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Volume 15, Number 1—January 2009

CME ACTIVITY

Sphingomonas paucimobilis Bloodstream Infections Associated with Contaminated Intravenous Fentanyl1

Lisa L. MaragakisComments to Author , Romanee Chaiwarith, Arjun Srinivasan, Francesca J. Torriani, Edina Avdic, Andrew Lee, Tracy R. Ross, Karen C. Carroll2, and Trish M. Perl2
Author affiliations: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (L.L. Maragakis, A. Lee, K.C. Carroll, T.M. Perl); Johns Hopkins University Bloomberg School of Public Health, Baltimore (R. Chaiwarith); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. Srinivasan); University of California, San Diego, California, USA (F.J. Torriani); The Johns Hopkins Hospital, Baltimore (E. Avdic, T.R. Ross)

Main Article

Table 2

Demographic and clinical characteristics of patients with Sphingomonas paucimobilis bloodstream infection, United States, 2007*

Patient no./ age, y/gender Hospital unit (US state) Clinical diagnosis Date(s) of fentanyl administration† Date(s) of infection Treatment Outcome PFGE strain‡
1/65/M Medicine (MD) Osteomyelitis; MRSA wound infection NA Nov 14 ADT, central line removed and replaced Survived Unique
2/64/M NCCU (MD) Subarachnoid hemorrhage Oct 29–31,
Nov 2–3,
Nov 11–22 Nov 14, Nov 18 ADT, central line removed and replaced Survived A
3/46/F NCCU (MD) Subarachnoid hemorrhage Nov 10–11
Nov 16–18 Nov 11
Nov 17
Nov 19 ADT, central line removed and replaced Survived A
4/69/F NCCU (MD) Subarachnoid hemorrhage Nov 18 Nov 18 ADT, central line removed and replaced Survived A
5/38/F MICU (MD) Group A streptococcal sepsis Nov 16 Nov 16 ADT§ Died A
6/38/M Oncology (MD) Head and neck tumor Nov 20,
Nov 26 Nov 20,
Nov 23 ADT, implanted medication port removed and replaced Survived A
7/38/M SICU (CA) Temporal lobe hemorrhage Oct 29 Oct 29 ADT Survived NA¶
8/59/M SICU (CA) Entero-cutaneous fistula; aorto-bifemoral bypass surgery Nov 8 Nov 8 ADT Survived NA¶

*All infections (except in patient 1) developed after administration of intravenous fentanyl compounded at an out-of-state pharmacy; MD, Maryland; CA, California; NCCU, neurologic critical care unit; MICU, medical intensive care unit; SICU, surgical intensive care unit; NA, not applicable; ADT, antimicrobial drug therapy; MRSA, methicillin-resistant Staphylococcus aureus; PFGE, pulsed-field gel electrophoresis.
†Intravenous fentanyl in 0.9% sodium chloride solution from a 250-mL (10 mcg/mL) bag prepared at compounding pharmacy A.
‡Strain A is the outbreak strain that was indistinguishable by PFGE from the fentanyl isolates.
§The patient died of Group A streptococcal sepsis before the blood culture results for S. paucimobilis became available.
¶Isolates from patients 7 and 8 in the California hospital were not available for strain typing.

Main Article

1Data presented in part at the 18th Annual Meeting of the Society for Healthcare Epidemiology of America; Orlando, Florida; April 6, 2008 (abstract 478).

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