Bacterial Contamination during Continuous Administration of Liquid Enteral Nutrition Formula in a Sterile Sealed Bag: A Prospective Interventional Study.

INTRODUCTION: In nutrition therapy for critically ill patients, it is recommended that enteral nutrition (EN) formula be changed every 8 h to avoid bacterial contamination. However, it remains unknown whether long-term administration of EN formula from a sterile sealed bag without changing the formula can cause bacterial contamination. This study investigates the association between bacterial contamination and administration of liquid EN formula from a sterile sealed bag without changing the formula for 24 h. METHODS: This single-center, prospective, interventional study included patients aged ≥20 years who were admitted to an intensive care unit and received 24-h continuous liquid EN formula from a sterile sealed bag. A 3-mL sample of the formula was collected from each bag every 4 h for bacterial culture. The primary outcome was the detection of bacterial colonies. RESULTS: A total of 630 specimens from 30 patients were cultured. No bacterial colonies were detected. CONCLUSION: There was no association between bacterial contamination and continuous administration of liquid EN formula from a sterile sealed bag for 24 h. Therefore, this study recommends continuous administration of EN from a sterile sealed bag for 24 h without changing the EN formula under those limited conditions.

Study on the new strategy and key techniques for accurate prevention and treatment of nonalcoholic steatohepatitis based on intestinal target bacteria.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has emerged as a major health problem worldwide; according to statistics, 10% to 25% of patients with NAFLD can progress to nonalcoholic steatohepatitis (NASH). A link between the composition and metabolites of intestinal microbiota and the development of NAFLD is becoming clearer. It is believed that microbiota factors are driving forces of hepatic steatosis and inflammation. The formulated food that contains prebiotics and dietary fiber may improve NAFLD by altering the intestinal flora and its metabolites. METHODS: The study plan to recruit adult patients (18-75 years, n = 120) with NAFLD, range of alanine aminotransferase is 1.5 to 5 times upper limit of normal (ULN) or liver biopsy is confirmed as NASH. Participants will be randomly allocated into 2 groups: formulated food (n = 80) and a placebo group (n = 40) for 24 weeks. Both groups will receive lifestyle and nutritional advice. The primary endpoint is a decrease in MRS-PDFF by more than 30% from baseline at 24 weeks. The secondary endpoints include the change of anthropometric, liver function, glycolipid metabolism, and systemic inflammation at 4, 12, and 24 weeks. In addition, we consider the changes in intestinal microbiota as an exploration to assess the abundance and diversity at 24 weeks. Weeks 24 to 36 are the follow-up period of drug withdrawal. DISCUSSION: This clinical trial will provide evidence of efficacy and safety of formulated food as a potential new therapeutic agent for NAFLD patients. TRIAL REGISTRATION: The trial is registered in the China Clinical Trial Center (ChiCTR1800016178).

Evaluation of the Prebiotic Potential of a Commercial Synbiotic Food Ingredient on Gut Microbiota in an Ex Vivo Model of the Human Colon.

Behavior and mood disorders have been linked to gut microbiota dysbiosis through the "microbiota-gut-brain axis". Microbiota-targeting interventions are promising therapeutic modalities to restore or even maintain normal microbiome composition and activity in these disorders. Here, we test the impact of a commercial synbiotic formulation on gut microbiota composition and metabolic activity. We employed an ex-vivo continuous fermentation model that simulates the proximal colon to assess the effect of this formulation on microbiota structure and functionality as compared to no treatment control and microcrystalline cellulose as a dietary fiber control. The test formulation did not alter the diversity of gut microbiota over 48 h of treatment. However, it induced the enrichment of Lactobacillus, Collinsella and Erysipelotrichaceae. The test formulation significantly increased the level of microbiota-generated butyrate within 12 h of treatment as compared to 24 h required by microcrystalline cellulose to boost its production. The test formulation did not lead to a significant change in amino acid profiles. These results provide evidence of potential benefits related to synbiotic effects and general gut health and support the potential of this food formulation as a therapeutic dietary intervention in mood and behavior disorders.

Accepted Safe Food-Handling Procedures Minimizes Microbial Contamination of Home-Prepared Blenderized Tube-Feeding.

