BACKGROUND Glucose imbalance is common in total parenteral nutrition(TPN).Hypoglycemia seems to be less frequent than hyperglycemia,but it influences the clinical outcome to a greater extent.Therefore,it should be eff...BACKGROUND Glucose imbalance is common in total parenteral nutrition(TPN).Hypoglycemia seems to be less frequent than hyperglycemia,but it influences the clinical outcome to a greater extent.Therefore,it should be effectively prevented and treated.However,there is no relevant report on how to treat hypoglycemia caused by TPN in patients with liver cell injury.CASE SUMMARY We present three patients with liver cell injury who developed severe hypo-glycemia during or after TPN infusion.The causes of severe hypoglycemia and glucose-raising strategies were discussed.According to the physiological charac-teristics of the hepatocellular injury,the ratio of nutrition components prescribed in TPN was appropriately adjusted for the three cases.We simultaneously reduced the dose of insulin and fat emulsion,and increased the dose of glucose in TPN.The blood glucose level was restored to normal range and clinical symptoms were eliminated.CONCLUSION When hypoglycemia occurs during or after TPN in patients with hepatocellular injury,physicians need to simultaneously reduce insulin and fat emulsion,and increase glucose,and correct severe hypoglycemia in time to reduce its adverse consequences.展开更多
Objective:To evaluate the application effect of enteral and parenteral nutrition therapy combined with a health belief education model in patients with inflammatory bowel disease.Methods:80 patients with inflammatory ...Objective:To evaluate the application effect of enteral and parenteral nutrition therapy combined with a health belief education model in patients with inflammatory bowel disease.Methods:80 patients with inflammatory bowel disease admitted to the Shanghai Zhangjiang Institute of Medical Innovation were chosen.This study was carried out from August 2022 to October 2023.The patients were randomly divided into a study group(40 cases)and a control group(40 cases).The treatment plan for the control group was the conventional treatment model,while the treatment plan for the study group was to provide enteral and parenteral nutrition therapy combined with a health belief education model based on the control group.The efficacy of both groups was compared.Results:In the study group,the therapeutic effect for 31 patients(77.50%)was markedly effective and 7 was effective(17.50%),accounting for 95.0%of the total,which was higher than the control group at 80.0%(P<0.05).The relief time of relevant symptoms in the study group was shorter than that of the control group(P<0.05).Before treatment,there were no differences in the high-sensitivity C-reactive protein(hs-CRP),interleukin 10(IL-10),and tumor necrosis factor-α(TNF-α)between both groups(P>0.05).After treatment,the levels of inflammatory factors in the study group(hs-CRP(8.02±1.13)mg/L,IL-10(9.24±1.25)pg/mL,and TNF-α(7.19±1.04)ng/L)were lower than those in the control group(P<0.05).Conclusion:Enteral and parenteral nutritional therapy combined with a health belief education model showed significant efficacy in inflammatory bowel disease patients.Patient symptoms were relieved and inflammatory reactions were reduced.This method is worthy of popularization.展开更多
Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe t...Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe traumatic brain injury (STBI).Methods A prospective randomized control trial was carried out from January 2009 to May 2012 inNeurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow ComaScale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were administratedEN, PN or EN＋PN treatments respectively. The indexes of nutritional status, immune function,complications and clinical outcomes were examined and compared statistically.展开更多
AIM:To investigate the effect of early enteral nutrition(EEN)combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy(PD).METHODS:From January 2006,all patients were given EEN combin...AIM:To investigate the effect of early enteral nutrition(EEN)combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy(PD).METHODS:From January 2006,all patients were given EEN combined with parenteral nutrition(PN)(EEN/PN group,n=107),while patients prior to this date were given total parenteral nutrition(TPN)(TPN group,n=67).Venous blood samples were obtained for a nutrition-associated assessment and liver function tests on the day before surgery and 6 d after surgery.The assessment of clinical outcome was based on postoperative complications.Follow-up for infectious and noninfectious complications was carried out for 30 d after hospital discharge.Readmission within 30 d afterdischarge was also recorded.RESULTS:Compared with the TPN group,a significant decrease in prealbumin(PAB)(P=0.023)was seen in the EEN/PN group.Total bilirubin(TB),direct bilirubin(DB)and lactate dehydrogenase(LDH)were significantly decreased on day 6 in the EEN/PN group(P=0.006,0.004 and 0.032,respectively).The rate of gradeⅠcomplications,gradeⅡcomplications and the length of postoperative hospital stay in the EEN/PN group were significantly decreased(P=0.036,0.028and 0.021,respectively),and no hospital mortality was observed in our study.Compared with the TPN group(58.2%),the rate of infectious complications in the EEN/PN group(39.3%)was significantly decreased(P=0.042).Eleven cases of delayed gastric emptying were noted in the TPN group,and 6 cases in the EEN/PN group.The rate of delayed gastric emptying and hyperglycemia was significantly reduced in the EEN/PN group(P=0.031 and P=0.040,respectively).CONCLUSION:Early enteral combined with PN can greatly improve liver function,reduce infectious complications and delayed gastric emptying,and shorten postoperative hospital stay in patients undergoing PD.展开更多
AIM To investigate the interference ofmethionine.free parenteral nutrition plus 5-Fu（-MetTPN+5-Fu）in gastric cancer cell kineticsand the side effects of the regimen.METHODS Fifteen patients with advancedgastric canc...AIM To investigate the interference ofmethionine.free parenteral nutrition plus 5-Fu（-MetTPN+5-Fu）in gastric cancer cell kineticsand the side effects of the regimen.METHODS Fifteen patients with advancedgastric cancer were randomly divided into twogroups,7 patients were given preoperatively aseven-day course of standard parenteralnutrition in combination with a five-day courseof chemotherapy（sTPN+5-Fu）,while the other8 patients were given methionine-deprivedparenteral nutrition and 5-Fu（-MetTPN+5-Fu）.Cell cycles of gastric cancer and normal mucosawere studied by flow cytometry（FCM）.Bloodsamples were taken to measure the serumprotein,methionine（Met）and cysteine（Cys）levels,and liver and kidney functions.RESULTS As compared with the resultsobtained before the treatment,the percentage ofG<sub>0</sub>/G<sub>1</sub> tumor cells increased and that of S phasedecreased in the-MetTPN+5-Fu group,while thecontrary was observed in the sTPN+5-Fu group.Except that the ALT,AST and AKP levels wereslightly increased in a few cases receiving-MetTPN+5-Fu,all the other biochemicalparameters were within normal limits.Serum Cys level decreased slightly after the treatmentin both groups.Serum Met level of patientsreceiving sTPN+5-Fu was somewhat higher aftertreatment than that before treatment;however,no significant change occurred in the -MetTPN+5-Fu group,nor operative complications in bothgroups.CONCLUSION -MetTPN+5-Fu exerted asuppressive effect on cancer cell proliferation,probably through a double mechanism ofcreating a state of'Met starvation'adverse tothe tumor cell cycle,and by allowing 5-Fu to killspecifically cells in S phase.Preoperative short-term administration of -MetTPN+5-Fu had littleundesirable effect on host metabolism.展开更多
AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition(TPN) and early enteral nutrition supplemented with parenteral nutrition(EEN + PN).METHODS: Three hundred and fo...AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition(TPN) and early enteral nutrition supplemented with parenteral nutrition(EEN + PN).METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy(PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group(n = 87) and a TPN group(n = 253). Demographic characteristics, comorbidities, preoperative biochemicalparameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed. RESULTS: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings(P > 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying(16.1% vs 6.7%, P = 0.016), pulmonary infection(10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection(18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time(9 d vs 5 d, P = 0.006), postoperative hospital stay(25 d vs 20 d, P = 0.055) and higher hospitalization expenses(USD10397 vs USD8663.9, P = 0.008), compared to those with TPN.CONCLUSION: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively.展开更多
BACKGROUND: Parenteral nutrition-associated liver disease (PNALD) has been common in patients who require long-term parenteral nutrition. PNALD develops in 40%-60% of infants on long-term parenteral nutrition compared...BACKGROUND: Parenteral nutrition-associated liver disease (PNALD) has been common in patients who require long-term parenteral nutrition. PNALD develops in 40%-60% of infants on long-term parenteral nutrition compared with 15%-40% of adults on home parenteral nutrition for intestinal failure. The pathogenesis of PNALD is multifactorial and remains unclear There is no specific treatment. Management strategies for its prevention and treatment depend on an understanding of many risk factors. This review aims to provide an update on the pathogenesis and treatment of this disease. DATA SOURCES: A literature search was performed on the MEDLINE and Web of Science databases for articles published up to October 2011, using the keywords: parenteral nutrition associated liver disease, intestinal failure associated liver disease lipid emulsions and fish oil. The available data reported in the relevant literatures were analyzed. RESULTS: The literature search provided a huge amount of evidence about the pathogenesis and management strategies on PNALD. Currently, lack of enteral feeding, extended duration of parenteral nutrition, recurrent sepsis, and nutrient deficiency or excess may play important roles in the pathogenesis of PNALD. Recent studies found that phytosterols present as contaminants in soy-based lipid emulsions, are also an important factor in the pathogenesis. Moreover, the treatment of PNALD is discussed. CONCLUSIONS: The use of lipid emulsions, phytosterols in particular, is associated with PNALD. Management strategies for the prevention and treatment of PNALD include consideration of early enteral feeding, the use of specialized lipid emulsions such as fish oil emulsions, and isolated small bowel or combined liver and small bowel transplantation. A greater understanding of the pathogenesis of PNALD has led to promising interventions to prevent and treat this condition. Future work should aim to better understand the mechanisms of PNALD and the long-term outcomes of its treatment.展开更多
AIM To investigate the influence of L-methioninedeprived total parentaral nutrition with 5-FU on gastric cancer and host metabolism.``METHODS N-methyI-N-nitro-nitrosoguanidine ( MNNG )induced gastric cancer rats were ...AIM To investigate the influence of L-methioninedeprived total parentaral nutrition with 5-FU on gastric cancer and host metabolism.``METHODS N-methyI-N-nitro-nitrosoguanidine ( MNNG )induced gastric cancer rats were randomly divided into four groups: Met-containing TPN group (n= 11 ), Metdeprived TPN group (n = 12), Met-containing TPN + 5-FU group (n = 11) and Met-deprived TPN + 5-FU group (n-12). Five rats in each group were sacrificed after 7days of treatment and the samples were taken for examination. The remaining rats in each group were then fed separately with normal diet after the treatment until death, the life span was noted.``RESULTS The tumors were enlarged in Met-containing group and shrank in Met-deprived group markedly after the treatment. The DNA index (DI) of tumor cells and the body weight (BW) of rats had no significant change in the two groups, however, the ratio of tumor cells' S phase was increased The ratio of G2M phase went up in Metcontaining group, but down in Met-deprived group. In the other two groups that 5-FU was added, the BW of rats,and the diameter of tumors, the DI of tumor cells, the S and G2M phase ratio of tumor cells were all decreased,particularly in Met-deprived plus 5-FU group. Pathological examination revealed that the necrotic foci of the tumor tissue increased after Met-deprived TPN treatment, and the nucleoli of tumor cells enlarged. In -MetTPN + 5-FUgroup, severe nuclear damage was also found by karyopyknosis and karyorrhexis, meanwhile there was slight degeneration in some liver and kidney cells. The serum free Met and Cysteine decreased markedly (P<0.001), while other amino acids, such as serum free serine and glutamine increased significantly ( P< 0.005).All the rats died of multiple organ failure caused by cancer metastasis. The average survival time was 18.6 days in Met-containing TPN group. 31 days in Met-deprived TPN group, 27.5 days in Met-containing TPN + 5-FU group, and 43 days in Met-deprived TPN+ 5-FU group (P<0.05).``CONCLUSION Met-deprived TPN causes methionine starvation of tumor cells, and can enhance the anti-tumor effect of 5-FU and prolong the life span of gastric cancerbearing rats.展开更多
AIM:To investigate the use of lipid emulsion substitutingfor glucose in postoperative hypocaloric peripheral parenteral nutrition (HPPN).METHODS:This prospective, randomized study was conducted on 20 postoperative gas...AIM:To investigate the use of lipid emulsion substitutingfor glucose in postoperative hypocaloric peripheral parenteral nutrition (HPPN).METHODS:This prospective, randomized study was conducted on 20 postoperative gastrointestinal cancer patients. They were randomized and equally divided into interventional group and control group, and both were administered isocaloric and isonitrogenous diets with for lipid emulsion substituting for partial glucose loads in the interventional group.RESULTS: Nutritional parameters and biochemical data were compared between the two groups before and after 6-d of HPPN. Most investigated variables showed no significant changes after administration of HPPN with lipid emulsion. However, the postoperative triglyceride level was significantly lower in the interventional group than in the control group (P < 0.05). In comparison with lipid emulsion, glucose administration resulted in less decrease in postoperative prealbumin level (P < 0.05).CONCLUSION: In addition to supplementing with essential fatty acid, it seems that HPPN with lipid emulsion is well-tolerated and beneficial to postoperative gastrointestinal cancer patients.展开更多
