Postoperative Infections Traced to Contamination of an Intravenous Anesthetic, Propofol

Bennett, Siiri N.; McNeil, Michael M.; Bland, Lee A.; Arduino, Matthew J.; Villarino, Margarita E.; Perrotta, Dennis M.; Burwen, Dale R.; Welbel, Sharon F.; Pegues, David A.; Stroud, Leonardo A.; Zeitz, Paul; Jarvis, William R.

doi:10.1056/nejm199507203330303

Cited by 491 publications

(239 citation statements)

References 34 publications

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“…ERIOPERATIVE infectious complications have been attributed to propofol as a possible causative agent [1][2][3][4] because of suspected lapses in aseptic technique when handling the drug. 1,5 The absence of preservatives in the propofol preparation may support microbial growth.…”

Section: [Le Maniement D'usage Du Propofol Prévient La Contamination mentioning

confidence: 99%

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Le maniement d’usage du propofol prévient la contamination aussi effectivement que la stricte adhésion aux recommandations du fabricant

Lorenz

Kolbitsch

Lass‐Flörl

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Propofol is a potential vector of infection, because it contains no preservative. Thus, the manufacturer's specific recommendations for preparing injections or infusions go beyond the guidelines commonly used in our operating rooms for preparing other iv drugs. The purpose of the present study was to determine whether in the daily routine of an operating theatre a modified propofol handling technique can prevent contamination as effectively as do the manufacturer's handling recommendations. M Me et th ho od ds s: : A total of 160 consecutive neurosurgical patients were allocated to either Group I (manufacturer's handling recommendations: i.e., 1) disinfecting propofol vials and ampoules before filling syringes; 2) replacing empty syringes; 3) discarding all material at the end of surgery); or Group II (modified propofol handling protocol: i.e., 1) refilling empty syringes; 2) renewing only the infusion line to the patient). R Re es su ul lt ts s: : Total contamination rates were comparable in both groups (Group I: 14/160 (8.75%), Group II: 13/160 (8.13%) (P 2 =0.074; P=0.96). Frequency of contamination was not different between groups; either in sample 1 taken at the beginning of the procedure, (Group I: 5/80 (6.25%) vs Group II: 6/80 (7.5%); P 2 =0.098; P=0.76) or in sample 2, taken at the end, (Group I: 9/80 (11.25%) vs Group II: 7/80 (8.75%); P 2 =0.278; P=0.598). C Co on nc cl lu us si io on n: : We conclude that in the daily routine of the operating theatre following a modified propofol handling protocol prevents contamination of propofol syringes as effectively as does adhering to the manufacturer's specific handling recommendations. However, neither of the tested guidelines completely prevented contamination. Groupe I et 13/160 (8,13 %) dans le Groupe II (P 2 = 0,074; P = 0,96). La fréquence de contamination ne diffère pas d'un groupe à l'autre, pour l'échantillon 1 prélevé au début de l'opération (Groupe I : 5/80 (6,25 %) vs Groupe II : 6/80 (7,5 %); P 2 = 0,098; P = 0,76) ou l'échantillon 2 à la fin (Groupe I : 9/80 (11,25 %)vs Groupe II : 7/80 (8,75 %); P 2 = 0,278; P = 0,598 Objectif : Le propofol, ne contenant aucun agent de conservation, est un vecteur potentiel d'infection. C'est pourquoi les recommandations spécifiques du fabricant au sujet de la préparation d'injections ou de perfusions vont au delà des directives habituellement suivies dans nos salles d'opération pour la préparation d'autres médicaments intraveineux. Nous avons voulu déterminer si, en modifiant le maniement du propofol en salle d'opération, nous pouvions prévenir la contamination aussi efficacement qu'en suivant à la lettre les recom

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Section: [Le Maniement D'usage Du Propofol Prévient La Contamination mentioning

confidence: 99%

“…1,5 The absence of preservatives in the propofol preparation may support microbial growth. [6][7][8][9][10][11][12][13][14] Admixture of thiopentone, 15 lidocaine [16][17][18][19] or disodium edetate 20 diminishes microbial growth in propofol, although microbial destruction is not achieved.…”

