Examining low bacterial dietary practice: A survey on low bacterial food

  • Arno P. Mank
    Corresponding author. Corresponding author at: Department of Oncology/Hematology F6.155, Academic Medical Centre, PO Box 22700, 1100 DE Amsterdam, The Netherlands. Tel.: +31205666090/+31205667905; fax: +31205669030.
    Department of Oncology/Hematology, Academic Medical Centre, Meibergreef 9, NL-1105 AZ Amsterdam, The Netherlands
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  • Michelle Davies
    Haematology and Transplant Unit, Christie Hospital, Wilmslow Road, Manchester M20 4BX, UK
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  • for the research subgroup of the European Group for Blood and Marrow Transplantation Nurses Group (EBMT-NG)


      Patients with haematological malignancies have periods of neutropenia caused by the disease process and subsequent treatments, during which time they are at an increased risk of developing life threatening infections. Historically, many measures have been initiated to protect patients during this time. One such measure has been to provide a low bacterial diet to minimise the number of pathogens ingested from food. However, scientific literature lacks any substantial evidence confirming whether this is beneficial in the management of these patients while guidelines are often unclear and give conflicting advice. A detailed survey was carried out to examine the use of low bacterial diets considering criteria, conditions and specific dietary products. One hundred and eight questionnaires were completed, mainly European. Ninety-five (88%) centres used guidelines to advise practice for inpatients. Although 88% of the hospitals have guidelines, when these were examined there were enormous differences in both the guidelines themselves and the way in which they are implemented. The restrictions seen are varied and sometimes even contradict each other. Forty-eight (44%) of the respondents imposed restrictions on all products mentioned. Conditions for starting or stopping dietary restrictions were also diverse. This survey highlights the need to attempt to standardise dietary restrictions in a patient group for whom good nutrition is paramount.


