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Zhang W, Ma C, Hu L, Wang L, Xu F. Late-onset sepsis in newborns caused by Bacillus Cereus: a case report and literature review. Ann Clin Microbiol Antimicrob 2024; 23:66. [PMID: 39061043 PMCID: PMC11282708 DOI: 10.1186/s12941-024-00712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 06/02/2024] [Indexed: 07/28/2024] Open
Abstract
Bacillus cereus is a bacterium capable of causing late-onset neonatal sepsis. By analyzing 11 cases, this study investigates the diagnosis, treatment, and prognosis of Bacillus cereus infections, aiming to provide insights into clinical diagnosis and therapy. The study scrutinized 11 instances of late-onset neonatal sepsis, including two fatalities attributable to Bacillus cereus, one accompanied by cerebral hemorrhage. An examination and analysis of these cases' symptoms, signs, laboratory tests, and treatment processes, along with a review of related literature from 2010 to 2020, revealed a high mortality rate of 41.38% in non-gastrointestinal infections caused by Bacillus cereus. Our findings underscore the critical importance of rapid diagnosis and effective antimicrobial therapy in reducing mortality rates. Once the source of infection is identified, implementing effective infection control measures is essential.
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Affiliation(s)
- Wang Zhang
- The Third Affiliated Hospital of Zhengzhou University, No. 7, Kangfuqian Street, Erqi District, Zhengzhou, Henan, 450052, China
| | - Caihua Ma
- The Third Affiliated Hospital of Zhengzhou University, No. 7, Kangfuqian Street, Erqi District, Zhengzhou, Henan, 450052, China
| | - Linghui Hu
- The Third Affiliated Hospital of Zhengzhou University, No. 7, Kangfuqian Street, Erqi District, Zhengzhou, Henan, 450052, China
| | - Ling Wang
- The Third Affiliated Hospital of Zhengzhou University, No. 7, Kangfuqian Street, Erqi District, Zhengzhou, Henan, 450052, China
| | - Falin Xu
- The Third Affiliated Hospital of Zhengzhou University, No. 7, Kangfuqian Street, Erqi District, Zhengzhou, Henan, 450052, China.
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2
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Moro GE, Girard M, Peila C, Garcia N, Escuder-Vieco D, Keller K, Cassidy T, Bertino E, Boquien CY, Buffin R, Calvo J, Gaya A, Gebauer C, Lamireau D, Lembo D, Picaud JC, Wesolowska A, Arslanoglu S, Cavallarin L, Giribaldi M. New alternatives to holder pasteurization in processing donor milk in human milk banks. Front Nutr 2024; 11:1409381. [PMID: 38988859 PMCID: PMC11234892 DOI: 10.3389/fnut.2024.1409381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/13/2024] [Indexed: 07/12/2024] Open
Abstract
Infectious and toxicological risks are the main potential hazards that operators of Human Milk Banks (HMBs) encounter and must eliminate. HMBs are trying to implement procedures that allow to manage and sanitize human milk without altering significantly its nutritional and biologically protective components, obtaining a product characterized by a valid balance between safety and biological quality. The history of human milk processing is linked to the origins of HMBs themselves. And although other forms of sterilization were used originally, pasteurization soon became the recognized most effective means for sanitizing milk: all the milk that arrives at the HMB must be pasteurized. Holder pasteurization (HoP) is the most used methodology, and it is performed using low temperature and long time (+62.5°C for 30 min). With HoP some bioactive milk components are lost to varying degrees, but many other precious bioactive compounds are completely or partially preserved. To improve the quality of human milk processed by HMBs, maintaining in the meantime the same microbiological safety offered by HoP, new technologies are under evaluation. At present, High-Temperature Short-Time pasteurization (HTST) and High-Pressure Processing are the most studied methodologies. HTST is already utilized in some HMBs for daily practical activity and for research purposes. They seem to be superior to HoP for a better preservation of some nutritional and biologically protective components. Freeze-drying or lyophilization may have advantages for room temperature storage and transportation. The aim of this study is to evaluate the advancement regarding the processing of DHM with a literature search from 2019 to 2022. The effects of the new technologies on safety and quality of human milk are presented and discussed. The new technologies should assure microbiological safety of the final product at least at the same level as optimized HoP, with an improved preservation of the nutritional and bioactive components of raw human milk.
