Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae

Background The objective of this study was to determine whether neonatal nasogastric enteral feeding tubes are colonised by the opportunistic pathogen Cronobacter spp. (Enterobacter sakazakii) and other Enterobacteriaceae, and whether their presence was influenced by the feeding regime. Methods One hundred and twenty-nine tubes were collected from two neonatal intensive care units (NICU). A questionnaire on feeding regime was completed with each sample. Enterobacteriaceae present in the tubes were identified using conventional and molecular methods, and their antibiograms determined. Results The neonates were fed breast milk (16%), fortified breast milk (28%), ready to feed formula (20%), reconstituted powdered infant formula (PIF, 6%), or a mixture of these (21%). Eight percent of tubes were received from neonates who were 'nil by mouth'. Organisms were isolated from 76% of enteral feeding tubes as a biofilm (up to 107 cfu/tube from neonates fed fortified breast milk and reconstituted PIF) and in the residual lumen liquid (up to 107 Enterobacteriaceae cfu/ml, average volume 250 µl). The most common isolates were Enterobacter cancerogenus (41%), Serratia marcescens (36%), E. hormaechei (33%), Escherichia coli (29%), Klebsiella pneumoniae (25%), Raoultella terrigena (10%), and S. liquefaciens (12%). Other organisms isolated included C. sakazakii (2%),Yersinia enterocolitica (1%),Citrobacter freundii (1%), E. vulneris (1%), Pseudomonas fluorescens (1%), and P. luteola (1%). The enteral feeding tubes were in place between < 6 h (22%) to > 48 h (13%). All the S. marcescens isolates from the enteral feeding tubes were resistant to amoxicillin and co-amoxiclav. Of additional importance was that a quarter of E. hormaechei isolates were resistant to the 3rd generation cephalosporins ceftazidime and cefotaxime. During the period of the study, K. pneumoniae and S. marcescens caused infections in the two NICUs. Conclusion This study shows that neonatal enteral feeding tubes, irrespective of feeding regime, act as loci for the bacterial attachment and multiplication of numerous opportunistic pathogens within the Enterobacteriaceae family. Subsequently, these organisms will enter the stomach as a bolus with each feed. Therefore, enteral feeding tubes are an important risk factor to consider with respect to neonatal infections.

Multiphase modelling of the characteristics of close coupled gas atomization

Not withstanding the high demand of metal powder for automotive and High Tech applications, there are still many unclear aspects of the production process. Only recentlyhas supercomputer performance made possible numerical investigation of such phenomena. This thesis focuses on the modelling aspects of primary and secondary atomization. Initially two-dimensional analysis is carried out to investigate the influence of flow parameters (reservoir pressure and gas temperature principally) and nozzle geometry on final powder yielding. Among the different types, close coupled atomizers have the best performance in terms of cost and narrow size distribution. An isentropic contoured nozzle is introduced to minimize the gas flow losses through shock cells: the results demonstrate that it outperformed the standard converging-diverging slit nozzle. Furthermore the utilization of hot gas gave a promising outcome: the powder size distribution is narrowed and the gas consumption reduced. In the second part of the thesis, the interaction of liquid metal and high speed gas near the feeding tube exit was studied. Both axisymmetric andnon-axisymmetric geometries were simulated using a 3D approach. The filming mechanism was detected only for very small metal flow rates (typically obtained in laboratory scale atomizers). When the melt flow increased, the liquid core overtook the adverse gas flow and entered in the high speed wake directly: in this case the disruption isdriven by sinusoidal surface waves. The process is characterized by fluctuating values of liquid volumes entering the domain that are monitored only as a time average rate: it is far from industrial robustness and capability concept. The non-axisymmetric geometry promoted the splitting of the initial stream into four cores, smaller in diameter and easier to atomize. Finally a new atomization design based on the lesson learned from previous cases simulation is presented.

Geometrical optimization of a fast pyrolysis bubbling fluidized bed reactor using comutational fluid dynamics

This paper analyzes the physical phenomena that take place inside an 1 kg/h bubbling fluidized bed reactor located at Aston University and presents a geometrically modified version of it, in order to improve certain hydrodynamic and gas flow characteristics. The bed uses, in its current operation, 40 L/min of N2 at 520 °C fed through a distributor plate and 15 L/min purge gas stream, i.e., N2 at 20 °C, via the feeding tube. The Eulerian model of FLUENT 6.3 is used for the simulation of the bed hydrodynamics, while the k - ε model accounts for the effect of the turbulence field of one phase on the other. The three-dimensional simulation of the current operation of the reactor showed that a stationary bubble was formed next to the feeding tube. The size of the permanent bubble reaches up to the splash zone of the reactor, without any fluidizaton taking place underneath the feeder. The gas flow dynamics in the freeboard of the reactor is also analyzed. A modified version of the reactor is presented, simulated, and analyzed, together with a discussion on the impact of the flow dynamics on the fast pyrolysis of biomass. © 2010 American Chemical Society.