Objective: To observe the effects of S-adenosylmethio-nine (SAMe) in the treatment of cholestasis after totalparenteral nutrition (TPN).Methods: Thirty SD rats were randomly divided intocontrol group, hypercalorie gro...Objective: To observe the effects of S-adenosylmethio-nine (SAMe) in the treatment of cholestasis after totalparenteral nutrition (TPN).Methods: Thirty SD rats were randomly divided intocontrol group, hypercalorie group, hypercalorie+SAMegroup, sepsis group and sepsis+SAMe group to com-pare their states of cholestasis. Sixteen patients re-ceived SAMe because of cholestasis after prolongedTPN, and the therapeutic efficacy was observed.Results: Bile flow was obviously decreased and theserum levels of total bile acid and gamma-glutamyltranspeptidase(γ-GT) were markedly increased in thehypercalorie and sepsis groups. Meanwhile, hepatocytefatty degeneration, dilatation of cholangioles, and bilesludge could be seen microscopically. SAMe adminis-tration in the hypercalorie+SAMe and sepsis+SAMegroups could increase the bile flow, decrease theserum levels of total bile acid and γ-GT, reduce thepathological damage to the liver, and clear the bilesludge in the cholangioles. Cholestasis and abnormalliver function were the main manifestations of the 16patients before SAMe administration. After SAMe treat-ment for 3 weeks, serum levels of total bilirubin, al-kaline phosphatase(AKP), γ-GT, alanine aminotrans-ferase(ALT), and aspartate aminotransferase(AST)were obviously decreased, and normalized in the 4thweek.Conclusion: SAMe could prevent and treat cholestasiswithout discontinuation of TPN.展开更多
Objective: The efficacy of Ji Desheng snake pills combined with hypertonic glucose external application in treating drug-induced superficial phlebitis caused by parenteral nutrition (PN) is observed. Methods: Fifty-tw...Objective: The efficacy of Ji Desheng snake pills combined with hypertonic glucose external application in treating drug-induced superficial phlebitis caused by parenteral nutrition (PN) is observed. Methods: Fifty-two cases of drug-induced superficial phlebitis after peripheral parenteral nutrition (PPN) were selected, which were randomly divided into experimental group and control group in accordance with the phlebitis grading. In the experimental group, Ji Desheng snake pills were crushed to make a paste with 50% glucose solution, which was then applied to the affected area of phlebitis, the surface was covered with clean gauze, and properly fixed with tape or bandage. The drug was replaced once a day. In the control group, the gauze soaked with 50% magnesium sulfate solution was used, which was applied to the affected part three times a day in wet, and the efficacy was observed respectively on the 1st, 3rd, 5th and 7th days after applying the drug. Results: On the 1st and 3rd days after treatment, the observed effective rate of the experimental group was higher than that of the control group (42.31% vs. 15.38% and 76.92% vs. 46.15%, respectively). The difference was statistically significant (p th and 7th days after treatment, there was no statistical significance with respect to the efficacy between the experimental group and the control group (p > 0.05). Conclusion: The significant efficacy could be found in early stage after drug-induced superficial phlebitis was treated by Ji Desheng snake pills combined with hypertonic glucose external application, which was superior to that of the traditional treatment of wet application by using gauze soaked in 50% magnesium sulfate solution.展开更多
AIM To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease. METHODS A retrospective chart review of 49 premature infants on parenteral nutriti...AIM To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease. METHODS A retrospective chart review of 49 premature infants on parenteral nutrition for > 30 d who received packed red blood cell(PRBC) transfusions was performed. Parenteral nutrition associated liver disease was primarily defined by direct bilirubin(db) > 2.0 mg/dL. A high transfusion cohort was defined as receiving > 75 mL packed red blood cells(the median value). KaplanMeier plots estimated the median volume of packedred blood cells received in order to develop parenteral nutrition associated liver disease.RESULTS Parenteral nutritional associated liver disease(PNALD) was noted in 21(43%) infants based on db. Among the 27 high transfusion infants, PNALD was present in 17(64%) based on elevated direct bilirubin which was significantly greater than the low transfusion recipients. About 50% of the infants, who were transfused 101-125 mL packed red blood cells, developed PNALD based on elevation of direct bilirubin. All infants who were transfused more than 200 mL of packed red blood cells developed PNALD. Similar results were seen when using elevation of aspartate transaminase or alanine transaminase to define PNALD.CONCLUSION In this retrospective, pilot study there was a statistically significant correlation between the volume of PRBC transfusions received by premature infants and the development of PNALD.展开更多
Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new proph...Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.展开更多
The compounding of total parenteral nutrition solutions (TPN) in the hospital pharmacy is a high-risk activity for which a quality assurance programme is necessary. The complexity of parenteral nutrition solutions con...The compounding of total parenteral nutrition solutions (TPN) in the hospital pharmacy is a high-risk activity for which a quality assurance programme is necessary. The complexity of parenteral nutrition solutions containing almost 50 ingredients makes it difficult to measure each of them. On the other hand, the assay of electrolytes such as sodium and potassium is accepted as a quality marker for estimating compounding errors. Thus, the aim of this study was to estimate the influence of ingredients on the accuracy of assays of electrolytes. Experiments were performed with aqueous working simulated solutions of sodium and potassium prepared by the addition of each nutrient step by step, (dextrose, amino acids, lipids, vitamins and trace elements). Sodium and potassium levels were measured by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS) and Atomic Emission Spectroscopy (ICP-AES). The performance of these methods was compared using statistical evaluations (t-test and Mann–Whitney test).The study highlights the interference of amino acids, vitamins and trace elements when measuring sodium, but no interference was noted during the measurement of potassium. To reduce the risk and to improve the quality of compounding, we used an automated compounding device but, even in this case, the acceptance criterion for sodium and potassium determination was not <10%.展开更多
