Brote de fungemias por Sarocladium kiliense en ocho hospitales públicos por contaminación intrínseca de ondansetrón intravenoso

Abstract

Outbreak of fungemias by Sarocladium kiliense in eight public hospitals per intrinsic contamination of ondansetron intravenous Sarocladium kiliense is a saprophyte fungus that can cause opportunistic infections associated to invasive procedures. We report a multi-hospital nosocomial outbreak of fungemias due to this agent. Patients with positive blood culture to this agent were studied after six bloodstream infections identified in three Chilean hospitals in July 2013 were reported to Ministry of Health National Infection and Prevention Control Program. In general, there were mild clinical manifestations, without deaths attributable to the infection. Epidemiological and microbiological study identified 65 cases in 8 hospitals, mostly pediatric patients in chemotherapy. Initial studies of 94 different drugs and medical devices had negative results, until a second analysis of specific blisters and their pharmaceutical matrix selected by epidemiological criteria identified an intrinsic contamination of ondansetron blisters from a specific producer used in all the patients. A recall of contaminated ondansetron blisters was performed in all the country, after which the outbreak was contained. Surveillance and response of local and national infection prevention and control programs and laboratory support were key to control of a national multi-hospital common source outbreak due to contamination of a drug by an unusual fungus.

SarocladiumandAcremoniuminfections: New faces of an old opportunistic fungus

“…53 Patients succumbed to the infection in seven cases. 8,25,27,28,59,61 These cases perfectly illustrate the need for mycological analysis of blood samples in febrile neutropenic patients. It is also worth mentioning that antifungal susceptibility testing of the isolates involved in the reported cases of fungaemia was crucial to selecting the best treatment, since traditional therapy with AMB failed in numerous cases.…”

“…Fungaemia is the most common clinical manifestation of Sarocladium/Acremonium infections, with 106 different cases described. [8][9][10]19,[25][26][27][28][51][52][53][54][55][56][57][58][59][60][61][62] This condition has affected patients ranging from 27 weeks to 74 years old, although 90% of the patients from the two biggest outbreaks (Colombia and Chile) were younger than 16 years old. Most of the cases were reported from Chile (67) and Colombia (16), and practically all of them resulted from receiving contaminated intravenous medication.…”

“…Fungaemia is the most common clinical manifestation of Sarocladium/Acremonium infections, with 106 different cases described 8‐10,19,25‐28,51‐62 . This condition has affected patients ranging from 27 weeks to 74 years old, although 90% of the patients from the two biggest outbreaks (Colombia and Chile) were younger than 16 years old.…”

“…In addition, one case was resolved without treatment, 51 and in another case the mere removal of the catheter was enough to solve the infection 53 . Patients succumbed to the infection in seven cases 8,25,27,28,59,61 …”

Invasive fungal disease in humans: are we aware of the real impact?

“…(16,17) Another saprophyte mold, Sarocladium kiliense, was isolated from several fungaemia cases associated with the administration of contaminated antinausea medication among oncology patients. (18,19)…”