A nosocomial outbreak of Salmonella enteritidis associated with lyophilized enteral nutrition

A nosocomial outbreak of Salmonella enteritidis associated with lyophilized enteral nutrition
October 2004
Received 25 August 2003; accepted 25 February 2004. Available online 15 September 2004
D. M. Matsuokaa, S. F. Costaa, c, C. Manginia, G. M. D. Almeidab, C. N. Bentob, I. M. Van Der Heijdenc, R. E. Soaresc, S. Gobaraa, L. G. F. T?voraa and A. S. Levin
Journal of Hospital Infection
Volume 58, Issue 2
ScienceDirect
a Nosocomial Infection Control Group, Hospital das Cl?nicas, University of S?o Paulo, S?o Paulo, Brazil
b Laboratory of Microbiology, Hospital das Cl?nicas, University of S?o Paulo, S?o Paulo, Brazil
c Laboratory of Medical Investigation (LIM-54), Hospital das Cl?nicas, University of S?o Paulo, S?o Paulo, Brazil
d Department of Infectious Diseases, Hospital das Cl?nicas, University of S?o Paulo, S?o Paulo, Brazil
Abstract
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.
Author Keywords: Salmonella enteritidis; Nosocomial outbreak; Enteral nutrition; Lyophilization
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