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Omotani S, Murakami K, Naka A, Hatsuda Y, Myotoku M. Differences in the growth of microorganisms depends on the type of semi-solid enteral nutritional supplements. J Pharm Health Care Sci 2023; 9:27. [PMID: 37653514 PMCID: PMC10472649 DOI: 10.1186/s40780-023-00297-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/11/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Enteral nutritional supplements are used in many medical facilities and home care, but require appropriate management because they are nutrient-rich products. Recently, infection control methods for Ready To Hang (RTH) preparations, which are widely used and are expected to reduce the risk of infection, have not been established in Japan and are dependent on caregivers. Therefore, we evaluated the difference in the growth of microorganisms depending on the type of enteral nutrients following contamination with microorganisms. METHODS Nine types of enteral nutrition were used. Escherichia coli (E. coli) W3110, Serratia marcescens (S. marcescens) NBRC3046, and Candida albicans (C. albicans) IFM61197 were used as test bacteria. The bacterial solution was added to the enteral nutritional supplement, adjusted, and the number of bacteria was measured at 0, 4, 8, and 24 h after the addition of the bacterial solution at 25 °C and in the dark. RESULTS E. coli and S. marcescens grew in RACOL®-NF SemiSolid for Enteral Use, Hine® Jerry AQUA, and Mermed Plus® over a 24-h period; however, a decrease was observed for other enteral nutrition products. In contrast, C. albicans grew in all enteral nutrition products. CONCLUSION Because the viscosity and calorie content vary among enteral nutrition preparations in which growth was observed, we found that pH had the greatest effect on the differences in bacterial growth. Nonetheless, C. albicans growth occurred in all nine types of enteral nutrients, indicating that unlike bacteria, its growth was independent of pH. If semi-solid enteral nutrients are contaminated with microorganisms for any reason, microorganisms will grow, so appropriate infection control is necessary to prevent infection.
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Affiliation(s)
- Sachiko Omotani
- Faculty of Pharmacy, Osaka Ohtani University, 3-11-1, Nishikiori-Kita, Tondabayashi, Osaka, 584-8540, Japan
| | - Kanaha Murakami
- Faculty of Pharmacy, Osaka Ohtani University, 3-11-1, Nishikiori-Kita, Tondabayashi, Osaka, 584-8540, Japan
| | - Arisa Naka
- Faculty of Pharmacy, Osaka Ohtani University, 3-11-1, Nishikiori-Kita, Tondabayashi, Osaka, 584-8540, Japan
| | - Yasutoshi Hatsuda
- Faculty of Pharmacy, Osaka Ohtani University, 3-11-1, Nishikiori-Kita, Tondabayashi, Osaka, 584-8540, Japan
| | - Michiaki Myotoku
- Faculty of Pharmacy, Osaka Ohtani University, 3-11-1, Nishikiori-Kita, Tondabayashi, Osaka, 584-8540, Japan.
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2
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Ohara H. Growth and Control of Catheter-related Bloodstream Infection Causing Bacteria in Nutrient Solutions. YAKUGAKU ZASSHI 2022; 142:303-315. [DOI: 10.1248/yakushi.21-00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hiroshi Ohara
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University
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Thomas-Rüddel D, Schlattmann P, Pletz M, Kurzai O, Bloos F. Risk factors for invasive candida infection in critically ill patients - a systematic review and meta-analysis. Chest 2021; 161:345-355. [PMID: 34673022 PMCID: PMC8941622 DOI: 10.1016/j.chest.2021.08.081] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background Current guidelines recommend empirical antifungal therapy in patients with sepsis with high risk of invasive Candida infection. However, many different risk factors have been derived from multiple studies. These risk factors lack specificity, and broad application would render most ICU patients eligible for empirical antifungal therapy. Research Question What risk factors for invasive Candida infection can be identified by a systematic review and meta-analysis? Study Design and Methods We searched PubMed, Web of Science, ScienceDirect, Biomed Central, and Cochrane and extracted the raw and adjusted OR for each risk factor associated with invasive Candida infection. We calculated pooled ORs for risk factors present in more than one study. Results We included 34 studies in our meta-analysis resulting in the assessment of 29 possible risk factors. Risk factors for invasive Candida infection included demographic factors, comorbid conditions, and medical interventions. Although demographic factors do not play a role for the development of invasive Candida infection, comorbid conditions (eg, HIV, Candida colonization) and medical interventions have a significant impact. The risk factors associated with the highest risk for invasive Candida infection were broad-spectrum antibiotics (OR, 5.6; 95% CI, 3.6-8.8), blood transfusion (OR, 4.9; 95% CI, 1.5-16.3), Candida colonization (OR, 4.7; 95% CI, 1.6-14.3), central venous catheter (OR, 4.7; 95% CI, 2.7-8.1), and total parenteral nutrition (OR, 4.6; 95% CI, 3.3-6.3). However, dependence between the various risk factors is probably high. Interpretation Our systematic review and meta-analysis identified patient- and treatment-related factors that were associated with the risk for the development of invasive Candida infection in the ICU. Most of the factors identified were either related to medical interventions during intensive care or to comorbid conditions.
