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.

Word of mouth communication within online communities:conceptualizing the online social network

Word of mouth (WOM) communication is a major part of online consumer interactions, particularly within the environment of online communities. Nevertheless, existing (offline) theory may be inappropriate to describe online WOM and its influence on evaluation and purchase.The authors report the results of a two-stage study aimed at investigating online WOM: a set of in-depth qualitative interviews followed by a social network analysis of a single online community. Combined, the results provide strong evidence that individuals behave as if Web sites themselves are primary "actors" in online social networks and that online communities can act as a social proxy for individual identification. The authors offer a conceptualization of online social networks which takes the Web site into account as an actor, an initial exploration of the concept of a consumer-Web site relationship, and a conceptual model of the online interaction and information evaluation process. © 2007 Wiley Periodicals, Inc. and Direct Marketing Educational Foundation, Inc.

Policy on the hoof:the handling of the foot and mouth disease outbreak in 2001

The foot and mouth disease (FMD) epidemic of 2001 was a disaster for sections of the agricultural industry, a number of businesses and for the Ministry of Agriculture, Fisheries and Food (MAFF), which met its demise as a government department during the crisis, being replaced by the Department of the Environment, Food and Rural Affairs (DEFRA). There were some 2,030 confirmed cases and over four million animals slaughtered. It caused the postponement of local elections and of a general election. From a public policy perspective it raised questions about contingency planning, the adjustment of policy to take account of change and how to manage a crisis. This article focuses on the background to the crisis and how it was handled.