BACKGROUND: The number of patients requiring home enteral nutrition (HEN) continues to increase. Many of these patients are interested in using blended food instead of, or in addition to, commercial enteral formula (CEF). Increased risk of food-borne illness is a concern of blenderized tube-feeding (BTF). This project assessed a standard procedure for minimizing bacterial growth of BTF prepared in the home setting. METHODS: Fifty participants prepared BTF in their kitchens using a standard preparation procedure to minimize bacterial contamination. BTF was assessed for growth of aerobic microorganisms, Escherichia coli, Staphylococcus aureus, and coliforms at baseline, 24-hour, and 48-hour intervals after preparation for a total of 150 colony forming units (CFU) counts performed. RESULTS: No sample had zero aerobic microbial counts; yet no substantial increase in microbial counts was observed during the 48 hours. At baseline and 24 hours, 5/50 (10%) had a CFU count of >104 , and at 48 hours, 6/50 (12%) exceeded 104 CFUs. Out of 150 CFU counts, 2 (1.3%) were just over 105 CFU/mL. Samples exceeding 104 CFU/mL were likely contaminated by common endospore-forming bacteria found in soil or by bacteria in milk that was close to its expiration date. CONCLUSION: In this study, 88% of the samples met the US Food Code criteria for safe food consumption; 10.7% met guidelines for marginal safety by other standards; and 1.3% slightly exceeded 105 CFUs. Established safe food-handling procedures can minimize bacterial contamination of BTF and consequently reduce risk of food-borne infection in HEN patients.

Comparison of Microbial Growth Between Commercial Formula and Blenderized Food for Tube Feeding.

BACKGROUND: Many healthcare facilities and providers prohibit blenderized tube feeding (BTF) for patients who request it due to concerns of high microbial load. The current project compared microbial loads of a standard ready-to-feed polymeric commercial formula (CF), a BTF made using baby food (BTF-BF), and a BTF prepared from blending whole food (BTF-WF), following food safety standards expected of U.S. hospitals. METHODS: Three tube-feeding formulas (CF, BTF-BF, BTF-WF) were prepared in a U.S. hospital and delivered in vitro to an unoccupied patient room. Samples were collected at zero hour, 2 hours, and 4 hours and compared for growth of aerobic microorganisms, Staphylococus aureus, coliforms, and Escherichia coli. The experiment was conducted in triplicate, 1 week apart. RESULTS: No S. aureus or coliform/E. coli were detected at any time point following preparation, and total bacterial count was well below acceptable limits. All 3 feeding formulas at zero hour, 2 hours, and 4 hours for each of the 3 sampling dates were acceptable for human consumption. CONCLUSION: Judicious BTF recipe selection and adherence to safe food handling provide a safe feeding substrate equivalent to CF in the hospital setting. Due to increased use and interest in BTF by patients and their caregivers, healthcare facilities may need to reexamine their policies prohibiting BTF use.

Nutritional and microbiological quality of commercial and homemade blenderized whole food enteral diets for home-based enteral nutritional therapy in adults.

BACKGROUND & AIMS: Serious nutritional and contamination risks may be involved in the preparation of blenderized tube-feeding diets and in the handling of commercial diets. Their nutritional and microbiological quality in home settings is unknown. The objective of this study was to assess the nutritional and microbiological quality of commercial enteral and homemade blenderized whole foods diets intended to adult patients in home nutritional therapy. METHODS: In a cross sectional study, 66 samples of commercial (CD) and noncommercial (NCD) enteral diets were collected at the homes of patients in home enteral nutritional therapy, 33 of each type. Commercial diets were either powder (PCD; n = 13) or liquid (LCD; n = 20). The samples were analyzed in laboratory to assess their nutritional and microbiological quality. Anthropometric data of mid upper arm circumference (MUAC) and triceps skinfold (TST) thickness were obtained from the patients' medical records. RESULTS: NCD presented significantly lower values for protein, fat, fiber, carbohydrate and energy while water content was significantly higher. PCD and LCD did not show any statistically significant differences between them. In the NCD, the values measured for macronutrients and energy corresponded to less than 50% of the prescribed values (except for fat). In CD, protein value was about 20% more than the prescribed value; fat and energy values corresponded to approximately 100% of the prescription, while carbohydrate corresponded to 92%. Regardless the type of the diet, prevalence of undernutrition was high in both groups though patients of the NCD presented a higher percentage. Samples of NCD complied significantly less with the microbiological standards; only 6.0% complied with the standard for coliform bacteria. Escherichia coli was detected in 10, 2, and 2 samples of NCD, PCD and LCD, respectively. CONCLUSIONS: Homemade blenderized enteral diets showed low values of energy and macronutrients, delivered less than 50% of the prescribed values and had high levels of bacterial contamination.

