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.

Studies on the chromosomal bets-lactamase of pseudomonas aeruginosa

The chromosomal ß-lactamase of Pseudomonas aeruginosa SAlconst (a derepressed laboratory strain) was isolated and purified. Two peaks of activity were observed on gel permeation chromatography (one major peak mol. wt. 45 kD and one minor peak of 54 kD). Preparations from 12 clinical derepressed strains showed identical results. Chromosomal ß-lactamase production in both normal and derepressed P. aeruginosa strains was induced both by iron restricted growth conditions and by penicillin G. The majority of the enzyme (80-90%) was found in the periplasm and cytoplasm but a significant amount (2-20%) was associated with the outer membrane (OM). The growth conditions did not affect the distribution of the enzyme between subcellular fractions although higher activity was found in the cells grown under iron limitation and/ or in the presence of ß-lactams. The penicillanate sulphone inhibitor, tazobactam, displayed irreversible kinetics whilst cloxacillin, cefotaxime, ampicillin and penicillin G were all competitive inhibitors of the enzyme. Similar results were obtained for the Enterobacter cloacae P99 [ß-lactamase, but tazobactam displayed a non-classical kinetic pattern for the Staphylococcus aureus PC1 ß-lactamase. The residues involved in ß-lactam hydrolysis by the P aeruginosa SAlconst enzyme were detennined by affinity labelling with tazobactam. A tryptic digestion fragment of the inhibited enzyme contained the amino acids D, T, S, E, P, G, A, C, V, M, I, Y, F, H, K, R. This suggests the involvement of the conserved SVSK, DAE and KTG motifs found in all penicillin sensitive proteins. A model of the 3-D structure of the active site of the P aeruginosa SAlconst chromosomal ß-!actamase was constructed from the published amino acid sequence of P aeruginosa chromosomal ß-lactamase and the a-carbon coordinates of the S. aureus PCI ß-lactamase by homology modelling and energy minimisation. The crystal structure of tazobactam was determined and energy minimised. Computer graphics docking identified Ser 72 as a possible residue involved in a secondary attack on the C5 position of tazobactam after initial ß-lactam hydrolysis by serine 70. The enhanced activity of tazobactam over sulbactam might be explained by the triazole substituent which might participate in favourable hydrogen bonding between N3 and active site residues.