Enteral versus parenteral nutrition: no difference in the incidence of fungal infections in critically-ill patients on mechanical ventilation with selective digestive decontamination

Background

Infections are an important cause of morbidity and mortality in patients in the intensive care units (ICUs). Fungal infections have increased substantially over recent years and fungi have become one of the important pathogens in intensive care patients. This study was undertaken to test the hypothesis that the incidence of fungal infections is lower in critically-ill patients under mechanical ventilation receiving enteral rather than parenteral nutrition.

Methods

By using a prospectively-built database, we analyzed retrospectively the charts of 110 critically-ill, intubated patients hospitalized in surgical and medical ICUs and receiving selective digestive decontamination (SDD). SDD is the prophylactic use of topical, nonabsorbable antibiotics to reduce the incidence of respiratory tract infections in critically-ill patients. It is known that this therapy significantly reduces the incidence, but not the mortality rate of pneumonia in ICU patients. In this study the SDD for all patients comprised of a PNV solution (polymyxin B, neomycin, vancomycin) at a dosage of 15 ml administered six times daily. Seventy-nine patients received enteral nutrition and 31 patients parenteral nutrition.

Those patients without contraindications, and expected to be intubated for more than 72 h, received enteral nutrition which was started within 24 h after intubation. Patients with contraindications for enteral nutrition received parenteral nutrition which was discontinued when the criteria for enteral nutrition were met. We compared the incidence of fungal infections in both subgroups of patients, i.e., enteral versus parenteral nutrition.

Results

The two subgroups were similar with regard to their APACHE II score, in age, sex distribution and comorbidities at the time of study entry. The rate of fungal infection was seen to be higher in the parenteral nutrition group, 5 out of 29, as compared to 7 out of 71 in the enteral nutrition group. However, this difference was not considered to be statistically significant.

Conclusion

No significant difference is observed between enteral vs. parenteral nutrition in the incidence of fungal infections in critically-ill patients receiving SDD.