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Clinical nutrition, enteral and parenteral nutrition

The impact of parenteral nutrition preparation on bloodstream infection risk and costs

European Journal of Clinical Nutrition volume 68, pages 953–958 (2014)Cite this article

Abstract

Background:

Catheter-related bloodstream infections (BSIs) are a serious problem leading to increased morbidity, longer hospital stay, and hence, additional costs. This study evaluated the risk of BSI and the cost of parenteral nutrition (PN) in Germany.

Subjects/Methods:

A retrospective observational chart review of patients hospitalized from October 2009 to April 2011 and receiving PN via ready-to-use three-chamber bag (MCB), single bottle (SB) or hospital compounded admixture (CPN) was conducted across Germany. Propensity score-adjusted models were used to evaluate the association between the type of PN, BSI (Cox Proportional Hazards) and hospitalization cost (generalized linear models) within a subgroup receiving all three macronutrients (lipids, amino acids, glucose).

Results:

Of the 1995 patient records reviewed (MCB=816; CPN=584; SB=595), 1457 patients received all three macronutrients. After adjustment, SB was associated with an increased hazard of BSI, vs MCB without additions (hazard ratio (HR) (95% confidence interval (CI))=2.53 (1.66–3.86)) in the total cohort. Adding supplements to MCB on the ward also increased the BSI risk in both total and subgroup analyses. In patients receiving all three macronutrients, adjusted total costs were MCB (no additions): €6,572 (95% CI: €6,896–6263); CPN: €6,869 (€7,283–6479); SB: €6,872 (€7,242–6521); MCB (ward additions): €7,402 (€7,878–6955); P<0.001; P<0.001.

Conclusion:

Use of MCB does not appear to increase treatment costs, possibly by reducing the risk of infection. This study identified several PN preparation methods associated with a significantly increased hazard for BSI; definitive CPN findings are limited by our inability to distinguish automated from manual pharmacy compounding.

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Acknowledgements

We thank Professor Georg Kreymann and Gabrielle Luft from medical affairs covering Baxter European region for their input and guidance on expected treatment patterns in Germany. Additionally, Cynthia Macahilig, Frank Malinoski, Matt Prinz, Pete Wolthoff and Zelik Moses from Medical Data Analytics for their contributions.

Author information

Author notes

  1. R S Turpin: Author participated and contributed to study while at Baxter Healthcare.

Authors and Affiliations

  1. Department of Health Delivery Systems and Pharmacoeconomics, Takeda Pharmaceuticals, Deerfield, IL, USA

    R S Turpin

  2. Department of Public Policy, Thomas Jefferson University, Philadelphia, PA, USA

    R S Turpin

  3. Department of Global Health Economics and Outcomes Research/Market Access, Baxter Healthcare, Deerfield, IL, USA

    R S Turpin, M Sanon & F Xiaoqing Liu

  4. Department of Health Economics and Outcomes Research, Pharmerit North America, Bethesda, MD, USA

    C Solem, S Mehta & M Botteman

  5. Department of Intensive Care and Nutrition, Fernandes Tavora Hospital, Fortaleza, Brazil

    A Pontes-Arruda

  6. Department of Nutrition, Christus University Center School of Medicine, Fortaleza, Brazil

    A Pontes-Arruda

  7. Department of Medical Affairs, Baxter Healthcare, Asia Pacific, Shanghai, People’s Republic of China

    A Pontes-Arruda

Authors
  1. R S Turpin
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  2. C Solem
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  3. A Pontes-Arruda
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  4. M Sanon
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  5. S Mehta
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  6. F Xiaoqing Liu
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  7. M Botteman
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Corresponding author

Correspondence to M Sanon.

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Competing interests

Turpin R was an employee at Baxter Healthcare, which provided funding, during this research. Currently employed with Takeda. Solem C is a research consultant with Pharmerit and research received funding from Baxter Healthcare. Pontes-Arruda A was an outside consultant and provided subject matter expertise. After completion of project Dr Pontes-Arruda A is now an employee at Baxter Healthcare and Baxter Healthcare provided funding for this research. Sanon M and Xiaoqing Liu F are employee at Baxter Healthcare and Baxter Healthcare provided funding for this research. Botteman M and Mehta S are research consultant with Pharmerit and research received funding from Baxter Healthcare.

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Supplementary Information accompanies this paper on European Journal of Clinical Nutrition website

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Turpin, R., Solem, C., Pontes-Arruda, A. et al. The impact of parenteral nutrition preparation on bloodstream infection risk and costs. Eur J Clin Nutr 68, 953–958 (2014). https://doi.org/10.1038/ejcn.2014.34

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