title: The impact of parenteral nutrition preparation on bloodstream infection risk and costs.
abstract: BACKGROUND
  Catheter-related bloodstream infections (BSIs) are a serious problem leading to increased morbidity, longer hospital stay, and hence, additional costs. This study evaluated the risk of BSI and the cost of parenteral nutrition (PN) in Germany.
  
  
  METHODS
  A retrospective observational chart review of patients hospitalized from October 2009 to April 2011 and receiving PN via ready-to-use three-chamber bag (MCB), single bottle (SB) or hospital compounded admixture (CPN) was conducted across Germany. Propensity score-adjusted models were used to evaluate the association between the type of PN, BSI (Cox Proportional Hazards) and hospitalization cost (generalized linear models) within a subgroup receiving all three macronutrients (lipids, amino acids, glucose).
  
  
  RESULTS
  Of the 1995 patient records reviewed (MCB=816; CPN=584; SB=595), 1457 patients received all three macronutrients. After adjustment, SB was associated with an increased hazard of BSI, vs MCB without additions (hazard ratio (HR) (95% confidence interval (CI))=2.53 (1.66-3.86)) in the total cohort. Adding supplements to MCB on the ward also increased the BSI risk in both total and subgroup analyses. In patients receiving all three macronutrients, adjusted total costs were MCB (no additions): \[euro]6,572 (95% CI: \[euro]6,896-6263); CPN: \[euro]6,869 (\[euro]7,283-6479); SB: \[euro]6,872 (\[euro]7,242-6521); MCB (ward additions): \[euro]7,402 (\[euro]7,878-6955); P<0.001; P<0.001.
  
  
  CONCLUSIONS
  Use of MCB does not appear to increase treatment costs, possibly by reducing the risk of infection. This study identified several PN preparation methods associated with a significantly increased hazard for BSI; definitive CPN findings are limited by our inability to distinguish automated from manual pharmacy compounding.
authors.affiliation: 1] Department of Health Delivery Systems and Pharmacoeconomics, Takeda Pharmaceuticals, Deerfield, IL, USA [2] Department of Public Policy, Thomas Jefferson University, Philadelphia, PA, USA [3] Department of Global Health Economics and Outcomes Research/Market Access, Baxter Healthcare, Deerfield, IL, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Turpin
authors.affiliation: Department of Health Economics and Outcomes Research, Pharmerit North America, Bethesda, MD, USA.
authors.forename: C
authors.initials: C
authors.lastname: Solem
authors.affiliation: 1] Department of Intensive Care and Nutrition, Fernandes Tavora Hospital, Fortaleza, Brazil [2] Department of Nutrition, Christus University Center School of Medicine, Fortaleza, Brazil [3] Department of Medical Affairs, Baxter Healthcare, Asia Pacific, Shanghai, People's Republic of China.
authors.forename: A
authors.initials: A
authors.lastname: Pontes-Arruda
authors.affiliation: Department of Global Health Economics and Outcomes Research/Market Access, Baxter Healthcare, Deerfield, IL, USA.
authors.forename: M
authors.initials: M
authors.lastname: Sanon
authors.affiliation: Department of Health Economics and Outcomes Research, Pharmerit North America, Bethesda, MD, USA.
authors.forename: S
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Department of Global Health Economics and Outcomes Research/Market Access, Baxter Healthcare, Deerfield, IL, USA.
authors.forename: F
authors.initials: F
authors.lastname: Xiaoqing Liu
authors.affiliation: Department of Health Economics and Outcomes Research, Pharmerit North America, Bethesda, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Botteman
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D003428:Cross Infection / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D057947:Parenteral Nutrition Solutions / Q000191:economics; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D057947:Parenteral Nutrition Solutions