An Outbreak of Klebsiella pneumoniae and Enterobacter aerogenes Bacteremia After Interventional Pain Management Procedures, New York City, 2008

Wong, Melissa R.; Rosso, Paula Del; Heine, Lisa; Volpe, Verónica; Lee, Lillian; Kornblum, John; Lin, Ying; Layton, Marcelle; Weiss, Don

doi:10.1097/aap.0b013e3181fa1163

Cited by 21 publications

(13 citation statements)

References 15 publications

(4 reference statements)

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“…28 With regard to infectious complications, risks tend to rise in immunocompromised patients, with prolonged epidural catheterization, when the proceduralist unknowingly harbors virulent nasopharyngeal pathogens and does not wear a mask, and/or when practitioners breach aseptic technique. 7,28,[37][38][39][40] Table 2 lists studies reported since 1990 that document incidences of neuraxial injury (often combining hematoma, infection, direct spinal cord injury, etc). These studies point to several common themes.…”

Section: Incidence Of Neuraxial Injurymentioning

confidence: 99%

The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine

Neal¹,

Barrington

Brull

et al. 2015

Regional Anesthesia and Pain Medicine

377

240

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The Second American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine updates information that was originally presented at the Society's first open forum on this subject (2005) and published in 2008. Portions of the second advisory were presented in an open forum (2012) and are herein updated, with attention to those topics subject to evolving knowledge since the first and second advisory conferences. The second advisory briefly summarizes recommendations that have not changed substantially. New to this iteration of the advisory is information related to the risk of nerve injury inherent to common orthopedic surgical procedures. Recommendations are expanded regarding the preventive role of various monitoring technologies such as ultrasound guidance and injection pressure monitoring. New clinical recommendations focus on emerging concerns including spinal stenosis and vertebral canal pathologies, blood pressure management during neuraxial anesthesia, administering blocks in anesthetized or deeply sedated patients, patients with preexisting neurologic disease, and inflammatory neuropathies. An updated diagnostic and treatment algorithm is presented.

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Section: Incidence Of Neuraxial Injurymentioning

confidence: 99%

The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine

Neal¹,

Barrington

Brull

et al. 2015

Regional Anesthesia and Pain Medicine

377

240

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“…7e9 Although individual cases of infection are uncommon, outbreaks of infection associated with contaminated epidural or intra-articular injections are even more unusual. During the past decade, such examples include three outbreaks of Serratia marcescens infection associated with epidural or intra-articular injections, 10e12 an outbreak of Klebsiella pneumoniae and Enterobacter aerogenes bacteremia after sacroiliac (SI) joint steroid injections, 13 an outbreak of Exophiala dermatitidis infection after epidural and intraarticular steroid injections, 14 and an outbreak of Aspergillus meningitis after spinal anesthesia for caesarean section. 7 The largest of these outbreaks involved 11 patients.…”

mentioning

confidence: 99%

Exserohilum Infections Associated with Contaminated Steroid Injections

Ritter

Muehlenbachs

Blau

et al. 2013

The American Journal of Pathology

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The ASCP designates this journal-based CME activity ("ASIP 2013 AJP CME Program in Pathogenesis") for a maximum of 48 AMA PRA Category 1 Credit(s)ä. Physicians should only claim credit commensurate with the extent of their participation in the activity. CME Disclosures: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose. September 2012 marked the beginning of the largest reported outbreak of infections associated with epidural and intra-articular injections. Contamination of methylprednisolone acetate with the black mold, Exserohilum rostratum, was the primary cause of the outbreak, with >13,000 persons exposed to the potentially contaminated drug, 741 confirmed drug-related infections, and 55 deaths. Fatal meningitis and localized epidural, paraspinal, and peripheral joint infections occurred. Tissues from 40 laboratoryconfirmed cases representing these various clinical entities were evaluated by histopathological analysis, special stains, and IHC to characterize the pathological features and investigate the pathogenesis of infection, and to evaluate methods for detection of Exserohilum in formalin-fixed, paraffin-embedded (FFPE) tissues. Fatal cases had necrosuppurative to granulomatous meningitis and vasculitis, with thrombi and abundant angioinvasive fungi, with extensive involvement of the basilar arterial circulation of the brain. IHC was a highly sensitive method for detection of fungus in FFPE tissues, demonstrating both hyphal forms and granular fungal antigens, and PCR identified Exserohilum in FFPE and fresh tissues. Our findings suggest a pathogenesis for meningitis involving fungal penetration into the cerebrospinal fluid at the injection site, with transport through cerebrospinal fluid to the basal cisterns and subsequent invasion of the basilar arteries. Further studies are needed to characterize Exserohilum and investigate the potential effects of underlying host factors and steroid administration on the pathogenesis of infection. Accepted for publication

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“…[14][15][16][17] A matter of particular concern is the infection risk due to unsafe injection practices that are associated with the use of single-dose vials for multiple patients [18][19][20] and the use of multi-dose vials. [6][7][8][9] International guidelines on preventing contamination of anaesthetic-associated medication 21,22 clearly state that preservative-free vials are single-patient, single-dose items.…”

mentioning

confidence: 99%

Microbial contamination and labelling of self-prepared, multi-dose phenylephrine solutions used at a teaching hospital

Heever

Scribante

Perrie

et al. 2016

Southern African Journal of Anaesthesia and Analgesia

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Background: Common practice at Chris Hani Baragwanath Academic Hospital (CHBAH) is to use boluses from a self-prepared, multi-dose phenylephrine solution to treat spinal anaesthesia-induced hypotension in patients undergoing a Caesarean section. The aims of this study were to determine if there was microbial contamination of the solutions and to evaluate whether healthcare workers adhered to appropriate labelling and aspiration practices. Methods: A sample was collected and the labelling data were documented from the solutions found in the two obstetric theatres at CHBAH over a three-month period. The samples were sent to a laboratory for microbial investigation. Results: Microbial contamination was identified in 6.4% of samples collected. The name of the solution was indicated on 100% of the containers and the concentration of the solution was on 96.4%. The date the solution was prepared was indicated on 74.6% of containers and the time the solution was prepared was on 57.3%. Only 8.2% of healthcare workers who prepared the solution confirmed it by placing a signature on the container. Labelling data were written directly on 100% of the containers and a spikedevice was used in 64.5% of the containers. Conclusions: This study demonstrated microbial contamination of the solution and may indicate an infection hazard. Healthcare workers also did not adhere to appropriate labelling and aspiration practices. This is important for all patients from a patient safety perspective and the need to improve quality of care.

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An Outbreak of Klebsiella pneumoniae and Enterobacter aerogenes Bacteremia After Interventional Pain Management Procedures, New York City, 2008

Cited by 21 publications

References 15 publications

The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine

The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine

Exserohilum Infections Associated with Contaminated Steroid Injections

Microbial contamination and labelling of self-prepared, multi-dose phenylephrine solutions used at a teaching hospital

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