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Parenteral nutrition associated with increased infection rate in children with cancer
M L Christensen1, M L Hancock, J Gattuso
1Pharmaceutical Division, St. Jude Children's Research Hospital, Memphis, Tennessee.
Insights
Parenteral nutrition increases infection risk in pediatric cancer patients with central venous access devices (CVAD). This study found a 2.4-fold higher infection risk in children receiving parenteral nutrition, highlighting the need for careful management.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Clinical Nutrition
Background:
- Parenteral nutrition (PN) is associated with increased infectious complications in adult cancer patients.
- Pediatric cancer patients often require central venous access devices (CVADs) for treatment and supportive care.
Purpose of the Study:
- To assess the infection risk associated with parenteral nutrition in pediatric cancer patients with CVADs.
- To identify factors contributing to infection in this vulnerable population.
Main Methods:
- A study of 310 pediatric cancer patients with CVADs (Hickman/Broviac catheters or implantable ports).
- Data collected on CVAD duration, parenteral nutrition administration, and infection events.
- Multivariate Cox proportional hazards model used to analyze risk factors.
Main Results:
- The overall infection rate was 0.06 infections/100 days, increasing to 0.5 infections/100 days during PN administration.
- Patients receiving PN had a 2.4-fold greater risk of infection (95% CI 1.5-3.9).
- Acute nonlymphocytic leukemia and Hickman/Broviac catheters were also associated with increased infection risk.
Conclusions:
- Parenteral nutrition administration significantly increases infection risk in pediatric cancer patients with CVADs.
- These findings underscore the importance of monitoring and infection prevention strategies in this patient group.
Background:
Recent meta-analyses of published controlled studies concluded that adult patients with cancer randomly assigned to receive parenteral nutrition had higher rates of infectious complications than control subjects.
Methods:
The infection risk associated with parenteral nutrition was assessed in 310 pediatric patients with cancer. These patients had central venous access devices (CVAD), Hickman/Broviac (H/B) catheters, or implantable subcutaneous ports in place for the delivery of chemotherapy and supportive care.
Results:
The median duration of CVAD placement was 363 days; a total of 450 patient years (i.e., the sum of the total years of catheters experienced from all patients studied) were examined. Overall, the infection rate was 0.06 infections/100 days. During the period of parenteral nutrition administration, the rate increased to 0.5 infections/100 days. Among patients who received parenteral nutrition, there were no significant differences in any clinical parameter between the patients who developed an infection and those who did not. When evaluating the entire study population, infection was more likely to occur in patients who had acute nonlymphocytic leukemia (P < 0.01) or H/B catheters (P < 0.01), or who received parenteral nutrition (P < 0.02); there was no relationship between infection and catheter duration, days hospitalized, or days neutropenic (absolute neutrophil count < 0.5 x 10(9)/l). Only CVAD type and parenteral nutrition retained significance in a multivariate Cox proportional hazards model. After adjustment for diagnosis and CVAD type, the risk of infection was 2.4-fold greater in patients given parenteral nutrition (95% confidence interval 1.5 to 3.9; P < 0.001).
Conclusion:
These data confirm that administration of parenteral nutrition is associated with an increased risk of infection in children who have CVAD in place for cancer therapy.