Canadian Journal of Infection Control | SUMMER 2017 | Volume 32 | Issue 2 | 115-118 CONCISE REPORT Lipid emulsion increases the risk of central line infection in Japanese adult inpatients: A retrospective study Satoru Mitsuboshi, 1 * Bachelor of Pharmacy, Email: ccrtyo34057@gmail.com Hitoshi Yamada, 1 Bachelor of Pharmacy, Email: hitosiyama1104@gmail.com Kazuhiko Nagai, 1 Bachelor of Pharmacy, Email: nagai_k@niigata-min.or.jp 1 Department of Pharmacy, Kaetsu Hospital, 1459-1 Higashikanazawa, Akiha-ku, Niigata-shi, Niigata 956-0814, Japan. *Corresponding author: Satoru Mitsuboshi 1459-1 Higashikanazawa, Akiha-ku, Niigata-shi, Niigata 956-0814, Japan E-mail: ccrtyo34057@gmail.com Tel: +81250224711 FAX: +81250224760 Financial disclosure: None declared. ABSTRACT Background: Several studies have suggested that lipid emulsion (LE) increases the risk of central line infection (CLI) in adult patients. However, there are limited data on the relationship between LE and CLI. Methods: We retrospectively reviewed all patients who had had a central venous catheter (CVC) inserted during a 13-month period at our institution. CLI was defined as a catheter-related local infection or a central line-associated bloodstream infection. Results: We observed 25 CLIs in 163 cases (143 patients) of CVC insertion, giving a rate of 4.6 per 1000 catheter days. In multivariate logistic regression analyses, administration of LE was associated with an increased risk of CLI (odds ratio 3.12, 95% confidence interval 1.22–8.58). Parenteral nutrition was also associated with an increased risk of CLI (odds ratio 7.86, 95% confidence interval 1.45–146.10). Conclusions: Our results suggest that administration of LE is associated with an increased risk of CLI in hospitalized Japanese adults. KEY WORDS lipid emulsion, central line infection, parenteral nutrition INTRODUCTION Infusion of lipid emulsion (LE) during the early period following injury has been reported to increase susceptibility to infection (1). Further, LE administered more than twice weekly is associated with central line-associated bloodstream infection (CLABSI) in patients receiving home parenteral nutrition (PN) (2). Freeman et al. (3) showed that catheters could be colonized within 24-48 h of insertion, and when a nutrient-rich growth medium such as LE is infused through the colonized catheter, only a few hours of rapid growth are required for numbers of coagulase-negative staphylococci to reach levels sufficient for bloodstream invasion. Moreover, some studies have suggested that infusion of LE is a risk factor for coagulase-negative staphylococcal bacteremia in very low birth weight newborns (4) and Malassezia furfur fungaemia in infants (5). Further, in a systematic review and meta-analysis, Austin et al. showed that inclusion of LE in PN is one of several factors that may influence microbial growth (6). These observations suggest that LE may be associated with an increased risk of central line infection (CLI). However, a database analysis by Pontes-Arruda et al. (7) reported no significant association between LE administered with premixed PN and increased risk of infectious morbidity when compared with PN that did not contain lipids. In contrast, several studies have reported that LE increases the risk of CLI in adult patients receiving critical care (1) and home PN (2), while Austin et al. (6) reported that the evidence base for an association between LE and microbial growth is equivocal. The aim of this study was to examine the relationship between LE and CLI in Japanese adult inpatients. METHODS This 13-month retrospective study and its protocol were approved by the Ethics Committee of Kaetsu Hospital. The records of all patients who had undergone insertion of a central venous catheter (CVC) in Kaetsu Hospital, a 261-bed facility Acknowledgement: The authors thank the staff and patients who participated in this study. Conflicts of interest: None declared. 115