Postoperative Infections Traced to Contamination of an Intravenous Anesthetic, Propofol
Siiri N. Bennett, M.D., Michael M. McNeil, M.B., B.S., M.P.H., Lee A. Bland, M.A., M.P.H., Matthew J. Arduino, M.S., Dr.P.H., M. Elsa Villarino, M.D., M.P.H., Dennis M. Perrotta, Ph.D., Dale R. Burwen, M.D., Sharon F. Welbel, M.D., David A. Pegues, M.D., Leonardo Stroud, M.D., M.P.H., Paul S. Zeitz, D.O., M.P.H., and William R. Jarvis, M.D.
Background Between June 1990 and February 1993, the Centersfor Disease Control and Prevention conducted investigationsat seven hospitals because of unusual outbreaks of bloodstreaminfections, surgical-site infections, and acute febrile episodesafter surgical procedures.
Methods We conducted case–control or cohort studies, orboth, to identify risk factors. A case patient was defined asany patient who had an organism-specific infection or acutefebrile episode after a surgical procedure during the studyperiod in that hospital. The investigations also included reviewsof procedures, cultures, and microbiologic studies of infecting,contaminating, and colonizing strains.
Results Sixty-two case patients were identified, 49 (79 percent)of whom underwent surgery during an epidemic period. Postoperativecomplications were more frequent during the epidemic periodthan before it. Only exposure to propofol, a lipid-based anestheticagent, was significantly associated with the postoperative complicationsat all seven hospitals. In six of the outbreaks, an etiologicagent (Staphylococcus aureus, Candida albicans, Moraxella osloensis,Enterobacter agglomerans, or Serratia marcescens) was identified,and the same strains were isolated from the case patients. Althoughcultures of unopened containers of propofol were negative, attwo hospitals cultures of propofol from syringes currently inuse were positive. At one hospital, the recovered organism wasidentical to the organism isolated from the case patients. Interviewswith and observation of anesthesiology personnel documenteda wide variety of lapses in aseptic techniques.
Conclusions With the increasing use of lipid-based medications,which support rapid bacterial growth at room temperature, strictaseptic techniques are essential during the handling of theseagents to prevent extrinsic contamination and dangerous infectiouscomplications.
Source Information
From the Hospital Infections Program, National Center for Infectious Diseases (S.N.B., L.A.B., M.J.A., M.E.V., D.R.B., S.F.W., D.A.P., L.S., W.R.J.), the Division of Bacterial and mycotic Diseases (M.M.M.), and the Division of Field Epidemiology, Epidemiology Program Office (P.S.Z.), Centers for Disease Control and Prevention, Atlanta; and the Texas Department of Health, Austin (D.M.P.).
Address reprint requests to Dr. Jarvis at the Hospital Infections Program, MS E-69, Centers for Disease Control and Prevention, 1600 Clifton Rd., NE, Atlanta, GA 30333.
Propofol and Postoperative Infections
Bach A., Geiss H. K., Grounds R.M., Kolbitsch C., Lass-Flörl C., Benzer A., Bennett S. N., Jarvis W. R.
Extract |
Full Text
N Engl J Med 1995;
333:1505-1507, Nov 30, 1995.
Correspondence
This article has been cited by other articles:
Lyles, A., Fanikos, J., Jewell, K.
(2009). Aligning pharmacy and health-system objectives to eliminate central-line-associated bacteremias. Am J Health Syst Pharm
66: 2189-2197
[Full Text]
Stucki, C., Sautter, A.-M., Favet, J., Bonnabry, P.
(2009). Microbial contamination of syringes during preparation: The direct influence of environmental cleanliness and risk manipulations on end-product quality. Am J Health Syst Pharm
66: 2032-2036
[Abstract][Full Text]
Deletoile, A., Decre, D., Courant, S., Passet, V., Audo, J., Grimont, P., Arlet, G., Brisse, S.
(2009). Phylogeny and Identification of Pantoea Species and Typing of Pantoea agglomerans Strains by Multilocus Gene Sequencing. J. Clin. Microbiol.
47: 300-310
[Abstract][Full Text]
Cruz, A. T., Cazacu, A. C., Allen, C. H.
(2007). Pantoea agglomerans, a Plant Pathogen Causing Human Disease. J. Clin. Microbiol.
45: 1989-1992
[Abstract][Full Text]
Driscoll, D. F., Silvestri, A. P., Bistrian, B. R., Mikrut, B. A.
(2007). Stability of total nutrient admixtures with lipid injectable emulsions in glass versus plastic packaging. Am J Health Syst Pharm
64: 396-403
[Abstract][Full Text]
Sabsovich, I., Rehman, Z., Yunen, J., Coritsidis, G.
