Current Tropical Medicine Reports

, Volume 4, Issue 3, pp 172–177 | Cite as

Fungemia Related to Parenteral Nutrition

  • Cecilia Quesada
  • Jorge Aceituno
  • Ronaldo Suárez
  • Celso Mazariegos
Nutrition (K Schlosser Montes, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Nutrition


Purpose of Review

Lipid emulsions in parenteral nutrition are commonly associated with fungal infections, and this assumption may cause parenteral nutrition administration to be discontinued in patients who are benefiting from it. Our purpose was to describe the multiple factors associated to fungemia in patients with parenteral nutrition and to describe the management of this condition. So, it is of utmost importance to review current information in order to be able to either recommend or suspend lipid emulsion in patients with infection risk.

Recent Findings

The theory that lipid emulsions in parenteral nutrition are associated with fungal infections is weak and other factors need to be considered when suggesting recommendations for the duration of parenteral nutrition or lipid emulsion administration.


We review current information about fungemia in parenteral nutrition. We review epidemiology, etiology, risk factors associated with fungemia, and topics of interest such as the relationship between lipids in parenteral nutrition and infection.


Fungaemia Parenteral nutrition Lipids Candida Intensive care 


Compliance with Ethical Standards

Conflict of Interest

Cecilia Quesada, Jorge Aceituno, Ronaldo Suárez, and Celso Mazariegos each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Luzzati R, Cavinato S, Giangreco M, Granà G, Centonze S, Deiana ML, et al. Peripheral and total parenteral nutrition as the strongest risk factors for nosocomial candidemia in elderly patients: a matched case-control study. Mycoses. 2013;56(6):664–71.CrossRefPubMedGoogle Scholar
  2. 2.
    Chow JK, Golan Y, Ruthazer R, Karchmer AW, Carmeli Y, Lichtenberg D, et al. Factors associated with candidemia caused by non-albicans Candida species versus Candida albicans in the intensive care unit. Clin Infect Dis [Internet]. 2008;46(8):1206–1213. Available from: doi: 10.1086/529435.CrossRefGoogle Scholar
  3. 3.
    Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag. 2014;10:95–105.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Cuerda C, Parón L. DOMICILIARIA. :30–5.Google Scholar
  5. 5.
    • Muskett H, Shahin J, Eyres G, Harvey S, Rowan K, Harrison D. Risk factors for invasive fungal disease in critically ill adult patients: a systematic review. Crit Care [Internet]. 2011;15(6):R287. Available from: doi: 10.1186/cc10574. It is a systematic review performed to identify articles that investigated risk factors, risk prediction models or clinical decisions rules for invasive fungal disease in critically ill adults patients.
  6. 6.
    Yang S-P, Chen Y-Y, Hsu H-S, Wang F-D, Chen L, Fung C-P. A risk factor analysis of healthcare-associated fungal infections in an intensive care unit: a retrospective cohort study. BMC Infect Dis [Internet]. 2013;13(1):10. Available from: doi: 10.1186/1471-2334-13-10.CrossRefGoogle Scholar
  7. 7.
    • Ferrer C, Almirante B. Infecciones relacionadas con el uso de los cateteres vasculares. Enferm Infecc Microbiol Clin. 2014;32(2):115–24. Reviews the epidemiology, diagnosis, therapeutic and preventive aspects of the venous catheter-related infections.Google Scholar
  8. 8.
    Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G. Invasive fungal infections in the ICU: how to approach, how to treat. Molecules. 2014;19(1):1085–119.CrossRefPubMedGoogle Scholar
  9. 9.
    • Staun M, Pironi L, Bozzetti F, Baxter J, Forbes A, Joly F, et al. ESPEN guidelines on parenteral nutrition: home parenteral nutrition (HPN) in adult patients. Clin Nutr. 2009;28(4):467–79. This article shows guidelines that highlight areas of good practice and promote the use of standardized treatment protocols for the management of Home Parenteral Nutrition in adult patients. Google Scholar
  10. 10.
    Kuwahara T, Shimono K, Kaneda S, Tamura T, Ichihara M, Nakashima Y. Growth of microorganisms in total parenteral nutrition solutions containing lipid. Int J Med Sci. 2010;7(3):101–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bajwa S, Kulshrestha A. Fungal infections in intensive care unit: challenges in diagnosis and management. Ann Med Health Sci Res [Internet]. 2013;3(2):238. Available from: CrossRefGoogle Scholar
  12. 12.
    Warren M, McCarthy MS, Roberts PR. Practical application of the revised guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. Nutr Clin Pract [Internet]. 2016;31(3):334–341. Available from: doi: 10.1177/0884533616640451.CrossRefPubMedGoogle Scholar
  13. 13.
    Worthington P, Balint J, Bechtold M, Bingham A, Chan L-N, Durfee S, et al. When Is Parenteral Nutrition Appropriate? J Parenter Enter Nutr [Internet]. 2017;14860711769525. Available from: doi: 10.1177/0148607117695251.
