Efficacy of Parenteral Nutrition Supplemented With Glutamine Dipeptide to Decrease Hospital Infections in Critically Ill Surgical Patients

• Type of Material: Article
• Authors: Concepción F. Estívariz, Emory University; Daniel P. Griffith, Emory University; Menghua Luo, Emory University; Elaina E. Szeszycki, Emory University; Nisha Dave, Emory University; Nicole M. Daignault, Emory University; Glen F. Bergman, Emory University; Therese McNally, Emory University; Cindy H. Battey, Emory University; Celeste E. Furr, Emory University; Li Hao, Emory University; James G Ramsay, Emory University; Carolyn R. Accardi, Emory University; George A Cotsonis, Emory University; Dean P Jones, Emory University; John R Galloway, Emory University; Thomas R. Ziegler, Emory University; Niloofar Bazargan, Emory University
• Language: English
• Date: 2008-07
• Publisher: SAGE Publications (UK and US)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2008 American Society for Parenteral and Enteral Nutrition
• Final Published Version (URL): http://pen.sagepub.com/content/32/4/389.long
• Title of Journal or Parent Work: Journal of Parenteral and Enteral Nutrition
• ISSN: 0148-6071
• Volume: 32
• Issue: 4
• Start Page: 389
• End Page: 402
• Grant/Funding Information: National Center for Research Resources : NCRR; National Institute of Diabetes and Digestive and Kidney Diseases : NIDDK
• Keywords: glutamine; hospital infections; critical illness; parenteral nutrition
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Nutrition

Abstract

Background Nosocomial infections are an important cause of morbidity and mortality in the surgical intensive care unit (SICU). Clinical benefits of glutamine-supplemented parenteral nutrition may occur in hospitalized surgical patients, but efficacy data in different surgical subgroups are lacking. The objective was to determine whether glutamine-supplemented parenteral nutrition differentially affects nosocomial infection rates in selected subgroups of SICU patients. Methods This was a double-blind, randomized, controlled study of alanyl-glutamine dipeptide-supplemented parenteral nutrition in SICU patients requiring parenteral nutrition and SICU care after surgery for pancreatic necrosis, cardiac, vascular, or colonic surgery. Subjects (n = 59) received isocaloric/isonitrogenous parenteral nutrition, providing 1.5 g/kg/d standard glutamine-free amino acids (STD-PN) or 1.0 g/kg/d standard amino acids + 0.5 g/kg/d glutamine dipeptide (GLN-PN). Enteral feedings were advanced as tolerated. Nosocomial infections were determined until hospital discharge. Results Baseline clinical/metabolic data were similar between groups. Plasma glutamine concentrations were low in all groups and were increased by GLN-PN. GLN-PN did not alter infection rates after pancreatic necrosis surgery (17 STD-PN and 15 GLN-PN patients). In nonpancreatic surgery patients (12 STD-PN and 15 GLN-PN), GLN-PN was associated with significantly decreased total nosocomial infections (STD-PN 36 vs GLN-PN 13, P < .030), bloodstream infections (7 vs 0, P < .01), pneumonias (16 vs 6, P < .05), and infections attributed to Staphylococcus aureus (P < .01), fungi, and enteric Gram-negative bacteria (each P < .05). Conclusions Glutamine dipeptide-supplemented parenteral nutrition did not alter infection rates following pancreatic necrosis surgery but significantly decreased infections in SICU patients after cardiac, vascular, and colonic surgery.