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Pseudomonas cepacia bacteraemia due to intrinsic contamination of an anaesthetic. Bacteriological and serological
Abstract:
In November-December 1977 an epidemic of bacteraemia due to P. cepacia was observed in Odense, Denmark (nine patients), and in Nijmegen, Holland (seven patients). All patients recovered. The epidemic was traced to intrinsic contamination of two batches of the anaesthetic fentanyl. All isolates from the patients and from the two batches belonged to the same biotype, had identical sensitivity patterns, and identical antigens. The P. cepacia strain differed from stock strains in being able to grow in two passages in methyl-p-hydroxi-benzoate, 0.5 mg/ml, which promoted the growth of the microorganism: inocula of 2-20 cfu were sufficient to initiate growth in the drug or preservative. These facts indicate the inadvisability of using p-hydroxi-benzoates as preservatives in vials. The strain was inhibited at temperatures above 38.5 degrees C, corresponding to the recovery of the patients after a period with fever above 39 degrees C. Fourteen out of 15 patients examined had agglutinin titres greater than or equal to 320, while 36 blood donors had titres less than 40. Of 12 patients with postoperative fever in the same period whose blood cultures did not yield P. cepacia, three had titres greater than 320.
Insights
An epidemic of bacteraemia caused by Pseudomonas cepacia was linked to contaminated fentanyl anesthetic batches. This highlights the risks of using p-hydroxybenzoates as preservatives in injectable medications.
Area of Science:
- Microbiology
- Epidemiology
- Clinical Medicine
Background:
- An outbreak of bacteraemia occurred in Denmark and Holland in 1977.
- Nine patients in Denmark and seven in Holland were affected.
Purpose of the Study:
- To investigate the cause of the bacteraemia epidemic.
- To identify the source and characteristics of the causative microorganism.
Main Methods:
- Epidemiological investigation tracing the outbreak to contaminated fentanyl batches.
- Microbiological analysis of patient and batch isolates, including biotyping, sensitivity testing, and antigen analysis.
- Assessment of bacterial growth in the presence of methyl-p-hydroxybenzoate and temperature sensitivity.
Main Results:
- The epidemic was traced to intrinsic contamination of two fentanyl anesthetic batches.
- All patient and batch isolates of Pseudomonas cepacia were identical in biotype, sensitivity, and antigens.
- The P. cepacia strain demonstrated enhanced growth in methyl-p-hydroxybenzoate and was inhibited above 38.5°C.
- Elevated agglutinin titres were observed in patients compared to blood donors.
Conclusions:
- Contaminated fentanyl anesthetic was the source of the P. cepacia bacteraemia outbreak.
- The use of p-hydroxybenzoates as preservatives in vials is inadvisable due to promoting bacterial growth.
- The P. cepacia strain's temperature sensitivity correlated with patient recovery from fever.