Glutamine administration reduces Gram-negative bacteremia in severely burned patients

A prospective, randomized, double-blind trial versus isonitrogenous control

Paul E. Wischmeyer, James Lynch, Jennifer L. Liedel, Rachel Wolfson, Jacob Riehm, Lawrence Gottlieb, Madelyn Kahana

Research output: Contribution to journalArticle

267 Citations (Scopus)

Abstract

Objective: To determine the effect of intravenous glutamine supplementation vs. an isonitrogenous control on infectious morbidity in severely burned patients. Previous clinical studies in seriously ill patients suggest a beneficial effect of glutamine on infectious morbidity, but no trials have examined possible clinical benefits in severely burned patients. Design: Prospective, double-blind, randomized trial. Setting: Burn intensive care unit of a university hospital. Patients: Twenty-six severe burn patients with total burn surface area of 25% to 90% and presence of full-thickness burns. Patients were evaluated for occurrence of bacteremia and antibiotic use during the first 30 days of their burn unit admission. Nutritional status and overall inflammation were also measured. Intervention: Either intravenous glutamine or an isonitrogenous control amino acid solution was administered as a continuous infusion during burn intensive care unit stay. Measurements and Main Results: The incidence of Gram-negative bacteremia was significantly reduced in the glutamine-supplemented group (8%) vs. control (43%; p < .04). No difference was seen in the incidence of Gram-positive bacteremia or fungemia. Average number of positive blood cultures, antibiotic usage, and mortality rates also were reduced but did not reach statistical significance. Significant improvements in serum transferrin and prealbumin were observed in glutamine-supplemented patients at 14 days after burn injury (p < .01 and .04, respectively). C-reactive protein was also significantly reduced at 14 days after burn injury in the glutamine group (p < .01). Conclusions: Significantly fewer bacteremic episodes with Gram-negative organisms occurred in the glutamine-supplemented patients. Glutamine supplementation improved measures of nutrition and decreased measures of overall inflammation. In addition, a trend toward lower mortality rate, decreased overall bacteremia incidence, and antibiotic usage in the glutamine group was observed. Glutamine's beneficial effects may be a result of improved gut integrity or immune function, but the precise mechanism of glutamine's protection is unknown.

Original languageEnglish (US)
Pages (from-to)2075-2080
Number of pages6
JournalCritical Care Medicine
Volume29
Issue number11
StatePublished - 2001
Externally publishedYes

Fingerprint

Bacteremia
Glutamine
Anti-Bacterial Agents
Intensive Care Units
Incidence
Fungemia
Inflammation
Morbidity
Burn Units
Prealbumin
Mortality
Wounds and Injuries
Transferrin
Nutritional Status
Burns
C-Reactive Protein
Amino Acids

Keywords

  • Amino acid
  • Burn injury
  • Gram-negative bacteremia
  • Intensive care unit
  • Nutrition
  • Outcome study

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Glutamine administration reduces Gram-negative bacteremia in severely burned patients : A prospective, randomized, double-blind trial versus isonitrogenous control. / Wischmeyer, Paul E.; Lynch, James; Liedel, Jennifer L.; Wolfson, Rachel; Riehm, Jacob; Gottlieb, Lawrence; Kahana, Madelyn.

In: Critical Care Medicine, Vol. 29, No. 11, 2001, p. 2075-2080.

