Association between mixed oil lipid emulsions and all‐cause infections relative to soybean oil lipid emulsions in hospitalized adults: A retrospective cohort study

Intravenous lipid emulsions are a key component of parenteral nutrition, and their fatty acid compositions may influence immune responses and clinical outcomes. This retrospective cohort study conducted from January 2020 to December 2022 compared clinical outcomes of hospitalized non-critical care patients receiving parenteral nutrition with either mixed oil or soybean oil lipid emulsions for at least 48 h. The primary outcome was a composite of the presence of pneumonia, urinary tract infection, or an intra-abdominal collection diagnosed within 14 days of initiating parenteral nutrition. Secondary outcomes included catheter-related bloodstream infection, length of hospital stay, duration of antibiotic therapy, in-hospital mortality, and changes in the aspartate transaminase (AST)/alanine transaminase (ALT) ratio over time. Among 266 patients (mixed oil lipid emulsion: n = 130; soybean oil lipid emulsion: n = 136) there was no statistically significant difference in all-cause infections (P = 0.21). In patients receiving lipid emulsions for >7 days, the use of mixed oil lipid emulsions was associated with a shorter median antibiotic duration (4 days: interquartile range [IQR] 1-8.5 vs 7 days: IQR 5-10; P = 0.04). Additionally, patients who received mixed oil emulsions for >7 days had a significantly greater change in the AST/alkaline phosphatase ratio after 14 days compared with the soybean oil group (β = -0.51; P = 0.02). Although there was no difference in all-cause infections between types of lipid emulsions, mixed oil lipid emulsions were associated with shorter antibiotic use and lower AST/ALT ratio in hospitalized, non-critical care patients receiving parenteral nutrition for >7 days.