Longer hospitalization of patients with positive blood cultures receiving TPN

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“Continuation of TPN after a positive blood culture was associated with statistically significantly longer hospitalization before and after adjustment for co-morbid conditions.” Patel et al (2014).

Reference:

Patel, V., Liu, X., Paul, M. and Belisle, C.D. (2014) Longer Hospitalization of Patients with Positive Blood Cultures Receiving Total Parenteral Nutrition. Surgical Infections. April 21st. [epub ahead of print].

Abstract:

Background: Total parenteral nutrition (TPN) via central venous catheters has improved nutrient delivery to patients unable to receive nutrition enterally, but its administration can be complicated by bacteremia and fungemia.

Methods: At a large tertiary care academic medical center, 245 patients with concurrent positive blood cultures, among 1,716 adult patients who received TPN over a period of three consecutive years, were divided into those in whom parenteral nutrition was continued and those in whom it was stopped after the occurrence of a positive blood culture. To determine whether continuation of TPN after a positive blood culture was associated with a statistically significantly longer hospitalization than with its discontinuation after a positive blood culture, we performed a logistic regression analysis with step-wise selection, with parenteral nutrition status as the dependent variable and type of venous access, type of pathogen responsible for a positive blood culture, recurrence of a positive blood culture, respiratory failure, shock, and length of stay as covariates.

Results: The prevalence of positive blood cultures was 14% among all hospitalized patients given parenteral nutrition. Parenteral nutrition was continued in 60% of the patients. Baseline co-morbid and laboratory parameters were comparable in the group of patients in whom TPN was continued and the group in which it was stopped except that the white blood cell count (WBC) was lower in the former group (9.1±6.6 g/dL vs. 12±12.1 g/dL, p=0.015). Both groups received an average of 30 kcal/kg and 1.4 g protein/kg via TPN. There was no difference in the two groups in total calories, lipids, protein, or glutamine-base received before the occurrence of a positive blood culture (p=0.86, p=0.51, p=0.79, and p=0.42, respectively). The hospital stay of the group in which TPN was continued after a positive blood culture was statistically significantly longer than that of the group in which it was discontinued (44.6±32.3 d vs. 28.2±18.5 d, p<0.001). This difference remained significant in the multivariable logistic regression analysis.

Conclusion: Continuation of TPN after a positive blood culture was associated with statistically significantly longer hospitalization before and after adjustment for co-morbid conditions.

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