With the wide application of parental nutrition(PN) and central venous catheter(CVC) to tumor patients, the relative infection led by CVC has become a common and troublesome hospital infection in clinics. During infus...With the wide application of parental nutrition(PN) and central venous catheter(CVC) to tumor patients, the relative infection led by CVC has become a common and troublesome hospital infection in clinics. During infusion, PN fluid forms a high-sugar and high-fat micro-environment around CVC, facilitating the adhesion, growth, and diffusion of pathogenic bacteria. This condition forms a bacterial biofilm(BF) consisting of one or several kinds of pathogenic bacteria. Upon formation of the film, pathogens in the BF can resist anti-bacterial drugs and immune cells, causing repeated infections of bacteria or fungi and endangering the lives of patients. In this paper, we summarize the applications of PN, characteristics of CVC infection in tumor patients, mixed BF, and related research methods to provide reference for studies of mixed BF infection of CVC.展开更多
Objective:To explore the effect of enteral and parenteral nutritional diet intervention on recovery, nutritional status and immune function for gastric cancer patients after radical gastrectomy.Methods:A total of 180 ...Objective:To explore the effect of enteral and parenteral nutritional diet intervention on recovery, nutritional status and immune function for gastric cancer patients after radical gastrectomy.Methods:A total of 180 patients with gastric cancer treated in our hospital from January 2016 to December 2017 were selected, and randomly divided into the control group and the observation group by computer, each with 90 cases. Control group received parenteral nutrition intervention, and observation group received enteral and parenteral nutritional diet intervention. Cellular immune function, humoral immune function, nutritional status, and complications occurrence rate were compared between two groups.Results: The levels of cellular immune function between the two groups had no difference before intervention (P>0.05). After intervention, the observation group had higher levels of CD3+, CD4+, and CD4+/CD8+ as well as lower level of CD8+ than those of control group (P<0.05). The IgM, IgA, and IgG levels between the two groups had no difference before treatment (P>0.05), which were decreased after treatment (P<0.05), and were lower in the observation group than those in the control group (P<0.05). The albumin and prealbumin levels between the two groups had no difference before intervention (P>0.05), which were increased after treatment, and were higher in observation group than those in the control group (P<0.05). The incidence of complications in the observation group was significantly lower than that in the control group (P<0.05).Conclusion:The application of enteral and parenteral nutritional diet intervention can promote the recovery, improve the nutritional status and immune function for gastric cancer patients after radical gastrectomy, which has fewer complications.展开更多
Standard parenteral nutrition solutions are mixtures comprising interacting components that may degrade themselves over time. The objective of this study was to investigate the physicochemical and microbiological stab...Standard parenteral nutrition solutions are mixtures comprising interacting components that may degrade themselves over time. The objective of this study was to investigate the physicochemical and microbiological stability of a hospital preparation for parenteral nutrition in neonatology. The analyses were performed throughout the storage of the preparations at 2–8 °C(up to 4 months). The extent of stability was based on the determination of amino acids dosage, visual and physicochemical properties(glucose and electrolytes concentrations, pH and osmolality measurements, particle counting) and microbiological analysis(sterility test). A thermal degradation of ascorbic acid was conducted to evaluate the antioxidant properties of the parenteral mixture. Physicochemical and microbiological controls were found to comply with the specifications. Amino acids showed a good stability throughout the 4 months storage except for cysteine, which was progressively degraded to cystine, conferring a yellow coloration to parenteral solutions. Parenteral nutrition standards solutions remain stable for 4 months at 2–8 °C,ensuring safe administration in preterm infants.展开更多
BACKGROUND Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with imm...BACKGROUND Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with immense socio-economic burden. One treatment aspect is parenteral antiinfective therapy, which usually requires an inpatient setting [Inpatient parenteral antibiotic therapy (IPAT)]. An alternative is outpatient parenteral treatment [Outpatient parenteral antibiotic therapy (OPAT)]. To conduct a health economic cost-benefit analysis of OPAT, a detailed cost analysis of IPAT and OPAT is required. So far, there is a lack of knowledge on the health economic effects of IPAT and OPAT for PPJI. AIM To review an economic comparison of IPAT and OPAT. METHODS A systematic literature review was performed through Medline following the PRISMA guidelines. RESULTS Of 619 identified studies, 174 included information of interest and 21 studies were included for quantitative analysis of OPAT and IPAT costs. Except for one study, all showed relevant cost savings for OPAT compared to IPAT. Costs for IPAT were between 1.10 to 17.34 times higher than those for OPAT. CONCLUSION There are only few reports on OPAT for PPJI. Detailed analyses to support economic or clinical guidelines are therefore limited. There is good clinical evidence supporting economic benefits of OPAT, but more high quality studies are needed for PPJI.展开更多
文摘BACKGROUND Glucose imbalance is common in total parenteral nutrition(TPN).Hypoglycemia seems to be less frequent than hyperglycemia,but it influences the clinical outcome to a greater extent.Therefore,it should be effectively prevented and treated.However,there is no relevant report on how to treat hypoglycemia caused by TPN in patients with liver cell injury.CASE SUMMARY We present three patients with liver cell injury who developed severe hypo-glycemia during or after TPN infusion.The causes of severe hypoglycemia and glucose-raising strategies were discussed.According to the physiological charac-teristics of the hepatocellular injury,the ratio of nutrition components prescribed in TPN was appropriately adjusted for the three cases.We simultaneously reduced the dose of insulin and fat emulsion,and increased the dose of glucose in TPN.The blood glucose level was restored to normal range and clinical symptoms were eliminated.CONCLUSION When hypoglycemia occurs during or after TPN in patients with hepatocellular injury,physicians need to simultaneously reduce insulin and fat emulsion,and increase glucose,and correct severe hypoglycemia in time to reduce its adverse consequences.
