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Microbial growth and endotoxin production in the intravenous anesthetic propofol
M J Arduino1, L A Bland, S K McAllister
1Hospital Infections Program, Centers for Disease Control, United States Department of Health and Human Services, Atlanta, Georgia.
Objective:
In this study, we measured microbial growth and endotoxin production in the intravenous anesthetic propofol using 10 different microbial strains; 6 isolated from outbreak cases and 4 from laboratory stock cultures.
Design:
In each trial, endotoxin-free glass tubes containing 10 ml propofol were inoculated with 10(0)-10(3) CFU/ml of the test organism and incubated at 30 degrees C for 72 hours.
Setting:
In May and June 1990, the Centers for Disease Control received reports of 5 outbreaks in 5 states of postsurgical patient infections and/or pyrogenic reactions. Epidemiologic and laboratory investigations implicated extrinsic contamination of an intravenous anesthetic, propofol, as the probable source of these outbreaks.
Results:
After 24 hours, 9 of the 10 cultures increased in viable counts by 3 to 6 logs. At least 1 ng/ml of endotoxin was produced within 24 hours by Escherichia coli, Enterobacter cloacae, and Acinetobacter calcoaceticus subspecies anitratus.
Conclusions:
Propofol can support rapid microbial growth and endotoxin production. To avoid infectious complications, scrupulous aseptic technique should be used when preparing or administering this anesthetic.
Insights
Propofol, an intravenous anesthetic, can support rapid microbial growth and endotoxin production. Strict aseptic techniques are crucial to prevent postsurgical infections linked to contaminated propofol.
Area of Science:
- Microbiology
- Anesthesiology
- Infectious Diseases
Background:
- Reports of postsurgical infections and pyrogenic reactions in 1990 were linked to contaminated propofol.
- Investigations identified extrinsic contamination of the intravenous anesthetic as the probable source of outbreaks.
Purpose of the Study:
- To measure microbial growth and endotoxin production in propofol.
- To assess the risk of microbial contamination in intravenous anesthetic propofol.
Main Methods:
- Ten microbial strains, including six from outbreak cases, were used.
- Propofol samples were inoculated with microbial cultures and incubated at 30°C for 72 hours.
Main Results:
- Nine of ten microbial cultures showed significant growth (3-6 logs) within 24 hours.
- Escherichia coli, Enterobacter cloacae, and Acinetobacter calcoaceticus produced endotoxins within 24 hours.
Conclusions:
- Propofol can support rapid microbial proliferation and endotoxin generation.
- Meticulous aseptic technique is essential during propofol preparation and administration to prevent infectious complications.