A Liquid Chromatography-Tandem Mass Spectrometry Method for the Detection of Antimicrobial Agents from Seven Classes in Calf Milk Replacers: Validation and Application.

Calf milk replacers are low-cost feeds that contain available, digestible protein. During their reconstitution, however, the addition of drugs, such as antibiotics, could make them a very simple route for illicit treatment for therapeutic, preventive, or growth-promoting purposes. We developed an HPLC-MS/MS method, preceded by a unique extraction step, able to identify 17 antibiotics from seven classes (penicillins, tetracyclines, fluoroquinolones, sulfonamides, cephalosporins, amphenicols, and lincosamides) in this matrix. Prior to solid phase extraction (SPE), the sample underwent deproteinization and defatting. The method was fully validated according to Commission Decision 2002/657/EC. Decision limits (CCα) and detection capability (CCß) were in the ranges of 0.13-1.26 and 0.15-1.47 ng/mL, respectively. Thirty-eight samples were finally analyzed, showing the occasional presence of marbofloxacin (six samples) and amoxicillin (one sample).

Potential virulence of Klebsiella sp. isolates from enteral diets

We aimed to evaluate the potential virulence of Klebsiellaisolates from enteral diets in hospitals, to support nosocomial infection control measures, especially among critical-care patients. Phenotypic determination of virulence factors, such as capsular expression on the external membrane, production of aerobactin siderophore, synthesis of capsular polysaccharide, hemolytic and phospholipase activity, and resistance to antibiotics, which are used therapeutically, were investigated in strains ofKlebsiella pneumoniae and K. oxytoca. Modular industrialized enteral diets (30 samples) as used in two public hospitals were analyzed, and Klebsiella isolates were obtained from six (20%) of them. The hypermucoviscous phenotype was observed in one of the K. pneumoniae isolates (6.7%). Capsular serotypes K1 to K6 were present, namely K5 and K4. Under the conditions of this study, no aerobactin production, hemolytic activity or lecithinase activity was observed in the isolates. All isolates were resistant to amoxicillin and ampicillin and sensitive to cefetamet, imipenem, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim. Most K. pneumoniae isolates (6/7, 85.7%) from hospital B presented with a higher frequency of resistance to the antibiotics tested in this study, and multiple resistance to at least four antibiotics (3/8; 37.5%) compared with isolates from Hospital A. The variations observed in the antibiotic resistance profiles allowed us to classify theKlebsiella isolates as eight antibiotypes. No production of broad-spectrum β-lactamases was observed among the isolates. Our data favor the hypothesis that Klebsiella isolates from enteral diets are potential pathogens for nosocomial infections.

Potential virulence of Klebsiella sp. isolates from enteral diets.

We aimed to evaluate the potential virulence of Klebsiella isolates from enteral diets in hospitals, to support nosocomial infection control measures, especially among critical-care patients. Phenotypic determination of virulence factors, such as capsular expression on the external membrane, production of aerobactin siderophore, synthesis of capsular polysaccharide, hemolytic and phospholipase activity, and resistance to antibiotics, which are used therapeutically, were investigated in strains of Klebsiella pneumoniae and K. oxytoca. Modular industrialized enteral diets (30 samples) as used in two public hospitals were analyzed, and Klebsiella isolates were obtained from six (20%) of them. The hypermucoviscous phenotype was observed in one of the K. pneumoniae isolates (6.7%). Capsular serotypes K1 to K6 were present, namely K5 and K4. Under the conditions of this study, no aerobactin production, hemolytic activity or lecithinase activity was observed in the isolates. All isolates were resistant to amoxicillin and ampicillin and sensitive to cefetamet, imipenem, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim. Most K. pneumoniae isolates (6/7, 85.7%) from hospital B presented with a higher frequency of resistance to the antibiotics tested in this study, and multiple resistance to at least four antibiotics (3/8; 37.5%) compared with isolates from Hospital A. The variations observed in the antibiotic resistance profiles allowed us to classify the Klebsiella isolates as eight antibiotypes. No production of broad-spectrum ß-lactamases was observed among the isolates. Our data favor the hypothesis that Klebsiella isolates from enteral diets are potential pathogens for nosocomial infections.

