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Author Notes:

Address correspondence to: Thomas R. Ziegler, MD, Suite GG-23, General Clinical Research Center, Emory University Hospital, 1364 Clifton Road, Atlanta, GA 30322; tzieg01@emory.edu.

We thank the Emory GCRC research staff, the Emory University Hospital SICU nurses, and Susan Rogers of the Emory University Hospital Investigational Drug Service for their help with the protocol. We gratefully acknowledge the support of Ewald Schlotzer, PhD, from Fresenus-Kabi, Bad Homburg, Germany.

Authors contributed to study design (CFE, DPG, GAC, DPJ, JRG, TRZ), practical aspects of study performance (CFE, DPG, ML, EES, NB, ND, NMD, GFB, TM, CHB, CEF, LH, JGR, CRA, JRG, TRZ), data analysis (CFE, ML, GAC, TRZ), and manuscript preparation and review (CFE, DPG, ML, GAC, DPJ, JRG, TRZ).

TRZ received an investigator-initiated grant to support partial costs of the study and glutamine dipeptide from Fresenius-Kabi. Otherwise, no author has a conflict of interest.

Financial disclosure: supported by National Institutes of Health grant R03 DK54823 (TRZ), Emory General Clinical Research Center (GCRC) grant M01 RR00039 (GAC and TRZ), and an investigator-initiated grant from Fresenius-Kabi (TRZ).

Subjects:

Research Funding:

National Center for Research Resources : NCRR

National Institute of Diabetes and Digestive and Kidney Diseases : NIDDK

Keywords:

  • critical illness
  • glutamine
  • hospital infections
  • parenteral nutrition

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

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Journal Title:

Journal of Parenteral and Enteral Nutrition

Volume:

Volume 32, Number 4

Publisher:

, Pages 389-402

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2008 American Society for Parenteral and Enteral Nutrition

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