 或混合油 IFE (MO-IFE) 肠外营养 (PN) 的儿科患者导管相关血流感染 (CR-BSI) 的发生率。我们假设与 SO-IFE 相比，使用 MO-IFE 与感染率降低独立相关。回顾性队列研究。三级转诊儿童医院及其相关肠胃康复诊所（01/01/2015 – 07/31/2019）。对审查期间开始接受 IFE 治疗的年龄 < 18 岁患者的 IFE 暴露天数进行了计数，这些患者放置了中心静脉导管 (CVC) 用于 PN 给药，每周至少接受 3 次 IFE，持续至少 7 天。主要结局包括总 CR-BSI 率和分类 CR-BSI 率，以每 1000 个脂肪乳日感染数的平均值和标准误 (SE) 表示。指定了以下类别：白色念珠菌、非白色念珠菌、凝固酶阴性葡萄球菌 (CoNS)、肠杆菌、耐甲氧西林金黄色葡萄球菌、甲氧西林敏感金黄色葡萄球菌和假单胞菌。使用具有泊松分布的广义线性混合模型将平均感染率比较量化为发病率比 (IRR)。对 1131 名患者的 743 次 SO-IFE 和 450 次 MO-IFE 暴露进行了审查，治疗时间分别为 37,599 天和 19,796 天。从发现显着差异的结果来看，SO-IFE 的 CoNS 平均感染率为 3.58 (SE 0.5)/1000 天，MO-IFE 的平均感染率为 1.39 (SE 0.45)/1000 天（IRR [95% 置信区间 (CI)]：0.27 [0.16–0.46]；p < 0.01）。 SO-IFE 的总平均感染率为 7.33 (SE 0.76)/1000 天，MO-IFE 为 4.52 (SE 0.75)/1000 天（IRR [95% CI]：0.60 [0.44–0.81]；p < 0.01）。与较高感染率相关的其他因素包括女性、新生儿年龄和仅住院患者的 IFE 暴露。在儿科患者中，与 SO-IFE 相比，接受 MO-IFE 与较低的 CoNS 和总 CR-BSI 发生率相关。这些发现可能对接受 PN 的儿科患者的 IFE 选择产生重大影响。
To compare rates of catheter-related bloodstream infections (CR-BSI) in pediatric patients who received parenteral nutrition (PN) with either soybean oil-based intravenous fat emulsion (SO-IFE) or mixed oil IFE (MO-IFE). We hypothesized that the use of MO-IFE would be independently associated with reduced infection rates compared to SO-IFE. Retrospective cohort study. Tertiary referral children’s hospital and its associated gastrointestinal rehabilitation clinic (01/01/2015 – 07/31/2019). Days of IFE exposure were counted for patients aged < 18 years on IFE initiated during the review period, who had a central venous catheter (CVC) placed for PN administration, received IFE at least three times weekly, and for at least 7 days. The primary outcome included total and categorical CR-BSI rates expressed as the average with standard error (SE) number of infections per 1000 fat emulsion days. The following categories were specified: Candida albicans, non-albicans Candida spp., coagulase-negative Staphylococcus (CoNS), Enterobacterales, methicillin-resistant S. aureus, methicillin-susceptible S. aureus, and Pseudomonadales. Average infection rate comparisons were quantified as incidence rate ratios (IRR) using generalized linear mixed modeling with a Poisson distribution. 743 SO-IFE and 450 MO-IFE exposures were reviewed from 1131 patients, totaling 37,599 and 19,796 days of therapy, respectively. From those found significantly different, the average rate of infections with CoNS was 3.58 (SE 0.5)/1000 days of SO-IFE and 1.39 (SE 0.45)/1000 days of MO-IFE (IRR [95% confidence interval (CI)]: 0.27 [0.16–0.46]; p < 0.01). Total average rates of infection were 7.33 (SE 0.76)/1000 days of SO-IFE and 4.52 (SE 0.75)/1000 days of MO-IFE (IRR [95% CI]: 0.60 [0.44–0.81]; p < 0.01). Other factors associated with higher infection rates include female gender, neonatal age, and inpatient-only IFE exposure. Receipt of MO-IFE was associated with lower rates of CoNS and total CR-BSIs compared to SO-IFE in pediatric patients. These findings could have major implications on IFE selection for pediatric patients receiving PN.
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DOI：
10.1097/mpg.0000000000003382
发表时间：
2022-06-01
影响因子：
2.9
作者：
Stultz, Jeremy S.;Fly, James H.;Bagga, Bindiya;Arnold, Sandra R.;Algotar, Anushree;Lee, Kelley R.
通讯作者：
Lee, Kelley R.
影响因子：
3.4
作者：
Goulet, Olivier;Antebi, Helena;Colomb-Jung, Virginie
通讯作者：
Colomb-Jung, Virginie
影响因子：
4.4
作者：
Garnacho-Montero, J;Ortiz-Leyba, C;Jiménez-Jiménez, FJ
通讯作者：
Jiménez-Jiménez, FJ
影响因子：
6.4
作者：
Swindell, Kim;Lattif, Ali Abdul;Ghannoum, Mahmoud A.
通讯作者：
Ghannoum, Mahmoud A.
影响因子：
5.2
作者：
Cheung GYC;Bae JS;Otto M
通讯作者：
Otto M