Microbiological quality of enteral feeding and infant formula produced in dietary units, according to the triad of Donabedian.

INTRODUCTION AND AIMS: Microbial contamination of enteral feeding and infant formulas can result in a risk of worsening of the clinical condition of the patients, who are already weakened and susceptible to pathogens. The objective was to evaluate aspects of the management of quality hygienic - sanitary of enteral feeding and infant formulas in hospitals, focusing on the structure, process and outcome. METHODS: An observational, descriptive, prospective, with quantitative and qualitative variables study was done. The survey was conducted for 12 months and 227 samples of enteral feeding and 176 of infant formula were collected in Nutrition and Dietetic Services of Health Secretary / Federal District. In evaluating the operating conditions, the Tool 2 was applied to: Enteral Nutrition Preparation. Data were analyzed from the unified Donabedian's triad for evaluation of health services. RESULTS: The results obtained with the Tool 2 demonstrated that the Storage Block complies with legal requirements. Moreover, Dressing Block is a risk factor for the contamination. From the 403 samples, 56% corresponded to samples of Enteral Nutrition and 44% to samples of Infant Formulas. The data indicate that from 227 samples of Enteral Nutrition, 6.2% were in disagreement with the legislation, while from 176 samples of Infant Formulas, 4.6% were also in disagreement with the legislation. CONCLUSION: The ineffective implementation of the sanitary and hygienic requirements during the preparation results in a microbiologically unsafe product to patients in debilitated health state, and the count of mesophilic microorganisms can be a good indicator of microbiological safety.

Introducción y objetivo: La contaminación microbiológica de dietas enterales y fórmulas infantiles puede conducir a una situación de riesgo de agravación del cuadro clínico de pacientes, ya debilitados y susceptibles a los agentes patógenos. El objetivo fue evaluar aspectos de la gestión de calidad de condiciones sanitarias de dietas enterales y fórmulas infantiles en los hospitales, centrándose en estructura, proceso y resultado. Métodos: Fue hecho un estudio observacional, descriptivo, prospectivo, con variables cuantitativas y cualitativas. La encuesta fue por 12 meses y se recogieron 227 muestras de dietas enterales y 176 de fórmulas infantiles en los Servicios de Nutrición y Dietética de la Secretaría de Estado de Salud del Distrito Federal. Los datos fueron analizados a partir de la Tríada de Donabedian para la evaluación de los servicios de salud por medio de un cuestionario. Resultados: Los resultados obtenidos muestran que en Bloque Almacenamiento cumple con los requisitos legales. Por otro lado, el Bloque Vestuario es un factor de riesgo de contaminación. De las 403 muestras, 56% eran muestras de Nutrición Enteral y 44%, muestras de Fórmulas Infantiles. Los datos indican que de 227 muestras de Nutrición Enteral, un 6,2% estaban en desacuerdo con la ley, mientras que de las 176 muestras de las Fórmulas Infantiles, 4,6% también estaban en desacuerdo con la legislación. Conclusión: La falta de aplicación efectiva de requisitos higiénicos sanitários durante la preparación resulta en producto microbiológicamente inseguro para pacientes debilitados, y el recuento de mesófilos totales puede ser un buen indicador de la seguridad microbiológica.

Microbial contamination of enteral feeding products in thermoneutral and hyperthermal ICU environments.

