title: Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients.
abstract: BACKGROUND
  Nosocomial infections are an important cause of morbidity and mortality in the surgical intensive care unit (SICU). Clinical benefits of glutamine-supplemented parenteral nutrition may occur in hospitalized surgical patients, but efficacy data in different surgical subgroups are lacking. The objective was to determine whether glutamine-supplemented parenteral nutrition differentially affects nosocomial infection rates in selected subgroups of SICU patients.
  
  
  METHODS
  This was a double-blind, randomized, controlled study of alanyl-glutamine dipeptide-supplemented parenteral nutrition in SICU patients requiring parenteral nutrition and SICU care after surgery for pancreatic necrosis, cardiac, vascular, or colonic surgery. Subjects (n = 59) received isocaloric/isonitrogenous parenteral nutrition, providing 1.5 g/kg/d standard glutamine-free amino acids (STD-PN) or 1.0 g/kg/d standard amino acids + 0.5 g/kg/d glutamine dipeptide (GLN-PN). Enteral feedings were advanced as tolerated. Nosocomial infections were determined until hospital discharge.
  
  
  RESULTS
  Baseline clinical/metabolic data were similar between groups. Plasma glutamine concentrations were low in all groups and were increased by GLN-PN. GLN-PN did not alter infection rates after pancreatic necrosis surgery (17 STD-PN and 15 GLN-PN patients). In nonpancreatic surgery patients (12 STD-PN and 15 GLN-PN), GLN-PN was associated with significantly decreased total nosocomial infections (STD-PN 36 vs GLN-PN 13, P < .030), bloodstream infections (7 vs 0, P < .01), pneumonias (16 vs 6, P < .05), and infections attributed to Staphylococcus aureus (P < .01), fungi, and enteric Gram-negative bacteria (each P < .05).
  
  
  CONCLUSIONS
  Glutamine dipeptide-supplemented parenteral nutrition did not alter infection rates following pancreatic necrosis surgery but significantly decreased infections in SICU patients after cardiac, vascular, and colonic surgery.
authors.affiliation: Emory University Hospital Nutrition and Metabolic Support Service, Department of Medicine, Atlanta, GA 30322, USA.
authors.forename: Concepción F
authors.initials: CF
authors.lastname: Estívariz
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Griffith
authors.forename: Menghua
authors.initials: M
authors.lastname: Luo
authors.forename: Elaina E
authors.initials: EE
authors.lastname: Szeszycki
authors.forename: Niloofar
authors.initials: N
authors.lastname: Bazargan
authors.forename: Nisha
authors.initials: N
authors.lastname: Dave
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Daignault
authors.forename: Glen F
authors.initials: GF
authors.lastname: Bergman
authors.forename: Therese
authors.initials: T
authors.lastname: McNally
authors.forename: Cindy H
authors.initials: CH
authors.lastname: Battey
authors.forename: Celeste E
authors.initials: CE
authors.lastname: Furr
authors.forename: Li
authors.initials: L
authors.lastname: Hao
authors.forename: James G
authors.initials: JG
authors.lastname: Ramsay
authors.forename: Carolyn R
authors.initials: CR
authors.lastname: Accardi
authors.forename: George A
authors.initials: GA
authors.lastname: Cotsonis
authors.forename: Dean P
authors.initials: DP
authors.lastname: Jones
authors.forename: John R
authors.initials: JR
authors.lastname: Galloway
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Ziegler
mesh_terms: D018806:APACHE; D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection / Q000517:prevention & control*; D019587:Dietary Supplements; D004151:Dipeptides / Q000008:administration & dosage / Q000494:pharmacology; D004311:Double-Blind Method; D005260:Female; D005973:Glutamine / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D010288:Parenteral Nutrition / Q000379:methods*; D011184:Postoperative Period; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D004151:Dipeptides; D005973:Glutamine; C054122:alanylglutamine