(458) Risk Factors Associated With Primary Bloodstream Infections in Adults Receiving Parenteral Nutrition

Introduction: Parenteral nutrition (PN) provides life-sustaining therapy but is also associated with complications such as primary bloodstream infections (pBSIs). Recent evidence suggests that 100% soybean oil intravenous lipid emulsions (SO-ILE) may put patients at higher risk for infection due to having pro-inflammatory properties when compared to mixed oil intravenous lipid emulsions (MO-ILE) which have anti-inflammatory properties. The purpose of this study is to determine independent risk factors associated with pBSIs in patients receiving PN with SO-ILE or MO-ILE.

Methods: This IRB-approved, retrospective, propensity-matched cohort analysis included patients admitted to an 877-bed academic medical center between January 2018 and November 2023. Adult patients who received PN (with an ILE) for ≥3 days were included. Patient cohorts were defined by those who developed a pBSI (cases) and those who did not (controls). A pBSI was defined as a bloodstream infection occurring ≥72 hours after ILE initiation, with no other documented source of infection other than the central venous catheter (CVC). Every patient with a pBSI was matched to two patients without a pBSI using propensity scores calculated using CVC line days. The primary outcome was to identify independent risk factors for pBSI. Secondary outcomes included microbiology of pBSI, hospital length of stay (LOS), and in-hospital mortality. Multivariable logistic regression was used to identify factors independently associated with pBSIs.

Results: A total of 243 patients were included, 81 patients in the pBSI group and 162 patients in the no-pBSI group. Of these, 130 (53%) were admitted to the intensive care unit and 89 (36.6%) were on home PN prior to admission. SO-ILE was prescribed to 130 (53%) patients and MO-ILE to 113 (47%) patients. Charlson Comorbidity Index >2 was the only factor independently associated with pBSI (adjOR 1.5, 95% CI 0.9-2.7). Staphylococcus species (38%) and Candida species (26%) were the most common pathogens identified. There was no difference in hospital LOS and in-hospital mortality between groups.

Conclusions: Patients who received PN therapy and had a Charlson Comorbidity Index >2 were at higher risk for pBSI. No differences were observed in rates of pBSI between patients receiving SO-ILE or MO-ILE.