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Microbial Biofilm Development on Neonatal Enteral Feeding Tubes

Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 830)

Abstract

Neonates in intensive care units often require supporting medical devices and antibiotic treatment. The intensive care treatment combined with their immature immune system, the increased permeability of mucosa, and the undeveloped microflora of the gut may render the neonates highly vulnerable to colonisation and subsequent infections when exposed to opportunistic pathogens. These infections may not only be local gastrointestinal infections, but also systematic following translocation from the gastrointestinal system. This could be particularly alarming considering that common antibiotics may not be effective if the causative strain is multi-drug resistant.

This chapter reviews our information on the microbial colonization of neonatal feeding tubes. The range of organisms which have been recovered are wide, and while primarily bacterial, fungi such as Candida have also been found. The bacteria are principally Staphylococcus spp. and Enterobacteriaceae. The Enterobacteriaceae isolates are predominantly Enterobacter cancerogenus, Serratia marcescens, Enterobacter hormaechei, Escherichia coli and Klebsiella pneumoniae. Many of these isolates encode for antibiotic resistance; E. hormaechei (ceftazidine and cefotaxime) and S. marcescens strains (amoxicillin and co-amoxiclav).

Keywords

Neonatal Intensive Care Unit Infant Formula Enteral Feeding Neonatal Infection Enteral Feeding Tube 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Abou-Assi S, Craig K, O’Keefe SJD (2002) Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: results of a randomized comparative study. Am J Gastroenterol 97:2255–2262PubMedCrossRefGoogle Scholar
  2. Anderson KR, Norris DJ, Godfrey LB, Avent CK, Butterworth CE Jr (1984) Bacterial contamination of tube-feeding formulas. JPEN J Parenter Enteral Nutr 8:673–678PubMedCrossRefGoogle Scholar
  3. Anderton A (1993) Bacterial contamination of enteral feeds and feeding systems. Clin Nutr 12:S16–S32CrossRefGoogle Scholar
  4. Anderton A (1995) Reducing bacterial contamination in enteral tube feeds. Br J Nurs 4:368–376PubMedCrossRefGoogle Scholar
  5. Bergogne-Berezin E, Towner KJ (1996) Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 9:148–165PubMedCentralPubMedGoogle Scholar
  6. Boles BR, Thoendel M, Singh PK (2004) Self-generated diversity produces “insurance effects” in biofilm communities. Proc Natl Acad Sci U S A 101:16630–16635PubMedCentralPubMedCrossRefGoogle Scholar
  7. Bryan FL (1990) Hazard analysis critical control point (HACCP) systems for retail food and restaurant operations. J Food Prot 53:978–983Google Scholar
  8. Caubilla-Barron J, Forsythe SJ (2007) Dry stress and survival time of Enterobacter sakazakii and other Enterobacteriaceae in dehydrated powdered infant formula. J Food Prot 70:2111–2117Google Scholar
  9. Cawthorn DM, Botha S, Witthuhn RC (2008) Evaluation of different methods for the detection and identification of Enterobacter sakazakii isolated from South African infant formula milks and the processing environment. Int J Food Microbiol 127:129–138PubMedCrossRefGoogle Scholar
  10. Chan L, Yasmin AH, Ngeow YF, Ong GSY (1994) Evaluation of the bacteriological contamination of a closed feeding system for enteral nutrition. Med J Malaysia 49:62–67PubMedGoogle Scholar
  11. Codex Alimentarius Commission CAC (2008). Code of hygienic practice for powdered formulae for infants and young children. CAC/RCP 66. Joint FAO/WHO Food Standards Programme, Rome. http://www.codexalimentarius.org/standards/list-of-standards/en/?provide=standards&orderField=fullReference&sort=asc&num1=CAC/RC
