Session Type: ePosters
Session Title: ePosters
Authors(s): S. Slonim, L. Leibovici
Authors Affiliations(s): Rabin Medical Center, Israel
Background:
Parenteral nutrition (PN) is considered as an independent risk factor for infections. The aim of this study is to evaluate rates and outcomes of PN associated infections, defining the characteristics of high-risk patients and assessing risk factors.
Methods:We performed a systematic review and meta-analysis by searching Medline, The Cochrane Library and EMBASE databases, between 01.01.2011 and 31.12.2017. We included adult patients who received PN in different settings. Both RCTs and cohort studies were included. We collected patients characteristics, outcomes and potential confounders. After evaluated the methodological quality of the studies we performed a meta-analysis and implemented a random effects model due to high heterogeneity.
Results:We included 106 studies with 152 sub-studies with a total of 89,867 participants.
The general total infection rate (IR) was 4.4 per 1000 feeding days [95% CI 4.06-4.75] with a very high heterogeneity (I2=99.1).
Chronic patients with home PN, had the lowest IR – 2.03 per 1000 feeding days [95% CI 1.55-2.5], followed by cancer patients– 2.32 [95% CI 1.3-3.3] and surgical patients - 3.83 per 1000 feeding days [95% CI 2.66-4.99]. The highest IR, 11.24 per 1000 feeding days [95% CI 10.55-11.93] was in patients who started their PN while hospitalized for an emergency.
In a subgroup analysis by catheter type, the lowest IR was in patients with PICC line 0.85 [95% CI 0-2.23]. Reported early initiation of PN was associated with lower IR 3.87 [95% CI 2.4-5.3] vs. 4.45 [95% CI 4.09-4.8], p<0.001. Implementation of infection prevention protocols and controlled catheter insertion were also associated with lower IR (2.17 [95% CI 1.44-2.9] and 3.126 [95% CI 2.33-3.91], respectively). IR declined over the years, with 0.86 per1000 feeding days [95% CI 0-1.8] in recent studies.
Most (60%) infections were caused by gram-positive bacteria, followed by 30% caused by gram-negative bacteria and 12% caused by fungal infections.
Conclusions:In this systematic review and meta analysis we showed a constant decrease in the rate of PN associated catheter infections over the years and that home PN, PICC line, early initiation of PN and implementation of infection prevention protocols are associated with lower rates of infections.
Keyword(s): parenteral nutrition, catheter related blood stream infections, risk factorsSession Type: ePosters
Session Title: ePosters
Authors(s): S. Slonim, L. Leibovici
Authors Affiliations(s): Rabin Medical Center, Israel
Background:
Parenteral nutrition (PN) is considered as an independent risk factor for infections. The aim of this study is to evaluate rates and outcomes of PN associated infections, defining the characteristics of high-risk patients and assessing risk factors.
Methods:We performed a systematic review and meta-analysis by searching Medline, The Cochrane Library and EMBASE databases, between 01.01.2011 and 31.12.2017. We included adult patients who received PN in different settings. Both RCTs and cohort studies were included. We collected patients characteristics, outcomes and potential confounders. After evaluated the methodological quality of the studies we performed a meta-analysis and implemented a random effects model due to high heterogeneity.
Results:We included 106 studies with 152 sub-studies with a total of 89,867 participants.
The general total infection rate (IR) was 4.4 per 1000 feeding days [95% CI 4.06-4.75] with a very high heterogeneity (I2=99.1).
Chronic patients with home PN, had the lowest IR – 2.03 per 1000 feeding days [95% CI 1.55-2.5], followed by cancer patients– 2.32 [95% CI 1.3-3.3] and surgical patients - 3.83 per 1000 feeding days [95% CI 2.66-4.99]. The highest IR, 11.24 per 1000 feeding days [95% CI 10.55-11.93] was in patients who started their PN while hospitalized for an emergency.
In a subgroup analysis by catheter type, the lowest IR was in patients with PICC line 0.85 [95% CI 0-2.23]. Reported early initiation of PN was associated with lower IR 3.87 [95% CI 2.4-5.3] vs. 4.45 [95% CI 4.09-4.8], p<0.001. Implementation of infection prevention protocols and controlled catheter insertion were also associated with lower IR (2.17 [95% CI 1.44-2.9] and 3.126 [95% CI 2.33-3.91], respectively). IR declined over the years, with 0.86 per1000 feeding days [95% CI 0-1.8] in recent studies.
Most (60%) infections were caused by gram-positive bacteria, followed by 30% caused by gram-negative bacteria and 12% caused by fungal infections.
Conclusions:In this systematic review and meta analysis we showed a constant decrease in the rate of PN associated catheter infections over the years and that home PN, PICC line, early initiation of PN and implementation of infection prevention protocols are associated with lower rates of infections.
Keyword(s): parenteral nutrition, catheter related blood stream infections, risk factors