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Affiliation(s)
- Daniel Thomas-Rüddel
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany;.
| | - Peter Schlattmann
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften (IMSID), Jena University Hospital Jena
| | - Mathias Pletz
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Institute for Infectious Diseases and Infection Control, Jena University Hospital Jena
| | - Oliver Kurzai
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knoell-Institute, Jena; University of Wuerzburg, Institute for Hygiene and Microbiology, Germany
| | - Frank Bloos
- Center for Sepsis Control & Care, Jena University Hospital, Jena, Germany;; Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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4
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Ohara H, Watanabe M, Takebayashi M, Abe S, Matsuzaki T, Hayasaka M. Bactericidal and Antiproliferative Effects of Peripheral Parenteral Nutrition Solutions with Sodium Bisulfite on Pathogenic Microorganisms in Catheter Lumens. Int J Med Sci 2020; 17:1833-1839. [PMID: 32714086 PMCID: PMC7378669 DOI: 10.7150/ijms.48829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
Catheter-related bloodstream infections (CRBSIs) due to pathogenic microorganisms pose a major threat to patients requiring parenteral nutrition (PN). Additives contained in medicines and foods have antiproliferative and bacteriostatic effects on pathogenic microorganisms. Therefore, PN solutions containing additives may also have an antibacterial effect. However, so far, there have been no reports on or observations of a PN solution with bactericidal activity. In this study, we assessed several nutrition solutions with antimicrobial activities and investigated their effects on pathogenic microorganisms colonizing catheter lumens. We selected the highly acidic Plas-Amino® (PA), which contains a large amount of sodium bisulfite as a preservative and potentially has an antimicrobial effect. In this study, we used the following pathogenic bacteria as the main causatives of CRBSIs: Staphylococcus aureus, Staphylococcus epidermidis, Bacillus cereus, Serratia marcescens, Pseudomonas aeruginosa, and Candida albicans. We then created a catheter lumen microorganism contamination model and evaluated the antibacterial effect of PA; we found that all bacteria in the control group grew significantly in the catheter lumen in a time-dependent manner at 48 and 72 h. On the other hand, we demonstrated that PA has bactericidal effects on S. aureus, S. epidermidis, B. cereus, S. marcescens, and P. aeruginosa in the catheter lumen and confirmed that it has a remarkable antiproliferative effect on C. albicans. Hence, we concluded that highly acidic PN solutions that contain a preservative like sodium bisulfite have bactericidal and growth inhibition effects on microorganisms in the catheter lumens of patients with CRBSIs and patients with totally implantable central venous access devices, in whom it is difficult to remove the catheter.
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Affiliation(s)
- Hiroshi Ohara
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan.,Department of Pharmacy, Ohu University Hospital, 31-1 Misumido, Tomitamachi-aza, Koriyama, Fukushima 963-8611, Japan
| | - Masanori Watanabe
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan
| | - Masamu Takebayashi
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan
| | - Saori Abe
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan
| | - Tetsuya Matsuzaki
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan
| | - Masataka Hayasaka
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomitamachi-Aza, Koriyama, Fukushima 963-8611, Japan
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5
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Pillonetto M, Arend L, Gomes SMT, Oliveira MAA, Timm LN, Martins AF, Barth AL, Mazzetti A, Hersemann L, Smits THM, Mira MT, Rezzonico F. Molecular investigation of isolates from a multistate polymicrobial outbreak associated with contaminated total parenteral nutrition in Brazil. BMC Infect Dis 2018; 18:397. [PMID: 30103698 PMCID: PMC6090600 DOI: 10.1186/s12879-018-3287-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 07/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background Between November 2013 and June 2014, 56 cases of bacteremia (15 deaths) associated with the use of Total Parenteral Nutrition (TPN) and/or calcium gluconate (CG) were reported in four Brazilian states. Methods We analyzed 73 bacterial isolates from four states: 45 from blood, 25 from TPN and three from CG, originally identified as Acinetobacter baumannii, Rhizobium radiobacter, Pantoea sp. or Enterobacteriaceae using molecular methods. Results The first two bacterial species were confirmed while the third group of species could not be identified using standard identification protocols. These isolates were subsequently identified by Multi-Locus Sequence Analysis as Phytobacter diazotrophicus, a species related to strains from similar outbreaks in the United States in the 1970’s. Within each species, TPN and blood isolates proved to be clonal, whereas the R. radiobacter isolates retrieved from CG were found to be unrelated. Conclusion This is the first report of a three-species outbreak caused by TPN contaminated with A. baumannii, R. radiobacter and P. diazotrophicus. The concomitant presence of clonal A. baumannii and P. diazotrophicus isolates in several TPN and blood samples, as well as the case of one patient, where all three different species were isolated simultaneously, suggest that the outbreak may be ascribed to a discrete contamination of TPN. In addition, this study highlights the clinical relevance of P. diazotrophicus, which has been involved in outbreaks in the past, but was often misidentified as P. agglomerans. Electronic supplementary material The online version of this article (10.1186/s12879-018-3287-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcelo Pillonetto
- Core for Advanced Molecular Investigation, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil. .,Central Public Health Laboratory - State of Paraná - LACEN/PR, Molecular Bacteriology Division, São José dos Pinhais, PR, Brazil.
