Epidemic septic arthritis caused by Serratia marcescens and associated with a benzalkonium chloride antiseptic

Abstract

During a 6-week period, 10 patients were admitted to a hospital for treatment of knee or shoulder joint infections due to Serratia species. Isolates from eight patients were identified as Serratia marcescens with identical biochemical characteristics and antibiotic susceptibility patterns. Before the onset of infections, all patients had been treated by two orthopedic surgeons who shared an office. Studies revealed that infections were associated with previous joint injections (P = 4.44 x 10-5) of methylprednisolone and lidocaine. Environmental cultures revealed that a canister of cotton balls soaked in aqueous benzalkonium chloride and two multiple-dose vials of methylprednisolone previously used by office personnel were contaminated with the epidemic strain of S. marcescens. The canister may have served as a potential reservoir for contamination of sterile solutions and equipment used for joint injections, of skin at the injection site, and of hands of personnel. No further cases occurred after the use of aqueous benzalkonium chloride was discontinued.

Risk of septic arthritis after intra‐articular medication: a study of 16,624 injections in Thoroughbred racehorses

“…Bacterial contamination of the antiseptic may be considered, yet it would be expected to result in a cluster or epidemic of cases from which bacteria capable of contaminating the antiseptic, such as Serratia marcescens, would be uniformly isolated. 9 During the period of our study, cases occurred sporadically. Unfortunately, bacteria were not isolated from all cases of septic arthritis.…”

“…Risk factors reported in humans include inattention to aseptic technique, age of practitioner <45 years old (vs >60 years old), use of corticosteroid from a multidose vial or not packaged in a sterile syringe, introduction of a needle through a site of infection, the presence of systemic infection and use of immunosuppressive drugs. 6,9,10 Risk factors for complications following IAM in horses have not been well studied, although intra-articular use of polysulfated glycosaminoglycan (PSGAG) or corticosteroid is a proposed risk factor because both drugs impair the local defence mechanisms of the joint. 11 The principal aims of this study were to determine the risk of septic arthritis following IAM in horses and to identify potential risk factors.…”

Effects of Extended Storage of Chlorhexidine Gluconate and Benzalkonium Chloride Solutions on the Viability of Burkholderia cenocepacia

“…These bacteria are generally opportunistic, affecting people with impaired immunity or conditions such as cystic fibrosis (CF) or chronic granulomatous disease [11][12][13]. More than 40 outbreaks due to BCC-contaminated antiseptic solutions and equipment have been reported [14][15][16][17][18][19][20][21][22][23][24][25][26]. Recently, the Centers for Disease Control and Prevention investigated an outbreak of bloodstream infections caused by BCC [27].…”

Identification of Serratia species, clinical distribution, antibiotic susceptibility

“…Bu bakteri grubunun intravenöz, intraperitoneal ve üriner kateterler ile birlikte bazı antiseptik solüsyonlarında kolonizasyonu sonucu gelişen hastane enfeksiyonları tipiktir. Yaplan çalışmalarda hastane personeli tarafından elden ele yatay bulaş sonucu salgınlar görülebileceği bildirilmiştir (3,9,20,24,26,32) .…”