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Affiliation(s)
- Guido E Moro
- Associazione Italiana delle Banche del Latte Umano Donato (AIBLUD), Milan, Italy
| | - Melissa Girard
- Medical Affairs and Innovation, Héma-Québec, Québec, QC, Canada
| | - Chiara Peila
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Nadia Garcia
- Banco Regional de Leche Materna Aladina-MGU, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Diana Escuder-Vieco
- Banco Regional de Leche Materna Aladina-MGU, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Kristin Keller
- Banco Regional de Leche Materna Aladina-MGU, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Tanya Cassidy
- Kathleen Lonsdale Health Research Institute, Maynooth University, Maynooth, Ireland
| | - Enrico Bertino
- Neonatal Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | | | - Rachel Buffin
- Neonatology UnitCroix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
- Rhône-Alpes-Auvergne Regional Human Milk Bank, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Javier Calvo
- Group of Cell Therapy and Tissue Engineering (TERCIT), Fundació Banc de Sang i Teixits de les Illes Balears (FBSTIB), Research Institute on Health Sciences (IUNICS) and Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Antoni Gaya
- Group of Cell Therapy and Tissue Engineering (TERCIT), Fundació Banc de Sang i Teixits de les Illes Balears (FBSTIB), Research Institute on Health Sciences (IUNICS) and Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Corinna Gebauer
- Abteilung Neonatologie Klinik und Poliklinik für Kinder und Jugendliche, Leipzig, Germany
| | - Delphine Lamireau
- Human Milk Bank of University Hospital of Bordeaux, Lamireau, France
| | - David Lembo
- Laboratory of Molecular Virology and Antiviral Research, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Jean-Charles Picaud
- Department of Neonatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- CarMen Laboratory, INSERM, INRA, Université Claude Bernard Lyon1, Lyon, France
| | - Aleksandra Wesolowska
- Laboratory of Human Milk and Lactation Research at Milk Bank in Holy Family Hospital, Department of Medical Biology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Sertac Arslanoglu
- Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Laura Cavallarin
- Consiglio Nazionale delle Ricerche, Istituto di Scienze delle Produzioni Alimentari, Turin, Italy
| | - Marzia Giribaldi
- Consiglio Nazionale delle Ricerche, Istituto di Scienze delle Produzioni Alimentari, Turin, Italy
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3
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Tönnies H, Heep A, Herrmann J, Lange M, Mellmann A, Hamprecht A. Investigating environmental transmission to resolve a Bacillus cereus group outbreak in a neonatal intensive care unit using core genome multilocus sequence typing. Antimicrob Resist Infect Control 2024; 13:1. [PMID: 38184647 PMCID: PMC10771705 DOI: 10.1186/s13756-023-01359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND We analyzed an outbreak of Bacillus cereus group (Bcg) at a single-center neonatal intensive care unit level IV by conducting comprehensive sampling of both patients and the environment. METHODS Between 06/2020 and 10/2021, all Bcg isolates identified by both regular colonization screening and additional sampling of the environment were subjected to whole-genome sequencing, followed by in vitro extraction of MLST ST, resistance genes and virulence factors. Using publicly available genome sequences, we defined an ad hoc core genome multilocus sequence typing (cgMLST) scheme comprising 2759 target genes for Bcg typing, which we applied to the detected isolates. We have compared the results with a stable cgMLST that was published in the meantime and completed the investigation with a SNP analysis. RESULTS We analyzed 28 Bcg isolates from patient and environmental samples using MLST and cgMLST. This revealed multiple sequence types, with ST127 being the most common (n = 13). Both cgMLST schemes grouped ten of the 13 ST127 isolates into a cluster, including two invasive isolates from two different patients and several environmental samples. SNP analysis postulated a screen from a ventilation machine as a possible reservoir. CONCLUSION In sensitive settings such as neonatal intensive care units, considering the environment in outbreak analyses is crucial, especially when investigating potential transmission routes through shared devices. When dealing with widespread bacteria such as Bcg, high-resolution typing techniques are necessary. In this study, we successfully resolved an outbreak of Bcg infections using a custom cgMLST scheme combined with a SNP analysis.
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Affiliation(s)
- Hauke Tönnies
- Institute of Hygiene, University Hospital Münster, Münster, Germany.
