CLABSI Trends and Parenteral Nutrition

Healthcare-associated infections (HAIs) harmful for patients and costly for the health system. Central line associated bloodstream infections (CLABSI) are the most costly of HAIs (between 45K to 55K per CLABSI), increase length of stay by several days, and increase mortality by 15% to 40%. Although the rate of CLABSI has been decreasing since the institution of several preventive practices, the rates remain pretty high.

Patients who receive parenteral nutrition have more than 4-times higher risk of CLABSI than those who who do not receive parenteral nutrition. However the data on the risk of CLABSI risk since the institution of penalties for CLABSI by CMS (Centers for Medicare & Medicaid Services) was not available, that was until the publication of study by Fonseca et al. They used data from all adult patient discharges between January 1, 2009, and December 31, 2014, from 2 affiliated hospitals in a large health system in New York City. They conducted univariate and multivariate analyses to examine the relationship and temporal trends between parenteral nutrition and CLABSIs.

Of the 38,674 patients with central lines, 3517 developed CLABSIs. Of these 3517 patients, 767 patients were prescribed parenteral nutrition. Patients who were prescribed parenteral nutrition were 2.65 times more likely to have CLABSI than patients without parenteral nutrition. What this study shows is that there has been a decrease in the risk of CLABSI among patients who receive parenteral nutrition, although the risk remains much higher. Obviously, this study advocates for additional research to identifies strategies to decrease the risk of CLABSI in patients who receive parenteral nutrition.