| | - Lavinia Arend
- Central Public Health Laboratory - State of Paraná - LACEN/PR, Molecular Bacteriology Division, São José dos Pinhais, PR, Brazil
| | - Suzie M T Gomes
- Brazilian Health Surveillance Agency - ANVISA, Brasília, DF, Brazil
| | - Marluce A A Oliveira
- Ezequiel Dias Foundation, Central Public Health Laboratory - State of Minas Gerais, Bacteriology Division, Belo Horizonte, MG, Brazil
| | - Loeci N Timm
- Central Public Health Laboratory - State of Rio Grande do Sul, Bacteriology Division, Porto Alegre, RS, Brazil
| | - Andreza F Martins
- Research Laboratory on Bacterial Resistance (LABRESIS), Federal University of Rio Grande do Sul, Hospital de Clínicas, Porto Alegre, RS, Brazil
| | - Afonso L Barth
- Research Laboratory on Bacterial Resistance (LABRESIS), Federal University of Rio Grande do Sul, Hospital de Clínicas, Porto Alegre, RS, Brazil
| | - Alana Mazzetti
- Core for Advanced Molecular Investigation, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Lena Hersemann
- Environmental Genomics and Systems Biology Research Group, Institute of Natural Resource Sciences (IUNR), Zurich University of Applied Sciences ZHAW, Wädenswil, Switzerland.,Present Address: Scientific Computing Facility, Max Planck Institute of Molecular Cell Biology and Genetics, Pfotenhauerstrasse 108, 01307, Dresden, Germany
| | - Theo H M Smits
- Environmental Genomics and Systems Biology Research Group, Institute of Natural Resource Sciences (IUNR), Zurich University of Applied Sciences ZHAW, Wädenswil, Switzerland
| | - Marcelo T Mira
- Core for Advanced Molecular Investigation, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Fabio Rezzonico
- Environmental Genomics and Systems Biology Research Group, Institute of Natural Resource Sciences (IUNR), Zurich University of Applied Sciences ZHAW, Wädenswil, Switzerland
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Riera P, Garrido-Alejos G, Cardenete J, Moliner E, Zapico-Muñiz E, Cardona D, Garin N. Physicochemical Stability and Sterility of Standard Parenteral Nutrition Solutions and Simulated Y-Site Admixtures for Neonates. Nutr Clin Pract 2018; 33:694-700. [DOI: 10.1002/ncp.10013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/11/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Pau Riera
- Pharmacy Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
- Faculty of Pharmacy and Food Sciences; Universitat de Barcelona; Barcelona Spain
| | - Gemma Garrido-Alejos
- Pharmacy Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Joana Cardenete
- Pharmacy Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Elisenda Moliner
- Neonatal Unit; Department of Paediatrics; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Edgar Zapico-Muñiz
- Clinical Biochemistry Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Daniel Cardona
- Pharmacy Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Noe Garin
- Pharmacy Department; Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona; Barcelona Spain
- Instituto de Salud Carlos III; Centro de Investigación Biomédica en Red de Salud Mental; Madrid Spain
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7
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Kemegne GA, Mkounga P, Essia Ngang JJ, Sado Kamdem SL, Nkengfack AE. Antimicrobial structure activity relationship of five anthraquinones of emodine type isolated from Vismia laurentii. BMC Microbiol 2017; 17:41. [PMID: 28228111 PMCID: PMC5322612 DOI: 10.1186/s12866-017-0954-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 02/11/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Antimicrobial activity of anthraquinone compounds of emodine type has been reported by many authors. These compounds are found in Vismia laurentii (Clusiaceae), a plant used in traditional pharmacopoeia for treatment of microbial infections among others affections. The continuous identification of new compounds has raised the problem of the relation between the structure and antimicrobial properties. RESULTS The yeast growth kinetics parameters were not influenced by the pH variation as it was the case for the other tested bacteria. Fungicidal activities were noted for all molecules while only few of them had bactericidal activities, mostly on Gram positive bacteria. Mathematical model establishing a quantitative relationship between physicochemical properties of molecules and their fungicidal activities were obtained for Candida albicans and showed that physicochemical properties impacting on antifungal activity were polarizability, partition coefficient, molecular weight and hydrogen bond acceptor. CONCLUSIONS This work demonstrated that the presence of a long aliphatic chain methoxy group substituted in position two of the emodine structure increased the antibacterial properties of the studied compounds. Moreover this antimicrobial property depends on the pH of the environment, and specifically on the polarizability and number of hydrogen bond acceptors of the compound.
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Affiliation(s)
- Gislaine Aurelie Kemegne
- Department of Microbiology, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
| | - Pierre Mkounga
- Department of Organic Chemistry, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
| | - Jean Justin Essia Ngang
- Department of Microbiology, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
| | - Sylvain Leroy Sado Kamdem
- Department of Microbiology, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
| | - Augustin Ephrem Nkengfack
- Department of Organic Chemistry, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon
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Omotani S, Tani K, Nagai K, Hatsuda Y, Mukai J, Myotoku M. Water Soluble Vitamins Enhance the Growth of Microorganisms in Peripheral Parenteral Nutrition Solutions. Int J Med Sci 2017; 14:1213-1219. [PMID: 29104477 PMCID: PMC5666554 DOI: 10.7150/ijms.21424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/21/2017] [Indexed: 11/16/2022] Open
Abstract
Peripheral parenteral nutrition (PPN) solutions contain amino acids, glucose, and electrolytes, with or without some water soluble vitamins. Peripheral venous catheters are one of the causes of catheter related blood stream infection (CRBSI), which requires infection control. In Japan, PPN solutions have rarely been prepared under aseptic conditions. However, in recent years, the necessity of adding vitamins to infusions has been reported. Therefore, we investigated the effects of water soluble vitamins on growth of microorganisms in PPN solutions. AMINOFLUID® (AF), BFLUID® (BF), PARESAFE® (PS) and PAREPLUS® (PP) PPN solutions were used. Water soluble vitamins contained in PP were also used. Causative microorganisms of CRBSI were used. Staphylococcus epidermidis decreased after 24 hours or 48 hours in all solutions. On the other hand, Escherichia coli, Serratia marcescens, Pseudomonas aeruginosa, Staphylococcus aureus and Candida albicans increased, especially in PP. When each water soluble vitamin was added to BF and PS, growth of S. aureus was greater in solutions that contained nicotinamide than in solutions that contained other vitamins. As for C. albicans, they grew in all test solutions. C. albicans grew especially well in solutions that contained biotin. When commercial amino acids and glucose solutions with electrolytes are administered, in particular those containing multivitamins or water soluble vitamins, efforts to control infection must be taken to prevent proliferation of microorganisms.
