The success of enteral nutrition and ICU-acquired infections: a multicenter observational study

Clin Nutr. 2011 Apr;30(2):148-55. doi: 10.1016/j.clnu.2010.09.011. Epub 2010 Oct 25.


Background and aims: The objective of this study was to evaluate the relationship between increasing success with enteral nutrition (EN) and acquired infection in the Intensive Care Unit (ICU).

Methods: We conducted a prospective, multicenter, observational study in 3 Medical/Surgical ICUs. We included patients mechanically ventilated in ICU more than 72 h and who received enteral nutrition only. Charts were reviewed to determine success with EN delivery and clinical outcomes. Suspected infections were adjudicated by 2 or more clinicians to determine the presence or absence of infection (rated as either probable or possible infection).

Results: Of the 207 patients included in this analysis, the average age was 62.0 years; APACHE II score was 23.3; BMI: 28.5; and 73% were medical. Overall, patients received 48.9% (range 0-120%) of their energy and 45.1% (range 0-120%) of their protein requirements from EN. Overall, 25.1% developed an infection after 72 h from admission, 21.7% developed an infection after 96 h from admission, and the 28-day mortality was 29.0%. In a regression model, greater amounts of energy and protein were consistently associated with a reduction in infection. However, estimates only achieved levels near statistical significance for risk of at least 1 probable infection after >96 h (Odds Ratio [0R]: 0.32, 95% Confidence Interval [CI]: 0.10-1.02, p=0.054 and OR: 0.40, 95% CI: 0.18-0.89, p=0.024 per 1000 kcal/day energy and 30 grams/day protein, respectively). In all cases, the OR was lower when considering infections that developed after 96 h compared to infections that developed after 72 h and when considering 'Probable' infections compared to all infections which included 'Possible' infections.

Conclusions: Successful EN may be associated with a reduction in infectious complications, particularly after 96 h of ICU admission.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Analysis of Variance
  • Confidence Intervals
  • Cross Infection / epidemiology
  • Cross Infection / therapy*
  • Energy Intake
  • Enteral Nutrition / methods*
  • Female
  • Hospital Mortality
  • Humans
  • Infections / therapy*
  • Intensive Care Units / statistics & numerical data*
  • Length of Stay
  • Male
  • Middle Aged
  • Odds Ratio
  • Prospective Studies
  • Regression Analysis
  • Respiration, Artificial
  • Treatment Outcome