Abstract:
Background: Catheter-related bloodstream infections (CRBSI) represent approximately 15% of healthcare-associated infections and up to 40% of nosocomial bacteremia cases. In-line filters are widely employed to remove particles, air, and microorganisms from infusion lines. However, their effectiveness in preventing infections remains uncertain. This study evaluated the association between in-line filter use and CRBSI and identified risk factors in patients receiving parenteral nutrition (PN).
Methods: We retrospectively reviewed adults who received PN at Mie University Hospital between June 2020 and May 2025. Patients ≤18 years or those receiving PN other than Elneopa®, Fulcalic®, or Bifreed® were excluded. CRBSI rates were compared between patients with and without online filters. Chi-square and unpaired t-tests were used to assess risk factors, and decision tree analysis examined predictor hierarchies.
Results: Baseline characteristics were comparable between the groups among 862 patients. The incidence of CRBSI was reduced in patients who used in-line filters (p < 0.001). Prolonged PN infusion duration, absence of in-line filter use, and intensive care unit (ICU) admission were significant risk factors for CRBSI. Decision tree analysis identified in-line filter use, infusion duration, and ICU admission as key determinants, with ICU admission plus prolonged infusion forming the highest-risk branch.
Conclusion: In-line filters were associated with reduced CRBSI, indicating potential benefit in preventing infusion-related contamination. However, ICU admission and prolonged infusion remained strong predictors, demonstrating that filters alone are insufficient in high-risk settings. Overall, filters may complement broader infection control measures, and further prospective studies are needed to confirm efficacy and cost-effectiveness.
Reference:Kato H, Hagihara M, Mikamo H, Iwamoto T. Impact of In-Line Filters and Risk Factors on Catheter-Related Bloodstream Infection in Parenteral Nutrition. J Hosp Infect. 2026 Mar 13:S0195-6701(26)00084-8. doi: 10.1016/j.jhin.2026.02.019. Epub ahead of print. PMID: 41833860.