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Affiliation(s)
- Sachiko Omotani
- Laboratory of Practical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Osaka Ohtani University
| | - Katsuji Tani
- Laboratory of Environmental Science and Microbiology, Faculty of Pharmacy, Osaka Ohtani University
| | - Katsuhito Nagai
- Laboratory of Practical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Osaka Ohtani University
| | - Yasutoshi Hatsuda
- Laboratory of Practical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Osaka Ohtani University
| | - Junji Mukai
- Laboratory of Practical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Osaka Ohtani University
| | - Michiaki Myotoku
- Laboratory of Practical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy, Osaka Ohtani University
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9
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Magdesian KG, Bozorgmanesh R. Nutritional considerations for horses with colitis. Part 2: Parenteral nutrition, new nutritional considerations and specific dietary recommendations. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - R. Bozorgmanesh
- Veterinary Medical Teaching Hospital; School of Veterinary Medicine; University of California; Davis USA
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10
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Systematic review and meta-analyses of the effect of lipid emulsion on microbial growth in parenteral nutrition. J Hosp Infect 2016; 94:307-319. [PMID: 27765342 DOI: 10.1016/j.jhin.2016.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/30/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND As lipid in parenteral nutrition (PN) purportedly enhances microbial growth, recommendations limit infusion of lipid PN (or lipid emulsion) from a single container to 24h (48h for lipid-free PN). However, the associated evidence base is ambiguous. AIM To examine factors affecting microbial growth in PN. METHODS A systematic review with meta-analyses examined effects of nutrients on microbial growth in PN infusates over a 48-h period using the growth ratio {GR=log10[colony-forming units (cfu)/mL at 48h/cfu/mL at time zero]}. FINDINGS Factors influencing GR in PN included glucose, microbial species, temperature, osmolarity, presence of vitamins, trace elements and lipid, and amino acid profile. Using unmatched datasets (N=306), a general linear model found that lipid inclusion in PN represented 3.3% of the variability, which was less than that due to glucose concentration (5.8%), microbial species (35.3%) and microbe-infusate interaction (4.4%). Using matched datasets (N=38 pairs), lipid inclusion in PN represented 5.4% of the variability (P=0.076), which was less than that due to glucose concentration (8.5%; P=0.025), microbial species (75.5%; P<0.001) and microbe-infusate interaction (13.3%; P=0.382). Using meta-analyses of matched datasets, the presence of lipid in PN at fixed glucose concentrations did not significantly increase GR of Candida albicans, Escherichia coli or Staphylococcus epidermidis (P=0.352, P=0.025 and P=0.494, respectively; overall P=0.175). CONCLUSION Lipid inclusion in PN is only one of several factors that may influence microbial growth in PN. Any recommendations about the duration of PN infusion from a single container should account for all these factors, and should be weighted according to microbial species likely to contaminate PN.
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11
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Kuwahara T, Kaneda S, Shimono K. Adding Biotin to Parenteral Nutrition Solutions Without Lipid Accelerates the Growth of Candida albicans. Int J Med Sci 2016; 13:724-9. [PMID: 27648003 PMCID: PMC5027192 DOI: 10.7150/ijms.15951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We have previously demonstrated that Candida albicans requires multivitamins (MVs) or lipid to increase rapidly in parenteral nutrition (PN) solutions. In this study, in detail, the effects of vitamins on the growth of C. albicans in PN solutions without lipid were investigated. METHODS In the 1st experiment, a commercial PN solution without lipid was supplemented with water-soluble vitamins (SVs: vitamins B1, B2, B6, B12 and C, folic acid, nicotinamide, biotin and panthenol), water-insoluble vitamins (IVs: vitamins A, D, E and K) or both (MVs). In the 2nd experiment, the test solutions were prepared by supplementing the PN solution with one of each or all of the SVs. In the 3rd experiment, another commercial peripheral PN (PPN) solution without lipid was supplemented with SVs, nicotinic acid, biotin or both nicotinic acid and biotin. In each of the experiments, a specified number of C. albicans organisms was added to each test solution, and all of the test solutions were allowed to stand at room temperature (23-26ºC). The number of C. albicans was counted at 0, 24, 48 and 72 hours after the addition of the organism. RESULTS In the 1st experiment, the C. albicans increased rapidly in the PN solution supplemented with the SVs, but increased slowly without the SVs, regardless of the addition of the IVs. In the 2nd experiment, the C. albicans increased rapidly in the PN solution supplemented with the SVs or biotin, but increased slowly with each of the other water-soluble vitamins. In the 3rd experiment, the C. albicans increased rapidly in the PPN solution supplemented with the SVs or biotin, but increased slowly with the addition of nicotinic acid. CONCLUSIONS These results suggested that adding MVs or SVs to PN solutions without lipid promotes the growth of C. albicans, and that this effect is mostly attributable to biotin.
