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. 2022 Dec;42(12):898-904.
doi: 10.1002/phar.2740. Epub 2022 Nov 21.

Comparison of catheter-related bloodstream infection rates in pediatric patients receiving parenteral nutrition with soybean oil-based intravenous fat emulsion versus a mixed oil fat emulsion

Gustavo R Alvira-Arill  1   2 , Oscar R Herrera  1   2 , Chi Chun Steve Tsang  1 , Junling Wang  1 , Brian M Peters  1   3 , Jeremy S Stultz  1   2
Affiliations

Comparison of catheter-related bloodstream infection rates in pediatric patients receiving parenteral nutrition with soybean oil-based intravenous fat emulsion versus a mixed oil fat emulsion

Gustavo R Alvira-Arill et al. Pharmacotherapy. 2022 Dec.

Abstract

Study objective: To compare rates of catheter-related bloodstream infections (CR-BSI) in pediatric patients who received parenteral nutrition (PN) with either soybean oil-based intravenous fat emulsion (SO-IFE) or mixed oil-IFE (MO-IFE). We hypothesized that the use of MO-IFE would be independently associated with reduced infection rates compared with SO-IFE.

Design: Retrospective cohort study.

Setting: Tertiary referral children's hospital and its associated gastrointestinal rehabilitation clinic (01 January, 2015-31 July, 2019).

Patients: Days of IFE exposure were counted for patients aged <18 years on IFE initiated during the review period, who had a central venous catheter (CVC) placed for PN administration, received IFE at least three times weekly, and for at least 7 days.

Measurements: The primary outcome included total and categorical CR-BSI rates expressed as the average with standard error (SE) number of infections per 1000 fat emulsion days. The following categories were specified: Candida albicans, non-albicans Candida spp., coagulase-negative Staphylococcus (CoNS), Enterobacterales, methicillin-resistant S. aureus, methicillin-susceptible S. aureus, and Pseudomonadales. Average infection rate comparisons were quantified as incidence rate ratios (IRR) using generalized linear mixed modeling with a Poisson distribution.

Main results: Seven hundred and forty-three SO-IFE and 450 MO-IFE exposures were reviewed from 1131 patients, totaling 37,599 and 19,796 days of therapy, respectively. From those found significantly different, the average rate of infections with CoNS was 3.58 (SE 0.5)/1000 days of SO-IFE and 1.39 (SE 0.45)/1000 days of MO-IFE (IRR [95% confidence interval, CI]: 0.27 [0.16-0.46]; p < 0.01). Total average rates of infection were 7.33 (SE 0.76)/1000 days of SO-IFE and 4.52 (SE 0.75)/1000 days of MO-IFE (IRR [95% CI]: 0.60 [0.44-0.81]; p < 0.01). Other factors associated with higher infection rates include female gender, neonatal age, and inpatient-only IFE exposure.

Conclusions: Receipt of MO-IFE was associated with lower rates of CoNS and total CR-BSIs compared with SO-IFE in pediatric patients. These findings could have major implications on IFE selection for pediatric patients receiving PN.

Keywords: Candida; Staphylococcus; catheter-related infections; intravenous fat emulsions; parenteral nutrition; pediatrics; sepsis.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Totala and categorical average catheter-related bloodstream infection rates based on IFE formulationb Abbreviations: CA, Candida albicans; CoNS, coagulase-negative Staphylococcus; EB, Enterobacterales; EC, Enterococcus; IFE, intravenous fat emulsion; MO-IFE, mixed oil-IFE; MRSA, methicillin-resistant S. aureus; MSSA, methicillin-susceptible S. aureus; NAC, non-albicans Candida spp.; PM, Pseudomonadales; SO-IFE, soybean oil-IFE *, P < 0.05 using unadjusted Poisson regression models aTotal rates not summative of categories as co-infections counted as one bRates expressed as average +/− SE
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