| | - Axel Heep
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - Jörg Herrmann
- Institute of Hygiene, University Hospital Oldenburg, Oldenburg, Germany
| | - Matthias Lange
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | | | - Axel Hamprecht
- Institute of Medical Microbiology and Virology, University Hospital Oldenburg, Oldenburg, Germany
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4
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Oreg A, Negev M. Peer-to-Peer Human Milk-Sharing Among Israeli Milk Donors: A Mixed-Methods Study in the Land of Milk and Honey. J Hum Lact 2023; 39:688-700. [PMID: 37688471 PMCID: PMC10580680 DOI: 10.1177/08903344231196113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/10/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Evidence is lacking on the phenomenon of peer-to-peer human milk-sharing in the Middle East, specifically, in Israel. RESEARCH AIMS This study aimed to uncover peer-to-peer human milk-sharing in Israel, learn about how and whether donors engage in safe milk handling and storage practices, and assess knowledge about human milk and breastfeeding among this milk-sharing population. We also aimed to investigate donors' selectiveness in their decisions about to whom they donate their milk and their perceptions about the sale and purchase of human milk. METHODS We conducted a semi-structured online survey, including both closed- and open-ended questions and used mixed methods to analyze responses descriptively. We used non-probability sampling to obtain a broad sample of human milk donors. RESULTS Out of 250 completed surveys, most participants (87.2%, n = 218) reported engaging in safe milk-sharing practices and were generally knowledgeable about the health risks associated with milk-sharing. Participant religiosity was associated with somewhat lower hygiene practices (r = -0.15, p ≤ .05). Most of the participants (81.7%, n = 190) were against the sale of human milk. Participants generally expressed no preference about the recipient of their milk, with some exceptions. CONCLUSION The milk-handling and storage practices of the participants in this study suggest a need to improve knowledge and awareness of safe milk storage temperature and the importance of washing hands before pumping milk, particularly within the religious sector. We propose that guidelines about safe milk-sharing practices be written and adopted by the Israeli Ministry of Health, and communicated through pediatricians, family doctors, nurses in Mother and Child Clinics (In Hebrew: Tipat Halav), and social media.
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Affiliation(s)
- Ayelet Oreg
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Maya Negev
- School of Public Health, University of Haifa, Haifa, Israel
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5
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Arduino I, Calvo J, Rittà M, Cabeza S, Llobera M, Lembo D, Gayà A, Donalisio M. Impact of time-temperature combinations on the anti-Cytomegalovirus activity and biological components of human milk. Pediatr Res 2023; 94:956-964. [PMID: 37059899 DOI: 10.1038/s41390-023-02606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND There is extensive evidence that Holder pasteurization (HoP) (30 min at 62.5 °C) has harmful effects on the bioactivities of human milk (HM). We previously demonstrated that lowering HoP temperature is sufficient to inactivate Cytomegalovirus (HCMV). Here, we analyzed the effect of lowering time/temperature on the antiviral activity against HCMV and IgA levels of HM. METHODS Eighty HM samples from five mothers were pasteurized in a range of temperature (62.5-56 °C) and time (40-10 min) in a conventional setting of Human Milk Bank. Unpasteurized HM from each mother was used as control. The samples were assayed against HCMV-AD169 strain in cell cultures and IgA levels were determined by ELISA. RESULTS All HM samples exhibited anti-HCMV activity, to a different extent. An improvement of antiviral activity was observed in samples treated at 60, 58 and 56 °C compared to those at 62.5 °C, with ID50 values near those of unpasteurized milk. Similarly, better retention in IgA levels was observed by reducing the temperature of treatment. CONCLUSIONS We demonstrated that a 2.5 °C reduction of heat treatment significantly preserved the IgA content and fully restored the anti-HCMV activity of HM, supporting this variant of HoP as a valid alternative to preserve HM bioactivities. IMPACT This work questions the standard HoP and opens the debate on whether the pasteurization temperature commonly used in Human Milk Banks should be lowered to better preserve the biological components of the milk. A reduction of HoP temperature at 60 °C determined a significant preservation of anti-HCMV activity and IgA content of donor HM, compared to standard HoP. This alternative HoP is highly feasible compared to other substitute pasteurization techniques, since it would employ the same pasteurizer equipment found in most Human Milk Banks.
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Affiliation(s)
- Irene Arduino
- Department of Clinical and Biological Sciences, Laboratory of Molecular Virology and Antiviral Research, University of Turin, Orbassano, Italy
| | - Javier Calvo
- Banc de Teixits, Fundació Banc de Sang i Teixits de les Illes Balears (FBSTIB), Palma, Spain
- Cell Therapy and Tissue Engineering Group (TERCIT), Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Massimo Rittà
- Department of Clinical and Biological Sciences, Laboratory of Molecular Virology and Antiviral Research, University of Turin, Orbassano, Italy
| | - Sergio Cabeza
- Banc de Teixits, Fundació Banc de Sang i Teixits de les Illes Balears (FBSTIB), Palma, Spain
| | - Marta Llobera
- Banc de Teixits, Fundació Banc de Sang i Teixits de les Illes Balears (FBSTIB), Palma, Spain
| | - David Lembo
- Department of Clinical and Biological Sciences, Laboratory of Molecular Virology and Antiviral Research, University of Turin, Orbassano, Italy
| | - Antoni Gayà
- Banc de Teixits, Fundació Banc de Sang i Teixits de les Illes Balears (FBSTIB), Palma, Spain
- Cell Therapy and Tissue Engineering Group (TERCIT), Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Manuela Donalisio
- Department of Clinical and Biological Sciences, Laboratory of Molecular Virology and Antiviral Research, University of Turin, Orbassano, Italy.
