Kanamori Shota, Koya Hiroaki, Kurata Naomi, Ishino Keiko
Department of Infection Control Sciences, Showa University Graduate School of Pharmacy, Tokyo, Japan.
Department of Hospital Pharmaceutics, Showa University Graduate School of Pharmacy, Tokyo, Japan.
Ann Nutr Metab. 2025;81(3):150-159. doi: 10.1159/000543972. Epub 2025 Feb 5.
Enteral nutrition is used in patients with stroke, head-and-neck or esophageal cancer surgery, or repeated aspiration pneumonia. Japanese enteral nutrition guidelines recommend percutaneous endoscopic gastrostomy tube (PEG) for long-term use of >4 weeks and nasogastric tube (NGT) for short-term use of <4 weeks. Catheters may be contaminated with microorganisms because enteral feeding products passed through them daily, but there are few reports on catheter contamination in Japan and no reports on the duration of catheter use. There are also reports that enteral feeding is a risk factor for the appearance of drug-resistant bacteria. Therefore, this study aimed to determine whether microorganisms could be isolated from enteral feeding catheters and determine the percentage of drug-resistant bacteria.
Forty-six PEGs and 59 NGTs were collected at Showa University Hospital and Showa University Fujigaoka Rehabilitation Hospital from May 2019 to March 2020. Microorganisms were cultured by incubating 20 mL pass/wash solution of sterile purified water on BHI agar medium (37°C) for 24-72 h. The strains were isolated and cultured, then frozen (80°C) and stored. Antimicrobial susceptibility was determined by broth microdilution method.
Microorganisms were detected in 37 PEGs and 57 NGTs (p = 0.007). Bacteria were detected in 27 PEGs and 53 NGTs (p < 0.001), and yeasts were detected in 29 PEGs and 28 NGTs (p = 0.112). Drug-resistant bacteria were isolated from 19.6% (9 of 46) in PEGs and 23.7% (14 of 59) in NGTs.
PEGs and NGTs were contaminated with microorganisms, and drug-resistant bacteria were isolated. This study provides a rationale for future appropriate use in enteral feeding catheters.
肠内营养用于中风、头颈部或食管癌手术患者，或反复发生吸入性肺炎的患者。日本肠内营养指南推荐长期使用（超过4周）时采用经皮内镜下胃造瘘管（PEG），短期使用（少于4周）时采用鼻胃管（NGT）。由于肠内营养产品每天通过导管，导管可能被微生物污染，但日本关于导管污染的报道很少，且没有关于导管使用时长的报道。也有报道称肠内营养是耐药菌出现的一个危险因素。因此，本研究旨在确定是否能从肠内营养导管中分离出微生物，并确定耐药菌的比例。
2019年5月至2020年3月期间，在昭和大学医院和昭和大学藤冈康复医院收集了46根PEG和59根NGT。将20 mL无菌纯净水冲洗液在脑心浸液琼脂培养基（37°C）上培养24 - 72小时，以培养微生物。分离并培养菌株，然后冷冻（80°C）保存。采用肉汤微量稀释法测定药敏性。
在37根PEG和57根NGT中检测到微生物（p = 0.007）。在27根PEG和53根NGT中检测到细菌（p < 0.001），在29根PEG和28根NGT中检测到酵母菌（p = 0.112）。从46根PEG中的19.6%（9根）和59根NGT中的23.7%（14根）中分离出耐药菌。
PEG和NGT被微生物污染，且分离出了耐药菌。本研究为未来肠内营养导管的合理使用提供了依据。
