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Does enteral glutamine supplementation decrease infectious morbidity?
Alison Saalwachter Schulman1, Kate F Willcutts, Jeffrey A Claridge
1Department of Surgery, University of Virginia Health System, Charlottesville, Virginia 22908-0709, USA.
Insights
Supplemental enteral glutamine did not reduce infection rates in critically ill surgical patients. This study found no significant differences in infection acquisition or characteristics with glutamine supplementation.
Area of Science:
- Critical Care Medicine
- Surgical Nutrition
- Infectious Disease Epidemiology
Background:
- Conflicting evidence exists regarding the benefits of supplemental glutamine in reducing infectious morbidity.
- The precise role of glutamine in critically ill surgical patients remains debated.
Purpose of the Study:
- To evaluate the impact of supplemental enteral glutamine on infection rates and outcomes.
- To investigate the effect of glutamine on infection characteristics in critically ill surgical patients.
Main Methods:
- 185 surgical and trauma patients in a surgical trauma intensive care unit (STICU) received sequential enteral nutrition.
- Patients were assigned to standard feeding, standard feeding with glutamine, or immune-modulated feeding with glutamine.
- Infections acquired during hospitalization were prospectively monitored.
Main Results:
- No significant difference in infection rates (59% vs. 64% vs. 69%) was observed among the three groups.
- The mean number of infections and common infection sites (lungs, blood, urine) did not differ.
- No significant variations in isolated organisms or antibiotic usage were noted between groups.
Conclusions:
- Supplemental enteral glutamine, at the studied dosage, did not alter the incidence or characteristics of infections.
- The findings suggest glutamine supplementation may not be beneficial for preventing infections in this patient population.
Background:
Although some studies have demonstrated lower infectious morbidity in patients receiving supplemental glutamine, there remains no consensus on the utility of such treatment. This study was designed to investigate the effects of supplemental enteral glutamine on the rate and outcomes of infection in critically ill surgical patients.
Methods:
All 185 surgical and trauma patients admitted to a single university surgical trauma intensive care unit (STICU) over an approximately three-year period who were to receive enteral nutrition support were assigned sequentially to one of three diets: standard 1-kCal/mL feedings with added protein (Group 1), standard feedings with glutamine 0.6 g/kg per day (Group 2), or immune-modulated feedings with a similar amount of glutamine (Group 3). Group compositions and patient characteristics were similar at baseline. Data were collected prospectively on infections acquired during hospitalization.
Results:
A total of 119 patients had at least one infection: 59% of the patients in Group 1, 64% of Group 2, and 69% of Group 3 (p = NS). There were no differences among the groups in the mean number of infections. The most common sites in all groups were the lungs, blood, and urine; and the frequencies of these infections did not differ between groups. Minor differences were found between groups in the organisms isolated. Antibiotic usage did not differ.
Conclusion:
Supplemental enteral glutamine in the dose studied does not appear to influence the acquisition or characteristics of infection in patients admitted to a mixed STICU.
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