Volume 14, Issue 1 (3-2026)                   JoMMID 2026, 14(1): 76-84 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Noufel B, Harifi Mood E, Ghazvini K. Enteral Nutrition Contamination as a Risk Factor for Ventilator-Associated Pneumonia in ICU Patients: A Study from Northeast Iran. JoMMID 2026; 14 (1) :76-84
URL: http://jommid.pasteur.ac.ir/article-1-800-en.html
Enteral Nutrition Contamination as a Risk Factor for Ventilator-Associated Pneumonia in ICU Patients: A Study from Northeast Iran
Baranoush Noufel , Elnaz Harifi Mood , Kiarash Ghazvini *
Department of Medical Microbiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract:   (567 Views)
Introduction: Ventilator-associated pneumonia (VAP) is a critical complication in hospitalized patients, particularly in intensive care units (ICUs). Evidence indicates an association between enteral nutrition (EN) contamination and nosocomial pneumonia, primarily through microbial colonization and aspiration. Accurate data on causative agents are vital for effective infection control. This 10‑month study at Ghaem Hospital, Mashhad, Iran, assessed the incidence of VAP in ICU patients and evaluated the microbiological contamination levels of enteral nutrition and its association with VAP development. Methods: This prospective cohort study in an ICU evaluated 51 patients receiving EN via nasogastric tubes. Microbial contamination was assessed at four stages (preparation, ICU delivery, administration, and post-administration residual) (threshold ≥10³ CFU/mL). Univariate and multivariable logistic regression analyses were employed to determine the independent association between enteral contamination and the development of VAP. Results: Out of 51 patients, VAP incidence was 60.8% (n=31). Significant contamination (≥10³ CFU/mL), dominated by Gram-negative bacilli, occurred predominantly at the bedside (Stages 3 and 4). Significant enteral contamination (≥ 10³ CFU/mL) was universally identified in all patients who developed VAP, underscoring its critical role as a primary reservoir and a key factor in the development of nosocomial pneumonia in this cohort. Conclusion: Contamination of enteral feeding solutions frequently exceeds safe microbiological thresholds and serves as a significant independent risk factor for VAP in ICU patients. Our findings underscore the critical importance of implementing rigorous aseptic protocols during the preparation and administration of enteral nutrition at the bedside. Adopting these measures is essential to mitigate infection risks and improve clinical outcomes in critically ill patients.
Keywords: Hospital-acquired pneumonia, Enteral nutrition, Intensive care units, Ventilator-associated pneumonia, Microbial contamination, Iran
Full-Text [PDF 485 kb]   (375 Downloads)    
Type of Study: Short communication | Subject: Diagnostic/screening methods and protocols
Received: 2025/10/21 | Accepted: 2026/02/21 | Published: 2026/03/17
References
1. Torres A, Cilloniz C, Niederman MS, Menéndez R, Chalmers JD, Wunderink RG, et al. Pneumonia. Nat Rev Dis Primers. 2021; 7: 25. [DOI:10.1038/s41572-021-00259-0] [PMID]
2. Liu JY, Dickter JK. Nosocomial infections: a history of hospital-acquired infections. Gastrointest Endosc Clin N Am. 2020; 30: 637-52. [DOI:10.1016/j.giec.2020.06.001] [PMID]
3. Lanks CW, Musani AI, Hsia DW. Community-acquired pneumonia and hospital-acquired pneumonia. Med Clin North Am. 2019; 103: 487-501. [DOI:10.1016/j.mcna.2018.12.008] [PMID]
4. Palmer SJ. An update on enteral feeding in the community. Br J Community Nurs. 2023; 28: 194-6. [DOI:10.12968/bjcn.2023.28.4.194] [PMID]
5. Ojo O, Keaveney E, Wang XH, Feng P. The effect of enteral tube feeding on patients' health-related quality of life: a systematic review. Nutrients. 2019; 11: 1046. [DOI:10.3390/nu11051046] [PMID] [PMCID]
6. Rowat A. Enteral tube feeding for dysphagic stroke patients. Br J Nurs. 2015; 24: 138-45. [DOI:10.12968/bjon.2015.24.3.138] [PMID]
7. World Health Organization. Global report on infection prevention and control [Internet]. Geneva: World Health Organization; 2022 [cited 2026 May 16]. Available from: https://iris.who.int/handle/10665/354489.
