Parenteral nutrition infectious

Parenteral nutrition can be a lifesaving therapy in patients with intestinal failure, but the oral or enteral route is preferred when providing nutrition support ( when the gut works, use it ). Compared with PN, enteral nutrition generally is associated with fewer infectious complications (e.g., pneumonia, intraabdominal abscess, and catheter-related infections) and potentially improved outcomes.1-3 However, if used in appropriate patients (i.e., patients with questionable intestinal function or when the intestine cannot be used), PN can be used safely and effectively and may improve nutrient delivery.4 Indications for PN are listed in Table 97-1.1... 

Enteral nutrition (EN) is associated with fewer infectious complications than parenteral nutrition (PN). 

EN has replaced parenteral nutrition (PN) (see Chap. 60) as the preferred method for the feeding of critically ill patients requiring specialized nutrition support. Advantages of EN over PN include maintaining GI tract structure and function fewer metabolic, infectious, and technical complications and lower costs. 

McCowen KC, Friel C, Sternberg J, Chan S, Forse RA, Burke PA, Bistrian BR. Hypocaloric total parenteral nutrition effectiveness in prevention of hyperglycemia and infectious complications—a randomized clinical trial. Crit Care Med 2000 28(11) 3606-11. 

Since the introduction of parenteral nutrition in hospital care the potential microbiological risks associated with the manufacture, preparation, and administration of these products have abated but not disappeared (133,152). Fatal infectious complications still occur. The parenteral nutrition mixture is a good growth medium for microorganisms, more conducive to microbial growth than glucose or amino acid solutions. Storage of mixtures... 

Journal of Emergency Medicine 10 735-745 van den Berghe G, Wouters P, Wbekers F et al 2001 Intensive insulin therapy in critically ill patients. New England Journal of M icine 345 1359-1367 van der Poll T, Levi M, Braxton C C 1998 Parenteral nutrition facilitates activation of coagulation but not of fibrinolysis during humein endotoxemia. Journal of Infectious Diseases 177 793-795... 

The gastrointestinal (Gl) tract defends the host from toxins and antigens by both immunologic and nonimmunologic mechanisms, collectively referred to as the gut barrier function. Whenever possible, enteral nutrition (EN) is preferred over parenteral nutrition (PN) because it is as effective, may reduce metabolic and infectious complications, and is less expensive. 

Sena MJ, Utter GH, Cuschieri J, Maier RV, Tompkins RG, Harbrecht BG, Moore EE, O Keefe GE. Early supplemental parenteral nutrition is associated with increased infectious complications in critically ill trauma patients. J Am Coll Surg 2008 207 (4) 459-67. 

BPS certification has been formally recognized by the American Association of Colleges of Pharmacy, the American College of Clinical Pharmacy, the American Pharmaceutical Association, the American Society for Parenteral and Enteral Nutrition, the American Society of Health-System Pharmacists, the Ordre des Pharmaciens du Quebec, the Society of Infectious Disca.ses Pharmacists, and the Society of Hospital Pharmacists of Australia. 

---