Microbial Growth Patterns in a Total Parenteral Nutrition Formulation Containing Lipid Emulsion

Gilbert, Michael L.; Gallagher, Susan C.; Eads, Michael; Elmore, Michael F.

doi:10.1177/0148607186010005494

Cited by 69 publications

(31 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous in vitro studies with LCT showed that Candida grows better in a lipid-rich environment (5,11,24,36). We did not find a growth-enhancing effect on Candida for parenteral LCT, suggesting that with its metabolic breakdown, the effects of LCT on candidal growth disappear, in contrast with what occurs with MCT.…”

contrasting

confidence: 79%

Parenteral Administration of Medium- but Not Long-Chain Lipid Emulsions May Increase the Risk for Infections byCandida albicans

Wanten¹,

Netea²,

Naber³

et al. 2002

Infect Immun

View full text Add to dashboard Cite

Intravenous administration to volunteers of an emulsion of medium-chain lipids, but not of an emulsion of pure long-chain lipids or a placebo, increased the growth of Candida albicans in serum and modulated Candida-induced cytokine production by mononuclear cells in a way suggesting that medium-chain, but not long-chain, triglycerides increase the risk for infections by Candida.The provision of total parenteral nutrition (TPN) is an indispensable strategy to improve the nutritional status of critically ill patients. However, altered immune responses by the TPN lipid component may contribute to the increased rate of infectious complications for these patients (43). It remains unclear whether structurally different lipid emulsions containing either pure long-chain triglycerides (LCT) or mixed longand medium-chain triglycerides (LCT-MCT) exert distinct immune-modulating effects (1, 3, 4, 7, 8, 10, 12-15, 18, 25, 27, 28, 32, 33, 35-37, 40, 42, 43, 44). Recently, we found that LCT-MCT, unlike LCT, increase in vitro oxygen radical production and adhesion of neutrophils but decrease cellular motility and killing of Candida albicans (20,(45)(46)(47)(48). This observation is important because clinical studies indicate that 5% of all patients receiving TPN develop candidemia, with significant mortality and morbidity (38).In the present study, we exposed LCT and LCT-MCT to the metabolisms and immune systems of healthy volunteers. We investigated the effects of lipids on two pathogenetic aspects of Candida infections: yeast growth and the balance of proinflammatory (gamma interferon [␥-IFN], tumor necrosis factor alpha [TNF-␣], interleukin-1␤ , and IL-6) and anti-inflammatory (IL-10) cytokines (2,19,29,30,34,41).Emulsions containing LCT, LCT-MCT, or saline were administered during 4 h to eight volunteers in a study with a crossover design and a 1-week washout period. Blood samples were taken before and after 4 h of lipid or placebo administration and analyzed as described below. In order to stabilize plasma triglyceride concentrations at a clinically relevant concentration of 3 to 5 mmol/liter, emulsions (overall, ca. 220 ml) were infused according to a triglyceride-clamp schedule (16,17). For emulsion characteristics, see Table 1.Leukocytes were isolated from 20 ml of blood anticoagulated with lithium-heparin (6,21,45). Peripheral blood mononuclear cells (PBMC) were removed and suspended in medium (RPMI 1640 DM; Flow Laboratories, Irvine, United Kingdom). Heat-killed C. albicans (strain UC820; final concentration, 10 7 CFU/ml) was used for ex vivo PBMC stimulation in the cytokine assays. After PBMC isolation, cell numbers were adjusted (5 ϫ 10 6 /ml) and cell suspension samples were incubated with Candida (24 h, 37°C). After incubation, the supernatants were frozen (Ϫ20°C) until assayed. IL-1␤ and TNF-␣ (both in nanograms per milliliter) in supernatants were measured by radioimmunoassays as described previously (23). Detection limits of the assay were 20 pg/ml for TNF-␣ and 40 pg/ml for IL-1␤. Interassay variation was les...

show abstract

contrasting

confidence: 79%

Parenteral Administration of Medium- but Not Long-Chain Lipid Emulsions May Increase the Risk for Infections byCandida albicans

Wanten¹,

Netea²,

Naber³

et al. 2002

Infect Immun

View full text Add to dashboard Cite

show abstract

“…Category IA 2. Replace tubing used to administer blood, blood products, or lipid emulsions (those combined with amino acids and glucose in a 3-in-1 admixture or infused separately) within 24 hours of initiating the infusion [158,[226][227][228][229]. Category IB.…”

Section: Category Ib II Surveillancementioning

confidence: 99%

Guidelines for the prevention of intravascular catheter-related infections

O’Grady¹,

Alexander²,

Dellinger³

et al. 2002

American Journal of Infection Control

636

843

View full text Add to dashboard Cite

These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The These guidelines are intended to provide evidencebased recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

show abstract

“…grow well in protein hydrolysate solutions but much less vigorously in the synthetic amino acid mixtures used for hyperalimentation today (61); bacterial growth generally is suppressed in synthetic amino acid solutions. Lipid emulsion supports the rapid growth of a wide variety of bacterial and fungal pathogens, including Candida (35, 55,126) and Malassezia spp., especially Malassezia furfur (6,100,155).…”

Section: Sources Of Microorganisms Causing Infusion-related Infectionsmentioning

confidence: 99%

Pathogenesis of infections related to intravascular catheterization

1993

View full text Add to dashboard Cite

Over the past few decades, there have been major technological improvements in the manufacture of intravenous solutions and the manufacture and design of catheter materials. However, the risk of infection in patients receiving infusion therapy remains substantial, in part because of host factors (for example, increased use of immunosuppressive therapy, more aggressive surgery and life support, and improved survival at the extremes of life) and in part because of the availability of catheters that can be left in place for very long periods. Microbial components of normal skin flora, particularly coagulase-negative staphylococci, have emerged as the predominant pathogens in catheter-associated infections. Therefore, efforts to prevent skin microorganisms from entering the catheter wound (such as tunnelling of catheters and use of catheter cuffs and local antimicrobial agents) are logical and relatively effective. The specific properties of microorganisms that transform normally harmless commensals such as coagulase-negative staphylococci into formidable pathogens in the presence of a plastic foreign body are being explored. For example, Staphylococcus epidermidis elaborates a polysaccharide adhesin that also functions as a capsule and is a target for opsonic killing. However, the interactions between microorganism and catheter that lead to adherence, persistence, infection, and dissemination appear to be multifactorial.

show abstract

Microbial Growth Patterns in a Total Parenteral Nutrition Formulation Containing Lipid Emulsion

Cited by 69 publications

References 17 publications

Parenteral Administration of Medium- but Not Long-Chain Lipid Emulsions May Increase the Risk for Infections byCandida albicans

Parenteral Administration of Medium- but Not Long-Chain Lipid Emulsions May Increase the Risk for Infections byCandida albicans

Guidelines for the prevention of intravascular catheter-related infections

Pathogenesis of infections related to intravascular catheterization

Contact Info

Product

Resources

About