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Nutrition-modulated, subtype-specific risk factors for catheter-related bloodstream infections in hospitalized
Minyi Zhu1, Sirui Liu1, Yi Wu1
1Clinical Nutrition Service Center, Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Background And Aims:
Parenteral nutrition is essential for patients with intestinal failure but predisposes them to catheter-related bloodstream infection, a serious complication threatening survival. Prior research emphasizes catheter management, while the role of parenteral nutrition delivery strategies-particularly energy proportion and nutrient composition-remains poorly understood. This study investigates catheter-related bloodstream infection risk factors, focusing on parenteral nutrition energy supply and formulation, and evaluates subtype-specific susceptibilities in hospitalized patients with intestinal failure.
Methods:
This retrospective study analyzed 321 hospitalized patients with intestinal failure, encompassing 9,365 catheter-days. catheter-related bloodstream infection incidence was calculated per 1,000 catheter-days. Univariate and multivariate logistic regression and Cox proportional hazards regression identified independent risk factors. Stratified analyses identified subtype-specific risks, and hospital stay length and health economic outcomes were assessed.
Results:
The overall catheter-related bloodstream infection incidence was 7.048 per 1,000 catheter-days, significantly exceeding benchmarks. Key independent risk factors were parenteral nutrition calories > 60% of resting energy expenditure (OR = 3.808, HR = 2.055), lymphocytopenia (< 1 × 109/L; OR = 6.047), high calorie-to-nitrogen ratio (≥ 100 kcal/g N; OR = 2.118), neutropenia (< 1.5 × 109/L; HR = 2.573), and hypertension (OR = 4.981). Subtype-specific modulation was evident. Catheter-related bloodstream infection significantly prolonged hospitalization by nearly 2 weeks and increased inpatient costs.
Conclusion:
Optimizing parenteral nutrition strategies, particularly by minimizing duration of high proportion of energy supply by parenteral nutrition through progressive enteral nutrition, is critical to reduce catheter-related bloodstream infection. Administering a low calorie-to-nitrogen ratio parenteral nutrition formula with immunonutrients is essential in unstable type I/II patients, while type III requires emphasis on blood pressure management. Universal multidrug-resistant pathogen vigilance is needed.
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