Arias M L, Monge R, Antillón F, Chávez C
Facultad de Microbiología, Universidad de Costa Rica.
Arch Latinoam Nutr. 1999 Dec;49(4):363-6.
Enteral feeding is the most common and preferred modality for providing nutritional support to hospital patients with a functional gastrointestinal tract that can not satisfy their nutritional requirements. Nevertheless, enteral feeding may be an important cause of bacterial infection. The aim of this study was to evaluate the microbial contamination level of enteral feedings distributed in Costa Rican hospitals. A total of 124 samples of enteral feeding, coming from five different hospitals from San José, Costa Rica, were evaluated during the second semester of 1997 and first of 1998 for the presence and identification of total and fecal coliforms, Pseudomonas sp. and Listeria sp. A subpopulation of the Pseudomonas isolated was analyzed for their antibiotic susceptibility patterns. The concentration of Gram negative rods in the samples of enteral feeding solutions ranged from 10(3) to 10(7) CFU/mL, markedly exceeding the permissible level (10(2) CFU/mL or less). The coliforms most frequently isolated included Enterobacter cloacae, Escherichia coil, Serratia sp. and Klebsiella pnuemoniae, Pseudomonas sp. was isolated in more than 70% of the samples made from commercial based solutions, fruits and vegetables. P. aeruginosa and P. fluorescens were the species most frequently isolated. Listeria sp. was not isolated from enteral solutions samples. The results obtained demonstrate that it is urgent to assure strict hygiene during the preparation and handling of all enteral feed in order to avoid bacterial growth. The implementation of HACCP (Hazard Analysis and Critical Control Points) system will be required in a near future for better quality control of enteral nutrition mixtures.
肠内营养是为胃肠道功能正常但无法满足营养需求的住院患者提供营养支持的最常见且首选的方式。然而，肠内营养可能是细菌感染的一个重要原因。本研究的目的是评估在哥斯达黎加医院分发的肠内营养制剂的微生物污染水平。1997年下半年和1998年上半年，对来自哥斯达黎加圣何塞市五家不同医院的总共124份肠内营养制剂样本进行了评估，以检测总大肠菌群、粪大肠菌群、假单胞菌属和李斯特菌属的存在及鉴定情况。对分离出的假单胞菌亚群分析了其抗生素敏感性模式。肠内营养制剂溶液样本中革兰氏阴性杆菌的浓度范围为10³至10⁷CFU/mL，明显超过了允许水平（10²CFU/mL或更低）。最常分离出的大肠菌群包括阴沟肠杆菌、大肠杆菌、沙雷氏菌属和肺炎克雷伯菌，超过70%由商业溶液、水果和蔬菜制成的样本中分离出了假单胞菌属。铜绿假单胞菌和荧光假单胞菌是最常分离出的菌种。未从肠内营养制剂溶液样本中分离出李斯特菌属。所获得的结果表明，迫切需要确保在所有肠内营养制剂的制备和处理过程中严格保持卫生，以避免细菌生长。在不久的将来将需要实施危害分析与关键控制点（HACCP）系统，以更好地控制肠内营养混合物。