(2007). Propofol Infusion Syndrome: A Case of Increasing Morbidity With Traumatic Brain Injury. Am J Crit Care
16: 82-85
[Abstract][Full Text]
Culp, K. E., Augoustides, J. G., Ochroch, A. E., Milas, B. L.
(2004). Clinical Management of Cardiogenic Shock Associated with Prolonged Propofol Infusion. Anesth. Analg.
99: 221-226
[Abstract][Full Text]
Egan, T. D., Kern, S. E., Johnson, K. B., Pace, N. L.
(2003). The Pharmacokinetics and Pharmacodynamics of Propofol in a Modified Cyclodextrin Formulation (Captisol(R)) Versus Propofol in a Lipid Formulation (Diprivan(R)): An Electroencephalographic and Hemodynamic Study in a Porcine Model. Anesth. Analg.
97: 72-79
[Abstract][Full Text]
O'Grady, N. P., Alexander, M., Dellinger, E. P., Gerberding, J. L., Heard, S. O., Maki, D. G., Masur, H., McCormick, R. D., Mermel, L. A., Pearson, M. L., Raad, I. I., Randolph, A., Weinstein, R. A.
(2002). Guidelines for the Prevention of Intravascular Catheter-Related Infections. Pediatrics
110: e51-51
[Abstract][Full Text]
Theilen, H. J., Adam, S., Albrecht, M. D., Ragaller, M.
(2002). Propofol in a Medium- and Long-Chain Triglyceride Emulsion: Pharmacological Characteristics and Potential Beneficial Effects. Anesth. Analg.
95: 923-929
[Abstract][Full Text]
Walder, B., Tramer, M. R., Seeck, M.
(2002). Seizure-like phenomena and propofol: A systematic review. Neurology
58: 1327-1332
[Abstract][Full Text]
Massari, M., Petrosillo, N., Ippolito, G., Solforosi, L., Bonazzi, L., Clementi, M., Manzin, A.
(2001). Transmission of Hepatitis C Virus in a Gynecological Surgery Setting. J. Clin. Microbiol.
39: 2860-2863
[Abstract][Full Text]
Weinstein, R. A.
(2001). Lessons from an Epidemic, Again. NEJM
344: 1544-1545
[Full Text]
Walder, B., Elia, N., Henzi, I., Romand, J. R., Tramer, M. R.
(2001). A Lack of Evidence of Superiority of Propofol Versus Midazolam for Sedation in Mechanically Ventilated Critically Ill Patients: A Qualitative and Quantitative Systematic Review. Anesth. Analg.
92: 975-983
[Abstract][Full Text]
Gillerman, R. G., Browning, R. A.
(2000). Drug Use Inefficiency: A Hidden Source of Wasted Health Care Dollars. Anesth. Analg.
91: 921-924
[Abstract][Full Text]
Chernin, E. L., Smiler, B.
(2000). Any Propofol Compatibility Study Must Include an Emulsion Stability Analysis. Anesth. Analg.
91: 1307-1308
[Full Text]
McNeil, M. M., Lasker, B. A., Lott, T. J., Jarvis, W. R.
(1999). Postsurgical Candida albicans Infections Associated with an Extrinsically Contaminated Intravenous Anesthetic Agent. J. Clin. Microbiol.
37: 1398-1403
[Abstract][Full Text]
Vidovich, M. I., Peterson, L. R., Wong, H. Y.
(1999). The Effect of Lidocaine on Bacterial Growth in Propofol. Anesth. Analg.
88: 936-936
[Abstract][Full Text]
Wachowski, I., Jolly, D. T., Hrazdil, J., Galbraith, J. C., Greacen, M., Clanachan, A. S.
(1999). The Growth of Microorganisms in Propofol and Mixtures of Propofol and Lidocaine. Anesth. Analg.
88: 209-212
[Abstract][Full Text]
Didier, M. E., Fischer, S., Maki, D. G.
(1998). Total Nutrient Admixtures Appear Safer than Lipid Emulsion Alone as Regards Microbial Contamination: Growth Properties of Microbial Pathogens at Room Temperature. JPEN J Parenter Enteral Nutr
22: 291-296
[Abstract]
Wiklund, R. A., Rosenbaum, S. H.
(1997). Anesthesiology- First of Two Parts. NEJM
337: 1132-1141
[Full Text]
Tobias, J. D.
(1997). Propofol Sedation for Terminal Care in Propofol Sedation for rT ermina Care in a Pediatric Patient. CLIN PEDIATR
36: 291-293
Bach, A., Geiss, H. K., Grounds, R.M., Kolbitsch, C., Lass-Florl, C., Benzer, A., Bennett, S. N., Jarvis, W. R.
(1995). Propofol and Postoperative Infections. NEJM
333: 1505-1507
[Full Text]
Nichols, R. L., Smith, J. W.
(1995). Bacterial Contamination of an Anesthetic Agent. NEJM
333: 184-185
[Full Text]
Previous
