Effects of enteral glutamine supplementation on reduction of infection and mortality in adult patients with severe thermal burns in Kenyatta National Hospital: a double blind randomized clinical trial

Abstract

Background: Post burn infection is a major cause of morbidity and mortality in patients with Severe burns in developing countries, Kenya included. Glutamine is a non essential amino acid which has been found to reduce the incidence of burn wound infection and mortality in patients with severe burns. There is no published local prospective data on the positive effects of _mile glutamine supplementation on reduction of postburn infection and mortality in severely burned patients. Objective: This study sought to determine the effect of enteral glutamine in reducing the incidence of postburn infections and mortality in patients with severe burns. Study design: A double blind randomized clinical trial. Setting: Bums unit and ward 4D of Kenyatta National Hospital, Kenya Methods: This was a double blind randomized clinical trial running for a period of 6 months from September 2010 to February 2011, involving 60 patients with severe burns who were randomized to 2 arms of treatment: (1) the glutamine group arm and the (2) isonitrogenous arm acting as the control. The patients randomized to the intervention group received glutamine in fonn of B-immune. 5 g of glutamine was provided every 8 hours to make a total of 15 g every day. Nasogastric tube feedings or patient-assisted feedings of a mixture of B-immune and milk were initiated on day 1 postburns and continued for a period of 28 days. Patients in the control arm received Fresubin Original, which is isonitrogenous to B- immune. Samples for blood cultures and wound surface swab cultures were taken aseptically from each recruited patient on week 1, 2, 3 and 4 respectively. Specimen analysis involved gram staining, culture and biochemical tests in accordance to the standard microbiological procedures.

In this study, a postbum infection was defined as a positive culture obtained on pus swab sample or blood culture. Results: Patients' demographic and baseline clinical chacteristics were similar in both arms of treatment. For the entire 4-week treatment period, the odds ratio of a positive blood culture was almost three-fold higher (2.7 (1.3-5.6) among patients in the control group compared to those in the Glutamine group (p= 0.04). In this particular study, glutamine reduced the incidence of Pseudomonas spp by 3.3-4.5 times. There were no significant differences in the incidence of Staphylococcus aureus in the two groups for the entire treatment period at p<0.05. The odds ratio of death was approximately 6-fold higher in the control group than in the glutamine group . PIIientS receiving glutamine had a statistically significant shorter length of stay compared to Implementation in severely burned adult patienm reduces Pseudomonas aerugirwsa, mortality rate and shortens duration of hospital stay.