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6
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Yang R, Chen D, Wang H, Xu X. Experiences of mothers of NICU preterm infants in milk management out of the hospital: a qualitative study. Int Breastfeed J 2022; 17:95. [PMID: 36587203 PMCID: PMC9805215 DOI: 10.1186/s13006-022-00540-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/21/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Human milk is important for the health and development of preterm infants. China's neonatal intensive care units (NICUs) have adopted the management system of maternal-infant separation. Human milk received and used by NICUs is managed by the infants' families in the out-of-hospital environment. There is scant publication on mothers' opinions on out-of-hospital human milk management. This study aimed to explore the experiences of Chinese mothers providing their infants in the NICUs with human milk expressed outside of the hospital. METHODS Semi-structured interviews were conducted with 23 participants recruited from June 2020 to November 2020, who transported their human milk to the human milk bank of Women's Hospital School of Medicine Zhejiang University during the hospitalization of their preterm infants. This study adopted a qualitative research approach with thematic analysis. RESULTS Three main themes were identified: 1) awareness of human milk management and a willingness to adopt it; 2) lack of standardization regarding expressing, storing, and transporting expressed human milk; and 3) the need for more external support. Theme 2 additionally has three sub-themes: I) differentiation of preparations before human milk expression; II) differentiation of devices for human milk expression; and III) insufficient knowledge and understanding. CONCLUSIONS In this study, all participants who received health education showed enthusiasm for participating in out-of-hospital human milk management. However, most participants had questions during the implementation process. Medical staff should provide professional and continuous external support to support mothers in implementing human milk management.
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Affiliation(s)
- Rui Yang
- grid.24696.3f0000 0004 0369 153XSchool of Nursing, Capital Medical University, Beijing, China
| | - Danqi Chen
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, Zhejiang, Hangzhou China
| | - Hua Wang
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, Zhejiang, Hangzhou China
| | - Xinfen Xu
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, Zhejiang, Hangzhou China ,grid.13402.340000 0004 1759 700XHaining Maternal and Child Health Hospital, Branch of Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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7
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Jandová M, Měřička P, Fišerová M, Landfeld A, Paterová P, Hobzová L, Jarkovská E, Kacerovský M, Houška M. Quantitative Risk Assessment of Bacillus cereus Growth during the Warming of Thawed Pasteurized Human Banked Milk Using a Predictive Mathematical Model. Foods 2022; 11:foods11071037. [PMID: 35407124 PMCID: PMC8997632 DOI: 10.3390/foods11071037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 02/04/2023] Open
Abstract
Bacillus cereus is relatively resistant to pasteurization. We assessed the risk of B. cereus growth during warming and subsequent storage of pasteurized banked milk (PBM) in the warmed state using a predictive mathematical model. Holder pasteurization followed by storage below −18 °C was used. Temperature maps, water activity values, and B. cereus growth in artificially inoculated PBM were obtained during a simulation of manipulation of PBM after its release from a Human Milk Bank. As a real risk level, we chose a B. cereus concentration of 100 CFU/mL; the risk was assessed for three cases: 1. For an immediate post-pasteurization B. cereus concentration below 1 CFU/mL (level of detection); 2. For a B. cereus concentration of 10 CFU/mL, which is allowed in some countries; 3. For a B. cereus concentration of 50 CFU/mL, which is approved for milk formulas. In the first and second cases, no risk was detected after 1 h of storage in the warmed state, while after 2 h of storage, B. cereus concentrations of 102 CFU/mL were occasionally encountered. In the third case, exceeding the B. cereus concentration of 102 CFU/mL could be regularly expected after 2 h of storage. Based on these results, we recommend that post-pasteurization bacteriological analysis be performed as recommended by the European Milk Bank Association (EMBA) and using warmed PBM within 1 h after warming (no exceptions).
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Affiliation(s)
- Miroslava Jandová
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (P.M.); (M.F.)
- Department of Histology and Embryology, Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic
- Correspondence: ; Tel.: +420-739-569-340
| | - Pavel Měřička
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (P.M.); (M.F.)
| | - Michaela Fišerová
- Tissue Bank, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic; (P.M.); (M.F.)
| | - Aleš Landfeld
- Food Research Institute Prague, 102 00 Prague, Czech Republic; (A.L.); (M.H.)
| | - Pavla Paterová
- Department of Clinical Microbiology, University Hospital Hradec Králové, 500 05 and Faculty of Medicine in Hradec Králové, Charles University, 500 03 Hradec Králové, Czech Republic;
| | - Lenka Hobzová
- Department of Hospital Hygiene, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic;
| | - Eva Jarkovská
- Department of Pediatrics, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic;
| | - Marian Kacerovský
- Department of Obstetrics and Gynecology, University Hospital Hradec Králové, 500 05 Hradec Králové, Czech Republic;
| | - Milan Houška
- Food Research Institute Prague, 102 00 Prague, Czech Republic; (A.L.); (M.H.)
