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Nosocomial Pseudomonas cepacia infection associated with chlorhexidine contamination
Abstract:
During the period of January to July 1980, a marked increase in the number of Pseudomonas cepacia isolates was observed in a microbiologic surveillance program. Although P. cepacia was isolated from wound specimens and vaginal cultures, the majority of isolates were of urinary origin from catheterized patients. Retrospective chart analysis of the patients failed to verify a causal pathogenic role for P. cepacia. However, fulminant sepsis subsequently developed in two hospitalized immunocompromised patients, with both blood and urine cultures positive for P. cepacia. Investigation revealed the presence of this organism in chlorhexidine (0.2 percent) mouthwash as well as other chlorhexidine antiseptic solutions used for routine urologic and obstetric procedures. The source of the P. cepacia was identified as the rubber tubing in the pharmacy through which deionized water passed during the dilution of concentrated (5 percent) chlorhexidine gluconate. In vitro tests demonstrated that P. cepacia was resistant to 0.2 percent chlorhexidine.
Insights
Pseudomonas cepacia outbreaks were linked to contaminated chlorhexidine antiseptic solutions. This organism, resistant to the antiseptic, caused sepsis in immunocompromised patients, highlighting a critical contamination source.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- A rise in Pseudomonas cepacia (now Burkholderia cepacia complex) isolates was noted in 1980.
- The majority of isolates were from urinary specimens of catheterized patients.
Observation:
- Pseudomonas cepacia was found in 0.2% chlorhexidine mouthwash and other antiseptic solutions.
- The contamination source was identified as rubber tubing used for diluting chlorhexidine gluconate in a pharmacy.
- In vitro studies confirmed Pseudomonas cepacia resistance to 0.2% chlorhexidine.
Findings:
- Two immunocompromised patients developed fulminant sepsis with positive blood and urine cultures for Pseudomonas cepacia.
- Retrospective chart analysis did not initially confirm Pseudomonas cepacia as pathogenic in most cases.
- The organism's presence in widely used antiseptics posed a significant nosocomial infection risk.
Implications:
- Highlights the importance of rigorous quality control in pharmaceutical preparation and antiseptic manufacturing.
- Underscores the potential for contaminated medical supplies to cause serious patient infections.
- Emphasizes the need for surveillance programs to detect and investigate unexpected microbial increases.