The Journal of hospital infection · 2026
Impact of in-line filters and risk factors on catheter-related bloodstream infection in parenteral nutrition.
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Kato H, Hagihara M, Mikamo H, Iwamoto T
Аннотация
BACKGROUND: Catheter-related bloodstream infections (CRBSIs) represent approximately 15% of healthcare-associated infections and up to 40% of nosocomial bacteraemia cases. In-line filters are widely used to remove particles, air, and micro-organisms from infusion lines. However, their effectiveness in preventing infections remains uncertain. This study evaluated the association between in-line filter use and CRBSI and identified risk factors in patients receiving parenteral nutrition (PN).
METHODS: We retrospectively reviewed adults who received PN at Mie University Hospital between June 2020 and May 2025. Patients aged ≤18 years or those receiving PN other than Elneopa®, Fulcalic®, or Bifreed® were excluded. CRBSI rates were compared between patients with and without online filters. χ2 and unpaired t-tests were used to assess risk factors, and decision tree analysis examined predictor hierarchies.
RESULTS: Baseline characteristics were comparable between the groups among 862 patients. The incidence of CRBSI was reduced in patients who used in-line filters (P < 0.001). Prolonged PN infusion duration, absence of in-line filter use, and intensive care unit (ICU) admission were significant risk factors for CRBSI. Decision tree analysis identified in-line filter use, infusion duration, and ICU admission as key determinants, with ICU admission plus prolonged infusion forming the highest-risk branch.
CONCLUSION: In-line filters were associated with reduced CRBSI, indicating potential benefit in preventing infusion-related contamination. However, ICU admission and prolonged infusion remained strong predictors, demonstrating that filters alone are insufficient in high-risk settings. Overall, filters may complement broader infection control measures, and further prospective studies are needed to confirm efficacy and cost-effectiveness.
METHODS: We retrospectively reviewed adults who received PN at Mie University Hospital between June 2020 and May 2025. Patients aged ≤18 years or those receiving PN other than Elneopa®, Fulcalic®, or Bifreed® were excluded. CRBSI rates were compared between patients with and without online filters. χ2 and unpaired t-tests were used to assess risk factors, and decision tree analysis examined predictor hierarchies.
RESULTS: Baseline characteristics were comparable between the groups among 862 patients. The incidence of CRBSI was reduced in patients who used in-line filters (P < 0.001). Prolonged PN infusion duration, absence of in-line filter use, and intensive care unit (ICU) admission were significant risk factors for CRBSI. Decision tree analysis identified in-line filter use, infusion duration, and ICU admission as key determinants, with ICU admission plus prolonged infusion forming the highest-risk branch.
CONCLUSION: In-line filters were associated with reduced CRBSI, indicating potential benefit in preventing infusion-related contamination. However, ICU admission and prolonged infusion remained strong predictors, demonstrating that filters alone are insufficient in high-risk settings. Overall, filters may complement broader infection control measures, and further prospective studies are needed to confirm efficacy and cost-effectiveness.