文摘Objective:To evaluate the application effect of enteral and parenteral nutrition therapy combined with a health belief education model in patients with inflammatory bowel disease.Methods:80 patients with inflammatory bowel disease admitted to the Shanghai Zhangjiang Institute of Medical Innovation were chosen.This study was carried out from August 2022 to October 2023.The patients were randomly divided into a study group(40 cases)and a control group(40 cases).The treatment plan for the control group was the conventional treatment model,while the treatment plan for the study group was to provide enteral and parenteral nutrition therapy combined with a health belief education model based on the control group.The efficacy of both groups was compared.Results:In the study group,the therapeutic effect for 31 patients(77.50%)was markedly effective and 7 was effective(17.50%),accounting for 95.0%of the total,which was higher than the control group at 80.0%(P<0.05).The relief time of relevant symptoms in the study group was shorter than that of the control group(P<0.05).Before treatment,there were no differences in the high-sensitivity C-reactive protein(hs-CRP),interleukin 10(IL-10),and tumor necrosis factor-α(TNF-α)between both groups(P>0.05).After treatment,the levels of inflammatory factors in the study group(hs-CRP(8.02±1.13)mg/L,IL-10(9.24±1.25)pg/mL,and TNF-α(7.19±1.04)ng/L)were lower than those in the control group(P<0.05).Conclusion:Enteral and parenteral nutritional therapy combined with a health belief education model showed significant efficacy in inflammatory bowel disease patients.Patient symptoms were relieved and inflammatory reactions were reduced.This method is worthy of popularization.
基金Supported by the Natural Science Foundation of Shandong province(Y2008C35)Technology Supporting Program of Qingdao(12-1-3-5-(1)-nsh)
文摘Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe traumatic brain injury (STBI).Methods A prospective randomized control trial was carried out from January 2009 to May 2012 inNeurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow ComaScale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were administratedEN, PN or EN＋PN treatments respectively. The indexes of nutritional status, immune function,complications and clinical outcomes were examined and compared statistically.
基金Supported by Grants from Jiangsu Provincial GovernmentChinaNo.ZX200605
文摘AIM:To investigate the effect of early enteral nutrition(EEN)combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy(PD).METHODS:From January 2006,all patients were given EEN combined with parenteral nutrition(PN)(EEN/PN group,n=107),while patients prior to this date were given total parenteral nutrition(TPN)(TPN group,n=67).Venous blood samples were obtained for a nutrition-associated assessment and liver function tests on the day before surgery and 6 d after surgery.The assessment of clinical outcome was based on postoperative complications.Follow-up for infectious and noninfectious complications was carried out for 30 d after hospital discharge.Readmission within 30 d afterdischarge was also recorded.RESULTS:Compared with the TPN group,a significant decrease in prealbumin(PAB)(P=0.023)was seen in the EEN/PN group.Total bilirubin(TB),direct bilirubin(DB)and lactate dehydrogenase(LDH)were significantly decreased on day 6 in the EEN/PN group(P=0.006,0.004 and 0.032,respectively).The rate of gradeⅠcomplications,gradeⅡcomplications and the length of postoperative hospital stay in the EEN/PN group were significantly decreased(P=0.036,0.028and 0.021,respectively),and no hospital mortality was observed in our study.Compared with the TPN group(58.2%),the rate of infectious complications in the EEN/PN group(39.3%)was significantly decreased(P=0.042).Eleven cases of delayed gastric emptying were noted in the TPN group,and 6 cases in the EEN/PN group.The rate of delayed gastric emptying and hyperglycemia was significantly reduced in the EEN/PN group(P=0.031 and P=0.040,respectively).CONCLUSION:Early enteral combined with PN can greatly improve liver function,reduce infectious complications and delayed gastric emptying,and shorten postoperative hospital stay in patients undergoing PD.