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8
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Zhang R, Zhuang Y, Xiao ZH, Li CY, Zhang F, Huang WQ, Zhang M, Peng XM, Liu C. Diagnosis and Surveillance of Neonatal Infections by Metagenomic Next-Generation Sequencing. Front Microbiol 2022; 13:855988. [PMID: 35401464 PMCID: PMC8989347 DOI: 10.3389/fmicb.2022.855988] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/07/2022] [Indexed: 12/21/2022] Open
Abstract
Microbial infections cause significant morbidity and mortality in neonates. Metagenomic next-generation sequencing is a hypothesis-free and culture-free test that enables broad identification of pathogens and antimicrobial resistance genes directly from clinical samples within 24 h. In this study, we used mNGS for etiological diagnosis and monitoring the efficacy of antibiotic treatment in a cohort of neonatal patients with severe infections. The median age was 19.5 (3–52) days, median gestational age was 37.96 (31–40+3) weeks, and the median birth weight was 3,261 (1,300–4,300) g. The types of infectious diseases included pneumonia, sepsis, and meningitis. mNGS reported microbial findings in all cases, which led to changes in antibiotic treatment. These included cases of Mycobacterium tuberculosis, Legionella pneumophila, and Bacillus cereus. Eight of ten infants recovered after antibiotic adjustment and showed normal development during follow-up. On the other hand, neurological retardation was seen in two infants with meningitis. mNGS enabled etiological diagnosis and guided antibiotic therapy when all conventional methods failed to discover the culprit. It has the potential to cut down the overall cost and burden of disease management in neonatal infections.
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Affiliation(s)
- Rong Zhang
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
| | - Yan Zhuang
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
| | - Zheng-hui Xiao
- Department of Emergency, Hunan Children’s Hospital, Changsha, China
| | - Cai-yun Li
- Department of Medical, Hangzhou Matridx Biotechnology Co., Ltd., Hangzhou, China
| | - Fan Zhang
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
| | - Wei-qing Huang
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
| | - Min Zhang
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
| | - Xiao-Ming Peng
- Department of Neonatology, Hunan Children’s Hospital, Changsha, China
- *Correspondence: Xiao-Ming Peng,
| | - Chao Liu
- Department of Medical, Hangzhou Matridx Biotechnology Co., Ltd., Hangzhou, China
- Chao Liu,
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9
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Enteral Linezolid as an Effective Option to Treat an Extremely Preterm Infant with Bacillus cereus Sepsis. CHILDREN 2022; 9:children9030415. [PMID: 35327787 PMCID: PMC8947578 DOI: 10.3390/children9030415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022]
Abstract
We report the safe and effective use of oral linezolid for treatment of Bacillus cereus sepsis in an extremely preterm neonate, previously fed with human donor milk, in which a Brevibacillus sp. was eventually found. Due to several predisposing factors, premature, very low birth weight newborns are extremely vulnerable to invasive infections by environmental pathogens. After vancomycin microbiologic treatment failure (despite adequate blood concentrations and clinical response), linezolid was chosen for its optimal enteral absorption and bioavailability, also after exhaustion of peripheral venous heritage. No adverse events were recorded, with clinical cure. We reviewed the literature on B. cereus infections in newborns, together with the available evidence on the use of linezolid in similar contexts.
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10
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Mallardi D, Piemontese P, Liotto N, Colombo RM, Dodaro A, Schiavello A, Tabasso C, Plevani L, Bezze E, Menis C, Roggero P, Mosca F. New Operating Approach to Limit Bacillus Cereus Contamination of Donor Human Milk. J Hum Lact 2022; 38:102-107. [PMID: 33745375 DOI: 10.1177/08903344211002563] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Domenica Mallardi
- 9339 NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasqua Piemontese
- 9339 NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nadia Liotto
- 9339 NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosaria M Colombo
- 9339 Unit of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Dodaro
- 9339 Unit of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Chiara Tabasso
- 9339 NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Plevani
- 9339 NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Bezze
- 9339 NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Menis
- 9339 NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Paola Roggero
- 9339 NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Fabio Mosca
- 9339 NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
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Bacillus cereus as a Major Cause of Discarded Pasteurized Human Banked Milk: A Single Human Milk Bank Experience. Foods 2021; 10:foods10122955. [PMID: 34945507 PMCID: PMC8700665 DOI: 10.3390/foods10122955] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 02/06/2023] Open
Abstract
A systematic study, performed from 2017–2020 looked at the rate of positive post-pasteurization B. cereus findings, the quantity of B. cereus in pasteurized banked human milk (PBM), and the rate of B. cereus toxicogenic isolates from PBM. During the study period, 6815.71 L (30,943 tested bottles) of PBM were tested, with an average amount per year of 1703.93 L (7736 tested bottles). The PBM discard rate per year due to bacterial contamination varied between 8.7–10.0% and contamination with B. cereus was the most frequent reason. The total number of B. cereus positive tests was 2739 and the proportion of its positivity from all positive tests was between 56.7–66.6%. The prevalence of B. cereus positive tests rose significantly in the summer months. The production of enterotoxin was found in 3 of the 20 tested samples (15.0%). The B. cereus CFU-quantities in the PBM were below 10 CFU/mL in 80% of cases (16 of 20 samples tested). The quantitative data can be used in the risk assessment of cold storage of PBM at temperatures above zero and manipulation of PBM prior to its administration.
