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Endogenous Candida endophthalmitis after intravenous anesthesia with propofol
M J Daily1, J B Dickey, K H Packo
1Department of Ophthalmology, Loyola University Medical Center, Maywood, IL 60153.
Abstract:
Propofol is an intravenous anesthetic agent that was approved by the US Food and Drug Administration in October 1989. It has gained rapid acceptance and is in widespread use. In June 1990, the Centers for Disease Control reported four clusters of postsurgical infections associated with the use of propofol. We describe one of those clusters, consisting of four cases of endogenous Candida albicans endophthalmitis. These infections occurred in nonimmunocompromised patients after they had undergone nonophthalmologic surgery in which propofol had been used as anesthesia. An investigation by the Centers for Disease Control concluded that the infections in these patients were due to extrinsic contamination of propofol during preparation for use at the hospital. Ophthalmologists should be aware of this new potential source of endogenous endophthalmitis.
Insights
Propofol, a widely used anesthetic, was linked to postsurgical infections. Contaminated propofol during preparation caused Candida albicans endophthalmitis in non-immunocompromised patients.
Area of Science:
- Anesthesiology
- Infectious Diseases
- Ophthalmology
Background:
- Propofol, an intravenous anesthetic, gained widespread use after FDA approval in 1989.
- The Centers for Disease Control reported clusters of postsurgical infections linked to propofol in 1990.
- Endogenous endophthalmitis is a serious intraocular infection.
Purpose of the Study:
- To describe a specific cluster of postsurgical infections associated with propofol.
- To identify the causative agent and source of these infections.
- To raise awareness among ophthalmologists about a potential new source of endogenous endophthalmitis.
Main Methods:
- Case series describing four patients with endogenous Candida albicans endophthalmitis.
- Investigation by the Centers for Disease Control to determine the cause of infection.
- Analysis of patient history, surgical procedures, and anesthetic agents used.
Main Results:
- Four non-immunocompromised patients developed Candida albicans endophthalmitis post-nonophthalmologic surgery.
- Propofol was used as the anesthetic agent in all cases.
- The Centers for Disease Control investigation concluded extrinsic contamination of propofol during hospital preparation was the cause.
Conclusions:
- Extrinsic contamination of propofol during preparation is a potential cause of endogenous endophthalmitis.
- Ophthalmologists should consider propofol contamination as a source of postsurgical endophthalmitis.
- This highlights the importance of aseptic techniques in anesthetic preparation.