Bactericidal and Antiproliferative Effects of Peripheral Parenteral Nutrition Solutions with Sodium Bisulfite on Pathogenic Microorganisms in Catheter Lumens

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.

The application of non-oxidizing biocides to prevent biofouling in reverse osmosis polyamide membrane systems: a review

“…A study by Murano et al (2005), on the bactericidal effects of SBS at varying acidic conditions, reported that SBS did not affect the viability of the target organism (H. pylori) at neutral pH (7.0) and was more effective at a lower pH. While studying the effects of SBS on pathogenic microorganisms in catheter lumens, Ohara et al (2020) confirmed that, at a low pH, SBS has an evident bactericidal effect against both P. aeruginosa and S. aureus. For SBS in particular, the type of microorganism present in the feed water will have a significant effect on its relative efficacy.…”

“…Sodium bisulfite is an inorganic salt, commercially used as a reducing agent in cosmetics, and as a preservative in a variety of food products and pharmaceuticals (Nair et al 2003;Macedo et al 2019;Ohara et al 2020). In industrial water treatment applications, SBS is regularly dosed as the reducing agent after chlorine disinfection to remove free chlorine from the system and is widely used as a preservative during long-term membrane storage (Penna et al 2002;Kucera 2019).…”

“…SBS scavenges oxygen, effectively removing it from the surrounding environment and killing aerobic bacteria (Feiner 2006;HNGC 2015). SBS is a cell membrane-active biocide; its strong bactericidal effect comes from inhibiting key enzymes in microorganisms, such as those involved in energy production (ATP synthesis) and bacterial metabolism (Irwin et al 2017;Ohara et al 2020). Due to its oxygen scavenging potential, the addition of SBS effectively controls aerobic bacterial growth but simultaneously creates an environment where anaerobic bacteria can proliferate (Kucera 2019).…”

“…As a result, SBS will not be effective on mature biofilms or EPS and is only effective in feed water that has a low potential for fouling. Ohara et al (2020) reported that SBS had a strong bactericidal effect at pH 4.6. This is supported by other studies which concluded the efficacy of SBS increased in acidic conditions (Penna et al 2002;Ryon et al 2002;Murano et al 2005).…”

Risk Factors for Bloodstream Infection in Patients Receiving Peripheral Parenteral Nutrition

“…Notably, 22% (range, 7-60%) of nosocomial catheter-related BSIs are attributed to PVCs (9). In particular, PPN may be a risk factor for PVCrelated BSI (PVC-BSI) (10)(11)(12). However, the incidence and risk factors for PVC-BSIs during PPN therapy have not been previously reported, and the evidence remains uncertain.…”