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High Hydrostatic Pressure Treatment Ensures the Microbiological Safety of Human Milk Including Bacillus cereus and Preservation of Bioactive Proteins Including Lipase and Immuno-Proteins: A Narrative Review. Foods 2021; 10:foods10061327. [PMID: 34207614 PMCID: PMC8230168 DOI: 10.3390/foods10061327] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022] Open
Abstract
Breast milk is the nutritional reference for the child and especially for the preterm infant. Breast milk is better than donated breast milk (DHM), but if breast milk is not available, DHM is distributed by the Human Milk Bank (HMB). Raw Human Milk is better than HMB milk, but it may contain dangerous germs, so it is usually milk pasteurized by a Holder treatment (62.5 °C 30 min). However, Holder does not destroy all germs, and in particular, in 7% to 14%, the spores of Bacillus cereus are found, and it also destroys the microbiota, lipase BSSL and immune proteins. Another technique, High-Temperature Short Time (HTST 72 °C, 5–15 s), has been tried, which is imperfect, does not destroy Bacillus cereus, but degrades the lipase and partially the immune proteins. Therefore, techniques that do not treat by temperature have been proposed. For more than 25 years, high hydrostatic pressure has been tried with pressures from 100 to 800 MPa. Pressures above 400 MPa can alter the immune proteins without destroying the Bacillus cereus. We propose a High Hydrostatic Pressure (HHP) with four pressure cycles ranging from 50–150 MPa to promote Bacillus cereus germination and a 350 MPa Pressure that destroys 106 Bacillus cereus and retains 80–100% of lipase, lysozyme, lactoferrin and 64% of IgAs. Other HHP techniques are being tested. We propose a literature review of these techniques.
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13
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Liao SL, Tsai MH. Bacillus cereus bacteremia in a preterm infant caused by consumption of contaminated breastmilk. Pediatr Neonatol 2021; 62:337-338. [PMID: 33446458 DOI: 10.1016/j.pedneo.2020.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/24/2020] [Accepted: 12/24/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sui-Ling Liao
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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14
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Jarzynka S, Strom K, Barbarska O, Pawlikowska E, Minkiewicz-Zochniak A, Rosiak E, Oledzka G, Wesolowska A. Combination of High-Pressure Processing and Freeze-Drying as the Most Effective Techniques in Maintaining Biological Values and Microbiological Safety of Donor Milk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2147. [PMID: 33671763 PMCID: PMC7926441 DOI: 10.3390/ijerph18042147] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Human milk banks have a pivotal role in provide optimal food for those infants who are not fully breastfeed, by allowing human milk from donors to be collected, processed and appropriately distributed. Donor human milk (DHM) is usually preserved by Holder pasteurization, considered to be the gold standard to ensure the microbiology safety and nutritional value of milk. However, as stated by the European Milk Banking Association (EMBA) there is a need to implement the improvement of the operating procedure of human milk banks including preserving and storing techniques. AIM The purpose of this study was to assess the effectiveness and safety of the selected new combination of methods for preserving donor human milk in comparison with thermal treatment (Holder pasteurization). METHODS We assessed (1) the concentration of bioactive components (insulin, adiponectin, leptin, activity of pancreatic lipase, and hepatocyte growth factor) and (2) microbiological safety in raw and pasteurized, high-pressure processed and lyophilization human breast milk. RESULTS The combination of two techniques, high-pressure processing and freeze-drying, showed the best potential for preserving the nutritional value of human milk and were evaluated for microbiological safety. Microbiological safety assessment excluded the possibility of using freeze-drying alone for human milk sample preservation. However, it can be used as a method for long-term storage of milk samples, which have previously been preserved via other processes. CONCLUSION The results show that high-pressure treatment is the best method for preservation that ensures microbiological safety and biological activity but subsequent freeze-drying allowed long-term storage without loss of properties.