Section: [Le Maniement D'usage Du Propofol Prévient La Contamination mentioning

confidence: 99%

Le maniement d’usage du propofol prévient la contamination aussi effectivement que la stricte adhésion aux recommandations du fabricant

Lorenz

Kolbitsch

Lass‐Flörl

et al. 2002

Can J Anesth/J Can Anesth

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“…Although this was a case-control study on postoperative infections, 6 of the 7 outbreaks reported were associated only with receipt of propofol (ie, infusions or maintenance), and in only 1 of these 6 outbreaks was the microorganism (identical to that isolated from the patient) recovered from an opened vial of propofol. 3 Moreover, in the same article, Bennett et al reported 2 deaths that Vonberg and Gastmeier also probably missed. Perhaps the web database (an unofficial platform of outbreaks) 2 selected by the authors was not appropriate to correctly answer the question posed in the review.…”

Section: Inconsistencies Regarding the Number Of Outbreaks And Mortalmentioning

confidence: 96%

“…2 Recently, outbreaks in the United States, Turkey, and some European countries have led to the recognition of tularemia as an emerging infectious disease. 3 F. tularensis is a highly infectious agent; a quantity of just 10-25 bacteria can infect a human and cause severe clinical disease. Hence, F. tularensis is considered a 'category A' bioterrorism agent.…”

Section: Potential Risk Of Aerosol-borne Francisella Tularensis Transmentioning

confidence: 99%

Inconsistencies Regarding the Number of Outbreaks and Mortality Rate of Hospital-Acquired Infections Caused by Contaminated Propofol

Zorrilla-Vaca

Vaca-Gonzalez

2015

Infect. Control Hosp. Epidemiol.

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“…Single source outbreaks of Enterobacter infections have been frequently traced to contaminated intravenous products, blood products, distilled water and pressure monitoring devices 2,7,22,24,25,31,32,34,35 . A longlasting epidemic caused by Enterobacter spp involving many hospitals and associated with the use of intrinsically contaminated intravenous solutions was reported in the 1970's in the United States by MAKI et al 22 .…”

Section: Introductionmentioning

confidence: 99%

Molecular epidemiology of a nosocomial outbreak due to Enterobacter cloacae and Enterobacter agglomerans in Campinas, São Paulo, Brazil

Gonçalves

Vaz

Leite

et al. 2000

Rev. Inst. Med. trop. S. Paulo

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SUMMARYA total of 73 isolates (57 Enterobacter cloacae and 16 Enterobacter agglomerans), recovered during an outbreak of bacteremia in the Campinas area, São Paulo, Brazil, were studied. Of these isolates, 61 were from parenteral nutrition solutions, 9 from blood cultures, 2 from a sealed bottle of parenteral nutrition solution, and one was of unknown origin. Of the 57 E. cloacae isolates, 54 were biotype 26, two were biotype 66 and one was non-typable. Of 39 E. cloacae isolates submitted to ribotyping, 87.2% showed the same banding pattern after cleavage with EcoRI and BamHI. No important differences were observed in the antimicrobial susceptibility patterns among E. cloacae isolates exhibiting the same biotype, serotype and ribotype. All E. agglomerans isolates, irrespective of their origin, showed same patterns when cleaved with EcoRI and BamHI. The results of this investigation suggest an intrinsic contamination of parenteral nutrition solutions and incriminate these products as a vehicle of infection in this outbreak.

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Postoperative Infections Traced to Contamination of an Intravenous Anesthetic, Propofol

Abstract: With the increasing use of lipid-based medications, which support rapid bacterial growth at room temperature, strict aseptic techniques are essential during the handling of these agents to prevent extrinsic contamination and dangerous infectious complications.

Cited by 491 publications

References 34 publications

Le maniement d’usage du propofol prévient la contamination aussi effectivement que la stricte adhésion aux recommandations du fabricant

Le maniement d’usage du propofol prévient la contamination aussi effectivement que la stricte adhésion aux recommandations du fabricant

Inconsistencies Regarding the Number of Outbreaks and Mortality Rate of Hospital-Acquired Infections Caused by Contaminated Propofol

Molecular epidemiology of a nosocomial outbreak due to Enterobacter cloacae and Enterobacter agglomerans in Campinas, São Paulo, Brazil

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