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        • Aker S.N.
        • Cheney C.L.
        The use of sterile and low microbial diets in ultra isolation environments.
        Journal of Parenteral and Enteral Nutrition. 1983; 7: 390-397
        • Bodey G.P.
        • Buckley M.
        • Sathe Y.S.
        • Freireich E.J.
        Quantitative relationships between circulating leukocytes and infection in patients with acute leukaemia.
        Annals of Internal Medicine. 1966; 64: 328-340
        • Carter L.W.
        Bacterial translocation: nursing implications in the care of patients with neutropenia.
        Oncology Nursing Forum. 1994; 21: 857-865
        • Daw M.A.
        • Falkiner F.R.
        Prevention of Gram-negative infections in neutropenic cancer patients.
        Saudi Medical Journal. 1994; 15: 196-203
        • Dezenhall A.
        • Curry-Bartley K.
        • Blackburn S.A.
        • De Lamerens S.
        • Khan A.R.
        Food and nutrition services in bone marrow transplant centers.
        Journal of the American Dietetic Association. 1987; 87: 1351-1353
        • Dietrich M.
        • Gaus W.
        • Vossen J.
        • van der Waaij D.
        • Wendt F.
        Protective isolation and antimicrobial decontamination in patients with high susceptibility to infection. A prospective cooperative study of gnotobiotic care in acute leukemia patients. I: clinical results.
        Infection. 1977; 5: 107-114
        • Dong F.M.
        • Hashisaka A.E.
        • Rasco B.A.
        • Einstein M.A.
        • Mar D.R.
        • Aker S.N.
        Irradiated or aseptically prepared frozen dairy desserts: acceptability to bone marrow transplant recipients.
        Journal of the American Dietetic Association. 1992; 92: 719-723
        • Eccles N.K.
        • Scott G.M.
        Aspergillus in pepper.
        Lancet. 1992; 7: 618
        • Finberg R.W.
        • Talcott J.A.
        Fever and neutropenia—how to use a new treatment strategy.
        New England Journal of Medicine. 1999; 341: 362-363
        • French M.R.
        • Levy-Milne R.
        • Zibrik D.
        A survey of the use of low microbial diets in pediatric bone marrow transplant programs.
        Journal of the American Dietetic Association. 2001; 101: 1194-1198
        • Hall J.
        • Hodgson G.
        • Kerr K.G.
        Provision of safe potable water for immunocompromised patients in hospital.
        Journal of Hospital Infection. 2004; 58: 155-158
        • Larson E.
        • Nirenberg A.
        Evidence-based nursing practice to prevent infection in hospitalized neutropenic patients with cancer.
        Oncology Nursing Forum. 2004; 31: 717-725
        • Lipkin A.C.
        • Lenssen P.
        • Dickson B.J.
        Nutrition issues in hematopoietic stem cell transplantation: state of the art.
        Nutrition in Clinical Practice. 2005; 20: 423-439
        • Maloney W.J.
        • Guerrant R.L.
        Epidemiology, therapy, and prevention of infection with Salmonella organisms.
        Current Opinion in Infectious Diseases. 1992; 5: 74-79
        • Moody K.
        • Finlay J.
        • Mancuso C.
        • Charlson M.
        Feasibility and safety of a pilot randomized trial of infection rate: Neutropenic diet versus standard food safety guidelines.
        Journal of Pediatric Hematology-Oncology. 2006; 28: 126-133
        • Normen L.
        • Bosaeus I.
        • Ekman T.
        Nutritional therapy during bone marrow transplantation. An overview.
        Scandinavian Journal of Nutrition/Naringsforskning. 1996; 40: 156-160
        • Pattison A.J.
        Review of current practice in ‘clean’ diets in the UK.
        Journal of Human Nutrition & Dietetics. 1993; 6: 3-11
        • Pizzo P.A.
        • Purvis D.S.
        • Waters C.
        Microbiological evaluation of food items. For patients undergoing gastrointestinal decontamination and protected isolation.
        Journal of the American Dietetic Association. 1982; 81: 272-279
        • Poe S.S.
        • Larson E.
        • McGuire D.
        • Krumm S.
        A national survey of infection prevention practice in bone marrow transplant units.
        Oncology Nursing Forum. 1994; 21: 1687-1693
        • Preisler H.D.
        • Goldstein I.M.
        • Henderson E.S.
        Gastrointestinal “sterilization” in the treatment of patients with acute leukemia.
        Cancer. 1970; 26: 1076-1081
        • Rampling A.
        Raw milk cheeses and Salmonella.
        British Medical Journal. 1996; 13: 67-68
        • Remington J.S.
        • Schimpff S.C.
        Occasional notes. Please don’t eat the salads.
        New England Journal of Medicine. 1981; 12: 433-435
        • Schimpff S.C.
        • Scott D.A.
        • Wade J.C.
        Infections in cancer patients: some controversial issues.
        Support in Care in Cancer. 1994; 2: 94-104
        • Smith L.H.
        • Besser S.G.
        Dietary restrictions for patients with neutropenia: a survey of institutional practices.
        Oncology Nursing Forum. 2000; 27: 515-520
        • Somerville E.T.
        Special diets for neutropenic patients: do they make a difference?.
        Seminars in Oncology Nursing. 1986; 2: 55-58
        • Sy D.C.
        • Flournoy D.J.
        Isolation of yeasts from frozen juices.
        Medical Science. 1986; 14: 575-576
        • Todd J.
        • Schmidt M.
        • Christain J.
        • Williams R.
        The low-bacteria diet for immunocompromised patients. Reasonable prudence or clinical superstition?.
        Cancer Practice. 1999; 7: 205-207
        • Vermorel-Faure O.
        • Lebeau B.
        • Mallaret M.R.
        • Michallet M.
        • Brut Ambroise-Thomas P.
        • Grillot P.
        Food-related fungal infection risk in agranulocytosis. Mycological control of 273 food items offered to patients hospitalized in sterile units.
        Presse Medicale. 1993; 6: 157-160
        • Wilkinson F.H.
        • Kerr K.G.
        Bottled water as a source of multi-resistant Stenotrophomonas and Pseudomonas species for neutropenic patients.
        European Journal of Cancer Care. 1998; 7: 12-14
        • Wilson B.J.
        Dietary recommendations for neutropenic patients.
        Seminars in Oncology Nursing. 2002; 18: 44-49
        • Yates J.W.
        • Holland J.F.A.
        Controlled study of isolation and endogenous microbial suppression in acute myelocytic leukemia patients.
        Cancer. 1973; 32: 1490-1498