8. Tesini BL, Dumyati G. Health care-associated infections in older adults: epidemiology and prevention. Infect Dis Clin North Am. 2023; 37: 65-86. [DOI:10.1016/j.idc.2022.11.004] [PMID]
9. Moradi H, Sajadi-Javan ZS, Mousavi S, Rostami S, Khaniabadi BM. Systematic review and meta-analysis of colistin plus meropenem therapy for the treatment of nosocomial pneumonia. Iran J Microbiol. 2024; 16: 722-31. [DOI:10.18502/ijm.v16i6.17244] [PMID] [PMCID]
10. Mgeladze G, Akhvlediani G, Khetsuriani S, Maisuradze G, Mrelashvili S. Nosocomial pneumonia in Georgia: a study of extended-spectrum beta-lactamase (ESBL)-producing versus non-extended-spectrum ESBL Gram-negative bacterial profiles. Cureus. 2024; 16: e75458. [DOI:10.7759/cureus.75458] [PMID] [PMCID]
11. Haeili M, Ghodousi A, Nomanpour B, Omrani M, Feizabadi MM. Drug resistance patterns of bacteria isolated from patients with nosocomial pneumonia at Tehran hospitals during 2009-2011. J Infect Dev Ctries. 2013;7:312-17. doi: 10.3855/jidc.2604. [DOI:10.3855/jidc.2604] [PMID]
12. Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) patient safety component manual [Internet]. Atlanta: CDC; 2024 [cited 2026 May 16]. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/pscmanual_current.pdf.
13. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016; 63: e61-111. [DOI:10.1093/cid/ciw353] [PMID] [PMCID]
14. Lee JSW, Kwok T, Chui PY, Ko FWS, Lo WK, Kam WC, et al. Can continuous pump feeding reduce the incidence of pneumonia in nasogastric tube-fed patients? A randomized controlled trial. Clin Nutr. 2010; 29: 453-8. [DOI:10.1016/j.clnu.2009.10.003] [PMID]
15. Mahinkazemi M, Tarighat-Esfanjani A, Safaiyan A. Bacterial contamination and nutritional adequacy of enteral tube feedings in Iran. Prog Nutr. 2017; 19: 283-90.
16. Rowat A. Enteral tube feeding for dysphagic stroke patients. Br J Nurs. 2015; 24: 138-45. [DOI:10.12968/bjon.2015.24.3.138] [PMID]
17. Japoni A, Vazin A, Davarpanah MA, Ardakani MA, Alborzi A, Japoni S, et al. Ventilator-associated pneumonia in Iranian intensive care units. J Infect Dev Ctries. 2011; 5: 286-93. [DOI:10.3855/jidc.1212] [PMID]
18. Sinha S, Lath G, Rao S. Safety of enteral nutrition practices: overcoming the contamination challenges. Indian J Crit Care Med. 2020; 24: 709-12. [DOI:10.5005/jp-journals-10071-23530] [PMID] [PMCID]
19. Centers for Disease Control and Prevention, National Healthcare Safety Network. Patient safety component (PSC) [Internet]. Atlanta: CDC; n.d. [cited 2026 May 16]. Available from: https://www.cdc.gov/nhsn/psc/index.html.
20. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion. Ventilator-associated event (VAE) [Internet]. Atlanta: CDC; n.d. [cited 2026 May 16]. Available from: https://www.cdc.gov/nhsn/psc/vae/index.html.
21. Weenk GH, Kemen M, Werner H-P. Risks of microbiological contamination of enteral feeds during the set up of enteral feeding systems. J Hum Nutr Diet. 1993; 6: 307-16. [DOI:10.1111/j.1365-277X.1993.tb00376.x]
22. Torres A, El-Ebiary M, Soler N, Montón C, Fàbregas N, Hernàndez C. Stomach as a source of colonization of the respiratory tract during mechanical ventilation: association with ventilator-associated pneumonia. Eur Respir J. 1996; 9: 1729-35. [DOI:10.1183/09031936.96.09081729] [PMID]
23. Metheny NA, McClave SA, Moore FA, Zaloga GP, Heyland DK, Campbell J, et al. Risk factors for aspiration. JPEN J Parenter Enteral Nutr. 2002; 26: S26-S33. [DOI:10.1177/014860710202600605]
24. Madden AM, Baines S, Bothwell S, Chen E, Goh S, Jerome L, et al. A laboratory-based evaluation of tube blocking and microbial risks associated with one blended enteral feed recipe. J Hum Nutr Diet. 2019; 32: 667-75. [DOI:10.1111/jhn.12685] [PMID]
25. Shabanpur M, Nachvak SM, Moradi S, Hedayati S, Hosseinikia M, Pasdar Y, et al. Nutritional care in Iranian intensive care units. Clin Nutr Res. 2018; 7: 136-45. [DOI:10.7762/cnr.2018.7.2.136] [PMID] [PMCID]
26. Martin-Loeches I, Reyes LF, Nseir S, Ranzani O, Povoa P, Diaz E, et al. European Network for ICU-Related Respiratory Infections (ENIRRIs): a multinational, prospective, cohort study of nosocomial LRTI. Intensive Care Med. 2023; 49: 1212-22. [DOI:10.1007/s00134-023-07210-9] [PMID] [PMCID]
27. Anderton A. Bacterial contamination of enteral feeds and feeding systems. Clin Nutr. 1993; 12 (suppl 1): S16-32. [DOI:10.1016/S0261-5614(09)90005-X]
Add your comments about this article : Your username or Email:
CAPTCHA
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.