M.W.J. Versleijen

Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: a heparin-controlled prospective trial.

BACKGROUND & AIMS Catheter-related bloodstream infections remain the major threat for Home Parenteral Nutrition programs. Taurolidine, a potent antimicrobial agent, holds promise as an effective catheter lock to prevent such infections. Aim of the present study was to compare taurolidine with heparin, the most frequently used lock, in this respect in these high-risk patients. METHODS Thirty patients from one referral centre for intestinal failure were enrolled after developing a catheter-related bloodstream infection. Following adequate treatment, either with or without a new access device (tunneled catheter or subcutaneous port), these patients were randomized to continue Home Parenteral Nutrition using heparin (n = 14) or taurolidine (n = 16) as catheter lock. RESULTS Whereas in controls 10 re-infections were observed, in the taurolidine group during 5370 catheter days only 1 re-infection occurred (mean infection-free survival 175 (95% CI 85-266; heparin) versus 641 (95% CI 556-727; taurolidine) days; log-rank p < 0.0001). No side effects or catheter occlusions were reported in either group. Moreover, after crossing-over of 10 patients with infections on heparin to taurolidine, only 1 new infection was observed. CONCLUSION Taurolidine lock dramatically decreased catheter-related bloodstream infections when compared with heparin in this high-risk group of Home Parenteral Nutrition patients.

Short-term infusion of a fish oil-based lipid emulsion modulates fatty acid status, but not immune function or (anti)oxidant balance: a randomized cross-over study.

Eur J Clin Invest 2012; 42 (3): 290–302

Psychosocial Complaints Are Associated With Venous Access–Device Related Complications in Patients on Home Parenteral Nutrition

BACKGROUND Complications related to venous access devices (VADs) remain the major drawback of home parenteral nutrition (HPN) support. In addition to technical issues, patients also experience psychosocial problems. The aim of this study is to present an overview of VAD-related complications in patients on long-term HPN and to assess whether these adversities are related to experienced psychosocial problems and quality of life (QOL). METHODS Information on VAD-related complications was collected from the medical charts of 110 adult HPN patients who were followed by the 2 major referral centers in the Netherlands. In addition, a survey was conducted in this group to characterize psychosocial problems and assess their association with technique-related complications; 75 patients (68%) responded. RESULTS At the time of survey, the majority of patients (76%) had developed 1 or more episodes of catheter-related sepsis at some point during their HPN treatment. The overall incidence of VAD-related blood stream infections (BSIs) was 3 per 1,000 venous access days. The incidence of VAD occlusions was 0.8 per 1,000 venous access days. During the observation period, there was a highly significant association between the incidence of VAD-related complications and the occurrence of psychosocial complaints (eg, depression, fatigue, social impairment, and decreased QOL). CONCLUSIONS Psychosocial complaints are associated with previously experienced VAD-related complications in patients on HPN therapy. Although only an association, and not a causal relationship is demonstrated by these findings, our results underscore the need for preventive and therapeutic measures regarding both types of problems in these patients.

Parenteral lipids impair pneumococcal elimination by human neutrophils.

Eur J Clin Invest 2010; 40 (8): 729–734

Parenteral medium-chain triglyceride-induced neutrophil activation is not mediated by a Pertussis Toxin sensitive receptor.

BACKGROUND & AIMS Lipid-induced immune modulation might contribute to the increased infection rate that is observed in patients using parenteral nutrition. We previously showed that emulsions containing medium-chain triglycerides (LCT/MCTs or pure MCTs), but not pure long-chain triglycerides (LCTs), impair neutrophil functions, modulate cell-signaling and induce neutrophil activation in vitro. It has recently been shown that medium-chain fatty acids are ligands for GPR84, a pertussis toxin (PT)-sensitive G-protein-coupled receptor (GPCR). This finding urged us to investigate whether MCT-induced neutrophil activation is mediated by PT-sensitive GPCRs. METHODS Neutrophils isolated from blood of healthy volunteers were pre-incubated with PT (0.5-1 microg/mL, 1.5 h) and analyzed for the effect of this pre-incubation on LCT/MCT (2.5 mmol/L)-dependent modulation of serum-treated zymosan (STZ)-induced intracellular Ca(2+) mobilization and on LCT/MCT (5 mmol/L)-induced expression of cell surface adhesion (CD11b) and degranulation (CD66b) markers and oxygen radical (ROS) production. RESULTS PT did not inhibit the effects of LCT/MCT on the STZ-induced increase in cytosolic free Ca(2+) concentration. LCT/MCT increased ROS production to 146% of unstimulated cells. However, pre-incubation with PT did not inhibit the LCT/MCT-induced ROS production. Furthermore, the LCT/MCT-induced increase in CD11b and CD66b expression (196% and 235% of unstimulated cells, respectively) was not inhibited by pre-incubation with PT. CONCLUSION LCT/MCT-induced neutrophil activation does not involve the action of a PT-sensitive G-protein-coupled receptor.