  12. Curtas S, Forbes B, Meguid V, Meguid MM (1991) Bacteriological safety of closed enteral nutrition delivery system. Nutrition 7:340–343PubMedGoogle Scholar
  13. Dancer GI, Mah JH, Kang DH (2009) Influences of milk components on biofilm formation of Cronobacter spp. (Enterobacter sakazakii). Lett Appl Microbiol 48:718–725PubMedGoogle Scholar
  14. Dima S, Kritsotakis EI, Roumbelaki M, Metalidis S, Karabinis A, Maguina N, Klouva F, Levidiotou S, Zakynthinos E, Kioumis J, Gikas A (2007) Device-associated nosocomial infection rates in intensive care units in Greece. Infect Control Hosp Epidemiol 28:602–605PubMedCrossRefGoogle Scholar
  15. Donlan RM, Costerton JW (2002) Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 15:167–193PubMedCentralPubMedCrossRefGoogle Scholar
  16. Edelson-Mammel S, Porteous MK, Buchanan RL (2006) Acid resistance of twelve strains of Enterobacter sakazakii, and the impact of habituating the cells to an acidic environment. J Food Sci 71:M201–M207CrossRefGoogle Scholar
  17. Freedland CP, Roller RD, Wolfe BM, Flynn NM (1989) Microbial contamination of continuous drip feedings. JPEN J Parenter Enteral Nutr 13:18–22PubMedCrossRefGoogle Scholar
  18. Fux CA, Wilson S, Stoodley P (2004) Detachment characteristics and oxacillin resistance of Staphyloccocus aureus biofilm emboli in an in vitro catheter infection model. J Bacteriol 186:4486–4491PubMedCentralPubMedCrossRefGoogle Scholar
  19. Garrouste-Orgeas M, Chevret S, Arlet G, Marie O, Rouveau M, Popoff N, Schlemmer B (1997) Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients. A prospective study based on genomic DNA analysis. Am J Respir Crit Care Med 156:1647–1655PubMedCrossRefGoogle Scholar
  20. Gerstel U, Romling U (2001) Oxygen tension and nutrient starvation are major signals that regulate agfD promoter activity and expression of the multicellular morphotype in Salmonella Typhimurium. Environ Microbiol 3:638–648PubMedCrossRefGoogle Scholar
  21. Greenough A (1996) Neonatal infections. Curr Opin Pediatr 8:6–10PubMedCrossRefGoogle Scholar
  22. Gupta R, Patel K, Calder PC, Yaqoob P, Primrose JN, Johnson CD (2003) A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHE II = 6). Pancreatology 3:406–413PubMedCrossRefGoogle Scholar
  23. Himelright I, Harris E, Lorch V, Anderson M (2002) Enterobacter sakazakii infections associated with the use of powdered infant formula – Tennessee, 2001. J Am Med Assoc 287:2204–2205CrossRefGoogle Scholar
  24. Holy O, Forsythe SJ (2014) Cronobacter spp. as emerging causes of healthcare-associated infection. J Hosp Infect 86:169–177PubMedCrossRefGoogle Scholar
  25. Hood SK, Zottola EA (1997) Adherence to stainless steel by foodborne microorganisms during growth in model food systems. Int J Food Microbiol 37:145–153PubMedCrossRefGoogle Scholar
  26. Hurrell E, Kucerova E, Loughlin M, Caubilla-Barron J, Forsythe SJ (2009a) Biofilm formation on enteral feeding tubes by Cronobacter sakazakii, Salmonella serovars and other Enterobacteriaceae. Int J Food Microbiol 136:227–231PubMedCrossRefGoogle Scholar
  27. Hurrell E, Kucerova E, Loughlin M, Caubilla-Barron J, Hilton A, Armstrong R, Smith C, Grant J, Shoo S, Forsythe S (2009b) Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae. BMC Infect Dis 9:146PubMedCentralPubMedCrossRefGoogle Scholar
  28. James GA, Korber DR, Caldwell DE, Costerton JW (1995) Digital image analysis of growth and starvation responses of a surface-colonizing Acinetobacter sp. J Bacteriol 177:907–915PubMedCentralPubMedGoogle Scholar
