Parenteral nutrition infection risk

Infection has long been recognized as a risk of parenteral nutrition and it has proved impossible to eliminate it (SEDA-22, 379). Once established, sepsis can increase the risk of fat overload syndrome. In an extensive study in Taiwan there was sepsis with positive blood cultures in 56 of 378 children receiving parenteral nutrition the risk factors were longer duration of parenteral nutrition, age under 3 months, the use of central venous catheters, gastrointestinal disease as an indication for parenteral nutrition, low birth weight, and short gestational age in prematurity (128). 

Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an important part of patient care. Malnutrition in hospitalized patients is associated with significant complications, including increased infection risk, poor wound healing, prolonged hospital stay, and increased mortality, especially in surgical and critically ill patients.1 Specialized nutrition support refers to the administration of nutrients via the oral, enteral, or parenteral route for therapeutic purposes.1 Parenteral nutrition (PN), also... 

Catheter infections in recipients of parenteral nutrition are of particular concern in children and can result in line removal, deep vein thrombosis, or an increased risk of hver disease. The incidence of catheter-related infections in 47 children receiving long-term parenteral nutrition has been studied retrospectively, one goal being to identify potential risk factors (35). The children had 125 catheters and 207 catheter-years. The average infection rate was 2.1/1000 parenteral nutrition days. The only factor identified was that early onset of infection after starting parenteral nutrition appeared to predict a poor prognosis. 

HIV-positive subjects are expected to be at even greater risk of line-related infection. A prospective study of 212 subjects with HIV infection with 327 central venous catheters has provided evidence of this enhanced risk (36). Over the period 1994-97, 33% were suspected as being infected, although only 61 episodes were diagnosed as catheter-related sepsis. Three variables affected the rate of sepsis parenteral nutrition, low numbers of circulating CD+ cells, and a high Apache score. 

Colomb V, Fabeiro M, Dabbas M, Goulet O, Merckx J, Ricour C. Central venous catheter-related infections in children on long-term home parenteral nutrition incidence and risk factors. Clin Nutr 2000 19(5) 355-9. 

Three risks of a parenteral nutrition support therapy are pneumothorax, air embolism, and infection. 

Similarly, early administration of parenteral nutrition after severe injury was associated with an increased risk of nosocomial infections in a retrospective cohort study of 567 patients, of whom 95... 

In a prospective cohort study including 24 infants, the incidence and risk factors of parenteral nutrition-associated liver disease (PNALD) was determined. Eight infants developed PNALD. The concluded that the duration of enteral starvation, gastrointestinal surgery, duration of enteral nutrition, maximum caloric and carbohydrate intakes were significant risks of PNALD in newborn infants [lob ll. In a retrospective review of the safety and efficacy of PN among 105 paediatric patients with bum injuries (>30% total-body sxuface area), no respiratory or blood infections were observed with the use of parenteral nutrition, and the overall mortality rate was 4% [107 ]. 

Aguilella Vizcaino MJ, Valero Zanuy MA, Gastalver Martin C, Gomis Munoz P, Moreno Villares JM, Le6n Sanz M. Incidence of catheter-related infection and associated risk factors in hospitalized patients with parenteral nutrition. [Article in Spanish] Nutr Hosp 2012 May-Jun 27(3) 889-93. 

Comparative studies In a systematic review of five randomized controlled comparisons of parenteral and enteral nutrition in patients with acute pancreatitis, there was diarrhea in 6 of 92 patients (7%) versus 24 of 82 (29%) respectively and hyperglycemia in 21 of 92 patients (23%) versus 7 of 82 (11%) [18 ]. The added risk of infections... 

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