Long-term olive oil-based parenteral nutrition sustains innate immune function in home patients without active underlying disease.

BACKGROUND & AIMS It remains unclear whether impaired host defenses contribute to the increased risk for infectious complications seen in patients on home parenteral nutrition (HPN). The aim of this study was to compare the innate immune function of patients on olive oil-based HPN with that of healthy controls. METHODS Innate immune functions and (anti-)oxidant balance were studied in 20 patients on olive oil-based HPN without an active underlying immune-mediated disease (Clinoleic(®), ≥ 6 months; >3 times/week), and 21 age- and sex-matched healthy controls. RESULTS Neutrophils of patients and controls had a similar capacity to eliminate Streptococcus pneumoniae. Also, levels of activation markers (CD66b, CD11b, CD62L) in granulocytes and monocytes, phorbol ester- and zymosan-induced neutrophil oxygen radical production were not different between patients and controls. No differences in (anti-)oxidant status were found, except for higher concentrations of oxidized glutathione and lower plasma selenium and vitamin C in patients compared to controls. CONCLUSION Compromised innate immune function does not seem to explain the increased risk for infectious complications in HPN patients using olive oil-based lipid emulsions.

PP048-MON IMMUNE FUNCTION OF PATIENTS ON OLIVE OIL-BASED HOME PARENTERAL NUTRITION WITHOUT AN IMMUNE MODULATING UNDERLYING DISEASE

PP048-MON IMMUNE FUNCTION OF PATIENTS ON OLIVE OILBASED HOME PARENTERAL NUTRITION WITHOUT AN IMMUNE MODULATING UNDERLYING DISEASE E.D. Olthof1, H.M. Roelofs1, M.W. Versleijen1, R.H. te Morsche1, E.R. Simonetti2, P.W. Hermans2, G.J. Wanten1. 1Department of Gastroenterology and Hepatology, 2Laboratory of Pediatric Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Rationale: It remains unclear whether the increased risk for infectious complications seen in patients on Home Parenteral Nutrition (HPN) results from impaired host defenses or from the presence of a venous access device. This study therefore compared immune function of patients on olive-oil based HPN and controls. Methods: Venous blood samples from 20 patients on oliveoil based HPN without an immune modulating underlying disease (Clinoleic®, 6 months; >3 times/ week), and 21 matched healthy controls were analyzed. Neutrophil function was assessed by evaluating neutrophil capacity to kill Streptococcus pneumonia, expression of markers for leukocyte adhesion (CD11b), -activation (CD62L) and -degranulation (CD66b) and stimulus induced oxygen radical production. Non-parametric statistical analysis was performed using the Mann-Whitney U test. Results: Neutrophils from HPN patients displayed a similar capacity to kill Streptococcus pneumoniae compared to controls (mean±SEM: 49±5% and 45±5% killing respectively, p = 0.513). Also, levels of CD66b (p = 0.725) in granulocytes and of CD11b and CD62L in granulocytes (p = 0.106 and p = 0.121 respectively) and monocytes (p = 0.958 and p = 0.211 respectively) were not different in patients and controls. Spontaneous, phorbol esterand zymosan-induced oxygen radical production was also not different in whole blood (p = 0.068, p = 0.835 and p = 0.167 respectively) or isolated neutrophils (p = 0.696, p = 0.784 and p = 0.835 respectively) of patients and controls. Conclusion: In conclusion, we found no evidence for the presence of compromised immune functions in patients on olive-oil based home parenteral nutrition without an immune modulating underlying disease to explain the increased susceptibility to infections seen in some of these patients. Disclosure of Interest: E. Olthof: None Declared, H. Roelofs: None Declared, M. Versleijen: None Declared, R. te Morsche: None Declared, E. Simonetti: None Declared, P. Hermans: None Declared, G. Wanten Grant/Research Support from: Baxter Netherlands BV