1443. Cumulative Intravenous Lipid Emulsion Infusion and Infection Risk
Session: Poster Abstract Session: Fungal Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Lipid emulsion as part of parenteral nutrition (PN) is a known risk factor for development of fungal bloodstream infections (FBSI). While increasing durations of PN therapy correlate with higher rates of infection, whether this immunosuppressive effect of lipid emulsion is specifically dose dependent has yet to be determined. The objective of this study is to compare patients receiving PN for set periods of time in order to determine if greater cumulative grams (g) of infused lipids is associated with an increased incidence of candidemia.

Methods: Adult patients who received PN for greater than 48h between August 2009 and August 2010 were retrospectively identified via chart review. Exclusion criteria included positive fungal blood cultures in the 14d preceding PN initiation, use of systemic antifungals 24h before or 48h post PN initiation, and empiric use of antifungals. Cumulative lipid dose, including that from propofol use, was calculated daily for each patient. Upon development of FBSI, total amount of infused lipid in the infected cohort was compared to that of the non-infected group at identical durations of PN therapy. SPSS 19.0 was utilized for statistical analysis. Mann-Whitney test was used to compare patient groups for non-parametric continuous variables and Chi-Square test was used to compare groups for nominal data. Alpha was set at 0.05.

Results: 339 courses of PN were screened with 154 patients included in the analysis, of which 16 (10%) developed FBSI within the initial 24d of PN with lipid emulsion therapy. Demographics, comorbid diseases, and APACHE II scores were similar between the infected and non-infected cohorts, while requirement of mechanical ventilation (68.8 vs. 37.0%, p=0.015) and vasopressor support (56.3 vs. 24.6%, p=0.011) was higher in the FBSI group. Cumulative lipid dose in FBSI patients at days 3-24 of PN therapy was not different as compared to non-infected patients (p>0.05).

Conclusion: Receipt of lipid emulsion via PN has been identified as a risk factor for the development of FBSI. This study explores if cumulative amount of lipid increases a patient's risk for FBSI independent of duration of PN therapy. Although the event rate in this cohort is low and lacks power, there is no evidence to suggest that quantity of lipid is associated with an increased risk of FBSI development.

Mark Decerbo, PharmD, BCPS, BCNSP1, Michelle Lew, Pharm.D./MBA Candidate 20132, Monica Ramirez, Pharm.D.2, Debra Bowersox, Pharm.D.2 and Mansi Shah, Pharm.D.2, (1)University of Nevada School of Medicine, Las Vegas, NV, (2)Roseman University of Health Sciences, Henderson, NV

Disclosures:

M. Decerbo, None

M. Lew, None

M. Ramirez, None

D. Bowersox, None

M. Shah, None

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