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Affiliation(s)
- Takashi Kuwahara
- Naruto Research Institute, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 115 Tateiwa, Naruto, Tokushima 772-8601, Japan
| | - Shinya Kaneda
- Naruto Research Institute, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 115 Tateiwa, Naruto, Tokushima 772-8601, Japan
| | - Kazuyuki Shimono
- Naruto Research Institute, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 115 Tateiwa, Naruto, Tokushima 772-8601, Japan
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Moulton-Meissner H, Noble-Wang J, Gupta N, Hocevar S, Kallen A, Arduino M. Laboratory replication of filtration procedures associated with Serratia marcescens bloodstream infections in patients receiving compounded amino acid solutions. Am J Health Syst Pharm 2015. [PMID: 26195654 DOI: 10.2146/ajhp150141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Specific deviations from United States Pharmacopeia standards were analyzed to investigate the factors allowing an outbreak of Serratia marcescens bloodstream infections in patients receiving compounded amino acid solutions. METHODS Filter challenge experiments using the outbreak strain of S. marcescens were compared with those that used the filter challenge organism recommended by ASTM International (Brevundimonas diminuta ATCC 19162) to determine the frequency and degree of organism breakthrough. Disk and capsule filters (0.22- and 0.2-μm nominal pore size, respectively) were challenged with either the outbreak strain of S. marcescens or B. diminuta ATCC 19162. The following variables were compared: culture conditions in which organisms were grown overnight or cultured in sterile water (starved), solution type (15% amino acid solution or sterile water), and filtration with or without a 0.5-μm prefilter. RESULTS Small-scale, syringe-driven, disk-filtration experiments of starved bacterial cultures indicated that approximately 1 in every 1,000 starved S. marcescens cells (0.12%) was able to pass through a 0.22-μm nominal pore-size filter, and about 1 in every 1,000,000 cells was able to pass through a 0.1-μm nominal pore-size filter. No passage of the B. diminuta ATCC 19162 cells was observed with either filter. In full-scale experiments, breakthrough was observed only when 0.2-μm capsule filters were challenged with starved S. marcescens in 15% amino acid solution without a 0.5-μm prefiltration step. CONCLUSION Laboratory simulation testing revealed that under certain conditions, bacteria can pass through 0.22- and 0.2-μm filters intended for sterilization of an amino acid solution. Bacteria did not pass through 0.2-μm filters when a 0.5-μm prefilter was used.
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Affiliation(s)
- Heather Moulton-Meissner
- Heather Moulton-Meissner, Ph.D., is Associate Service Fellow, Division of Healthcare Quality Promotion (DHQP); Judith Noble-Wang, Ph.D., is Supervisory Microbiologist, DHQP; LCDR Neil Gupta, USPHS, M.D., is Medical Officer, DHQP; LCDR Susan Hocevar, USPHS, M.D., is Medical Officer, DHQP; CDR Alex Kallen, USPHS, M.D., is Medical Officer, DHQP; and Matthew Arduino, Dr.P.H., is Branch Chief, Clinical Environmental Microbiology, DHQP, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Judith Noble-Wang
- Heather Moulton-Meissner, Ph.D., is Associate Service Fellow, Division of Healthcare Quality Promotion (DHQP); Judith Noble-Wang, Ph.D., is Supervisory Microbiologist, DHQP; LCDR Neil Gupta, USPHS, M.D., is Medical Officer, DHQP; LCDR Susan Hocevar, USPHS, M.D., is Medical Officer, DHQP; CDR Alex Kallen, USPHS, M.D., is Medical Officer, DHQP; and Matthew Arduino, Dr.P.H., is Branch Chief, Clinical Environmental Microbiology, DHQP, Centers for Disease Control and Prevention, Atlanta, GA
| | - Neil Gupta
- Heather Moulton-Meissner, Ph.D., is Associate Service Fellow, Division of Healthcare Quality Promotion (DHQP); Judith Noble-Wang, Ph.D., is Supervisory Microbiologist, DHQP; LCDR Neil Gupta, USPHS, M.D., is Medical Officer, DHQP; LCDR Susan Hocevar, USPHS, M.D., is Medical Officer, DHQP; CDR Alex Kallen, USPHS, M.D., is Medical Officer, DHQP; and Matthew Arduino, Dr.P.H., is Branch Chief, Clinical Environmental Microbiology, DHQP, Centers for Disease Control and Prevention, Atlanta, GA
| | - Susan Hocevar
- Heather Moulton-Meissner, Ph.D., is Associate Service Fellow, Division of Healthcare Quality Promotion (DHQP); Judith Noble-Wang, Ph.D., is Supervisory Microbiologist, DHQP; LCDR Neil Gupta, USPHS, M.D., is Medical Officer, DHQP; LCDR Susan Hocevar, USPHS, M.D., is Medical Officer, DHQP; CDR Alex Kallen, USPHS, M.D., is Medical Officer, DHQP; and Matthew Arduino, Dr.P.H., is Branch Chief, Clinical Environmental Microbiology, DHQP, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alex Kallen
- Heather Moulton-Meissner, Ph.D., is Associate Service Fellow, Division of Healthcare Quality Promotion (DHQP); Judith Noble-Wang, Ph.D., is Supervisory Microbiologist, DHQP; LCDR Neil Gupta, USPHS, M.D., is Medical Officer, DHQP; LCDR Susan Hocevar, USPHS, M.D., is Medical Officer, DHQP; CDR Alex Kallen, USPHS, M.D., is Medical Officer, DHQP; and Matthew Arduino, Dr.P.H., is Branch Chief, Clinical Environmental Microbiology, DHQP, Centers for Disease Control and Prevention, Atlanta, GA
| | - Matthew Arduino
- Heather Moulton-Meissner, Ph.D., is Associate Service Fellow, Division of Healthcare Quality Promotion (DHQP); Judith Noble-Wang, Ph.D., is Supervisory Microbiologist, DHQP; LCDR Neil Gupta, USPHS, M.D., is Medical Officer, DHQP; LCDR Susan Hocevar, USPHS, M.D., is Medical Officer, DHQP; CDR Alex Kallen, USPHS, M.D., is Medical Officer, DHQP; and Matthew Arduino, Dr.P.H., is Branch Chief, Clinical Environmental Microbiology, DHQP, Centers for Disease Control and Prevention, Atlanta, GA
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Elkhatib WF, Hair PS, Nyalwidhe JO, Cunnion KM. New potential role of serum apolipoprotein E mediated by its binding to clumping factor A during Staphylococcus aureus invasive infections to humans. J Med Microbiol 2015; 64:335-343. [PMID: 25878259 DOI: 10.1099/jmm.0.000010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Staphylococcus aureus is a crucial human pathogen expressing various immune-evasion proteins that interact with the host-cell molecules. Clumping factor A (ClfA) is a microbial surface protein that promotes S. aureus binding to fibrinogen, and is associated with septic arthritis and infective endocarditis. In order to identify the major human serum proteins that bind the ClfA, we utilized recombinant ClfA region A in a plate-based assay. SDS-PAGE analysis of the bound proteins yielded five prominent bands, which were analysed by MS yielding apolipoprotein E (ApoE) as the predominant protein. ClfA-sufficient S. aureus bound purified ApoE by more than one log greater than an isogenic ClfA-deficient mutant. An immunodot-blot assay yielded a linearity model for ClfA binding to human ApoE with a stoichiometric-binding ratio of 1.702 at maximal Pearson's correlation coefficient (0.927). These data suggest that ApoE could be a major and novel binding target for the S. aureus virulence factor ClfA. Thus, ClfA recruitment of serum ApoE to the S. aureus surface may sequester ApoE and blunt its host defence function against S. aureus-invasive infections to humans. In this context, compounds that can block or suppress ClfA binding to ApoE might be utilized as prophylactic or therapeutic agents.