  29. Jensen ET, Kharazmi A, Lam K, Costerton JW, Hoiby N (1990) Human polymorphonuclear leukocyte response to Pseudomonas aeruginosa grown in biofilms. Infect Immun 58:2383–2385PubMedCentralPubMedGoogle Scholar
  30. Jerassy Z, Yinnon AM, Mazouz-Cohen S, Benenson S, Schlesinger Y, Rudensky B, Raveh D (2006) Prospective hospital-wide studies of 505 patients with nosocomial bacteraemia in 1997 and 2002. J Hosp Infect 62:230–236PubMedCrossRefGoogle Scholar
  31. Kalfarentzos F, Kehagias J, Mead N, Kokkinis N, Gogos CA (1997) Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial. Br J Surg 84:1665–1669PubMedCrossRefGoogle Scholar
  32. Kim H, Ryu JH, Beuchat LR (2006) Attachment of and biofilm formation by Enterobacter sakazakii on stainless steel and enteral feeding tubes. Appl Environ Microbiol 72:5846–5856PubMedCentralPubMedCrossRefGoogle Scholar
  33. Kirby DF, Delegge MH, Fleming CR (1995) American Gastroenterological Association technical review on tube feeding for enteral nutrition. Gastroenterology 108:1282–1301PubMedCrossRefGoogle Scholar
  34. Koutsoumanis KP, Sofos JN (2004) Comparative acid stress response of Listeria monocytogenes, Escherichia coli O157:H7 and Salmonella Typhimurium after habituation at different pH conditions. Lett Appl Microbiol 38:321–326PubMedCrossRefGoogle Scholar
  35. Koutsoumanis KP, Kendall PA, Sofos JN (2004) Modeling the boundaries of growth of Salmonella Typhimurium in broth as a function of temperature, water activity, and pH. J Food Prot 67:53–59PubMedGoogle Scholar
  36. Kuusela AL (1998) Long-term gastric pH monitoring for determining optimal dose of ranitidine for critically ill preterm and term neonates. Arch Dis Child Fetal Neonatal Ed 78:F151–F153PubMedCentralPubMedCrossRefGoogle Scholar
  37. Lawrence JR, Caldwell DE (1987) Behavior of bacterial stream populations within the hydrodynamic boundary layers of surface microenvironments. Microb Ecol 14:15–27PubMedCrossRefGoogle Scholar
  38. Lee HW, Koh YM, Kim J, Lee JC, Lee YC, Seol SY, Cho DT (2008) Capacity of multidrug-resistant clinical isolates of Acinetobacter baumannii to form biofilm and adhere to epithelial cell surfaces. Clin Microbiol Infect 14:49–54PubMedCrossRefGoogle Scholar
  39. Marino LV, Goddard E, Whitelaw A, Workman L (2007) Prevalence of bacterial contamination of powdered infant feeds in a hospital environment. S Afr Med J 97:534–537PubMedGoogle Scholar
  40. Marshall KC (1988) Adhesion and growth of bacteria at surfaces in oligotrophic habitats. Can J Microbiol 34:503–506CrossRefGoogle Scholar
  41. Matlow A, Wray R, Goldman C, Streitenberger L, Freeman R, Kovach D (2003) Microbial contamination of enteral feed administration sets in a pediatric institution. Am J Infect Control 31:49–53PubMedCrossRefGoogle Scholar
  42. Mehall JR, Kite CA, Gilliam CH, Jackson RJ, Smith SD (2002a) Enteral feeding tubes are a reservoir for nosocomial antibiotic-resistant pathogens. J Pediatr Surg 37:1011–1012PubMedCrossRefGoogle Scholar
  43. Mehall JR, Kite CA, Saltzman DA, Wallett T, Jackson RJ, Smith SD (2002b) Prospective study of the incidence and complications of bacterial contamination of enteral feeding in neonates. J Pediatr Surg 37:1177–1182PubMedCrossRefGoogle Scholar
  44. Miled RB, Neves S, Baudouin N, Lombard B, Deperrois V, Colin P, Besse NG (2010) Impact of pooling powdered infant formula samples on bacterial evolution and Cronobacter detection. Int J Food Microbiol 138:250–259PubMedCrossRefGoogle Scholar
  45. Mitchell DJ, McClure BG, Tubman TR (2001) Simultaneous monitoring of gastric and oesophageal pH reveals limitations of conventional oesophageal pH monitoring in milk fed infants. Arch Dis Child 84:273–276PubMedCentralPubMedCrossRefGoogle Scholar
