Risk Factors of central-line associated bloodstream infections among adult patients on parenteral nutrition

Abstract

Central venous catheter is preferred for the administration of parenteral nutrition (PN) as it allows longer period of use and higher osmolarity cut-off. However, one of the common complications is central-line-associated bloodstream infection, which increases mortality and healthcare burden. This study aimed to determine the prevalence and risk factors of central-line associated bloodstream infection among adult patients on parenteral nutrition. This was a retrospective study involving all adult patients at Hospital Queen Elizabeth, Sabah who received parenteral nutrition via central venous catheter from 1 April 2022 to 31 March 2023. Potential risk factors of central-line associated bloodstream infection were identified from medical records. The infection prevalence was calculated and associated risk factors were determined using multiple logistic regression. Of 112 patients, more than half were male (n=70, 62.5%) with mean age of 53.4±15.1. Majority of the patients were from surgical ward (n=61, 61.6%), followed by intensive care unit (n=25, 22.3%). Central-line associated bloodstream infection was present in 25 patients (22.3%). The median PN duration was nine days (interquartile range = 5-19). Duration of parenteral nutrition was the only factor demonstrating a statistically significant association with central-line associated bloodstream infection (adjusted odds ratio=1.08; 95% confidence interval=1.03-1.13; p=0.001). Approximately a quarter of patients in our study developed central-line associated bloodstream infection. Longer duration of parenteral nutrition indicates longer catheterisation, which exposes patients to higher risk of infection, potentially via catheter manipulation or infusate contamination. Prospective studies should be considered in future to explore strategies in reducing the infection occurrence.