title: Bloodstream infections associated with parenteral nutrition preparation methods in the United States: a retrospective, large database analysis.
abstract: BACKGROUND
  The incidence of bloodstream infection (BSI) among patients receiving parenteral nutrition (PN) is reported to vary widely from 1.3%-39%. BSI rates in a large inpatient population were compared in this study to determine if PN prepared by different methods was associated with BSI.
  
  
  METHODS
  Data from Premier Perspective, the largest inpatient cost-based clinical and financial claims database in the United States, were analyzed. Included were all hospitalized patients age ≥18 years who received any PN from January 1, 2005, to December 31, 2007. BSI rates, the primary dependent variable, were defined as the occurrence ICD-9 codes of 038.x (septicemia), 995.91 (sepsis), 995.92 (severe sepsis), and 790.7 (bacteremia). The exposure cohort received PN in a commercial multichamber bag (MCB) (n = 4669), whereas the comparator group received PN prepared by a pharmacy (either hospital compounded or outsourced; n = 64,315). Observed data were adjusted using multivariate logistic regression for baseline differences, risk factors, and potential confounders, with propensity score matching as a sensitivity analysis.
  
  
  RESULTS
  The observed and adjusted BSI rates indicate that MCB is associated with fewer infections than pharmacy-prepared PN (observed 17.5% vs 26.6%; adjusted 19.6% vs 25.9%, both P < .001). Propensity-matched scores found similar results with observed BSI rates of 18.9% in patients receiving MCB and 24.6% in patients receiving a compounded PN.
  
  
  CONCLUSIONS
  Both the observed rate of BSI and adjusted probability of developing a BSI remained significantly lower for the MCB than the compounded PN group.
authors: Global Health Economics, Baxter Healthcare, Deerfield, Illinois 60015, USA. robin_turpin@baxter.com
authors: Robin S
authors: RS
authors: Turpin
authors: Todd
authors: T
authors: Canada
authors: Victor
authors: V
authors: Rosenthal
authors: Diane
authors: D
authors: Nitzki-George
authors: Frank Xiaoqing
authors: FX
authors: Liu
authors: Catherine J
authors: CJ
authors: Mercaldi
authors: Alessandro
authors: A
authors: Pontes-Arruda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology; D003132:Commerce; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D057947:Parenteral Nutrition Solutions; D010593:Pharmaceutical Services; D010607:Pharmacy Service, Hospital; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology*; D014481:United States / Q000453:epidemiology
chemical_list: D057947:Parenteral Nutrition Solutions