Can Glutamine Enable the Critically Ill to Cope Better With Infection?

Abstract

8% in patients receiving IV therapy, and one-third of BSIs are related to central venous lines used for parenteral nutrition (PN) or other intensive care therapies. Hospitalacquired infections (HAIs) affect 10% of patients admitted to acute hospitals in the United Kingdom, with an estimated annual cost of $2 billion. Between 10% and 35% of intensive care unit (ICU) patients in the United States develop nosocomial infections, of which 10% are BSIs. 2 With an attributable hospital mortality of 15%, which is rising annually, 3 this represents the eighth leading cause of death. 4 Extremely sick patients represent only about 10% of the ICU population but in surgical ICUs (SICUs), they exhibit the highest risk of HAI. 5 BSIs worsen the severity of the patient’s underlying disease, prolong hospitalization by at least 4 days, 6 and are expensive to treat. Nosocomial infections are more likely in long-stay patients who are taking longer to recover before leaving the SICU. Staphylococcus epidermidis, Staphylococcus aureus, and Staphylococcus enterococci are the bacteria most frequently implicated, 1 while Candida albicans is the most common fungal organism, found among normal flora of the GI tract and vagina. 7 Candida infection is generally nosocomial and accounts for many infections. Almost half the patients in the ICU stay longer than 5 days and suffer from 1 or more infections, of which 17% are fungal. Infection is thus closely related to the duration of ICU stay and has long been associated with increased morbidity and mortality. 8