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Contaminated enteral nutrition solutions as a cause of nosocomial bloodstream infection: a study using plasmid
J Levy1, Y Van Laethem, G Verhaegen
1Department of Pediatrics, Hôpital-Saint Pierre, Free University, Brussels, Belgium.
Abstract:
In July 1984, two patients fed enteral nutrition solutions contaminated with Enterobacter cloacae developed nosocomial bacteremia. Despite careful review of the preparation procedures as well as repeated microbiological surveys, 83 (27%) of the 309 formula bottles tested over a 1-yr period were contaminated and the source of contamination remained unknown. E. cloacae was the most frequent organism isolated (34%). The plasmid profiles of E. cloacae recovered from enteral nutrition solutions remained identical for several months. Blood culture isolates from 10 of the 40 patients who had developed E. cloacae nosocomial sepsis over a 7-yr period (1979-1985) had plasmid profiles linking them to contaminated enteral nutrition solutions. Epidemiological data from a case control study revealed that these 10 patients were indeed more likely to be exposed to enteral nutrition than the 30 others: 9/10 vs 10/30 (odds ratio 18, p = 0.002). Similarly, two of seven nosocomial Klebsiella pneumoniae bacteremias over a 6-month period in 1986 could be ascribed to administration of contaminated enteral liquid feeds prompting a general policy for using sterile commercially prepared solutions. Our results suggest that contaminated enteral nutrition solutions represent a significant cause of nosocomial sepsis.
Insights
Contaminated enteral nutrition solutions frequently caused hospital-acquired infections, specifically Enterobacter cloacae bacteremia. This study linked contaminated feeding formulas to serious sepsis cases, highlighting the need for sterile commercial solutions.
Area of Science:
- Infectious Diseases
- Microbiology
- Hospital Epidemiology
Background:
- Nosocomial infections pose a significant threat in healthcare settings.
- Enteral nutrition is crucial for patient recovery but can be a source of infection.
- Previous outbreaks linked to contaminated medical products underscore the importance of microbial surveillance.
Purpose of the Study:
- To investigate the source and impact of Enterobacter cloacae contamination in enteral nutrition solutions.
- To determine the association between contaminated enteral feeds and nosocomial sepsis.
- To evaluate the effectiveness of interventions in reducing infection rates.
Main Methods:
- Microbiological analysis of enteral nutrition formula bottles over a one-year period.
- Plasmid profiling of Enterobacter cloacae isolates from solutions and patient blood cultures.
- Case-control study to assess the epidemiological link between enteral nutrition exposure and sepsis.
- Analysis of Klebsiella pneumoniae bacteremias linked to enteral feeds.
Main Results:
- 27% of 309 formula bottles were contaminated, with Enterobacter cloacae being the most frequent isolate (34%).
- Plasmid profiles confirmed a link between E. cloacae in solutions and patient sepsis over a 7-year period.
- Patients exposed to enteral nutrition had a significantly higher risk of developing E. cloacae sepsis (odds ratio 18).
- Two Klebsiella pneumoniae bacteremias were also attributed to contaminated enteral feeds.
Conclusions:
- Contaminated enteral nutrition solutions are a significant source of nosocomial sepsis.
- Implementing a policy for sterile, commercially prepared solutions is crucial for patient safety.
- Enhanced microbial surveillance and strict preparation protocols are essential to prevent such outbreaks.