Effects of Lipid Emulsion and Multivitamins on the Growth of Microorganisms in Peripheral Parenteral Nutrition Solutions

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.

Enteral Nutrition versus Parenteral Nutrition after Major Abdominal Surgery in Patients with Gastrointestinal Cancer: A Systematic Review and Meta-Analysis

“…They perceived that postoperative patients who were fasted for extended periods of time had increased morbidity and mortality due to undernutrition 2. Total intravenous nutrition, also known as total parenteral nutrition (TPN), is a liquid mixture containing amino acids, glucose, electrolytes, lipid emulsion, and multivitamins (MV) that is delivered intravenously via a central line 3. In contrast, peripheral parenteral nutrition is delivered via a peripheral line and usually does not contain MV or LE 3.…”

“…Total intravenous nutrition, also known as total parenteral nutrition (TPN), is a liquid mixture containing amino acids, glucose, electrolytes, lipid emulsion, and multivitamins (MV) that is delivered intravenously via a central line 3. In contrast, peripheral parenteral nutrition is delivered via a peripheral line and usually does not contain MV or LE 3. Enteral nutrition (EN) is an oral nutritional supplement which can also be administered via a gastrostomy tube (G-tube) or other type of feeding tube.…”

Impact of Drug Shortages on Health System Pharmacies in the Southeastern United States

“…17,18 Nine deaths occurred due to a break in the sterile process when alternative products were being compounded during an amino-acid shortage. 19,20 Another high-risk method for obtaining limited medications is through the "grey market" in which middlemen obtain and sell scarce medications at highly inflated prices. The integrity of these drugs is unknown; some of them have been stolen or are counterfeit.…”

Use of Peripheral Parenteral Nutrition Solutions as a Risk Factor for <i>Bacillus cereus</i> Peripheral Venous Catheter-Associated Bloodstream Infection at a Japanese Tertiary Care Hospital: a Case-Control Study

“…A previous in vitro study proved B. cereus grows rapidly in PPN solutions with 3z amino acids, 7.5z glucose, and electrolytes (Aminofluid; Otsuka Pharmaceutical Factory, Tokyo, Japan) (20,21). Another possible mechanism accounting for the association of the use of PPN solutions with a higher risk for peripheral thrombophlebitis is greater vessel damage resulting from the chemical characteristics of the solutions (e.g., a low pH [6.4] and a high solution-to-serum osmolality ratio of approximately 3) (18,22,23).…”