BACKGROUND: Temperature is known to affect bacterial growth, but current safety recommendations for enteral formula are based on studies conducted in thermoneutral environments, which are not representative of select burn intensive care units (ICUs) that are kept therapeutically hyperthermal. This project evaluated microbial growth in 3 enteral feeding systems: closed, open, and open with modular additives (modular tube feeding [MTF]) exposed to 2 different environments. PROCEDURES: Product for each of the 3 systems was prepared and hung in both a thermoneutral (23.3°C) and a hyperthermal (32.5°C) ICU room. At baseline, 4 hours, and 8 hours, samples were plated and incubated overnight and the number of colony-forming units (CFUs) counted. FINDINGS: In the thermoneutral and hyperthermal environments, there was no evidence of microbial growth in the open or closed feeding systems at any time point. The MTF exhibited baseline contamination with a median of 10 CFUs (95% CI, 8-16) and significant growth over time to 54 CFUs (95% CI, 20-230) by 8 hours in the thermoneutral setting. In the hyperthermal environment, the MTF showed baseline contamination of 390 CFUs (95% CI, 40-1600) and significant growth over time, with 30% of samples exhibiting contamination levels exceeding Food and Drug Administration standards by 4 hours and CFUs being too numerous to count by 8 hours. CONCLUSION: CFUs in enteral formula did not differ between open and closed feeding systems in either environment for up to 8 hours; however, the addition of modulars to open systems may result in an unacceptable risk of contamination in hyperthermal environments.

Formulation of a nasogastric liquid feed and shelf-life extension using gamma radiation.

Nasogastric liquid feed formulation (NGLF) was developed for immunocompromised patients who are vulnerable targets of pathogenic assault. NGLF consisted of cereals, pulses, vegetables, and milk powder to provide balanced nutrients; however, the shelf life was only a few hours because this product was highly prone to microbial contamination and proliferation due to its high water content and rich nutrients. Postpreparation storage and distribution was very difficult, even at chilled temperatures. To overcome this problem, the NGLF was irradiated at various doses (2.5 to 10 kGy). Gamma irradiation at 10 kGy reduced the microbial load to nondetectable levels, and the product could be stored up to 1 month without any detectable increase in microbial load. The sensory evaluation did not indicate differences between the nonirradiated fresh, irradiated fresh, and stored samples. Nutritional quality in terms of total carbohydrates, dietary fiber, proteins, calories, vitamins A and C, and the micronutrients calcium, iron, and zinc was not affected by irradiation. NGLF also possessed antimutagenic potential against ethylmethanesulphonate-induced mutagenesis in Escherichia coli cells as evaluated by the rifampin resistance assay. This property of NGLF remained unchanged even after exposure to a 10-kGy dose of gamma radiation. Thus, irradiated NGLF seemed to be a safe and wholesome food for immunocompromised patients.

Commercial herbal slimming products: concern for the presence of heavy metals and bacteria.

The increment of rate in obesity, the phenomenon of fat phobia as well as the increased use of herbal medicine had lead to the emergence of herbal slimming products. However, numerous bacteria and heavy metal contaminations are often found in herbal products due to irregular handling practices. Ten different brands of products (labeled as A-J) were investigated. Seven heavy metals content such as As, Cd, Pb, Co, Cr, Cu and Zn were analyzed using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) and bacterial presence was determined by counting the total aerobic count. The identification of isolates was carried out by macroscopic and microscopic observation, biochemical tests and confirmation using commercial kits of Microgen GN-ID A+B and API 20 E. The heavy metal contents in the samples were below the limit of the standard limitation by WHO and Health Canada. However, sample A contained the highest total daily intake of heavy metals. Total aerobic count was highest in sample H followed by G, A, B, C, F, D, E, I and J in which G and H exceeded the standard total aerobic count (10(5) CFU g(-1)) as given by WHO. A total of nine isolates of Bacillus spp. and ten gram-negative bacteria were isolated in which Bacillus cereus and Pseudomonas aeruginosa were found in samples C and F, respectively. Considering the fact that the herbal sliming products contained low concentration of heavy metals and bacteria count, it should be consumed with caution.

