title: Is there a difference in bloodstream infections in critically ill patients associated with ready-to-use versus compounded parenteral nutrition?
abstract: OBJECTIVE
  Parenteral nutrition is widely used in critically ill patients receiving nutritional support. Several previous studies associated the use of parenteral nutrition with the development of bloodstream infections. This study compared bloodstream infections in critical care patients receiving parenteral nutrition (PN) prepared via conventional compounding versus premixed multichamber bags.
  
  
  METHODS
  Records in the Premier Perspective™ database for all in patients ≥ 18 years of age, with a minimum 3-day intensive care unit stay, who received PN between 2005 and 2007 were analyzed (n = 15,328). Statistical analysis of data, grouped according to preparation method, compared differences in both observed bloodstream infection rates and adjusted rates, using logistic regression to examine the impact of hospital and patient baseline characteristics.
  
  
  RESULTS
  Patients receiving compounded parenteral nutrition had longer intensive care unit stays (11.3 vs. 9.1 days) and longer hospital stays (22.6 vs. 19.4 days); both P < .001. After adjusting for baseline differences, the probability for bloodstream infections was 19% higher when using compounded parenteral nutrition vs. multichamber bags (29.6 vs. 24.9%; odd ratio = 1.29; 95% confidence interval = 1.06-1.59).
  
  
  CONCLUSIONS
  In this retrospective review of a large patient database the adjusted probability of bloodstream infection was significantly lower in patients receiving multichamber bags than compounded parenteral nutrition. These findings need to be investigated further in high quality observational studies and prospective clinical trials.
authors.affiliation: Department of Nutrition and Intensive Care, Fernandes Távora Hospital, Fortaleza, Ceará, Brazil. pontes-arruda@secrel.com.br
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pontes-Arruda
authors.forename: Gary
authors.initials: G
authors.lastname: Zaloga
authors.forename: Paul
authors.initials: P
authors.lastname: Wischmeyer
authors.forename: Robin
authors.initials: R
authors.lastname: Turpin
authors.forename: Frank X
authors.initials: FX
authors.lastname: Liu
authors.forename: Catherine
authors.initials: C
authors.lastname: Mercaldi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology*; D016638:Critical Illness; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010288:Parenteral Nutrition / Q000009:adverse effects*; D057947:Parenteral Nutrition Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D057947:Parenteral Nutrition Solutions