Epidemiology of bloodstream infection associated with parenteral nutrition

The best plan of care for a suspected or known infected catheter in a hospitalized patient is to reinsert a new central line after 48 hours of antibiotic treatment and negative blood cultures. In patients who receive long-term PN, hospitalization increases the risk of a nosocomial infection because the catheter can be contaminated by staff. A patient with fungemia must always be admitted and catheter removed. With gram-positive and gram-negative organisms, the catheter may not need to be removed. In most patients receiving PN at home, removing a long-term venous-access device is challenging. Peripheral vein access or peripherally inserted central catheters are needed until a new permanent device can be inserted after negative blood cultures are obtained. Evaluation of remote site infection also is necessary. Strategies to reduce or prevent infection include catheter lock therapy, daily evaluation of continued need for PN, enteral rather than PN support, and avoiding overfeeding. More studies are needed to demonstrate conclusively the benefits of immunonutrition, such as the use of omega-3 or glutamine supplements to reduce CR-BSIs in patients receiving PN.