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Microbial contamination of continuous drip feedings
C P Freedland1, R D Roller, B M Wolfe
1Department of Nutrition, University of California Davis Medical Center, Sacramento 95817.
Abstract:
We evaluated the extent and effects of bacterial contamination of an open continuous enteral feeding system. Eighty-two quantitative enteral feeding cultures and clinical data were obtained during 8 days of observation on each of 33 patients. Cultures of appropriate sites were obtained on febrile patients and compared to the enteral feeding culture. Gram negative bacilli (GNB) in the enteral feeding correlated with abdominal distension in the patients (10 of 12 patients with GNB compared to 5 of 21 without GNB; p less than 0.01). Nine of the 10 patients with GNB and distension were receiving systemic antimicrobics to which the organism was resistant. Contamination of feeding with Serratia marcescens correlated with cultures for the same organism in patients' other body sites (p less than 0.01). The feeding contaminant may have been the source of sepsis in one patient who expired from septic shock. No relationship was demonstrated between contamination and liquid stools or fever. Undiluted, canned feedings were significantly less contaminated at 24 hr (15%) than those requiring mixing of powder (94%) (p less than 0.0001). The canned feedings grew primarily enteric organisms, whereas the powder feedings grew flora typically resident on the skin. Mixing or diluting feedings appears to represent an increased risk of contamination. Growth of GNB may produce adverse effects. Further investigation into methods to limit contamination and growth is warranted.
Insights
Bacterial contamination in enteral feeding systems is common, especially with powdered formulas. Gram-negative bacilli in feeding correlate with abdominal distension, potentially leading to serious infections.
Area of Science:
- Microbiology
- Clinical Nutrition
- Infectious Diseases
Background:
- Open continuous enteral feeding systems are crucial for nutritional support.
- Bacterial contamination of these systems is a potential risk for patient safety.
Purpose of the Study:
- To assess the prevalence and clinical impact of bacterial contamination in enteral feeding systems.
- To identify factors influencing contamination levels and types.
Main Methods:
- Quantitative cultures of enteral feeding systems over 8 days for 33 patients.
- Clinical data collection, including abdominal distension, fever, and stool consistency.
- Comparison of feeding cultures with cultures from other body sites in febrile patients.
Main Results:
- Powdered formula feedings showed significantly higher contamination rates (94%) compared to canned formulas (15%).
- Gram-negative bacilli (GNB) in feeding correlated with abdominal distension (p<0.01).
- Serratia marcescens contamination in feeding linked to patient's body site cultures (p<0.01), with one sepsis case suspected.
Conclusions:
- Mixing or diluting enteral formulas increases contamination risk.
- GNB in feeding may cause adverse effects like abdominal distension.
- Further research is needed to develop strategies for reducing contamination in enteral feeding systems.