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Affiliation(s)
- Walid F Elkhatib
- Department of Pharmacy Practice, School of Pharmacy, Hampton University, Kittrell Hall, Hampton, VA 23668, USA.,Department of Pediatrics, Eastern Virginia Medical School, E.V. Williams Hall, 855 W. Brambleton Avenue, Norfolk, VA 23510, USA.,Department of Microbiology and Immunology, Faculty of Pharmacy, Ain Shams University, Organization of African Unity St., Abbassia, Cairo 11566, Egypt
| | - Pamela S Hair
- Department of Pediatrics, Eastern Virginia Medical School, E.V. Williams Hall, 855 W. Brambleton Avenue, Norfolk, VA 23510, USA
| | - Julius O Nyalwidhe
- Leroy T. Canoles Jr Cancer Research Center, Eastern Virginia Medical School, 651 Colley Avenue, Norfolk, VA, USA.,Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School 700 West Olney Road, Norfolk, VA, USA
| | - Kenji M Cunnion
- Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA 23507, USA.,Children's Specialty Group, 601 Children's Lane, Norfolk, VA 23507, USA.,Department of Pediatrics, Eastern Virginia Medical School, E.V. Williams Hall, 855 W. Brambleton Avenue, Norfolk, VA 23510, USA
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14
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Austin PD, Hand KS, Elia M. Factors influencing Candida albicans growth in parenteral nutrition with and without lipid emulsion: Using an established framework to inform maximum duration of infusion policy decisions. Clin Nutr 2014; 33:489-94. [DOI: 10.1016/j.clnu.2013.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 06/24/2013] [Accepted: 06/29/2013] [Indexed: 11/16/2022]
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15
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Gupta N, Hocevar SN, Moulton-Meissner HA, Stevens KM, McIntyre MG, Jensen B, Kuhar DT, Noble-Wang JA, Schnatz RG, Becker SC, Kastango ES, Shehab N, Kallen AJ. Outbreak of Serratia marcescens bloodstream infections in patients receiving parenteral nutrition prepared by a compounding pharmacy. Clin Infect Dis 2014; 59:1-8. [PMID: 24729502 DOI: 10.1093/cid/ciu218] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Compounding pharmacies often prepare parenteral nutrition (PN) and must adhere to rigorous standards to avoid contamination of the sterile preparation. In March 2011, Serratia marcescens bloodstream infections (BSIs) were identified in 5 patients receiving PN from a single compounding pharmacy. An investigation was conducted to identify potential sources of contamination and prevent further infections. METHODS Cases were defined as S. marcescens BSIs in patients receiving PN from the pharmacy between January and March 2011. We reviewed case patients' clinical records, evaluated pharmacy compounding practices, and obtained epidemiologically directed environmental cultures. Molecular relatedness of available Serratia isolates was determined by pulsed-field gel electrophoresis (PFGE). RESULTS Nineteen case patients were identified; 9 died. The attack rate for patients receiving PN in March was 35%. No case patients were younger than 18 years. In October 2010, the pharmacy began compounding and filter-sterilizing amino acid solution for adult PN using nonsterile amino acids due to a national manufacturer shortage. Review of this process identified breaches in mixing, filtration, and sterility testing practices. S. marcescens was identified from a pharmacy water faucet, mixing container, and opened amino acid powder. These isolates were indistinguishable from the outbreak strain by PFGE. CONCLUSIONS Compounding of nonsterile amino acid components of PN was initiated due to a manufacturer shortage. Failure to follow recommended compounding standards contributed to an outbreak of S. marcescens BSIs. Improved adherence to sterile compounding standards, critical examination of standards for sterile compounding from nonsterile ingredients, and more rigorous oversight of compounding pharmacies is needed to prevent future outbreaks.
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Affiliation(s)
- Neil Gupta
- Epidemic Intelligence Service Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan N Hocevar
- Epidemic Intelligence Service Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Bette Jensen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David T Kuhar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Judith A Noble-Wang
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rick G Schnatz
- Healthcare Quality Standards, United States Pharmacopeia, Rockville, Maryland
| | - Shawn C Becker
- Healthcare Quality Standards, United States Pharmacopeia, Rockville, Maryland
| | | | - Nadine Shehab
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexander J Kallen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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DeDonato BM, Bickford LI, Gates RJ. Microbial Growth in Neonatal Intravenous Fat Emulsion Administered Over 12 Versus 24 Hours. J Pediatr Pharmacol Ther 2013; 18:298-302. [DOI: 10.5863/1551-6776-18.4.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES
To determine whether an extended infusion time (24 hours) of intravenous fat emulsion is associated with an increase in microbial growth, versus a shorter infusion time (12 hours).
