A nosocomial outbreak of Salmonella enteritidis associated with lyophilized enteral nutrition

• Published in: The Journal of hospital infection Vol. 58; no. 2; pp. 122 - 127
• Main Authors: Matsuoka, D.M., Costa, S.F., Mangini, C., Almeida, G.M.D., Bento, C.N., Van Der Heijden, I.M., Soares, R.E., Gobara, S., Távora, L.G.F., Levin, A.S.
• Format: Journal Article
• Language: English
• Published: Kent Elsevier Ltd 01.10.2004; Elsevier
• Subjects: Adult; Aged; Anti-Infective Agents - pharmacology; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Brazil - epidemiology; Cross Infection - epidemiology; Cross Infection - etiology; Cross Infection - prevention & control; Disease Outbreaks; Drug Resistance, Bacterial; Eggs - microbiology; Enteral nutrition; Enteral Nutrition - adverse effects; Female; Food Microbiology; Freeze Drying; Hospitals, University; Human bacterial diseases; Humans; Infectious diseases; Lyophilization; Male; Medical Records; Medical sciences; Microbial Sensitivity Tests; Middle Aged; Nosocomial outbreak; Retrospective Studies; Salmonella enteritidis; Salmonella enteritidis - drug effects; Salmonella enteritidis - isolation & purification; Salmonella Food Poisoning - epidemiology; Salmonella Food Poisoning - etiology; Salmonella Food Poisoning - prevention & control; Brazil; Salmonella enteritidis; Lyophilization; Enteral nutrition; Nosocomial outbreak; Water; Nosocomial infection; Prognosis; Gastroenteritis; Asymptomatic; Blood; Enteral administration; Microbiological investigation; Bacteria; Intestinal disease; Salmonellosis; Feces; Hospital; Enterobacteriaceae; Gastric disease; Epidemic; Human; Nutrition; Albumin; Diarrhea; Morbidity; Feeding; Infection; Employee; Diet; Bacteriosis; Digestive diseases
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2004.05.003

Outbreaks of Salmonella spp. gastro-enteritis in hospitals are of concern because of the increased susceptibility of patients and associated high morbidity. This study is a report of a nosocomial outbreak of Salmonella enteritidis associated with enteral nutrition. In December 1999, one sample of enteral feed tested positive for S. enteritidis. During the subsequent 6 weeks, eight cases of nosocomial salmonellosis occurred. Patients involved in the outbreak were aged 19–79 years (median=36.5), and salmonella was isolated from the blood of two patients. All patients were receiving enteral nutrition at the time and all had diarrhoea. Three patients died. All 13 employees of the Nutrition Department were asymptomatic and their stool samples were negative. Environmental and water samples were also negative. The diet, however, contained lyophilized egg albumin. Molecular typing showed that the isolates of seven patients were indistinguishable from the one obtained from the enteral diet. It was thought that the nosocomial salmonellosis probably occurred due to the use of a commercial lyophilized diet. Another method of processing diets may be necessary to ensure patient safety.