Hyperglycemia predispose to catheter-related sepsis in diabetic patients receiving Total Parenteral Nutrition

Hyperglycemia is encountered during nutritional support in diabetics and in patients with stress-related glucose intolerance. Aim of this study is to determine the incidence of central venous catheter-related sepsis (CRS) and its relationship with the serum glucose levels in diabetic patients treated with Total Parenteral Nutrition (TPN).

Methods

Medical records of 123 surgical patients (median age 68.1 years) treated with TPN in our Department between 1/1/1990 and 31/12/1997 were reviewed. They received TPN for a median duration of 14.3 days (range 2-65) by the method of `all-in-one'. Out of these, 27 patients were diabetics. Two units of regular insulin were added in the TPN-bag for each 20 g of glucose contained, in each diabetic patient. The nutrient admixture was volumetrically delivered over 24 h through a subclavian vein catheter. The parameters measured were lenght of TPN therapy, serum glucose levels (measured every 6 h) during the nutritional support, and the incidence of CRS which was defined by local or systemic signs of sepsis, positive culture of the catheter tip, concurrent positive blood cultures and defervescence of the clinical signs of sepsis following catheter removal. Data analysis was done using the Fisher's exact test. Values P < 0.05 were considered statistically significant.

Results

There was no difference to the lenght of TPN therapy between diabetics and non diabetics. In 20 diabetics the serum glucose levels remained <200 mg/dl, and in 7 were constantly high (>200 mg/dl) in all measurements during TPN administration. Eleven out of the 96 non diabetics (11.4%) and 3 out of the 20 `euglycemic' diabetics (15%) presented CRS, but this difference was not significant (P = 0.8); however, CRS was presented in 5 out of the 7 diabetics whom serum glucose levels were >200 mg/dl during TPN therapy (P = 0.01).

Conclusion

The results of out study suggest that CRS is serious risk in diabetics receiving TPN if good control of glycemia is not maintained; in adverse, the incidence of CRS doesn't seem to be significantly increased in well-controlled diabetics.