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Affiliation(s)
- Sylwia Jarzynka
- Department of Medical Biology, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland; (S.J.); (K.S.); (O.B.); (A.M.-Z.); (G.O.)
| | - Kamila Strom
- Department of Medical Biology, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland; (S.J.); (K.S.); (O.B.); (A.M.-Z.); (G.O.)
| | - Olga Barbarska
- Department of Medical Biology, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland; (S.J.); (K.S.); (O.B.); (A.M.-Z.); (G.O.)
| | - Emilia Pawlikowska
- Institute of High Pressure Physics of the Polish Academy of Sciences, ul. Sokolowska 29/37, 01-142 Warsaw, Poland;
| | - Anna Minkiewicz-Zochniak
- Department of Medical Biology, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland; (S.J.); (K.S.); (O.B.); (A.M.-Z.); (G.O.)
| | - Elzbieta Rosiak
- Institute of Human Nutrition Sciences, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159c St., 02-776 Warsaw, Poland;
| | - Gabriela Oledzka
- Department of Medical Biology, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland; (S.J.); (K.S.); (O.B.); (A.M.-Z.); (G.O.)
| | - Aleksandra Wesolowska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Department of Medical Biology, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland
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15
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Cormontagne D, Rigourd V, Vidic J, Rizzotto F, Bille E, Ramarao N. Bacillus cereus Induces Severe Infections in Preterm Neonates: Implication at the Hospital and Human Milk Bank Level. Toxins (Basel) 2021; 13:123. [PMID: 33562185 PMCID: PMC7915446 DOI: 10.3390/toxins13020123] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 12/15/2022] Open
Abstract
Human breast milk (HBM) is a source of essential nutrients for infants and is particularly recommended for preterm neonates when their own mother's milk is not available. It provides protection against infections and decreases necrotizing enterocolitis and cardiovascular diseases. Nevertheless, HBM spoilage can occur due to contamination by pathogens, and the risk of a shortage of HBM is very often present. B. cereus is the most frequent ubiquitous bacteria responsible for HBM being discarded. It can contaminate HBM at all stages, from its collect point to the storage and delivery. B. cereus can induce severe infection in newborns with very low birth weight, with sometimes fatal outcomes. Although the source of contamination is rarely identified, in some cases, HBM was suspected as a potential source. Even if the risk is low, as infection due to B. cereus in preterm infants should not be overlooked, human milk banks follow strict procedures to avoid contamination, to accurately identify remaining bacteria following pasteurization and to discard non-compliant milk samples. In this review, we present a literature overview of B. cereus infections reported in neonates and the suspected sources of contamination. We highlight the procedures followed by the human milk banks from the collection of the milk to its microbiological characterization in Europe. We also present improved detection and decontamination methods that might help to decrease the risk and to preserve the public's confidence in this vital biological product for infants whose mothers cannot breastfeed.
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Affiliation(s)
- Delphine Cormontagne
- Micalis Institute, INRAE, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (D.C.); (J.V.); (F.R.)
| | - Virginie Rigourd
- Région Île-de-France Human Milk Bank, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France;
| | - Jasmina Vidic
- Micalis Institute, INRAE, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (D.C.); (J.V.); (F.R.)
| | - Francesco Rizzotto
- Micalis Institute, INRAE, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (D.C.); (J.V.); (F.R.)
| | - Emmanuelle Bille
- Department of Clinical Microbiology, Necker Enfants-Malades Hospital, AP-HP, 75015 Paris, France;
- INSERM U1151-CNRS UMR 8253, Institut Necker-Enfants Malades, Université de Paris, 75015 Paris, France
| | - Nalini Ramarao
- Micalis Institute, INRAE, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (D.C.); (J.V.); (F.R.)
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Adjidé CC, Léké A, Mullié C. Bacillus cereus contamination of pasteurized human milk donations: frequency, origin, seasonal distribution, molecular typing of strains and proposed corrective/preventive actions. J Matern Fetal Neonatal Med 2020; 35:1554-1561. [PMID: 32393084 DOI: 10.1080/14767058.2020.1763295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: An increase in pasteurized human milk contamination with Bacillus cereus was witnessed in milk donated to the Amiens-Picardie Human Milk Bank over the 2017-2018 period. To better understand the origin of such an increase, this study aimed to describe the frequency of Bacillus cereus contamination in anonymous and personalized human milk donations of Amiens Human Milk Bank in 2018, compare the genetic profiles of Bacillus cereus strains found in pasteurized human milk and set up corrective/preventive actions to reduce Bacillus cereus contamination.Study design: A retrospective cohort study of human milk donated from January to December 2018 was set. Data on the microbiological quality of donated human milk and genetic profiles of Bacillus cereus strains isolated from pasteurized donated human milk and the environment were collected.Results: The overall noncompliance rate related to the microbiological quality in the 1585 batches of analyzed human milk donations was of 27.3%. Post-Holder pasteurization, rejection rates were significantly higher for anonymous donations as compared to personalized ones. Bacillus cereus was the main cause of noncompliance. Bacillus cereus contaminations could not be attributed to a single strain spreading through Amiens human milk bank and Amiens hospital environment as the genetic profiles of the collected strains were different. Corrective actions led to a decrease in the noncompliance rate due to Bacillus cereus (37.7-9.7%) post-Holder pasteurization.Conclusion: Bacillus cereus was the primary cause of rejection for pasteurized human milk donations over the investigated period. These contaminations did not originate from the spread of a single strain. A first round of corrective actions enabled a fair decrease in Bacillus cereus contaminations.
