Pseudomonas Cepacia in 16 Non-Fatal Cases of Postoperative Bacteremia Derived from Intrinsic Contamination of the Anaesthetic Fentanyl: Clinical and Epidemiological Observations in Denmark and Holland

Abstract

From Nov. 15 to Dec. 17, 1977, Pseudomonas cepacia was isolated from the blood of 16 patients in Odense, Denmark, and Nijmegen, Holland, 2--5 days after an operation with general anaesthesia. The fever started 14--70 h after operation and lasted 2--4 days. All patients recovered. 14/15 patients examined 7--51 days later had agglutinating antibody titres of 400-3,200 against the epidemic strain. Ps. cepacia with identical biochemical characters and sensitivity pattern was isolated from unbroken vials containing the anaesthetic fentanyl, which had been given to all 16 patients. Two batches were contaminated, one heavily so (10(4)--10(5) cfu/0.1 ml). Seven other batches examined yielded no growth. The preservative added to the vials was a mixture of methyl- and propyl-p-hydroxybenzoates which not only allowed growth of the Ps. cepacia strain but could also serve as a carbon source as did citric and malonic acids. The concentration of preservative was not reduced in contaminated vials. The vials had not been sterilized after closure; too much reliance had been placed on an aseptic technique and insufficient preservatives.

Susceptibility of multiresistant strains ofBurkholderia cepaciato honey

“…Its natural habitat is soil, water and vegetation, but acquisition of this pathogen is often associated with hospitals; nosocomial postoperative infections of the urinary tract (Mitchell and Hayward 1966) and wounds (Bassett et al . 1970) have been traced to water‐borne contamination of disinfectant solutions, in Sweden postoperative bacteraemia in 16 patients was attributed to the contaminated anaesthetic fentanyl (Siboni et al . 1979), and two severely burned patients developed nosocomial septicaemia during treatment (Brauner et al .…”

The epidemiology of nosocomial epidemic Pseudomonas cepacia infections

“…Nosocomial epidemics of P. cepacia bloodstream infections have been the subject of at least 15 separate reports involving a variety of different reservoirs and different modes of transmission (1,7,8,10,11,18,25,28,31,34,36,40,45,47,CDC unpublished data).…”

“…In 3 investigations, the source of P. cepacia infections was intrinsic contamination of commercial intravenous products (36,40,47) (Table 1 ). Siboni et al (36) reported that outbreaks of bloodstream infections in Holland and Denmark were due to intrinsic contamination of the intravenous anesthetic Fentanyl*.…”

“…Two outbreaks involving patients with P. cepacia bacteremia and implicating single-use disposable transducer domes as the source of infections illustrate the complex epidemiology of these particular outbreaks (36,CDC unpublished data). In most cases, the single-use disposable transducer dome is attached to a reusable transducer after a small a m o u n t of fluid, the fluid couple, is applied to either the dome m e m b r a n e or transducer head (34).…”

“…The source of P. cepacia in cystic fibrosis patients is unclear, but some investigators have suggested the possibility of nosocomial person-to-person spread (36). P. cepacia colonization and infection in cystic fibrosis patients thus poses significant new challenges to infectious disease clinicians, pediatricians, microbiologists, and epidemiologists, and is the subject of a separate review accompanying this series (42).…”