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Contaminated Enteral Nutrition Solutions as a Cause of Nosocomial Bloodstream Infection: A Study Using Plasmid Fingerprinting
Jack Levy, M.D.
Department of Pediatrics, Hôpital-Saint Pierre, Free University of Brussels, Belgium, Department of Microbiology, Hôpital-Saint Pierre, Free University of Brussels, Belgium
Yves Van Laethem, M.D.
Department of Internal Medicine, Hôpital-Saint Pierre, Free University of Brussels, Belgium
Godelieve Verhaegen
Department of Microbiology, Hôpital-Saint Pierre, Free University of Brussels, Belgium
Chantal Perpête
Department of Hospital Infection Control, Hôpital-Saint Pierre, Free University of Brussels, Belgium
Jean-Paul Butzler
Department of Microbiology, Hôpital-Saint Pierre, Free University of Brussels, Belgium
Richard P. Wenzel
Division of Clinical Epidemiology, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
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)
Journal of Parenteral and Enteral Nutrition, Vol. 13, No. 3,
228-234 (1989)
DOI: 10.1177/0148607189013003228
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