ABSTRACT
CONTEXT: The safety of enteral formulas is important to restore and maintain the health of patients. OBJECTIVE: A systematic review of the literature was conducted to assess the microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home. DATA SOURCES: A systematic search was conducted of the Medline, Scopus, BVS, CAPES/MEC, Embase, Science Direct, and SciELO databases and gray literature. DATA EXTRACTION: Eligible studies that analyzed the contamination of enteral formulas manipulated in hospitals and/or at home were selected; a quality assessment tool was used. DATA ANALYSIS: Twenty-three studies evaluated 1099 enteral formulations. Of these, 44.67% of enteral formulas (n = 491) exceeded the acceptable bacterial count. Samples of homemade enteral formulation preparations (86.03%; n = 191) had the highest bacterial counts, followed by mixed preparations (79.72%; n = 59), and commercial formulas (30.01%; n = 241). The number of samples of enteral formulations that exceeded the bacterial count at home was 70.79% (n = 160 at the hospital was 37.91% (n = 331). Total coliforms (82.68%; n = 406) and mesophilic aerobes (79.22%; n = 389) were the most common microorganisms. Samples with bacterial pathogens were also identified, with Bacillus cereus (4.07%; n = 20) and Listeria monocytogenes (3.66%; n = 18) being the most prevalent. CONCLUSIONS: A high number of samples of enteral formulations exceeded the bacterial count, but the risk to patient's health when consuming enteral tube feeding prepared in hospitals or at home may be low. This is because the bacteria present in the samples are not considered potential causes of disease but rather indicators of hygiene conditions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42022367573.
ABSTRACT
BACKGROUND: Studies have shown an increase in the number of patients who use enteral nutrition at home and the benefits of this type of nutrition care. However, little is known about the risk of bacterial contamination of enteral formulations prepared at home. Therefore, the aim of the study was to assess the microbiological quality of home-prepared enteral formulations. METHODS: This study is a systematic review, registered in PROSPERO. The search for articles was carried out in databases and gray literature. Eligible studies that microbiologically analyzed homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs) that were prepared at home were selected. The types and quantities of microorganisms, sources of contamination in the handling area, and the consequences of contamination (signs and symptoms) were the subjects extracted from the studies. RESULTS: Five studies evaluated 217 enteral formulations. It was found that 72.81% of the enteral formulations exceeded the acceptable bacterial count in the case of at least one of the analyzed microorganisms. This result corresponded to 93.58% (n = 73) of the HEPs, 81.96% (n = 50) of the BEPs, and 44.87% (n = 35) of the CEFs. The presence of 10 different microorganisms was identified in the enteral formulations, and total coliforms and mesophilic aerobics were the microorganisms found in the greatest quantity in the samples. CONCLUSION: The three types of home-prepared enteral formulations showed unsatisfactory microbiological quality, indicating poor hygiene conditions during food handling.
Subject(s)
Enteral Nutrition , Food, Formulated , Humans , Food, Formulated/analysis , Food Handling , BacteriaABSTRACT
Fasting associated with chemotherapy could improve the efficacy of anticancer treatments without increasing their adverse effects. We conducted a systematic review following the PRISMA Statement to summarize the evidence on the effects of fasting on treatment response of adults undergoing chemotherapy and make suggestions for the design of future clinical trials The search was performed on CENTRAL, PubMed/MEDLINE, LILACS and Embase. Randomized and non-randomized clinical trials evaluating the effects of fasting (above 12 h, at anytime) on treatment response of adult cancer patients undergoing chemotherapy were included. The risk of bias assessment was conducted in accordance with the Cochrane Handbook. Literature search retrieved 1393 citations and three studies were included in the review. All studies had as an intervention fasting of at least 24 h, before chemotherapy. Two studies showed that immediately after chemotherapy, damage to healthy cells was increased, however after 48 and 72 h, of fasting there was a decrease on damage magnitude. There was no difference in chemotherapy-related adverse events between intervention and control groups. All studies presented two or more criteria with a high risk of bias. Fasting of at least 24 h, appears to be safe and showed some beneficial effects on chemotherapy toxicity, that could be further investigated, however studies presented heterogeneous samples and protocols. We highlight the need and provide recommendations for well-designed randomized clinical trials that evaluate the effect of fasting on chemotherapy-related adverse events. This systematic review was registered on PROSPERO as CRD42019120071.