Research output: Contribution to journalArticle

Wischmeyer, Paul E. ; Lynch, James ; Liedel, Jennifer L. ; Wolfson, Rachel ; Riehm, Jacob ; Gottlieb, Lawrence ; Kahana, Madelyn. / Glutamine administration reduces Gram-negative bacteremia in severely burned patients : A prospective, randomized, double-blind trial versus isonitrogenous control. In: Critical Care Medicine. 2001 ; Vol. 29, No. 11. pp. 2075-2080.
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abstract = "Objective: To determine the effect of intravenous glutamine supplementation vs. an isonitrogenous control on infectious morbidity in severely burned patients. Previous clinical studies in seriously ill patients suggest a beneficial effect of glutamine on infectious morbidity, but no trials have examined possible clinical benefits in severely burned patients. Design: Prospective, double-blind, randomized trial. Setting: Burn intensive care unit of a university hospital. Patients: Twenty-six severe burn patients with total burn surface area of 25{\%} to 90{\%} and presence of full-thickness burns. Patients were evaluated for occurrence of bacteremia and antibiotic use during the first 30 days of their burn unit admission. Nutritional status and overall inflammation were also measured. Intervention: Either intravenous glutamine or an isonitrogenous control amino acid solution was administered as a continuous infusion during burn intensive care unit stay. Measurements and Main Results: The incidence of Gram-negative bacteremia was significantly reduced in the glutamine-supplemented group (8{\%}) vs. control (43{\%}; p < .04). No difference was seen in the incidence of Gram-positive bacteremia or fungemia. Average number of positive blood cultures, antibiotic usage, and mortality rates also were reduced but did not reach statistical significance. Significant improvements in serum transferrin and prealbumin were observed in glutamine-supplemented patients at 14 days after burn injury (p < .01 and .04, respectively). C-reactive protein was also significantly reduced at 14 days after burn injury in the glutamine group (p < .01). Conclusions: Significantly fewer bacteremic episodes with Gram-negative organisms occurred in the glutamine-supplemented patients. Glutamine supplementation improved measures of nutrition and decreased measures of overall inflammation. In addition, a trend toward lower mortality rate, decreased overall bacteremia incidence, and antibiotic usage in the glutamine group was observed. Glutamine's beneficial effects may be a result of improved gut integrity or immune function, but the precise mechanism of glutamine's protection is unknown.",
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T2 - A prospective, randomized, double-blind trial versus isonitrogenous control

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AU - Liedel, Jennifer L.

AU - Wolfson, Rachel

AU - Riehm, Jacob

AU - Gottlieb, Lawrence

AU - Kahana, Madelyn

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AB - Objective: To determine the effect of intravenous glutamine supplementation vs. an isonitrogenous control on infectious morbidity in severely burned patients. Previous clinical studies in seriously ill patients suggest a beneficial effect of glutamine on infectious morbidity, but no trials have examined possible clinical benefits in severely burned patients. Design: Prospective, double-blind, randomized trial. Setting: Burn intensive care unit of a university hospital. Patients: Twenty-six severe burn patients with total burn surface area of 25% to 90% and presence of full-thickness burns. Patients were evaluated for occurrence of bacteremia and antibiotic use during the first 30 days of their burn unit admission. Nutritional status and overall inflammation were also measured. Intervention: Either intravenous glutamine or an isonitrogenous control amino acid solution was administered as a continuous infusion during burn intensive care unit stay. Measurements and Main Results: The incidence of Gram-negative bacteremia was significantly reduced in the glutamine-supplemented group (8%) vs. control (43%; p < .04). No difference was seen in the incidence of Gram-positive bacteremia or fungemia. Average number of positive blood cultures, antibiotic usage, and mortality rates also were reduced but did not reach statistical significance. Significant improvements in serum transferrin and prealbumin were observed in glutamine-supplemented patients at 14 days after burn injury (p < .01 and .04, respectively). C-reactive protein was also significantly reduced at 14 days after burn injury in the glutamine group (p < .01). Conclusions: Significantly fewer bacteremic episodes with Gram-negative organisms occurred in the glutamine-supplemented patients. Glutamine supplementation improved measures of nutrition and decreased measures of overall inflammation. In addition, a trend toward lower mortality rate, decreased overall bacteremia incidence, and antibiotic usage in the glutamine group was observed. Glutamine's beneficial effects may be a result of improved gut integrity or immune function, but the precise mechanism of glutamine's protection is unknown.

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KW - Outcome study

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