Premium
Contaminated Enteral Nutrition Solutions as a Cause of Nosocomial Bloodstream Infection: A Study Using Plasmid Fingerprinting
Author(s) -
Levy Jack,
Van Laethem Yves,
Verhaegen Godelieve,
Perpête Chantal,
Butzler JeanPaul,
Wenzel Richard P.
Publication year - 1989
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607189013003228
Subject(s) - bloodstream infection , enteral administration , parenteral nutrition , medicine , intensive care medicine
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. ( Journal of Parenteral and Enteral Nutrition 13 :228–234, 1989)