Parenteral nutrition associated with increased infection rate in children with cancer

Abstract

Background. Recent metaanalyses 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 × 109/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.

Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit

“…According to the literature [11,14,16,18,25,27,28], the use of PN appears to be a risk factor for the onset of CR-BSI. We found that 15.2% of patients with PN had CR-BSI versus 3% of those without PN.…”

“…We found that 15.2% of patients with PN had CR-BSI versus 3% of those without PN. It has been reported [28,29] that PN can increase the risk of CR-BSI by eight to ten times. In our study, combination of prolonged IT and administration of PN significantly increased the risk of CR-BSI during the first period of the study (Fig.…”

Prognostic Factors in the Resumption of Oral Dietary Intake After Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in Children

“…[3][4][5][6] Most HSCT patients receive PN when their oral dietary intake falls substantially below their nutrient requirements. Courses of PN commonly last until engraftment occurs and upper and lower gastrointestinal toxicities improve.…”

Antioxidant intake in paediatric oncology patients

“…(49,50) A study by Christensen et al (50) showed 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).…”