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Epidemic iatrogenic Acinetobacter spp. meningitis following administration of intrathecal methotrexate
1Tata Memorial Hospital, Bombay, India.
Abstract:
We report the first outbreak of Acinetobacter species meningitis in a group of children with acute leukaemia following the administration of intrathecal chemotherapy. Eight of twenty patients receiving methotrexate injections on a single day developed signs and symptoms of meningitis within 18 h of treatment, and cases were clustered by time of administration. A cohort study comparing case and non-case patients did not identify any specific host factor associated with meningitis. Acinetobacter calcoaceticus var anitratus was isolated from the cerebrospinal fluid (CSF) of five patients; three patients died. Our investigation determined that the methotrexate was extrinsically contaminated by reused needles, used for reconstitution and administration, which had been inadequately sterilized. Acinetobacter calcoaceticus var anitratus was isolated from an autoclaved needle and a vial of methotrexate used for chemotherapy; these and the clinical isolates had similar antibiograms. After introduction of single-use disposable needles no subsequent cases occurred.
Insights
Acinetobacter meningitis outbreaks in children with acute leukemia were linked to contaminated intrathecal chemotherapy. Reused needles for methotrexate administration caused the infections, leading to fatalities. Single-use needles prevented further cases.
Area of Science:
- Infectious Diseases
- Pediatric Oncology
- Microbiology
Background:
- Intrathecal chemotherapy is a critical treatment for acute leukemia in children.
- Acinetobacter species are opportunistic pathogens, posing risks in immunocompromised patients.
- Nosocomial infections can arise from contaminated medical procedures.
Purpose of the Study:
- To investigate the first reported outbreak of Acinetobacter meningitis in pediatric leukemia patients receiving intrathecal chemotherapy.
- To identify the source and transmission route of the Acinetobacter contamination.
- To determine risk factors and implement preventive measures.
Main Methods:
- A cohort study was conducted comparing patients who developed meningitis with those who did not.
- Cerebrospinal fluid (CSF) samples were analyzed for microbial pathogens.
- Microbiological cultures were performed on chemotherapy materials and medical equipment.
- Antimicrobial susceptibility testing was used to compare clinical and environmental isolates.
Main Results:
- Eight of twenty children developed Acinetobacter meningitis within 18 hours of receiving intrathecal methotrexate.
- Acinetobacter calcoaceticus var anitratus was isolated from the CSF of affected patients.
- Contamination was traced to reused needles inadequately sterilized during methotrexate reconstitution and administration.
- Similar antibiograms were observed between clinical and environmental isolates.
- Three patients died as a result of the infection.
Conclusions:
- Inadequate sterilization of reused needles during intrathecal chemotherapy administration is a significant risk factor for Acinetobacter meningitis outbreaks.
- Prompt implementation of single-use disposable needles effectively halted the outbreak.
- Strict adherence to aseptic techniques and sterilization protocols is crucial in preventing healthcare-associated infections in pediatric oncology.