Polymicrobial bacteremia associated with lipid emulsion in a neonatal intensive care unit

Polymicrobial bacteremia developed in 5 of 20 infants in a neonatal intensive care unit during a 48-hour period; 2 infants died. Klebsiella pneumoniae serotypes 21 and 24 and Enterobacter cloacae were isolated from four infants, and K. pneumoniae serotype 24 and E. cloacae were isolated from the other infant. Case-control studies revealed an association between receipt of lipid emulsion on one day and the subsequent development of bacteremia (P = 0.0005). Epidemiologic evidence suggested that extrinsic contamination of the lipid emulsion bottles had occurred when the hands of a nurse became transiently colonized with these organisms while she was caring for an infant colonized with K. pneumoniae and E. cloacae. Repeated entry of the lipid emulsion bottle, which was used as a multidose medication, probably resulted in contamination. No further cases occurred after lipid emulsion administration practices were changed. We recommend that, except in a pharmacy where conditions for unit dose distribution exist, lipid emulsion should not be used as a multiple dose medication because repeated entry of the bottles increases the risk of contamination. Furthermore lipid emulsion from one container should be administered to only one infant.