Microbiological contamination of enteral feeding solutions used in Costa Rican hospitals

Enteral feeding is the most common and preferred modality for providing nutritional support to hospital patients with a functional gastrointestinal tract that can not satisfy their nutritional requirements. Nevertheless, enteral feeding may be an important cause of bacterial infection. The aim of this study was to evaluate the microbial contamination level of enteral feedings distributed in Costa Rican hospitals. A total of 124 samples of enteral feeding, coming from five different hospitals from San José, Costa Rica, were evaluated during the second semester of 1997 and first of 1998 for the presence and identification of total and fecal coliforms, Pseudomonas sp. and Listeria sp. A subpopulation of the Pseudomonas isolated was analyzed for their antibiotic susceptibility patterns. The concentration of Gram negative rods in the samples of enteral feeding solutions ranged from 10(3) to 10(7) CFU/mL, markedly exceeding the permissible level (10(2) CFU/mL or less). The coliforms most frequently isolated included Enterobacter cloacae, Escherichia coil, Serratia sp. and Klebsiella pneumoniae. Pseudomonas sp. was isolated in more than 70% of the samples made from commercial based solutions, fruits and vegetables. P. aeruginosa and P. fluorescens were the species most frequently isolated. Listeria sp. was not isolated from enteral solutions samples. The results obtained demonstrate that it is urgent to assure strict hygiene during the preparation and handling of all enteral feed in order to avoid bacterial growth. The implementation of HACCP (Hazard Analysis and Critical Control Points) system will be required in a near future for better quality control of enteral nutrition mixtures.