基金the National Natural Science Foundation of China,No.39370780
文摘AIM To investigate the interference ofmethionine.free parenteral nutrition plus 5-Fu（-MetTPN+5-Fu）in gastric cancer cell kineticsand the side effects of the regimen.METHODS Fifteen patients with advancedgastric cancer were randomly divided into twogroups,7 patients were given preoperatively aseven-day course of standard parenteralnutrition in combination with a five-day courseof chemotherapy（sTPN+5-Fu）,while the other8 patients were given methionine-deprivedparenteral nutrition and 5-Fu（-MetTPN+5-Fu）.Cell cycles of gastric cancer and normal mucosawere studied by flow cytometry（FCM）.Bloodsamples were taken to measure the serumprotein,methionine（Met）and cysteine（Cys）levels,and liver and kidney functions.RESULTS As compared with the resultsobtained before the treatment,the percentage ofG<sub>0</sub>/G<sub>1</sub> tumor cells increased and that of S phasedecreased in the-MetTPN+5-Fu group,while thecontrary was observed in the sTPN+5-Fu group.Except that the ALT,AST and AKP levels wereslightly increased in a few cases receiving-MetTPN+5-Fu,all the other biochemicalparameters were within normal limits.Serum Cys level decreased slightly after the treatmentin both groups.Serum Met level of patientsreceiving sTPN+5-Fu was somewhat higher aftertreatment than that before treatment;however,no significant change occurred in the -MetTPN+5-Fu group,nor operative complications in bothgroups.CONCLUSION -MetTPN+5-Fu exerted asuppressive effect on cancer cell proliferation,probably through a double mechanism ofcreating a state of'Met starvation'adverse tothe tumor cell cycle,and by allowing 5-Fu to killspecifically cells in S phase.Preoperative short-term administration of -MetTPN+5-Fu had littleundesirable effect on host metabolism.
基金Supported by the National Natural Science Foundation,No.81372582“New-Star”Young Scientists Program of Shaanxi Province,No.2014kjxx-30the Fundamental Research Funds for the Central Universities
文摘AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition(TPN) and early enteral nutrition supplemented with parenteral nutrition(EEN + PN).METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy(PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group(n = 87) and a TPN group(n = 253). Demographic characteristics, comorbidities, preoperative biochemicalparameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed. RESULTS: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings(P > 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying(16.1% vs 6.7%, P = 0.016), pulmonary infection(10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection(18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time(9 d vs 5 d, P = 0.006), postoperative hospital stay(25 d vs 20 d, P = 0.055) and higher hospitalization expenses(USD10397 vs USD8663.9, P = 0.008), compared to those with TPN.CONCLUSION: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively.
文摘BACKGROUND: Parenteral nutrition-associated liver disease (PNALD) has been common in patients who require long-term parenteral nutrition. PNALD develops in 40%-60% of infants on long-term parenteral nutrition compared with 15%-40% of adults on home parenteral nutrition for intestinal failure. The pathogenesis of PNALD is multifactorial and remains unclear There is no specific treatment. Management strategies for its prevention and treatment depend on an understanding of many risk factors. This review aims to provide an update on the pathogenesis and treatment of this disease. DATA SOURCES: A literature search was performed on the MEDLINE and Web of Science databases for articles published up to October 2011, using the keywords: parenteral nutrition associated liver disease, intestinal failure associated liver disease lipid emulsions and fish oil. The available data reported in the relevant literatures were analyzed. RESULTS: The literature search provided a huge amount of evidence about the pathogenesis and management strategies on PNALD. Currently, lack of enteral feeding, extended duration of parenteral nutrition, recurrent sepsis, and nutrient deficiency or excess may play important roles in the pathogenesis of PNALD. Recent studies found that phytosterols present as contaminants in soy-based lipid emulsions, are also an important factor in the pathogenesis. Moreover, the treatment of PNALD is discussed. CONCLUSIONS: The use of lipid emulsions, phytosterols in particular, is associated with PNALD. Management strategies for the prevention and treatment of PNALD include consideration of early enteral feeding, the use of specialized lipid emulsions such as fish oil emulsions, and isolated small bowel or combined liver and small bowel transplantation. A greater understanding of the pathogenesis of PNALD has led to promising interventions to prevent and treat this condition. Future work should aim to better understand the mechanisms of PNALD and the long-term outcomes of its treatment.
基金Supported by the National Natural Science Foundation of China,No.39370780.
文摘AIM To investigate the influence of L-methioninedeprived total parentaral nutrition with 5-FU on gastric cancer and host metabolism.``METHODS N-methyI-N-nitro-nitrosoguanidine ( MNNG )induced gastric cancer rats were randomly divided into four groups: Met-containing TPN group (n= 11 ), Metdeprived TPN group (n = 12), Met-containing TPN + 5-FU group (n = 11) and Met-deprived TPN + 5-FU group (n-12). Five rats in each group were sacrificed after 7days of treatment and the samples were taken for examination. The remaining rats in each group were then fed separately with normal diet after the treatment until death, the life span was noted.``RESULTS The tumors were enlarged in Met-containing group and shrank in Met-deprived group markedly after the treatment. The DNA index (DI) of tumor cells and the body weight (BW) of rats had no significant change in the two groups, however, the ratio of tumor cells' S phase was increased The ratio of G2M phase went up in Metcontaining group, but down in Met-deprived group. In the other two groups that 5-FU was added, the BW of rats,and the diameter of tumors, the DI of tumor cells, the S and G2M phase ratio of tumor cells were all decreased,particularly in Met-deprived plus 5-FU group. Pathological examination revealed that the necrotic foci of the tumor tissue increased after Met-deprived TPN treatment, and the nucleoli of tumor cells enlarged. In -MetTPN + 5-FUgroup, severe nuclear damage was also found by karyopyknosis and karyorrhexis, meanwhile there was slight degeneration in some liver and kidney cells. The serum free Met and Cysteine decreased markedly (P<0.001), while other amino acids, such as serum free serine and glutamine increased significantly ( P< 0.005).All the rats died of multiple organ failure caused by cancer metastasis. The average survival time was 18.6 days in Met-containing TPN group. 31 days in Met-deprived TPN group, 27.5 days in Met-containing TPN + 5-FU group, and 43 days in Met-deprived TPN+ 5-FU group (P<0.05).``CONCLUSION Met-deprived TPN causes methionine starvation of tumor cells, and can enhance the anti-tumor effect of 5-FU and prolong the life span of gastric cancerbearing rats.