  46. Roberts E (2007) Nutritional support via enteral tube feeding in hospital patients. Br J Nurs 16:1058–1062PubMedCrossRefGoogle Scholar
  47. Roy S, Rigal M, Doit C, Fontan JE, Machinot S, Bingen E, Cezard JP, Brion F, Hankard R (2005) Bacterial contamination of enteral nutrition in a paediatric hospital. J Hosp Infect 59:311–316PubMedCrossRefGoogle Scholar
  48. Schreiner RL, Eitzen H, Gfell MA, Kress S, Gresham EL, French M, Moye L (1979) Environmental contamination of continuous drip feedings. Pediatrics 63:232–237PubMedGoogle Scholar
  49. Sondheimer JM, Clark DA, Gervaise EP (1985) Continuous gastric pH measurement in young and older healthy preterm infants receiving formula and clear liquid feedings. J Pediatr Gastroenterol Nutr 4:352–355PubMedCrossRefGoogle Scholar
  50. Stepanovic S, Dakic I, Opavski N, Jezek P, Ranin L (2003) Influence of the growth medium composition on biofilm formation by Staphylococcus sciuri. Ann Microbiol 53:63–74Google Scholar
  51. Thongpiyapoom S, Narong MN, Suwalak N, Jamulitrat S, Intaraksa P, Boonrat J, Kasatpibal N, Unahalekhaka A (2004) Device-associated infections and patterns of antimicrobial resistance in a medical-surgical intensive care unit in a university hospital in Thailand. J Med Assoc Thai 87:819–824PubMedGoogle Scholar
  52. Tucker HN, Miguel SG (1996) Cost containment through nutrition intervention. Nutr Rev 54:111–121PubMedCrossRefGoogle Scholar
  53. Van Acker J, de Smet F, Muyldermans G, Bougatef A, Naessens A, Lauwers S (2001) Outbreak of necrotizing enterocolitis associated with Enterobacter sakazakii in powdered milk formula. J Clin Microbiol 39:293–297PubMedCentralPubMedCrossRefGoogle Scholar
  54. Wagenvoort JH, Joosten EJ (2002) An outbreak Acinetobacter baumannii that mimics MRSA in its environmental longevity. J Hosp Infect 52:226–227PubMedCrossRefGoogle Scholar
  55. Wagner DR, Elmore MF, Knoll DM (1994) Evaluation of “closed” vs “open” systems for the delivery of peptide-based enteral diets. JPEN J Parenter Enteral Nutr 18:453–457PubMedCrossRefGoogle Scholar
  56. Washington N, Spensley PJ, Smith CA, Parker M, Bush D, Jackson SJ, Kapila L, Stephenson T, Washington C (1999) Dual pH probe monitoring versus single pH probe monitoring in infants on milk feeds: the impact on diagnosis. Arch Dis Child 81:309–312PubMedCentralPubMedCrossRefGoogle Scholar
  57. Weinstein JW, Roe M, Towns M, Sanders L, Thorpe JJ, Corey GR, Sexton DJ (1996) Resistant enterococci: a prospective study of prevalence, incidence, and factors associated with colonization in a University Hospital. Infect Control Hosp Epidemiol 17:36–41PubMedCrossRefGoogle Scholar
  58. Westerbeek EA, van den Berg A, Lafeber HN, Knol J, Fetter WP, van Elburg RM (2006) The intestinal bacterial colonisation in preterm infants: a review of the literature. Clin Nutr 25:361–368PubMedCrossRefGoogle Scholar
  59. Wiener J, Quinn JP, Bradford PA, Goering RV, Nathan C, Bush K, Weinstein RA (1999) Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. J Am Med Assoc 281:517–523CrossRefGoogle Scholar
  60. World Health Organization WHO (2007) Safe preparation, storage and handling of powdered infant formula guidelines. doi:9789241595414Google Scholar
  61. Zavros Y, Rieder G, Ferguson A, Merchant JL (2002) Gastritis and hypergastrinemia due to Acinetobacter lwoffii in mice. Infect Immun 70:2630–2639PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Medical Microbiology and Parasitology, Faculty of MedicineKing Abdulaziz UniversityJeddahKSA
  2. 2.Pathogen Research Group, School of Science and TechnologyNottingham Trent UniversityNottinghamUK

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