METHODS
Samples were collected from intravenous fat emulsions (n=132), from intravenous fat emulsions prepared in the current 24-hour infusion method (n=55), and from intravenous fat emulsions prepared in the twice-daily (12-hour infusion) method (n=55). In addition, samples were collected from pharmacy (n=22) to test for possible contamination.
RESULTS
No growth was observed in either arm of the study.
CONCLUSIONS
Current Kern Medical Center policy of preparation and administration of neonatal intensive care unit intravenous fat emulsion is safe and effective in regard to microbial growth.
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Affiliation(s)
- Bethany M. DeDonato
- Department of Clinical Pharmacy, Kern Medical Center, Bakersfield, California
| | - Lisa I. Bickford
- Department of Clinical Pharmacy, Kern Medical Center, Bakersfield, California
| | - Ryan J. Gates
- Department of Clinical Pharmacy, Kern Medical Center, Bakersfield, California
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17
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Raheem SA, Deen OJ, Corrigan ML, Parekh N, Quintini C, Steiger E, Kirby DF. Bariatric Surgery Complications Leading to Small Bowel Transplant. JPEN J Parenter Enteral Nutr 2013; 38:513-7. [DOI: 10.1177/0148607113486808] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Omer J. Deen
- Center for Human Nutrition, The Cleveland Clinic, Cleveland, Ohio
| | | | - Neha Parekh
- Intestinal Rehabilitation and Transplant, Cleveland, Ohio
| | | | - Ezra Steiger
- Cleveland Clinic Lerner College of Medicine, Nutrition Support Team, Intestinal Rehab and Transplant Program, Cleveland, Ohio
| | - Donald F. Kirby
- Center for Human Nutrition, The Cleveland Clinic, Cleveland, Ohio
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18
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Gajanayake I, Wylie CE, Chan DL. Clinical experience with a lipid-free, ready-made parenteral nutrition solution in dogs: 70 cases (2006-2012). J Vet Emerg Crit Care (San Antonio) 2013; 23:305-13. [PMID: 23461694 DOI: 10.1111/vec.12029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 01/29/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To review the clinical use of a lipid-free, ready-made amino acid and glucose parenteral nutrition (PN) solution in dogs. DESIGN Retrospective study of dogs from 2006 to 2012 that received this form of PN. SETTING University veterinary teaching hospital. ANIMALS Seventy dogs presented to the hospital for treatment of various diseases in which PN was used as part of patient management. Dogs were administered PN at the discretion of the primary clinician. INTERVENTION A lipid-free, ready-made solution containing amino acid (59 g/L) and dextrose (100 g/L) was administered intravenously as a constant rate infusion to provide nutritional support. MEASUREMENTS AND MAIN RESULTS PN was provided for a median of 2.2 days (range 0.5-9.5 days) in the 70 dogs, totaling 168 days of PN. The PN provided a median of 5.5 g/100 kcal of protein (range 1-9.5 g/100 kcal) and a median of 2.2 mg/kg of bodyweight per minute (range 0.8-5.2 mg/kg/min) of glucose, which reflected a median of 57% of the resting energy requirement (range 9-100%). Metabolic complications developed in 43 of 67 dogs where these data were recorded, but the development of hyperkalemia was the only complication associated with a poor outcome (eg, death or euthanasia). Mechanical complications were seen in 28 dogs, and all but one of these occurred when PN was delivered through peripheral catheters. Septic complications were confirmed in 5 dogs. CONCLUSIONS This form of PN is suitable for clinical use and can provide both protein and calories to ill dogs. It was, however, associated with a high rate of complications and requires careful patient monitoring.
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Affiliation(s)
- Isuru Gajanayake
- Departments of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, United Kingdom
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Kuwahara T, Kaneda S, Shimono K, Inoue Y. Effects of lipid emulsion and multivitamins on the growth of microorganisms in peripheral parenteral nutrition solutions. Int J Med Sci 2013; 10:1079-84. [PMID: 23869182 PMCID: PMC3714382 DOI: 10.7150/ijms.6407] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/14/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Blood stream infections caused by Bacillus cereus or Serratia marcescens in patients receiving peripheral parenteral nutrition (PPN) have occasionally been reported in Japan, but these microorganisms are not major causes of blood stream infections in patients receiving total parenteral nutrition via a central venous catheter. In Japan, commercially available PPN solutions contain amino acids, glucose, and electrolytes, but not contain lipid emulsion (LE) and multivitamins (MV). In this study, the effects of LE and MV on the growth of microorganisms such as Bacillus cereus, Serratia marcescens, Staphylococcus aureus, and Candida albicans in PPN solutions were investigated. METHODS A commercial 3% amino acid and 7.5% glucose solution with electrolytes (AF) was used as the base solution to prepare test solutions (LAF, AFV, and LAFV) containing LE, MV, or both. Specifically, 20% LE was added to AF in a ratio of 1:9 to prepare LAF. MV was added to AF and LAF to prepare AFV and LAFV, respectively. A specified number of each microorganism was added to each 100 mL of AF, LAF, AFV, and LAFV in sterile plastic flasks, and all flasks were allowed to stand at room temperature. The number of colony forming units per mL of each microorganism was counted at 0, 24, and 48 hours after the addition of each microorganism. RESULTS Both Bacillus cereus and Serratia marcescens increased rapidly in AF as well as in LAF, AFV, and LAFV. Staphylococcus aureus did not increased in AF, but increased slightly in LAF and increased rapidly in AFV and LAFV. Candida albicans increased slightly in AF and increased rapidly in LAF, AFV, and LAFV. CONCLUSIONS The results suggest the followings: if microbial contamination occurs, 1) Bacillus cereus and Serratia marcescens can grow rapidly in PPN solutions consisting of amino acids, glucose and electrolytes; 2) Staphylococcus aureus cannot grow without LE and MV, but can grow rapidly with MV; 3) Candida albicans can grow slowly without LE and MV, and the addition of LE or MV accelerates its growth.
