Volume 22, Number 6—June 2016
CME ACTIVITY - Synopsis
Infectious Disease Risk Associated with Contaminated Propofol Anesthesia, 1989–20141
, Jimmy J. Arevalo, Kevin Escandón-Vargas, Daniel Soltanifar, and Marek A. Mirski
Table 2
Microorganisms identified in propofol anesthesia-related iatragenic infection outbreaks, single cases, or laboratory-based studies of syringes, vials, or infusion lines*
| Category and microorganism | Type of infection | % Infections† | References |
|---|---|---|---|
| Gram-positive bacteria | 27.08 | ||
| Staphylococcus aureus | BSI, SSI | 27.08 | (2,6,8,30) |
| S. epidermidis‡ | – | – | (23,27,30,31) |
| MRSE§ | SSI | – | (31) |
| Streptococcus salivarius‡ | – | – | (22) |
| Enterococcus faecalis‡ | (32) | ||
| Micrococcus sp.‡ | – | – | (23,25,27) |
| Corynebacterium sp.‡ | – | – | (23) |
| Bacillus sp.‡ | – | – | (23,25) |
| Diphtheroids sp.‡ | – | – | (25) |
| Kocuria sp.‡ |
– |
– |
(27) |
| Gram-negative bacteria | 20.14 | ||
| Serratia marcescens | BSI, SSI | 9.72 | (2,4,15,30) |
| Enterobacter cloacae | BSI | 2.78 | (31) |
| E. agglomerans | BSI | 2.78 | (2) |
| Pseudomonas cepacia§ | BSI | – | (34) |
| P. aeruginosa§‡ | SSI | # | (30,33) |
| Escherichia coli§ | BSI | – | (35) |
| Klebsiella pneumoniae | BSI | 3.47 | (10,15) |
| Moraxella osloensis | BSI, SSI | 1.39 | (6) |
| Acinetobacter sp.‡ |
– |
– |
(27) |
| Fungus | 21.53 | ||
| Candida albicans |
BSI, SSI |
21.53 |
(2,6,14,30) |
| Viruses | 22.53 | ||
| HCV | Hepatitis C | 18.06# | (9,11–13) |
| HBV | Hepatitis B | 4.17 | (12) |
*Outbreak, >2 cases; BSI, bloodstream infection; SSI, surgical site infection; MRSE, methicillin-resistant Staphylococcus epidermidis; HCV, hepatitis C virus; HBV, hepatitis B virus; dashes indicate no infections identified
†Percentage of infection estimated among the total of victims involved only in outbreaks in which a pathogen was identified (n = 131). In total, 9.03% of the patients reported in the outbreaks had no microorganisms identified, in part because the cultures were obtained after administration of antimicrobial drugs.
‡Microorganisms that have been identified by culture of residual propofol after clinical use but so far have not been involved in propofol-related outbreaks or infection associated with propofol.
§MRSE, P. cepacia, P. aeruginosa, and E. coli have been identified in case reports of infection and septic shock, but so far have not been involved in propofol-related outbreaks.
#P. aeruginosa and HCV have been implicated in outbreaks in Catalonia and Galicia, Spain. However, these reports appeared in newspapers and because of that were not included in this synopsis article (http://elpais.com/diario/2011/03/05/sociedad/1299279606_850215.html and http://elpais.com/diario/2011/03/09/sociedad/1299625207_850215.html).
1Part of this work was presented at the XXXI Colombian Congress of Anesthesiology and Critical Care, Cali, Columbia, July 2015.