文摘AIM:To investigate the use of lipid emulsion substitutingfor glucose in postoperative hypocaloric peripheral parenteral nutrition (HPPN).METHODS:This prospective, randomized study was conducted on 20 postoperative gastrointestinal cancer patients. They were randomized and equally divided into interventional group and control group, and both were administered isocaloric and isonitrogenous diets with for lipid emulsion substituting for partial glucose loads in the interventional group.RESULTS: Nutritional parameters and biochemical data were compared between the two groups before and after 6-d of HPPN. Most investigated variables showed no significant changes after administration of HPPN with lipid emulsion. However, the postoperative triglyceride level was significantly lower in the interventional group than in the control group (P < 0.05). In comparison with lipid emulsion, glucose administration resulted in less decrease in postoperative prealbumin level (P < 0.05).CONCLUSION: In addition to supplementing with essential fatty acid, it seems that HPPN with lipid emulsion is well-tolerated and beneficial to postoperative gastrointestinal cancer patients.
文摘Objective: To observe the effects of S-adenosylmethio-nine (SAMe) in the treatment of cholestasis after totalparenteral nutrition (TPN).Methods: Thirty SD rats were randomly divided intocontrol group, hypercalorie group, hypercalorie+SAMegroup, sepsis group and sepsis+SAMe group to com-pare their states of cholestasis. Sixteen patients re-ceived SAMe because of cholestasis after prolongedTPN, and the therapeutic efficacy was observed.Results: Bile flow was obviously decreased and theserum levels of total bile acid and gamma-glutamyltranspeptidase(γ-GT) were markedly increased in thehypercalorie and sepsis groups. Meanwhile, hepatocytefatty degeneration, dilatation of cholangioles, and bilesludge could be seen microscopically. SAMe adminis-tration in the hypercalorie+SAMe and sepsis+SAMegroups could increase the bile flow, decrease theserum levels of total bile acid and γ-GT, reduce thepathological damage to the liver, and clear the bilesludge in the cholangioles. Cholestasis and abnormalliver function were the main manifestations of the 16patients before SAMe administration. After SAMe treat-ment for 3 weeks, serum levels of total bilirubin, al-kaline phosphatase(AKP), γ-GT, alanine aminotrans-ferase(ALT), and aspartate aminotransferase(AST)were obviously decreased, and normalized in the 4thweek.Conclusion: SAMe could prevent and treat cholestasiswithout discontinuation of TPN.
文摘Objective: The efficacy of Ji Desheng snake pills combined with hypertonic glucose external application in treating drug-induced superficial phlebitis caused by parenteral nutrition (PN) is observed. Methods: Fifty-two cases of drug-induced superficial phlebitis after peripheral parenteral nutrition (PPN) were selected, which were randomly divided into experimental group and control group in accordance with the phlebitis grading. In the experimental group, Ji Desheng snake pills were crushed to make a paste with 50% glucose solution, which was then applied to the affected area of phlebitis, the surface was covered with clean gauze, and properly fixed with tape or bandage. The drug was replaced once a day. In the control group, the gauze soaked with 50% magnesium sulfate solution was used, which was applied to the affected part three times a day in wet, and the efficacy was observed respectively on the 1st, 3rd, 5th and 7th days after applying the drug. Results: On the 1st and 3rd days after treatment, the observed effective rate of the experimental group was higher than that of the control group (42.31% vs. 15.38% and 76.92% vs. 46.15%, respectively). The difference was statistically significant (p th and 7th days after treatment, there was no statistical significance with respect to the efficacy between the experimental group and the control group (p > 0.05). Conclusion: The significant efficacy could be found in early stage after drug-induced superficial phlebitis was treated by Ji Desheng snake pills combined with hypertonic glucose external application, which was superior to that of the traditional treatment of wet application by using gauze soaked in 50% magnesium sulfate solution.
文摘AIM To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease. METHODS A retrospective chart review of 49 premature infants on parenteral nutrition for > 30 d who received packed red blood cell(PRBC) transfusions was performed. Parenteral nutrition associated liver disease was primarily defined by direct bilirubin(db) > 2.0 mg/dL. A high transfusion cohort was defined as receiving > 75 mL packed red blood cells(the median value). KaplanMeier plots estimated the median volume of packedred blood cells received in order to develop parenteral nutrition associated liver disease.RESULTS Parenteral nutritional associated liver disease(PNALD) was noted in 21(43%) infants based on db. Among the 27 high transfusion infants, PNALD was present in 17(64%) based on elevated direct bilirubin which was significantly greater than the low transfusion recipients. About 50% of the infants, who were transfused 101-125 mL packed red blood cells, developed PNALD based on elevation of direct bilirubin. All infants who were transfused more than 200 mL of packed red blood cells developed PNALD. Similar results were seen when using elevation of aspartate transaminase or alanine transaminase to define PNALD.CONCLUSION In this retrospective, pilot study there was a statistically significant correlation between the volume of PRBC transfusions received by premature infants and the development of PNALD.
文摘Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity, mortality and prolonged hospitalization in pediatric patients with home parenteral nutrition (HPN). In recent years, new prophylactic and treatment options have been evaluated to reduce the incidence of CRIs and infection related catheter removals. In children, two retrospective studies have shown the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs in pediatric oncology patients. However, prospective data are missing. Our aim of the present study was to evaluate prospectively the effect of ELT on the cure and recurrence rate of CRIs, duration of hospitalization and antibiotic use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included and randomised to ELT or standard flushing treatment (heparin or taurolidine). The primary outcomes were persistence and recurrence of the bacteraemia and Central Venous Access Device (CVAD) removal. Secondary outcomes included duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing 14 suspected CRI were analysed. Seven patients had proven CRIs by positive blood cultures. Four were treated with ELT and three with their standard flushing treatment. One CRI persisted in the control group. In one single patient, bacteraemia recurred three times within 24 weeks. This patient had been enrolled in both study arms. A CVAD removal was needed in one patient because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate or recurrences of CRIs compared to standard therapy in HPN treated children. There were also no differences in duration of hospitalization, the use of antibiotics or CVAD removal between both groups.