[Study of physicochemical and bacteriological impact of a weekly assembly of automated compounding BAXA(®) Exacta-Mix 2400 on parenteral nutrition admixture manufacturing]. / Étude de l'impact physicochimique et bactériologique d'un montage hebdomadaire de l'automate BAXA(®) Exacta-Mix 2400 sur la fabrication des poches de nutrition parentérale.

INTRODUCTION: The parenteral nutrition admixtures are manufactured with an automated compounding BAXA(®) Exacta-Mix 2400. A 48-hour assembly has been validated. To optimize time and cost, a weekly assembly was tested. MATERIALS AND METHODS: Assembly was made on the first day. Ten identical parenteral nutrition admixtures (different volumes and compositions) were produced each day. A macroscopic examination was done at D0, D7 and D14. Physicochemical controls (electrolytes determinations by atomic absorption spectrophotometry, osmolalities measurements) were performed. Microbiological tests included a filtration membrane sterility test (Steritest(®)) and a plate count agar environmental monitoring. RESULTS: All mixtures were considered stable. The 12 Steritest(®) (H24, H48, D7 and D14) did not show any bacterial or fungal contamination. No microorganism has been detected on the plate count agar at D4 and D7. Concerning the physicochemical parameters of each parental nutrition admixture, no significant difference (Wilcoxon test) with the first day was found. DISCUSSION AND CONCLUSIONS: The automated filling system BAXA(®) Exacta-Mix 2400 improves the quality and safety of production. According to these results, the weekly assembly is validated and permit to save time (80hours/year) and cost (40 000 euros on consumable/year).

Safety of decanted enteral formula hung for 12 hours in a pediatric setting.

BACKGROUND: Enteral nutrition has been an accepted mode of pediatric care for more than 40 years. Early reports in the literature documented high levels of bacterial contamination in enteral formulas delivered to patients. Safety standards for formula administration have not been universally followed. Evidence demonstrates that increased manipulation of the delivery system contributes to bacterial contamination. METHODS: A prospective, descriptive study was conducted with 30 pediatric patients. They received continuous enteral feedings using decanted formula over a minimum hang time of 12 hours. Formula was delivered according to current practice recommendations. Cultures were obtained and sent to the laboratory initially and every 4 hours. RESULTS: Cultures from 30 patients (average age 6.4 years) were obtained at baseline, 4, 8, and 12 hours. Nasogastric, nasojejunal, gastrostomy, or gastrojejunostomy feeding tubes were used. Formulas administered were polymeric and peptide based. Of the 119 cultures obtained, 8 were either collected improperly or revealed a contaminant. Of the 111 useable cultures, 100 showed no growth, 6 had growth below the Food and Drug Administration threshold for contamination (95% acceptable), and 5 (5%) in 2 patients were considered positive, with all cultures growing coliforms. No patient had any clinical signs of bacterial gastroenteritis (increased stool output, fever, or clinical deterioration) over the 48 hours after data collection. CONCLUSION: Decanted enteral formula administered continuously over 12 hours in a pediatric hospital setting has a lower than expected rate of bacterial growth when recommended handling practices are followed.

Effect of functional yogurt NY-YP901 in improving the trait of metabolic syndrome.

BACKGROUND/OBJECTIVES: This study was aimed to assess the beneficial effects on metabolic syndrome of functional yogurt NY-YP901 (Namyang Dairy Product Co. Ltd and Nutra R&BT Inc., Seoul, Korea) supplemented with mixture of Streptococcus thermophilus, Lactobacillus acidophilus, Bifidobacterium infantis and extra-ingredients containing Bifidobacterium breve (CBG-C2), Enterococcus faecalis FK-23, fibersol-2 and so on. SUBJECTS/METHODS: This study was designed as an 8-week randomized, double-blind, placebo-controlled, parallel study. Treatment and control groups consumed a functional yogurt NY-YP901 (150 ml) and a placebo yogurt twice a day, respectively, for 8 weeks. Body weight and body mass index (BMI), blood pressure, lipid profiles, fasting glucose with HbA1C and waist circumference were measured before and after treatment. Inclusion criteria were healthy individuals between the ages 20-65 years old who submitted an informed consent. RESULTS: During the period August 2009 to December 2009, 101 healthy participants (31 males and 70 females) finished the study. Treatment group were 53 individuals, and the control group were 48 individuals. In the treatment group consuming NY-YP901, statistically significant beneficial changes were observed in body weight (treatment group vs control group=-0.24±1.50 vs +0.64±1.39 kg, P<0.05), BMI (-0.10±0.58 vs +0.24±0.50 kg/m(2), P<0.05 ) and low-density lipoprotein (LDL)-cholesterol (-7.71±14.14 vs -0.43±15.32 mg/dl, P<0.05) after 8 weeks. The change in other parameters was not different between the treatment and the control groups. CONCLUSIONS: The functional yogurt NY-YP901 reduced LDL-cholesterol, body weight and BMI in the subjects at a 300-ml consumption daily for 8 weeks. From these findings, regular intake of functional yogurt NY-YP901 may be consequently related to improve metabolic syndrome.

