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Bacillus cereus infection in neonates and the absence of evidence for the role of banked human milk: Case reports and literature review

Published online by Cambridge University Press:  07 June 2019

Antoine Lewin ,
Caroline Quach ,
Virginie Rigourd ,
Jean-Charles Picaud ,
Thérèse Perreault ,
Pierre Frange ,
Marc-Christian Domingo ,
Cindy Lalancette ,
Gilles Delage  and
Marc Germain
Antoine Lewin*
Affiliation:
Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Québec, Canada
Caroline Quach
Affiliation:
Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, Québec, Canada Infection Control and Prevention Unit, Department of Pediatric Laboratory Medicine, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada Department of Epidemiology and Biostatistics, McGill University, Montreal, Québec, Canada
Virginie Rigourd
Affiliation:
Région Île-de-France Human Milk Bank, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
Jean-Charles Picaud
Affiliation:
Department of Neonatology, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France, and CarMeN Unit, INSERM U1060, INRA U1397, Claude Bernard University Lyon 1, Pierre Bénite, France
Thérèse Perreault
Affiliation:
Department of Neonatology and Department of Pediatrics, The Montreal Children’s Hospital, Montreal, Québec, Canada
Pierre Frange
Affiliation:
Laboratory of clinical microbiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Paris Descartes University, Sorbonne Paris Cité, Paris, France
Marc-Christian Domingo
Affiliation:
Laboratoire de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
Cindy Lalancette
Affiliation:
Laboratoire de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
Gilles Delage
Affiliation:
Medical Affairs and Innovation, Héma-Québec, Montréal, Québec, Canada
Marc Germain
Affiliation:
Medical Affairs and Innovation, Héma-Québec, Québec, Québec, Canada
*
Author for correspondence: Antoine Lewin, E-mail: antoine.lewin@hema-quebec.qc.ca
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Abstract

Background:

Banked human milk (BHM) has inherent infectious risks, even when pasteurized. Because of the ubiquity of Bacillus cereus in the environment and its ability to resist the Holder pasteurization process, there is a concern that BHM might lead to severe B. cereus infections.

Objective:

We reviewed observed and published cases to determine the potential causal role of BHM as the source of these infections.

Methods:

Two infants in the province of Québec (Canada) developed a B. cereus neonatal infection, and both had received BHM. We conducted bacteriological studies to compare clinical isolates and those found in these cases.

Results:

After extended culture of BHM retention lots, B. cereus was found to have been involved in batches related to the first case. However, molecular typing showed that the strain was different from the clinical isolate, therefore excluding BHM as the source of contamination. In the second case, a Brevibacillus spp was isolated, a species distinct from the clinical isolate.

Conclusion:

Based on these cases and others reported in the literature, a causal link between B. cereus contaminated BHM and preterm neonatal infection has never been documented. Therefore, the risk that BHM can cause this infection remains theoretical. Given the widespread presence of B. cereus in the hospital environment and its capacity to resist standard cleaning procedures, it seems likely that airborne or direct or indirect contact are the main sources of most, if not all, cases of severe B. cereus neonatal infections, even in babies exposed to BHM.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 7 , July 2019 , pp. 787 - 793
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved 

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