Serratia marcescens bacteremia traced to an infused narcotic

Authors

Belinda E. Ostrowsky , M.D., M.P.H., Virginia Commonwealth UniversityFollow
Cynthia Whitener , M.D., Pennsylvania State University College of Medicine
Helen K. Bredenberg , M.D., Epidemic Intelligence Service, Division of Applied Public Health Training
Loretta A. Carson , M.S., National Center for Infectious Diseases
Stacey Holt , B.S., Center for Infectious Diseases
Lori Hutwagner , M.S., Centers for Disease Control and Prevention
Matthew J. Arduino , Dr., Ph.D, National Center for Infectious Diseases
William R. Jarvis , M.D., National Center for Infectious Diseases

Document Type

Article

Original Publication Date

2002

Journal/Book/Conference Title

The New England Journal of Medicine

Volume

346

Issue

20

First Page

1529

Last Page

1537

DOI of Original Publication

10.1056/NEJMoa012370

Comments

Originally published at http://dx.doi.org/10.1056/NEJMoa012370

Date of Submission

January 2015

Abstract

BACKGROUND

From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak.

METHODS

A case was defined as the occurrence of S. marcescens bacteremia in any patient in the surgical intensive care unit during the period of the epidemic. To identify risk factors, we compared patients with S. marcescens bacteremia with randomly selected controls. Isolates from patients and from medications were evaluated by pulsed-field gel electrophoresis. The hair of one employee was tested for fentanyl.

RESULTS

Twenty-six patients with S. marcescens bacteremia were identified; eight (31 percent) had polymicrobial bacteremia, and seven of these had Enterobacter cloacae and S. marcescens in the same culture. According to univariate analysis, patients with S. marcescensbacteremia stayed in the surgical intensive care unit longer than controls (13.5 vs. 4.0 days, PS. marcescens and E. cloacae. The isolates from the case patients and from the fentanyl infusions had similar patterns on pulsed-field gel electrophoresis. After removal of the implicated respiratory therapist, no further cases occurred.

Full Text of Results...

CONCLUSIONS

An outbreak of S. marcescens and E. cloacae bacteremia in a surgical intensive care unit was traced to extrinsic contamination of the parenteral narcotic fentanyl by a health care worker. Our findings underscore the risk of complications in patients that is associated with illicit narcotic use by health care workers.

Rights

From The New England Journal of Medicine, Ostrowsky, B.E., Whitener, C., Bredenberg, H.K., et al., Serratia marcescens bacteremia traced to an infused narcotic, Vol. 346, Page 1529, Copyright © 2002 Massachusetts Medical Society. Reprinted with permission.

Is Part Of

VCU Family Medicine and Population Health Publications