Molecular epidemiological survey of Citrobacter freundii misidentified as Cronobacter spp. (Enterobacter sakazakii) and Enterobacter hormaechei isolated from powdered infant milk formula.

A total of 75 powdered infant milk formula (PIF) samples collected from pharmacies and drugstores in Western Sicily, Italy, and representative of 12 different brands were analyzed in this study to evaluate their microbiological quality. According to the U.S. Food and Drug Administration protocol, 32 samples out of 75 were contaminated by enterobacteria. Commercial biochemical API(r) 20E-system identification method indicated that six PIF samples were presumptively contaminated by Cronobacter spp., but further characterization by alpha-glucosidase based polymerase chain reaction (PCR) assay identification strongly suggested that these strains did not belong to the genus Cronobacter. Phylogenetic analysis of partial 16S rRNA (rrs) sequences combined with the results of biochemical tests allowed to identify the six strains as Citrobacter freundii. Similarly, rrs sequence analysis identified as Enterobacter hormaechei 23 strains originally ascribed to Enterobacter cloacae by the API 20E system. Characterization of C. freundii and E. hormaechei PIF isolates by the DiversiLab(r) repetitive sequence-based PCR (rep-PCR) typing method revealed a variety of amplification patterns, but the recovery of the same rep-PCR genotype in several products might indicate a special adaptation of genetic clones to this food or cross-contamination through common ingredients. Antibiotic-resistance profiles were also determined, but none of the strains tested was resistant to third-generation cephalosporins or fluoroquinolones and extended-spectrum beta-lactamase activity was not detected. Our results confirm that E. hormaechei contamination of PIF is widespread, thus making it a cause for concern. Similarly to what was demonstrated for E. hormaechei, we suggest that C. freundii also may be an under-reported cause of bacterial infection, especially in high-risk neonates, due to misidentification.

Probiotic bacteria Lactobacillus rhamnosus influences the blood profile in rainbow trout Oncorhynchus mykiss (Walbaum).

This paper reports the effect of feeding probiotic diets on blood profiles in rainbow trout. Two experiments were performed: in the first, fish of average weight 75 g were offered either a commercial feed or the same incorporated with 10(9) CFU g(-1) of lactic acid bacteria Lactobacillus rhamnosus for 30 days; in the second study performed for a similar duration, fish of average weight 126 g were offered formulated diets that either contained the same bacteria in heat-killed or freeze-dried form (nearly 10(11) CFU g(-1)), or the basal diet without the bacteria. Blood samples were collected at different times after commencement of probiotic feeding to determine the total cholesterol, triglyceride contents, the plasma alkaline phosphatase activity, plasma protein and hematocrit value. The plasma cholesterol significantly increased upon probiotic feeding in the first experiment. A significant elevation (P<0.05) of plasma cholesterol and triglyceride and alkaline phosphatase activity level was found in the freeze-dried probiotic fed groups at 20 and 30 days postfeeding. This was concomitant with the increased plasma protein and hematocrit values in FD group at 20 and 30 days. Likewise, the heat-killed probiotic fed group registered significantly high values of triglycerides, alkaline phosphatase activity, and plasma protein compared to the control diet fed groups after 20 days of feeding. Thus, alterations in the blood profiles could serve as supplementary information when examining the benefits of probiotics for fish.