Assessment of the association between mixed-oil lipid injectable emulsion use and 30-day mortality or infection persistence from fungal catheter-related bloodstream infections in pediatric patients following receipt of parenteral nutrition: A retrospective cohort study

Background: Compared to soybean-oil and fish-oil formulations, the use of mixed-oil lipid injectable emulsion is associated with reduced catheter-related bloodstream infection rates in pediatric patients receiving parenteral nutrition. The objective of this study was to compare clinical outcomes of fungal catheter-related bloodstream infections in pediatric patients following receipt of parenteral nutrition with mixed-oil (SMOFlipid) lipid injectable emulsion or other formulations (soybean-oil [Intralipid] or fish-oil [Omegaven]). Methods: A retrospective cohort study of pediatric patients with fungal catheter-related bloodstream infections following administration of parenteral nutrition and injectable lipid emulsion from five pediatric hospitals in the United States during a 5-year period was conducted. Differences in a composite outcome of 30-day mortality from first positive blood culture and/or infection persistence based on type of lipid injectable emulsion received prior to infection were assessed through generalized linear mixed models with binomial distribution. Results: One-hundred twelve fungal catheter-related bloodstream infections were assessed from 104 patients who received mixed-oil lipid injectable emulsion (n = 43) or other formulations (n = 69) prior to infection. Thirty-nine infections met the composite outcome (32 with persistent infection, three with 30-day mortality, and four with both). On multivariable analysis, receipt of mixed-oil lipid injectable emulsion demonstrated a non-statistically significant increase in the composite outcome (odds ratio [OR] [95% confidence interval {CI}]: 1.80 [0.75-4.34]; p = 0.19). Factors independently associated with the composite outcome include receipt of systemic antifungal prophylaxis (OR [95% CI]: 5.72 [1.33-24.7]; p = 0.019) and delay in central venous catheter removal (OR [95% CI]: 1.09 [1.01-1.19]; p = 0.03). Notable factors not associated with the composite outcome included continued receipt of lipid injectable emulsion, empiric antifungal choice, time to antifungal administration, and gastrointestinal surgery within 90 days prior to infection. Conclusion: Use of mixed-oil lipid injectable emulsion compared to other formulations (soybean-oil or fish-oil) demonstrated a non-statistically significant increase in 30-day mortality and/or infection persistence from fungal catheter-related bloodstream infections in pediatric patients receiving parenteral nutrition.