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Published on: September 20, 2019
Effects of lipid emulsion and multivitamins on the growth of microorganisms in peripheral parenteral nutrition
Takashi Kuwahara1, Shinya Kaneda, Kazuyuki Shimono
11. Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 115 Tateiwa, Naruto, Tokushima 772-8601, Japan. Kuwahara.Takashi@otsuka.jp
Background:
Blood stream infections caused by Bacillus cereus or Serratia marcescens in patients receiving peripheral parenteral nutrition (PPN) have occasionally been reported in Japan, but these microorganisms are not major causes of blood stream infections in patients receiving total parenteral nutrition via a central venous catheter. In Japan, commercially available PPN solutions contain amino acids, glucose, and electrolytes, but not contain lipid emulsion (LE) and multivitamins (MV). In this study, the effects of LE and MV on the growth of microorganisms such as Bacillus cereus, Serratia marcescens, Staphylococcus aureus, and Candida albicans in PPN solutions were investigated.
Methods:
A commercial 3% amino acid and 7.5% glucose solution with electrolytes (AF) was used as the base solution to prepare test solutions (LAF, AFV, and LAFV) containing LE, MV, or both. Specifically, 20% LE was added to AF in a ratio of 1:9 to prepare LAF. MV was added to AF and LAF to prepare AFV and LAFV, respectively. A specified number of each microorganism was added to each 100 mL of AF, LAF, AFV, and LAFV in sterile plastic flasks, and all flasks were allowed to stand at room temperature. The number of colony forming units per mL of each microorganism was counted at 0, 24, and 48 hours after the addition of each microorganism.
Results:
Both Bacillus cereus and Serratia marcescens increased rapidly in AF as well as in LAF, AFV, and LAFV. Staphylococcus aureus did not increased in AF, but increased slightly in LAF and increased rapidly in AFV and LAFV. Candida albicans increased slightly in AF and increased rapidly in LAF, AFV, and LAFV.
Conclusions:
The results suggest the followings: if microbial contamination occurs, 1) Bacillus cereus and Serratia marcescens can grow rapidly in PPN solutions consisting of amino acids, glucose and electrolytes; 2) Staphylococcus aureus cannot grow without LE and MV, but can grow rapidly with MV; 3) Candida albicans can grow slowly without LE and MV, and the addition of LE or MV accelerates its growth.
Insights
Microbial contamination in parenteral nutrition (PN) solutions can lead to rapid growth of bacteria like Bacillus cereus and Serratia marcescens. Staphylococcus aureus and Candida albicans growth is accelerated by lipid emulsion and multivitamins in PN.
Area of Science:
- Microbiology
- Clinical Nutrition
- Pharmaceutical Science
Background:
- Bloodstream infections from Bacillus cereus and Serratia marcescens in patients on peripheral parenteral nutrition (PPN) are reported in Japan.
- Commercial PPN solutions in Japan lack lipid emulsion (LE) and multivitamins (MV).
- Investigating the impact of LE and MV on microbial growth in PPN is crucial for patient safety.
Purpose of the Study:
- To determine the effect of lipid emulsion (LE) and multivitamins (MV) on the growth of Bacillus cereus, Serratia marcescens, Staphylococcus aureus, and Candida albicans in PPN solutions.
- To assess the risk of microbial proliferation in PPN under different compositional scenarios.
- To inform best practices for PPN preparation and administration.
Main Methods:
- Prepared PPN test solutions with varying combinations of amino acids, glucose, electrolytes, LE, and MV.
- Inoculated PPN solutions with specific microorganisms: Bacillus cereus, Serratia marcescens, Staphylococcus aureus, and Candida albicans.
- Quantified microbial growth (colony forming units/mL) at 0, 24, and 48 hours at room temperature.
Main Results:
- Bacillus cereus and Serratia marcescens demonstrated rapid growth in all tested PPN solutions.
- Staphylococcus aureus showed limited growth without LE and MV, but rapid growth when MV was present.
- Candida albicans exhibited slow growth initially, with accelerated proliferation upon addition of LE or MV.
Conclusions:
- Bacillus cereus and Serratia marcescens readily proliferate in standard PPN solutions if contaminated.
- Staphylococcus aureus requires LE and MV for significant growth, particularly with MV present.
- Candida albicans growth is enhanced by the presence of LE or MV in PPN solutions.
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