Research and Scholarship
Revisiting Infectious Complications Following Total Parenteral Nutrition Use During Hematopoietic Stem Cell Transplantation
Halina Rubin,(1) RPh, Jayesh Mehta,(1,2) MD, Jessica L. Fong,(1) PharmD, Deborah Greenberg,(1) PharmD, Solomiya Gruschak,(1,2) BS, and Steven Trifilio,(1,2) RPh
From (1)Northwestern Memorial Hospital Department of Pharmacy, Chicago, Illinois; (2)Robert H. Lurie Cancer Center and Northwestern University Feinberg School of Medicine, Chicago, Illinois
Authors’ disclosures of conflicts of interest are found at the end of this article.
Correspondence to: Halina Rubin, RPh,
Northwestern Memorial Hospital, 250 E.
Superior, Chicago, IL 60611.
E-mail: hrubin@nm.org
J Adv Pract Oncol 2020;11(7):675–682 |
https://doi.org/10.6004/jadpro.2020.11.7.2 |
© 2020 Harborside™
ABSTRACT
Background: Total parenteral nutrition (TPN) is frequently used to manage caloric needs during hematopoietic stem cell transplantation (HSCT). Previous studies in transplant patients who received TPN have reported widely discordant results with regard to infection and mortality, and risk factors for TPN-related infection remain unclear. Method: We conducted a retrospective study of all HSCT recipients treated with TPN between 2005 to 2014 at Northwestern Memorial Hospital to determine the incidence and epidemiology of infections. Electronic records were used to identify patients treated with TPN for at least 2 days who developed infection. Results: Among 198 patients treated with TPN, 30% developed documented infection. Total parenteral nutrition treatment duration (13 vs. 7 days; p < .0001) and the timing of TPN initiation (> day 9 post HSCT; p < .0001) were significantly higher in patients who received TPN and developed infection. Receipt of an allogeneic transplant was associated with increased risk for infection (p < .0138), and day 60 mortality was significantly higher in TPN-treated patients with infection (p < .0001). Conclusion: Stem cell recipients who receive TPN, especially from an allogeneic donor, have high rates of infection and mortality. Minimizing TPN exposure may reduce the chance for infection.
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