Summary Nutrition support is frequently required post‐allogeneic haematopoietic progenitor cell transplantation (HPCT); however, the impact of mode of feeding on the gastrointestinal microbiome has not been explored. This study aimed to determine if there is a difference in the microbiome between patients receiving enteral nutrition (EN) and parenteral nutrition (PN) post‐allogeneic HPCT. Twenty‐three patients received either early EN or PN when required. Stool samples were collected at 30 days post‐transplant and analysed with shotgun metagenomic sequencing. There was no difference in microbial diversity between patients who received predominantly EN (n = 13) vs. PN (n = 10) however patients who received predominantly EN had greater abundance of Faecalibacterium (P < 0·001) and ruminococcus E bromii (P = 0·026). Patients who had minimal oral intake for a longer duration during provision of nutrition support had a different overall microbial profile (P = 0·044), lower microbial diversity (P = 0·004) and lower abundance of faecalibacterium prausnitzii_C (P = 0·030) and Blautia (P = 0·007) compared to patients with greater oral intake. Lower microbial diversity was found in patients who received additional beta lactam antibiotics (P = 0·042) or had a longer length of hospital stay (P = 0·019). Post‐HPCT oral intake should be encouraged to maintain microbiota diversity and, if nutrition support is required, EN may promote a more optimal microbiota profile.

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Background The reuse of enteral tube feeding (ETF) equipment is not recommended due to the risk of microbial contamination and subsequent risk of infection; however, this practice continues in many ambulatory settings. A systematic review of the literature was undertaken to review the evidence underpinning the cleaning and reuse of ETF equipment. Methods Studies that investigated the reuse, decontamination, and/or cleaning of ETF equipment were considered for inclusion. Electronic databases were searched (no limits were placed on date of publication, age, or duration of reuse). Extracted data were assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses recommendations. Results Ten studies met inclusion criteria: 3 investigated changes to clinical outcomes with extending reuse from 24 to ≤72 hours using water rinses; 5 considered the efficacy of various cleaning methods assessed in laboratory conditions; 2 used a combination of both approaches. Sufficient data to allow GRADE assessment was found only for bottle‐type containers. Conclusions A very low level of evidence supports the cleaning and reuse of rigid and "unspecified" bottle containers; no studies were found to inform the reuse of syringes used for bolus feeding or any equipment used for water infusion or flushes. There is an absence of literature evaluating the safety and clinical outcomes of cleaning and reusing ETF equipment, and research is required to support equipment reuse.