Related Experiment Videos
Infections and pseudoinfections due to povidone-iodine solution contaminated with Pseudomonas cepacia
A L Panlilio1, C M Beck-Sague, J D Siegel
1Investigation and Prevention Branch, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia.
Insights
Contaminated povidone-iodine caused Pseudomonas cepacia infections in a pediatric facility. This investigation highlights the risk of intrinsic contamination in medical solutions, leading to patient pseudoinfection and bacteremia.
Area of Science:
- Infectious Diseases
- Microbiology
- Healthcare Epidemiology
Background:
- Pseudomonas cepacia (P. cepacia) is an opportunistic pathogen.
- Povidone-iodine is a common antiseptic used in healthcare settings.
- Intrinsic contamination of medical products can lead to healthcare-associated infections.
Purpose of the Study:
- To investigate the first documented instance of P. cepacia infections linked to intrinsically contaminated povidone-iodine.
- To identify the source and transmission route of P. cepacia in a pediatric facility.
Main Methods:
- Epidemiological investigation including case finding and risk factor analysis.
- Microbiological culturing of P. cepacia from patient samples and povidone-iodine solutions.
- Molecular typing (antibiogram, plasmid profiling, ribonucleotide typing) to compare isolates.
Main Results:
- Six patients developed P. cepacia infections or pseudoinfections (peritonitis, pseudobacteremia).
- Use of a specific lot of intrinsically contaminated povidone-iodine was a significant risk factor for peritoneal fluid infection.
- P. cepacia was isolated from multiple povidone-iodine containers and patient isolates showed identical molecular profiles.
Conclusions:
- Intrinsic contamination of povidone-iodine solution with P. cepacia can cause serious patient infections.
- Healthcare facilities must ensure the sterility of antiseptic solutions to prevent outbreaks.
- This study underscores the importance of rigorous quality control for medical supplies.
Abstract:
In 1989 we investigated the first instance of Pseudomonas cepacia infections due to intrinsic contamination of a povidone-iodine product. Six patients in a Texas pediatric facility had P. cepacia infection or pseudoinfection (three, peritonitis; one, pseudoperitonitis; and two, pseudobacteremia). Epidemiological studies showed one risk factor for infection of peritoneal fluid with P. cepacia: performance of peritoneal dialysis in the dialysis unit with use of one lot of povidone-iodine later found to be intrinsically contaminated (4/5 vs. 0/16, P = .001). Blood cultures yielded P. cepacia after nurses wiped the tops of blood culture bottles with the povidone-iodine solution before inoculation. P. cepacia was cultured from three povidone-iodine containers used at the hospital and from four containers of the same lot obtained from other health-care facilities in Texas and California. Isolates from patients and the povidone-iodine had similar antibiograms, identical plasmid profiles, and identical DNA banding patterns on the basis of results of ribonucleotide typing. This investigation demonstrates that intrinsic contamination of povidone-iodine solution with P. cepacia can result in infections in addition to colonization and/or pseudoinfection.