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Affiliation(s)
- Crespin C Adjidé
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - André Léké
- Lactarium-Biberonnerie, Unité des soins intensifs de néonatologie et de médecine néonatale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Catherine Mullié
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France.,Laboratoire AGIR UR UPJV 4294, UFR de Pharmacie, Université de Picardie Jules Verne, Amiens, France
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Abstract
β-Lactam antibiotics have been widely used as therapeutic agents for the past 70 years, resulting in emergence of an abundance of β-lactam-inactivating β-lactamases. Although penicillinases in Staphylococcus aureus challenged the initial uses of penicillin, β-lactamases are most important in Gram-negative bacteria, particularly in enteric and nonfermentative pathogens, where collectively they confer resistance to all β-lactam-containing antibiotics. Critical β-lactamases are those enzymes whose genes are encoded on mobile elements that are transferable among species. Major β-lactamase families include plasmid-mediated extended-spectrum β-lactamases (ESBLs), AmpC cephalosporinases, and carbapenemases now appearing globally, with geographic preferences for specific variants. CTX-M enzymes include the most common ESBLs that are prevalent in all areas of the world. In contrast, KPC serine carbapenemases are present more frequently in the Americas, the Mediterranean countries, and China, whereas NDM metallo-β-lactamases are more prevalent in the Indian subcontinent and Eastern Europe. As selective pressure from β-lactam use continues, multiple β-lactamases per organism are increasingly common, including pathogens carrying three different carbapenemase genes. These organisms may be spread throughout health care facilities as well as in the community, warranting close attention to increased infection control measures and stewardship of the β-lactam-containing drugs in an effort to control selection of even more deleterious pathogens.
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18
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Demers-Mathieu V, Mathijssen G, Fels S, Chace DH, Medo E. Impact of vaccination during pregnancy and staphylococci concentration on the presence of Bacillus cereus in raw human milk. J Perinatol 2020; 40:1323-1330. [PMID: 31919400 PMCID: PMC7223849 DOI: 10.1038/s41372-019-0586-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/10/2019] [Accepted: 12/21/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to determine whether vaccination during pregnancy, prematurity, and staphylococci concentration influenced the presence of B. cereus or staphylococcal enterotoxins (SEs) in raw human milk from healthy mothers. STUDY DESIGN Human milk samples were collected from 152 healthy women. B. cereus, S. aureus and coagulase-negative staphylococci (CNS) were enumerated using selective agar culture media. The detection of B. cereus spores and SEs were determined using ELISA. RESULTS CNS and B. cereus concentrations in milk from non-vaccinated mothers were higher than that from mothers vaccinated during pregnancy, but S. aureus did not differ. Prematurity did not affect B. cereus or staphylococci in human milk. S. aureus and CNS concentrations in human milk with the presence of B. cereus were higher than that with the absence of B. cereus. Viable B. cereus was present in 9.2% of raw human milk samples whereas SEs were not detected in any samples. CONCLUSIONS Vaccination during pregnancy and low concentration of staphylococci could reduce the risk of B. cereus in raw human milk. The screening of B. cereus in raw human milk must be performed before pasteurization to reduce the risk of B. cereus infection in preterm infants.
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Affiliation(s)
- Veronique Demers-Mathieu
- Department of Neonatal Immunology and Microbiology, Medolac Laboratories A Public Benefit Corporation, Boulder City, NV, USA.
| | - Gabrielle Mathijssen
- Department of Neonatal Immunology and Microbiology, Medolac Laboratories A Public Benefit Corporation, Boulder City, NV USA
| | - Shawn Fels
- Department of Neonatal Immunology and Microbiology, Medolac Laboratories A Public Benefit Corporation, Boulder City, NV USA
| | - Donald H. Chace
- Department of Neonatal Immunology and Microbiology, Medolac Laboratories A Public Benefit Corporation, Boulder City, NV USA
| | - Elena Medo
- Department of Neonatal Immunology and Microbiology, Medolac Laboratories A Public Benefit Corporation, Boulder City, NV USA
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