title: Growth of Staphylococcus aureus in Diprivan and Intralipid: implications on the pathogenesis of infections.
abstract: BACKGROUND
  The incidence and severity of infections are increased when Intralipid or Diprivan are administered to patients. Intralipid promotes infection, presumably by inhibiting the reticuloendothelial system, thereby suppressing the host's constitutive immunity, whereas Diprivan supposedly promotes infection by supporting bacterial growth and increasing the inoculating dose. This study considers whether bacterial replication alone in Intralipid and Diprivan adequately explains the increased risk of infection associated with these agents or whether other factors might also be involved.
  
  
  METHODS
  Staphylococcus aureus was cultured in 10% Intralipid or Diprivan at clinically relevant conditions or in Intralipid containing 0.005% (w/v) sodium EDTA, a current additive, to measure growth. To determine whether Intralipid affected infection, New Zealand white rabbits were injected intravenously with S. aureus with or without Intralipid. Twenty-four hours later, bacteria in lung, liver, spleen, and kidney tissues were enumerated.
  
  
  RESULTS
  S. aureus failed to grow in Diprivan or Intralipid containing 0.005% EDTA. Whereas S. aureus did replicate in plain Intralipid, growth was delayed until the bacteria conditioned the media. Once initiated, growth was slow at clinically relevant temperatures. The administration of Intralipid to rabbits significantly increased the recovery of staphylococci from the kidneys, P < 0.001, relative to the other tissues 24 h after an intravenous inoculation with S. aureus, compared with rabbits receiving S. aureus with no Intralipid.
  
  
  CONCLUSIONS
  These results suggest that Diprivan, and possibly Intralipid, represent poor media for the growth of S. aureus and may promote infection through mechanisms other than increased inoculum size.
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA. anita@anest2.anest.ufl.edu
authors.forename: P B
authors.initials: PB
authors.lastname: Langevin
authors.forename: N
authors.initials: N
authors.lastname: Gravenstein
authors.forename: T J
authors.initials: TJ
authors.lastname: Doyle
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
authors.forename: S
authors.initials: S
authors.lastname: Skinner
authors.forename: S O
authors.initials: SO
authors.lastname: Langevin
authors.forename: P A
authors.initials: PA
authors.lastname: Gulig
mesh_terms: D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D000818:Animals; D004492:Edetic Acid; D005217:Fat Emulsions, Intravenous / Q000494:pharmacology*; D007700:Kinetics; D015742:Propofol / Q000494:pharmacology*; D011817:Rabbits; D013203:Staphylococcal Infections / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development / Q000302:isolation & purification; D013696:Temperature
chemical_list: D018686:Anesthetics, Intravenous; D005217:Fat Emulsions, Intravenous; D004492:Edetic Acid; D015742:Propofol