Nutrition-modulated, subtype-specific risk factors for catheter-related bloodstream infections in hospitalized patients with intestinal failure

Minyi Zhu; Sirui Liu; Yi Wu; Qin Pan; Yupeng Zhang; Gulisudumu Maitiabula; Xuejin Gao; Xinying Wang

doi:10.3389/fnut.2025.1705357

Nutrition-modulated, subtype-specific risk factors for catheter-related bloodstream infections in hospitalized patients with intestinal failure

Front Nutr. 2025 Nov 20:12:1705357. doi: 10.3389/fnut.2025.1705357. eCollection 2025.

Authors

Minyi Zhu^#¹, Sirui Liu^#¹, Yi Wu^#¹, Qin Pan², Yupeng Zhang¹, Gulisudumu Maitiabula¹, Xuejin Gao^{1

3}, Xinying Wang^{1

2

3}

Affiliations

¹ Clinical Nutrition Service Center, Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
² Department of General Surgery, Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
³ Department of General Surgery, Jinling Hospital, Southeast University School of Medicine, Nanjing, China.

^# Contributed equally.

Abstract

Background and aims: Parenteral nutrition is essential for patients with intestinal failure but predisposes them to catheter-related bloodstream infection, a serious complication threatening survival. Prior research emphasizes catheter management, while the role of parenteral nutrition delivery strategies-particularly energy proportion and nutrient composition-remains poorly understood. This study investigates catheter-related bloodstream infection risk factors, focusing on parenteral nutrition energy supply and formulation, and evaluates subtype-specific susceptibilities in hospitalized patients with intestinal failure.

Methods: This retrospective study analyzed 321 hospitalized patients with intestinal failure, encompassing 9,365 catheter-days. catheter-related bloodstream infection incidence was calculated per 1,000 catheter-days. Univariate and multivariate logistic regression and Cox proportional hazards regression identified independent risk factors. Stratified analyses identified subtype-specific risks, and hospital stay length and health economic outcomes were assessed.

Results: The overall catheter-related bloodstream infection incidence was 7.048 per 1,000 catheter-days, significantly exceeding benchmarks. Key independent risk factors were parenteral nutrition calories > 60% of resting energy expenditure (OR = 3.808, HR = 2.055), lymphocytopenia (< 1 × 10⁹/L; OR = 6.047), high calorie-to-nitrogen ratio (≥ 100 kcal/g N; OR = 2.118), neutropenia (< 1.5 × 10⁹/L; HR = 2.573), and hypertension (OR = 4.981). Subtype-specific modulation was evident. Catheter-related bloodstream infection significantly prolonged hospitalization by nearly 2 weeks and increased inpatient costs.

Conclusion: Optimizing parenteral nutrition strategies, particularly by minimizing duration of high proportion of energy supply by parenteral nutrition through progressive enteral nutrition, is critical to reduce catheter-related bloodstream infection. Administering a low calorie-to-nitrogen ratio parenteral nutrition formula with immunonutrients is essential in unstable type I/II patients, while type III requires emphasis on blood pressure management. Universal multidrug-resistant pathogen vigilance is needed.

Keywords: catheter-related bloodstream infections; enteral nutrition; intestinal failure; nutritional support; parenteral nutrition.