Bacteria from intravenous fluids

Transfusion-transmitted Klebsiella pneumoniae fatalities, 1995 to 2004

Transfusion-transmitted bacterial sepsis is the third most common cause of transfusion-related fatalities reported to the Food and Drug Administration. Between October 1, 1995, and September 30, 2004, there were 665 reported transfusion fatalities. Eighty-five (13%) deaths were due to transfusion-transmitted bacterial infections, of which 58 (68%) were due to gram-negative organisms. The most common gram-negative organism associated with transfusion-transmitted deaths after receipt of platelets was Klebsiella pneumoniae. This article summarizes retrospectively the case series of deaths due to transfusion-transmitted K pneumoniae infection, reported to the Food and Drug Administration, 1995 to 2004. There were 12 deaths due to transfusion-transmitted K pneumoniae infection with 7 (58%) of the 12 cases occurring in 2002. Eleven deaths were caused by the transfusion of contaminated platelets and 1 death attributed to contaminated red blood cells. Extensive review of the seven 2002 fatality reports did not identify a common (shared) lot for items used during collection or processing of the blood product. In conclusion, in cases of suspected transfusion-transmitted septicemia, broad spectrum antibiotic coverage including coverage of gram-negative organisms should be considered. Strict adherence to infection control measures while collecting, processing, and handling all blood and blood components in both the clinical settings and in the laboratory should be followed. Further development of simple and effective test procedures for detecting bacteria in the blood is needed.

Assessment of risk of microbial contamination by use of multidose containers of injectable products

At a vaccination centre 200 emptied multidose vials were tested for sterility. All vials had contained 10 doses of a vaccine without added preservative. None of the 200 vials was culture-positive. The vaccine did not comply with the pharmacological test for effectiveness of antimicrobial preservatives.

Nosocomial infection in neonatal intensive care units

Nosocomial infection rates in neonatal intensive care units range from 5% to 25%. Both endemic and epidemic infections have been documented, with causative agents including gram-positive cocci, gram-negative bacilli, and viruses. This paper reviews the host, maternal, and environmental factors that influence susceptibility of neonates. Usual preventive measures, such as nursery design, staff apparel, handwashing, employee health, and neonatal care, as well as epidemic control measures to minimize infection risks and limit transmission of infectious organisms, are discussed.

Klebsiella

Belonging to the tribe Klebsielleae found in the family Enterobacteriaceae, the genus Klebsiella is the second most populous enteric genus found in the gastrointestinal tract of man. The genus Klebsiella is named after the late nineteenth century German microbiologist, Edwin Klebs, but the Klebsiella bacillus was for many years referred to as the Friedlander bacillus after being described by Carl Friedlander. The genus consists of four species, recognized by the Centers for Disease Control (CDC), and Bergey's Manual of Determinative Bacteriology, namely, K. pneumoniae (the type species), K. ozaenae, K. rhinoscleromatis, and K. oxytoca. K. pneumoniae is one of a few gram-negative rods that can cause a primary pneumonia.

Evaluation of bacterial contamination in blood processing

In the routine deglycerolization of frozen red blood cells, a bottle of solution intended as a final wash (0.8% NaCl, 0.2% dextrose) was found to be abnormally colored and slightly turbid. Close inspection revealed a small crack in the base of the bottle. A pure growth of Klebsiella pneumoniae was cultured. The rabbit pyrogen test on the solution was positive using 2.5 mul as was the limulus amebocyte lysate (LAL) test at a dilution of 1:10-5 for endotoxin. Studies of the growth of this organism are described and the clinical implications are discussed.