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Abstract

Introduction: An increase in central line associated bacteremias (CLABs) in patients on total parenteral nutrition (TPN) in our Surgical / Trauma Intensive Care Unit (STICU) prompted further investigation. Hypothesis: Increased CLABs with TPN in ICU patients may be associated with TPN related metabolic derangements, patient acuity and catheter management. Methods: 71 STICU patients on TPN between January 2009 and March 2012 were reviewed. Demographics including age and gender, diagnosis, ICU length of stay, TPN indication, catheter site and duration were collected. Triglyceride and serum glucose levels during TPN were recorded as metabolic indicators. The need for mechanical ventilation and vasopressors were used as acuity indicators. We determined CLABs by our Infection Prevention and Control criteria. All STICU CLABs were reviewed. Antimicrobial catheters were placed using a standardized central line bundle kit. The above data was compared to non STICU patients on TPN. Results: 10% of TPN patients developed CLABs over a period of 4 years, representing 30% of all STICU CLABs. The diagnoses were: 20% traumatic injuries, 18% GI perforation, 8.5% pancreatitis, 15.5% sepsis, 10% intestinal obstruction, 7% GI malignancy, 8.5% ischemic bowel and 12.6% other. There was no difference in age, gender, need for mechanical ventilation or vasopressors between CLABs and non CLABs patients. Triglyceride and glucose levels were elevated in CLABs patients but not significantly. There was no difference in catheter site with the internal jugular being most common in both groups. Catheters in patients with CLABs were in place for 11.8 days on average vs. 8.3 days in noninfected ones (p=0.0034). CLABs developed on an average of 11 days from catheter insertion. STICU length of stay was significantly longer in the CLABs patients (p= 0.0066) as was duration of TPN (p= 0.0033). No CLABs were identified in 95 non ICU patients that received TPN. Conclusions: In ICUs, TPN plays a significant role in CLABs development. Since no CLABs were identified in non ICU patients on TPN this may be due to patient acuity and catheter manipulation. In the ICU, catheters used for TPN should be closely monitored and may require more frequent replacement.