Volume 15, Number 1—January 2009
CME ACTIVITY - Research
Sphingomonas paucimobilis Bloodstream Infections Associated with Contaminated Intravenous Fentanyl1
Table 2
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.
1Data presented in part at the 18th Annual Meeting of the Society for Healthcare Epidemiology of America; Orlando, Florida; April 6, 2008 (abstract 478).