Systematic review and meta-analyses of the effect of lipid emulsion on microbial growth in parenteral nutrition.

Autor: Austin PD; Faculty of Medicine, University of Southampton, Southampton, UK; Southampton Pharmacy Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Electronic address: Peter.Austin@ouh.nhs.uk., Hand KS; Southampton Pharmacy Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Health Sciences, University of Southampton, Southampton, UK., Elia M; Faculty of Medicine, University of Southampton, Southampton, UK; Institute of Human Nutrition, University of Southampton, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2016 Dec; Vol. 94 (4), pp. 307-319. Date of Electronic Publication: 2016 Sep 07.
DOI: 10.1016/j.jhin.2016.08.026
Abstrakt: Background: As lipid in parenteral nutrition (PN) purportedly enhances microbial growth, recommendations limit infusion of lipid PN (or lipid emulsion) from a single container to 24h (48h for lipid-free PN). However, the associated evidence base is ambiguous.
Aim: To examine factors affecting microbial growth in PN.
Methods: A systematic review with meta-analyses examined effects of nutrients on microbial growth in PN infusates over a 48-h period using the growth ratio {GR=log 10 [colony-forming units (cfu)/mL at 48h/cfu/mL at time zero]}.
Findings: Factors influencing GR in PN included glucose, microbial species, temperature, osmolarity, presence of vitamins, trace elements and lipid, and amino acid profile. Using unmatched datasets (N=306), a general linear model found that lipid inclusion in PN represented 3.3% of the variability, which was less than that due to glucose concentration (5.8%), microbial species (35.3%) and microbe-infusate interaction (4.4%). Using matched datasets (N=38 pairs), lipid inclusion in PN represented 5.4% of the variability (P=0.076), which was less than that due to glucose concentration (8.5%; P=0.025), microbial species (75.5%; P<0.001) and microbe-infusate interaction (13.3%; P=0.382). Using meta-analyses of matched datasets, the presence of lipid in PN at fixed glucose concentrations did not significantly increase GR of Candida albicans, Escherichia coli or Staphylococcus epidermidis (P=0.352, P=0.025 and P=0.494, respectively; overall P=0.175).
Conclusion: Lipid inclusion in PN is only one of several factors that may influence microbial growth in PN. Any recommendations about the duration of PN infusion from a single container should account for all these factors, and should be weighted according to microbial species likely to contaminate PN.
(Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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