Pseudobacteremia attributed to contamination of povidone-iodine with Pseudomonas cepacia
Abstract:
Pseudomonas cepacia was recovered from the blood cultures of 52 patients in four hospitals in New York over 6 months from April through October 1980. Epidemiologic investigation in one hospital indicated that the positive results of blood culture represented pseudobacteremias and implicated a 10% povidone-iodine solution used as an antiseptic and disinfectant (Pharmadine; Sherwood Pharmaceutical Company, Mahwah, New Jersey) as the source of contamination. Physicians who drew blood cultures positive for P. cepacia were more likely to have left povidone-iodine on the skin before venipuncture (p = 0.026) and were more likely to have applied povidone-iodine to the blood culture bottle tops and to have left it there while inoculating the blood culture media (p = 0.007) than those who drew cultures negative for P. cepacia. Direct inoculation of Pharmadine into brain-heart infusion broth yielded P. cepacia; however, 2 weeks after the first cultures, the same Pharmadine bottles were culture negative. The iodine concentrations of the contaminated Pharmadine solutions were similar to those of 10% povidone-iodine solutions distributed by other manufacturers.
Insights
A 10% povidone-iodine solution (Pharmadine) contaminated blood cultures with Pseudomonas cepacia, leading to false positives. Proper antiseptic technique is crucial to prevent pseudobacteremia in clinical settings.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Pseudomonas cepacia (P. cepacia) bloodstream infections pose significant risks.
- Pseudobacteremia, or false-positive blood cultures, can lead to unnecessary treatments and patient anxiety.
- Identifying sources of contamination is critical for infection control.
Purpose of the Study:
- To investigate the source of P. cepacia contamination in blood cultures.
- To determine the role of a specific antiseptic solution in pseudobacteremia.
- To identify risk factors associated with P. cepacia contamination during blood culture collection.
Main Methods:
- Retrospective analysis of P. cepacia-positive blood cultures from four New York hospitals.
- Epidemiologic investigation at one hospital, including case-control analysis of physician techniques.
- Microbiological culture of antiseptic solutions and blood culture media.
Main Results:
- 52 patients had P. cepacia recovered from blood cultures over 6 months.
- A 10% povidone-iodine solution (Pharmadine) was implicated as the source of contamination.
- Specific techniques, such as leaving povidone-iodine on the skin or bottle tops, were associated with positive cultures.
Conclusions:
- Povidone-iodine solutions can be a source of P. cepacia contamination, leading to pseudobacteremia.
- Adherence to proper antiseptic protocols during blood culture collection is essential.
- Healthcare facilities must ensure the quality and sterility of disinfectants used.
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