title: Parenteral nutrition: a clear and present danger unabated by tight glucose control.
abstract: BACKGROUND
  The infectious risks of parenteral nutrition (PN) in critical illness are well described, although most literature predates tight glucose control (TGC) practice. The authors hypothesized that PN-related complications are ameliorated by TGC and are equivalent to those in enteral nutrition (EN) patients.
  
  
  METHODS
  A prospective cohort study of patients admitted to the surgical intensive care unit was conducted, comparing PN and EN patients. TGC target was 80 to 110 mg/dL. Univariate and multivariate logistic regression was used to explore the association between infectious outcomes and PN use.
  
  
  RESULTS
  One hundred fifty-five patients were studied. Mean daily glucose values were lower for the PN group than for the EN patients (118.2 vs 125.6 mg/dL, P = .002). Nonetheless, the incidence of bloodstream infection and catheter-related bloodstream infection was significantly associated with the administration of PN. In a multivariate logistic regression model, PN was associated with a >4-fold increase in the odds of having a catheter-related bloodstream infection (odds ratio, 4.48; 95% confidence interval, 1.14-17.49; P = .03).
  
  
  CONCLUSIONS
  Despite the successful implementation of TGC, PN is still a significant risk factor for infectious complications among surgical intensive care unit patients.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA. kmatsushima@hmc.psu.edu
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.forename: Alan
authors.initials: A
authors.lastname: Cook
authors.forename: Tracy
authors.initials: T
authors.lastname: Tyner
authors.forename: Lauren
authors.initials: L
authors.lastname: Tollack
authors.forename: Richard
authors.initials: R
authors.lastname: Williams
authors.forename: Susan
authors.initials: S
authors.lastname: Lemaire
authors.forename: Randall
authors.initials: R
authors.lastname: Friese
authors.forename: Heidi
authors.initials: H
authors.lastname: Frankel
mesh_terms: D016470:Bacteremia / Q000209:etiology*; D001786:Blood Glucose / Q000378:metabolism*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose