Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae

Edward Hurrell, Eva Kucerova, Michael Loughlin, Juncal Caubilla-Barron, Anthony C. Hilton, Richard A. Armstrong, Craig Smith, Judith Grant, Shiu Shoo, Stephen Forsythe

Research output: Contribution to journalArticle

Abstract

Background The objective of this study was to determine whether neonatal nasogastric enteral feeding tubes are colonised by the opportunistic pathogen Cronobacter spp. (Enterobacter sakazakii) and other Enterobacteriaceae, and whether their presence was influenced by the feeding regime. Methods One hundred and twenty-nine tubes were collected from two neonatal intensive care units (NICU). A questionnaire on feeding regime was completed with each sample. Enterobacteriaceae present in the tubes were identified using conventional and molecular methods, and their antibiograms determined. Results The neonates were fed breast milk (16%), fortified breast milk (28%), ready to feed formula (20%), reconstituted powdered infant formula (PIF, 6%), or a mixture of these (21%). Eight percent of tubes were received from neonates who were 'nil by mouth'. Organisms were isolated from 76% of enteral feeding tubes as a biofilm (up to 107 cfu/tube from neonates fed fortified breast milk and reconstituted PIF) and in the residual lumen liquid (up to 107 Enterobacteriaceae cfu/ml, average volume 250 µl). The most common isolates were Enterobacter cancerogenus (41%), Serratia marcescens (36%), E. hormaechei (33%), Escherichia coli (29%), Klebsiella pneumoniae (25%), Raoultella terrigena (10%), and S. liquefaciens (12%). Other organisms isolated included C. sakazakii (2%),Yersinia enterocolitica (1%),Citrobacter freundii (1%), E. vulneris (1%), Pseudomonas fluorescens (1%), and P. luteola (1%). The enteral feeding tubes were in place between < 6 h (22%) to > 48 h (13%). All the S. marcescens isolates from the enteral feeding tubes were resistant to amoxicillin and co-amoxiclav. Of additional importance was that a quarter of E. hormaechei isolates were resistant to the 3rd generation cephalosporins ceftazidime and cefotaxime. During the period of the study, K. pneumoniae and S. marcescens caused infections in the two NICUs. Conclusion This study shows that neonatal enteral feeding tubes, irrespective of feeding regime, act as loci for the bacterial attachment and multiplication of numerous opportunistic pathogens within the Enterobacteriaceae family. Subsequently, these organisms will enter the stomach as a bolus with each feed. Therefore, enteral feeding tubes are an important risk factor to consider with respect to neonatal infections.
LanguageEnglish
Article number1471
JournalBMC Infectious Diseases
Volume9
Issue number146
DOIs
Publication statusPublished - 1 Sep 2009

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Enteral Nutrition
Enterobacteriaceae
Serratia marcescens
Human Milk
Klebsiella pneumoniae
Cronobacter
Cronobacter sakazakii
Citrobacter freundii
Amoxicillin-Potassium Clavulanate Combination
Pseudomonas fluorescens
Enterobacter
Yersinia enterocolitica
Infant Formula
Ceftazidime
Cefotaxime
Neonatal Intensive Care Units
Amoxicillin
Microbial Sensitivity Tests
Cephalosporins
Biofilms

Bibliographical note

© 2009 Hurrell et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords

  • neonatal nasogastric enteral feeding tubes
  • pathogen Cronobacter spp
  • Enterobacter sakazakii
  • Enterobacteriaceae
  • feeding regime
  • neonatal intensive care
  • neonatal infections

Cite this

Hurrell, E., Kucerova, E., Loughlin, M., Caubilla-Barron, J., Hilton, A. C., Armstrong, R. A., ... Forsythe, S. (2009). Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae. BMC Infectious Diseases, 9(146), [1471]. https://doi.org/10.1186/1471-2334-9-146
Hurrell, Edward ; Kucerova, Eva ; Loughlin, Michael ; Caubilla-Barron, Juncal ; Hilton, Anthony C. ; Armstrong, Richard A. ; Smith, Craig ; Grant, Judith ; Shoo, Shiu ; Forsythe, Stephen. / Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae. In: BMC Infectious Diseases. 2009 ; Vol. 9, No. 146.
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abstract = "Background The objective of this study was to determine whether neonatal nasogastric enteral feeding tubes are colonised by the opportunistic pathogen Cronobacter spp. (Enterobacter sakazakii) and other Enterobacteriaceae, and whether their presence was influenced by the feeding regime. Methods One hundred and twenty-nine tubes were collected from two neonatal intensive care units (NICU). A questionnaire on feeding regime was completed with each sample. Enterobacteriaceae present in the tubes were identified using conventional and molecular methods, and their antibiograms determined. Results The neonates were fed breast milk (16{\%}), fortified breast milk (28{\%}), ready to feed formula (20{\%}), reconstituted powdered infant formula (PIF, 6{\%}), or a mixture of these (21{\%}). Eight percent of tubes were received from neonates who were 'nil by mouth'. Organisms were isolated from 76{\%} of enteral feeding tubes as a biofilm (up to 107 cfu/tube from neonates fed fortified breast milk and reconstituted PIF) and in the residual lumen liquid (up to 107 Enterobacteriaceae cfu/ml, average volume 250 µl). The most common isolates were Enterobacter cancerogenus (41{\%}), Serratia marcescens (36{\%}), E. hormaechei (33{\%}), Escherichia coli (29{\%}), Klebsiella pneumoniae (25{\%}), Raoultella terrigena (10{\%}), and S. liquefaciens (12{\%}). Other organisms isolated included C. sakazakii (2{\%}),Yersinia enterocolitica (1{\%}),Citrobacter freundii (1{\%}), E. vulneris (1{\%}), Pseudomonas fluorescens (1{\%}), and P. luteola (1{\%}). The enteral feeding tubes were in place between < 6 h (22{\%}) to > 48 h (13{\%}). All the S. marcescens isolates from the enteral feeding tubes were resistant to amoxicillin and co-amoxiclav. Of additional importance was that a quarter of E. hormaechei isolates were resistant to the 3rd generation cephalosporins ceftazidime and cefotaxime. During the period of the study, K. pneumoniae and S. marcescens caused infections in the two NICUs. Conclusion This study shows that neonatal enteral feeding tubes, irrespective of feeding regime, act as loci for the bacterial attachment and multiplication of numerous opportunistic pathogens within the Enterobacteriaceae family. Subsequently, these organisms will enter the stomach as a bolus with each feed. Therefore, enteral feeding tubes are an important risk factor to consider with respect to neonatal infections.",
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Hurrell, E, Kucerova, E, Loughlin, M, Caubilla-Barron, J, Hilton, AC, Armstrong, RA, Smith, C, Grant, J, Shoo, S & Forsythe, S 2009, 'Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae' BMC Infectious Diseases, vol. 9, no. 146, 1471. https://doi.org/10.1186/1471-2334-9-146

Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae. / Hurrell, Edward; Kucerova, Eva; Loughlin, Michael; Caubilla-Barron, Juncal; Hilton, Anthony C.; Armstrong, Richard A.; Smith, Craig; Grant, Judith; Shoo, Shiu; Forsythe, Stephen.

In: BMC Infectious Diseases, Vol. 9, No. 146, 1471, 01.09.2009.

Research output: Contribution to journalArticle

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T1 - Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae

AU - Hurrell, Edward

AU - Kucerova, Eva

AU - Loughlin, Michael

AU - Caubilla-Barron, Juncal

AU - Hilton, Anthony C.

AU - Armstrong, Richard A.

AU - Smith, Craig

AU - Grant, Judith

AU - Shoo, Shiu

AU - Forsythe, Stephen

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PY - 2009/9/1

Y1 - 2009/9/1

N2 - Background The objective of this study was to determine whether neonatal nasogastric enteral feeding tubes are colonised by the opportunistic pathogen Cronobacter spp. (Enterobacter sakazakii) and other Enterobacteriaceae, and whether their presence was influenced by the feeding regime. Methods One hundred and twenty-nine tubes were collected from two neonatal intensive care units (NICU). A questionnaire on feeding regime was completed with each sample. Enterobacteriaceae present in the tubes were identified using conventional and molecular methods, and their antibiograms determined. Results The neonates were fed breast milk (16%), fortified breast milk (28%), ready to feed formula (20%), reconstituted powdered infant formula (PIF, 6%), or a mixture of these (21%). Eight percent of tubes were received from neonates who were 'nil by mouth'. Organisms were isolated from 76% of enteral feeding tubes as a biofilm (up to 107 cfu/tube from neonates fed fortified breast milk and reconstituted PIF) and in the residual lumen liquid (up to 107 Enterobacteriaceae cfu/ml, average volume 250 µl). The most common isolates were Enterobacter cancerogenus (41%), Serratia marcescens (36%), E. hormaechei (33%), Escherichia coli (29%), Klebsiella pneumoniae (25%), Raoultella terrigena (10%), and S. liquefaciens (12%). Other organisms isolated included C. sakazakii (2%),Yersinia enterocolitica (1%),Citrobacter freundii (1%), E. vulneris (1%), Pseudomonas fluorescens (1%), and P. luteola (1%). The enteral feeding tubes were in place between < 6 h (22%) to > 48 h (13%). All the S. marcescens isolates from the enteral feeding tubes were resistant to amoxicillin and co-amoxiclav. Of additional importance was that a quarter of E. hormaechei isolates were resistant to the 3rd generation cephalosporins ceftazidime and cefotaxime. During the period of the study, K. pneumoniae and S. marcescens caused infections in the two NICUs. Conclusion This study shows that neonatal enteral feeding tubes, irrespective of feeding regime, act as loci for the bacterial attachment and multiplication of numerous opportunistic pathogens within the Enterobacteriaceae family. Subsequently, these organisms will enter the stomach as a bolus with each feed. Therefore, enteral feeding tubes are an important risk factor to consider with respect to neonatal infections.

AB - Background The objective of this study was to determine whether neonatal nasogastric enteral feeding tubes are colonised by the opportunistic pathogen Cronobacter spp. (Enterobacter sakazakii) and other Enterobacteriaceae, and whether their presence was influenced by the feeding regime. Methods One hundred and twenty-nine tubes were collected from two neonatal intensive care units (NICU). A questionnaire on feeding regime was completed with each sample. Enterobacteriaceae present in the tubes were identified using conventional and molecular methods, and their antibiograms determined. Results The neonates were fed breast milk (16%), fortified breast milk (28%), ready to feed formula (20%), reconstituted powdered infant formula (PIF, 6%), or a mixture of these (21%). Eight percent of tubes were received from neonates who were 'nil by mouth'. Organisms were isolated from 76% of enteral feeding tubes as a biofilm (up to 107 cfu/tube from neonates fed fortified breast milk and reconstituted PIF) and in the residual lumen liquid (up to 107 Enterobacteriaceae cfu/ml, average volume 250 µl). The most common isolates were Enterobacter cancerogenus (41%), Serratia marcescens (36%), E. hormaechei (33%), Escherichia coli (29%), Klebsiella pneumoniae (25%), Raoultella terrigena (10%), and S. liquefaciens (12%). Other organisms isolated included C. sakazakii (2%),Yersinia enterocolitica (1%),Citrobacter freundii (1%), E. vulneris (1%), Pseudomonas fluorescens (1%), and P. luteola (1%). The enteral feeding tubes were in place between < 6 h (22%) to > 48 h (13%). All the S. marcescens isolates from the enteral feeding tubes were resistant to amoxicillin and co-amoxiclav. Of additional importance was that a quarter of E. hormaechei isolates were resistant to the 3rd generation cephalosporins ceftazidime and cefotaxime. During the period of the study, K. pneumoniae and S. marcescens caused infections in the two NICUs. Conclusion This study shows that neonatal enteral feeding tubes, irrespective of feeding regime, act as loci for the bacterial attachment and multiplication of numerous opportunistic pathogens within the Enterobacteriaceae family. Subsequently, these organisms will enter the stomach as a bolus with each feed. Therefore, enteral feeding tubes are an important risk factor to consider with respect to neonatal infections.

KW - neonatal nasogastric enteral feeding tubes

KW - pathogen Cronobacter spp

KW - Enterobacter sakazakii

KW - Enterobacteriaceae

KW - feeding regime

KW - neonatal intensive care

KW - neonatal infections

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