  14. 14.
    •• Austin PD, Hand KS, Elia M. Systematic review and meta-analyses of the effect of lipid emulsion on microbial growth in parenteral nutrition. J Hosp Infect [Internet]. 2016;94(4):307–19. Available from: Meta-analyses that reviews the effect of adding a lipid emulsion to a parenteral nutrition mixture and microbial growth, it concludes that these two factors have no relation.
  15. 15.
    McCleary EJ, Tajchman S. Parenteral nutrition and infection risk in the intensive care unit. Nutr Clin Pract [Internet]. 2016;31(4):476–489. Available from: doi: 10.1177/0884533616653808.CrossRefGoogle Scholar
  16. 16.
    •• Sriram K, Meguid MM. Addition of lipids to parenteral nutrition does not cause fungal infections. Nutrition [Internet]. 2015;31(11–12):1443–6. doi: 10.1016/j.nut.2015.05.010. Review article that illustrates how adding lipids to parenteral nutrition does not increase risk of fungal infections.
  17. 17.
    O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control [Internet]. 2002;30(8):476–89. doi: 10.1016/j.ajic.2011.01.003.CrossRefGoogle Scholar
  18. 18.
    Aj U. Cochrane Database of Systematic Reviews Optimal timing for intravascular administration set replacement (Review) Optimal timing for intravascular administration set replacement (Review). 2013;(9). Available from:
  19. 19.
    Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, et al. ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr [Internet]. 2009;28(4):387–400. doi: 10.1016/j.clnu.2009.04.024.CrossRefGoogle Scholar
  20. 20.
    Pontes-Arruda A, dos Santos MCFC, Martins LF, Gonzalez ERR, Kliger RG, Maia M, et al. Influence of parenteral nutrition delivery system on the development of bloodstream infections in critically ill patients: an international, multicenter, prospective, open-label, controlled study—EPICOS study. J Parenter Enter Nutr [Internet]. 2012;36(5):574–86. doi: 10.1177/0148607111427040.CrossRefGoogle Scholar
  21. 21.
    Boisramé-Helms J, Toti F, Hasselmann M, Meziani F. Lipid emulsions for parenteral nutrition in critical illness. Prog Lipid Res. 2015;60:1–16. doi: 10.1016/j.plipres.2015.08.002.CrossRefPubMedGoogle Scholar
  22. 22.
    Fell GL, Nandivada P, Gura KM, Puder M. Intravenous lipid emulsions in parenteral nutrition. Adv Nutr. 2015;6:600–10.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Szlagatys-Sidorkiewicz A, Borkowska A, Jankowska A, Sroka M, Zagierski M, Gosk A, et al. Reorganization of nutritional therapy can markedly reduce the rate of catheter-related blood stream infections in pediatric patients receiving parenteral nutrition—a 7-year prospective follow-up study. Nutr Hosp. 2014;31(3):1116–21.PubMedGoogle Scholar
  24. 24.
    • Berdal JE, Haagensen R, Ranheim T, Bjørnholt JV. Nosocomial candidemia; risk factors and prognosis revisited; 11 years experience from a Norwegian secondary hospital. PLoS One. 2014;9(7):5–10. This article reviews the epidemiology and prognosis of candidemia in a secondary hospital, and examines the intra-hospital distribution of candidemia patients.Google Scholar
  25. 25.
    Bajwa SS, Kaur G. Nutritional concerns in critically ill burn patients. J Med Nutr Nutraceuticals. 2015;4(2):70. Available from: CrossRefGoogle Scholar
  26. 26.
    • de Rosa FG, Corcione S, Montrucchio G, Brazzi L, di Perri G. Appropriate treatment of invasive candidiasis in ICU: timing, colonization index, Candida score & biomarkers, towards de-escalation? Turk Anesteziyoloji ve Reanimasyon Dern Derg. 2016;44(6):279–82. This article summarizes the appropriate management for the candidiasis in the Intensive Care Unit.Google Scholar
  27. 27.
    Guducuoglu H, Gultepe B, Otlu B, Bektas A, Yildirim O, Tuncer O, et al. Candida albicans outbreak associated with total parenteral nutrition in the neonatal unit. Indian J Med Microbiol. 2016;34(2):202. Available from: CrossRefPubMedGoogle Scholar
  28. 28.
    León C, Ruiz-Santana S, Saavedra P, Castro C, Loza A, Zakariya I, et al. Contribution of Candida biomarkers and DNA detection for the diagnosis of invasive candidiasis in ICU patients with severe abdominal conditions. Crit Care. 2016;20(1):149. Available from: doi: 10.1186/s13054-016-1324-3.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    •• Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2015;62(4):e1–50. These are the 2016 revised recommendations for the management of candidiasis, proposed by the Infectious Diseases Society of America.Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Cecilia Quesada
    • 1
  • Jorge Aceituno
    • 2
  • Ronaldo Suárez
    • 2
  • Celso Mazariegos
    • 2
  1. 1.School of NutritionFrancisco Marroquin UniversityGuatemala CityGuatemala
  2. 2.Department of Internal MedicineHospital General San Juan de DiosGuatemala CityGuatemala

Personalised recommendations