Bussy V, Marechal F, Nasca S
Institut Jean-Godinot, Laboratoire de Microbiologie Médicale, Reims, France.
JPEN J Parenter Enteral Nutr. 1992 Nov-Dec;16(6):552-7. doi: 10.1177/0148607192016006552.
Enteral nutrition is an effective treatment for catabolic patients with normal intestinal absorption. However, tube-fed patients are at risk from superinfection. Our study is the first to evaluate in vivo the microbial contamination of solutions staying in the nasogastric tube of cancer patients receiving nutritional preparations. After daily feeding, the tube was rinsed with nonsterile tap water. Tap water staying overnight in the tube was considered as tube-rinsing solution. Microbial burden of nutritional preparations was determined on the fifth day of enteral nutrition, from opening the first container and throughout feeding. The next day, a sample of the tube-rinsing solution was cultured. All bacterial species were identified and antibiotic susceptibility pattern was assessed. Thirty-one cancer patients were included, 12 on the hospital's preparations and 19 on commercial feeding. Seven of the hospital--and none of the commercial--preparations were contaminated. Among the 48 samples collected during feeding, 16 were contaminated, including 10 hospital and 6 commercial preparations. All the 31 tube-rinsing solutions were contaminated and 102 strains cultured. Their median concentration was 10(6) colony-forming units/mL (range 10-10(10)). The strains were 48 Enterobacteriaceae, 20 group D streptococci, 9 Candida albicans, 9 Pseudomonas aeruginosa, and 16 others. Multiple antibiotic resistance was present in 12 of the 102 strains. Lower resistance was present in 33. The predominant microorganism of the tube-rinsing solution caused a bacterial colonization for three febrile patients. In conclusion, the feeding tube is an important reservoir for multiple antibiotic-resistant bacteria.
肠内营养是肠道吸收功能正常的分解代谢患者的一种有效治疗方法。然而，管饲患者存在发生二重感染的风险。我们的研究首次在体内评估了接受营养制剂的癌症患者鼻胃管内留存溶液的微生物污染情况。每日喂食后，用非无菌自来水冲洗管道。在管道中留存过夜的自来水被视为管道冲洗液。在肠内营养的第五天，从打开第一个容器开始直至喂食结束，测定营养制剂的微生物负荷。次日，对管道冲洗液样本进行培养。鉴定所有细菌种类并评估抗生素敏感性模式。纳入了31名癌症患者，其中12名使用医院制剂，19名使用商业喂养制剂。医院制剂中有7种被污染，商业制剂均未被污染。在喂食期间采集的48个样本中，16个被污染，包括10种医院制剂和6种商业制剂。所有31份管道冲洗液均被污染，共培养出102株菌株。它们的中位浓度为10⁶ 菌落形成单位/毫升（范围为10 - 10¹⁰）。这些菌株包括48株肠杆菌科细菌、20株D组链球菌、9株白色念珠菌、9株铜绿假单胞菌和16株其他细菌。102株菌株中有12株存在多重耐药性。33株菌株耐药性较低。管道冲洗液中的主要微生物导致3名发热患者发生细菌定植。总之，喂养管是多重耐药菌的一个重要储存库。