文摘The compounding of total parenteral nutrition solutions (TPN) in the hospital pharmacy is a high-risk activity for which a quality assurance programme is necessary. The complexity of parenteral nutrition solutions containing almost 50 ingredients makes it difficult to measure each of them. On the other hand, the assay of electrolytes such as sodium and potassium is accepted as a quality marker for estimating compounding errors. Thus, the aim of this study was to estimate the influence of ingredients on the accuracy of assays of electrolytes. Experiments were performed with aqueous working simulated solutions of sodium and potassium prepared by the addition of each nutrient step by step, (dextrose, amino acids, lipids, vitamins and trace elements). Sodium and potassium levels were measured by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS) and Atomic Emission Spectroscopy (ICP-AES). The performance of these methods was compared using statistical evaluations (t-test and Mann–Whitney test).The study highlights the interference of amino acids, vitamins and trace elements when measuring sodium, but no interference was noted during the measurement of potassium. To reduce the risk and to improve the quality of compounding, we used an automated compounding device but, even in this case, the acceptance criterion for sodium and potassium determination was not <10%.
文摘With the wide application of parental nutrition(PN) and central venous catheter(CVC) to tumor patients, the relative infection led by CVC has become a common and troublesome hospital infection in clinics. During infusion, PN fluid forms a high-sugar and high-fat micro-environment around CVC, facilitating the adhesion, growth, and diffusion of pathogenic bacteria. This condition forms a bacterial biofilm(BF) consisting of one or several kinds of pathogenic bacteria. Upon formation of the film, pathogens in the BF can resist anti-bacterial drugs and immune cells, causing repeated infections of bacteria or fungi and endangering the lives of patients. In this paper, we summarize the applications of PN, characteristics of CVC infection in tumor patients, mixed BF, and related research methods to provide reference for studies of mixed BF infection of CVC.
文摘Objective:To explore the effect of enteral and parenteral nutritional diet intervention on recovery, nutritional status and immune function for gastric cancer patients after radical gastrectomy.Methods:A total of 180 patients with gastric cancer treated in our hospital from January 2016 to December 2017 were selected, and randomly divided into the control group and the observation group by computer, each with 90 cases. Control group received parenteral nutrition intervention, and observation group received enteral and parenteral nutritional diet intervention. Cellular immune function, humoral immune function, nutritional status, and complications occurrence rate were compared between two groups.Results: The levels of cellular immune function between the two groups had no difference before intervention (P>0.05). After intervention, the observation group had higher levels of CD3+, CD4+, and CD4+/CD8+ as well as lower level of CD8+ than those of control group (P<0.05). The IgM, IgA, and IgG levels between the two groups had no difference before treatment (P>0.05), which were decreased after treatment (P<0.05), and were lower in the observation group than those in the control group (P<0.05). The albumin and prealbumin levels between the two groups had no difference before intervention (P>0.05), which were increased after treatment, and were higher in observation group than those in the control group (P<0.05). The incidence of complications in the observation group was significantly lower than that in the control group (P<0.05).Conclusion:The application of enteral and parenteral nutritional diet intervention can promote the recovery, improve the nutritional status and immune function for gastric cancer patients after radical gastrectomy, which has fewer complications.
文摘Standard parenteral nutrition solutions are mixtures comprising interacting components that may degrade themselves over time. The objective of this study was to investigate the physicochemical and microbiological stability of a hospital preparation for parenteral nutrition in neonatology. The analyses were performed throughout the storage of the preparations at 2–8 °C(up to 4 months). The extent of stability was based on the determination of amino acids dosage, visual and physicochemical properties(glucose and electrolytes concentrations, pH and osmolality measurements, particle counting) and microbiological analysis(sterility test). A thermal degradation of ascorbic acid was conducted to evaluate the antioxidant properties of the parenteral mixture. Physicochemical and microbiological controls were found to comply with the specifications. Amino acids showed a good stability throughout the 4 months storage except for cysteine, which was progressively degraded to cystine, conferring a yellow coloration to parenteral solutions. Parenteral nutrition standards solutions remain stable for 4 months at 2–8 °C,ensuring safe administration in preterm infants.
文摘BACKGROUND Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with immense socio-economic burden. One treatment aspect is parenteral antiinfective therapy, which usually requires an inpatient setting [Inpatient parenteral antibiotic therapy (IPAT)]. An alternative is outpatient parenteral treatment [Outpatient parenteral antibiotic therapy (OPAT)]. To conduct a health economic cost-benefit analysis of OPAT, a detailed cost analysis of IPAT and OPAT is required. So far, there is a lack of knowledge on the health economic effects of IPAT and OPAT for PPJI. AIM To review an economic comparison of IPAT and OPAT. METHODS A systematic literature review was performed through Medline following the PRISMA guidelines. RESULTS Of 619 identified studies, 174 included information of interest and 21 studies were included for quantitative analysis of OPAT and IPAT costs. Except for one study, all showed relevant cost savings for OPAT compared to IPAT. Costs for IPAT were between 1.10 to 17.34 times higher than those for OPAT. CONCLUSION There are only few reports on OPAT for PPJI. Detailed analyses to support economic or clinical guidelines are therefore limited. There is good clinical evidence supporting economic benefits of OPAT, but more high quality studies are needed for PPJI.