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Affiliation(s)
- Takashi Kuwahara
- 1. Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 115 Tateiwa, Naruto, Tokushima 772-8601, Japan.
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Abstract
Healthcare-associated infections (HAI) in preterm infants are a challenge to the care of these fragile patients. HAI-incidence rates range from 6 to 27 infections per 1000 patient-days. Most nosocomial infections are bloodstream infections and of these, the majority is associated with the use of central venous catheters. Many studies identified parenteral nutrition as an independent risk factor for HAI, catheter-associated bloodstream infection, and clinical sepsis. This fact and various published outbreaks due to contaminated parenteral nutrition preparations highlight the importance of appropriate standards in the preparation and handling of intravenous solutions and parenteral nutrition. Ready-to-use parenteral nutrition formulations may provide additional safety in this context. However, there is concern that such formulations may result in overfeeding and necrotizing enterocolitis. Given the risk for catheter-associated infection, handling with parenteral nutrition should be minimized and the duration shortened. Further research is required about this topic.
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Factors that influence Staphylococcus epidermidis growth in parenteral nutrition with and without lipid emulsion: a study framework to inform maximum duration of infusion policy decisions. Clin Nutr 2012; 31:974-80. [PMID: 22677158 DOI: 10.1016/j.clnu.2012.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/01/2012] [Accepted: 05/02/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND & AIMS Recommendations limit infusion of parenteral nutrition (PN) from bags with lipid to 24 h (48 h if lipid free) because lipid putatively encourages contaminant growth. This study aimed to examine these recommendations and identify factors affecting Staphylococcus epidermidis growth in PN. METHODS S. epidermidis growth was assessed in quadruplicate in 12 PN regimens, with and without lipid and varying glucose concentrations. RESULTS Baseline colony forming units (cfu)/mL (32.6) less than doubled at 48 h in all infusates. In PN infusates (pH 6.2 + 0.02 (SEM)) growth was independently increased by the presence of 5% w/v lipid (14.2 cfu/mL; P = 0.028), and glucose concentration (25.6 cfu/mL per 10% increase in w/v glucose; P = 0.003). In a separate analysis growth was stimulated by energy density (27.7 cfu/1000 kcal non-nitrogen energy in 2 L; P = 0.002), without a significant effect of % non-protein energy from lipid (-2.6 cfu/ml per 10%). CONCLUSIONS Using a framework developed to examine growth of potential contaminants in PN, no evidence was found to support the specific recommendation to restrict the maximum infusion duration of lipid containing PN to a greater extent than lipid free PN. S. epidermidis growth was not only affected by the presence of lipid, but also glucose concentration and energy density.
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Turpin RS, Canada T, Rosenthal VD, Nitzki-George D, Liu FX, Mercaldi CJ, Pontes-Arruda A. Bloodstream Infections Associated With Parenteral Nutrition Preparation Methods in the United States. JPEN J Parenter Enteral Nutr 2011; 36:169-76. [DOI: 10.1177/0148607111414714] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robin S. Turpin
- Global Health Economics, Baxter Healthcare, Deerfield, Illinois
- Public Policy Department, Thomas Jefferson Hospital, Philadelphia, Pennsylvania
| | - Todd Canada
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victor D. Rosenthal
- International Nosocomial Infection Control Consortium, Buenos Aires, Argentina
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Kuwahara T, Shimono K, Kaneda S, Tamura T, Ichihara M, Nakashima Y. Growth of microorganisms in total parenteral nutrition solutions containing lipid. Int J Med Sci 2010; 7:101-9. [PMID: 20567610 PMCID: PMC2880838 DOI: 10.7150/ijms.7.101] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 05/17/2010] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To identify the microorganisms that can grow rapidly in total parenteral nutrition (TPN) solutions, we investigated the growth of the major causes of catheter-related blood stream infection (Staphylococcus aureus, Serratia marcescens, Bacillus cereus, and Candida albicans) in TPN solutions containing lipid. METHODS The pH value of a TPN solution containing lipid (pH 6.0, containing 20 ppm of NaHSO(3)) was adjusted by the addition of HCl to 5.7, 5.4, or 4.9. The pH value of another TPN solution (pH5.5, containing 400 ppm of NaHSO(3)) was adjusted by the addition of NaOH to 5.9, 6.3, or 6.8. A specific number of each microorganism was added to 10 mL of each test solution and incubated at room temperature. The number of microorganisms was counted as colony forming units at 0, 24, and 48 hrs later. RESULTS C albicans increased similarly at any pH values in the TPN solution. The bacterial species also increased rapidly at pH6.0 in the solution containing 20 ppm of NaHSO(3), but growth was suppressed as the pH value was reduced, with growth halted at pH4.9. However, these bacterial species did not increase, even at pH5.9, in the other solution containing 400 ppm of NaHSO(3). CONCLUSIONS These results suggest that Candida species can grow rapidly in almost all TPN solutions regardless of the acidity, lipid, and NaHSO(3); also, some bacterial species may grow in TPN solutions containing lipid unless the pH value is 5.0 or less. Therefore, each TPN solution should be examined whether or not the bacterial species can proliferate.
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Affiliation(s)
- Takashi Kuwahara
- Preclinical Assessment Department, Otsuka Pharmaceutical Factory, Inc., Tokushima, Japan.
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