title: Influence of parenteral nutrition delivery system on the development of bloodstream infections in critically ill patients: an international, multicenter, prospective, open-label, controlled study--EPICOS study.
abstract: BACKGROUND
  Parenteral nutrition (PN) is associated with an increased risk of developing bloodstream infections (BSIs) but the impact of the PN delivery system upon BSI rates remains unclear. This was an international, multicenter, prospective, randomized, open-label, controlled trial that investigated the differences of BSIs associated with 2 different PN systems.
  
  
  METHODS
  Patients were randomly allocated in a 2:1:1 ratio to receive either PN delivered by a multichamber bag (MCB group), or by compounded PN made with olive oil (COM1 group) or with MCT/LCT (COM2 group). Blood cultures were performed to evaluate the incidence of BSIs, and catheter use data was collected to calculate CLAB and central venous catheter device use ratio (CVC-DUR). Secondary outcomes included the development of severe sepsis/septic shock, number of intensive care unit (ICU) and hospital days, and all-cause mortality at Day 28.
  
  
  RESULTS
  406 patients were included: 202 in the MCB group, 103 in the COM1 group, and 101 in the COM2 group. Baseline characteristics were well balanced between the 3 groups, BSIs were significantly higher in patients receiving compounded PN (46 BSIs for COM1+COM2 vs 34 BSIs for MCB; p = 0.03).CLAB was higher in patients receiving compounded PN (13.2 for COM1+COM2 vs 10.3 for MCB; p < 0.0001). No differences were observed for the secondary outcomes.
  
  
  CONCLUSIONS
  Compounded PN was associated with a higher incidence of BSIs and CLABs, suggesting that the use of MCB PN may play a role in reducing the incidence of BSIs in patients who receive PN.
  
  
  BACKGROUND
  NCT00798681.
authors.affiliation: Intensive Care and Nutrition Department, Fernandes Távora Hospital, Fortaleza, Brazil. pontesarruda@secrel.com.br
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pontes-Arruda
authors.forename: Maria Cecília Freitas Cesarino
authors.initials: MC
authors.lastname: Dos Santos
authors.forename: Laércia Ferreira
authors.initials: LF
authors.lastname: Martins
authors.forename: Eddy René Rodriguez
authors.initials: ER
authors.lastname: González
authors.forename: Ruben Gustavo
authors.initials: RG
authors.lastname: Kliger
authors.forename: Marcelo
authors.initials: M
authors.lastname: Maia
authors.forename: Gisele Brocco
authors.initials: GB
authors.lastname: Magnan
mesh_terms: D000328:Adult; D000368:Aged; D062905:Central Venous Catheters / Q000009:adverse effects / Q000382:microbiology; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D004032:Diet; D002149:Energy Intake; D005260:Female; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage / Q000097:blood; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology
chemical_list: D007328:Insulin