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Microorganisms and diarrhea in enterally fed intensive care unit patients
D C Belknap1, L J Davidson, D J Flournoy
1University of Oklahoma College of Nursing, Oklahoma City 73190.
Abstract:
Thirty-six intensive care unit patients, receiving aseptic or manually (routine) reconstituted enteral feeding formulas, were evaluated prospectively for the relationship of microbial involvement, gastric pH, and antimicrobial therapy to diarrhea. The routine protocol group had a significantly higher incidence of bacterial contamination than the aseptic protocol group (Fisher's exact test, p less than 0.05). There were no significant direct associations between isolate category (Gram-negative bacilli, Gram-positive cocci, Gram-negative cocci, yeast), gastric pH, or antimicrobials and diarrhea. However, two organisms (Group D Enterococci and yeast) were indirectly implicated in some cases of diarrhea.
Insights
Routine enteral feeding formulas showed higher bacterial contamination than aseptic methods. While direct links to diarrhea were not found, certain microbes like Group D Enterococci and yeast were indirectly implicated in some cases.
Area of Science:
- Critical Care Medicine
- Microbiology
- Gastroenterology
Background:
- Enteral feeding is crucial for intensive care unit (ICU) patients.
- Microbial contamination of enteral formulas is a potential concern.
- Diarrhea is a common complication in ICU patients, impacting outcomes.
Purpose of the Study:
- To investigate the relationship between microbial contamination of enteral formulas, gastric pH, antimicrobial therapy, and the incidence of diarrhea in ICU patients.
- To compare bacterial contamination rates between aseptic and routine (manual) reconstitution protocols for enteral feeding formulas.
Main Methods:
- Prospective evaluation of 36 ICU patients.
- Comparison of aseptic versus routine enteral formula reconstitution.
- Assessment of microbial contamination, gastric pH, and antimicrobial use.
- Correlation analysis with diarrhea incidence.
Main Results:
- The routine reconstitution protocol group exhibited a significantly higher incidence of bacterial contamination compared to the aseptic protocol group (p < 0.05).
- No significant direct associations were found between the category of microbial isolates (Gram-negative bacilli, Gram-positive cocci, Gram-negative cocci, yeast), gastric pH, or antimicrobial therapy and the occurrence of diarrhea.
- Group D Enterococci and yeast were indirectly implicated in a subset of diarrhea cases.
Conclusions:
- Manual reconstitution of enteral formulas leads to increased bacterial contamination compared to aseptic methods.
- While direct causative links were not established, specific microorganisms may play an indirect role in ICU-acquired diarrhea.
- Further research is warranted to elucidate the complex interplay between enteral feeding practices, microbial factors, and gastrointestinal complications in critically ill patients.