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Jamil A, Sharma H, Ali R, Klukowicz A, Taha A, Paige A, Bellary S, Ahmed A, Miller R, Chow P. Serratia marcescens Endocarditis in Prosthetic Valves. Cureus 2023; 15:e48957. [PMID: 38106730 PMCID: PMC10725715 DOI: 10.7759/cureus.48957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Serratia marcescens endocarditis is a rare occurrence. We describe a case of Serratia endocarditis in a patient with a prosthetic valve. The clinical course was complicated by widespread embolic phenomena causing stroke, gangrene of extremities, and septic emboli to the lungs, spleen, and eyes. She was not considered suitable for surgery due to severe consumptive coagulopathy and thrombocytopenia in the setting of widespread emboli. The patient was transitioned to do not resuscitate status and discharged to a long-term care facility with a grave prognosis explained to the family.
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Affiliation(s)
- Asma Jamil
- Pulmonary and Critical Care Medicine, Saint Michael's Medical Center, Newark, USA
| | - Hari Sharma
- Pulmonary and Critical Care Medicine, Saint Michael's Medical Center, Newark, USA
| | - Ruhma Ali
- Pulmonary and Critical Care Medicine, Saint Michael's Medical Center, Newark, USA
| | - Alan Klukowicz
- Pulmonary and Critical Care Medicine, Saint Michael's Medical Center, Newark, USA
| | - Abu Taha
- Ophthalmology, University of San Francisco, San Francisco, USA
| | - Amy Paige
- Pulmonary and Critical Care Medicine, Saint Michael's Medical Center, Newark, USA
| | - Sharath Bellary
- Pulmonary and Critical Care Medicine, Saint Michael's Medical Center, Newark, USA
| | - Abbas Ahmed
- Pulmonary and Critical Care Medicine, Saint Michael's Medical Center, Newark, USA
| | - Richard Miller
- Pulmonary and Critical Care Medicine, Saint Michael's Medical Center, Newark, USA
| | - Priscilla Chow
- Pulmonary and Critical Care Medicine, Saint Michael's Medical Center, Newark, USA
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Luther CA, Griffith JL, Kurland E, Al Shabeeb R, Eleryan M, Redbord K, Ozog DM. The infection rate of intralesional triamcinolone and the safety of compounding in dermatology for intradermal and subcutaneous injection: A retrospective medical record review. J Am Acad Dermatol 2020; 83:1044-1048. [PMID: 32442698 DOI: 10.1016/j.jaad.2020.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intralesional injection of sterile medications remains a mainstay in dermatology, enabling a tailored, low-cost, in-office therapy. After the 2012 United States outbreak of fungal meningitis from contaminated intrathecally administered corticosteroids, there has been increased regulation of in-office compounding, regardless of the administration route. Studies demonstrating the safety data of in-office corticosteroid compounding for intradermal or subcutaneous use are lacking. OBJECTIVE To assess the incidence of infection caused by compounded in-office intralesional triamcinolone. METHODS A retrospective medical record review identified patients who received in-office intralesional corticosteroid injections in 2016. Medical documentation within 30 days of injection was reviewed for suspected infection. RESULTS The records of 4370 intralesional triamcinolone injections were assessed, of which 2780 (64%) were compounded triamcinolone with bacteriostatic saline. We identified 11 (0.25%) suspected localized infections, with 4 of the 11 in the compounding cohort. Of these, 7 of 11 occurred after injection of an "inflamed cyst." No hospitalizations or deaths occurred. No temporal or locational relationships were identified. LIMITATIONS This study was limited to 2 academic institutions. A 30-day postinjection time frame was used. CONCLUSION In-office compounding for intralesional dermal and subcutaneous administration is safe when sterile products are used by medical practitioners. There is no increased risk of compounded triamcinolone relative to noncompounded triamcinolone.
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Affiliation(s)
- Chelsea A Luther
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - James L Griffith
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Elena Kurland
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Reem Al Shabeeb
- School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Misty Eleryan
- Department of Dermatology, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Kelley Redbord
- Department of Dermatology, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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A Case of Serratia marcescens Endocarditis in a Nonintravenous Drug-Using Male Patient and Review of Literature. Case Rep Infect Dis 2019; 2019:3715404. [PMID: 31321106 PMCID: PMC6610738 DOI: 10.1155/2019/3715404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/25/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Serratia marcescens is a rare cause of infective endocarditis and has almost exclusively been associated with intravenous drug use and hospital-acquired infections. Here, we present a case of infective endocarditis caused by Serratia marcescens in an otherwise healthy, nonintravenous drug-using male patient. Case Report A 41-year-old man presented with hypertension and hemoptysis. Blood cultures were obtained that showed bacteremia by Serratia marcescens. An echocardiogram was carried out that revealed severe mitral regurgitation accompanying ruptured mitral chordae tendineae. The patient received the appropriate antibiotic treatment, without further surgical intervention. Discussion Hospital-acquired infections by Serratia species are a common problem in medical practice and have been attributed to specialized interventional procedures. Taking into consideration the patient's immunocompetence and lack of intravenous drug use, it is possible that bacteremia could be attributed to a medical procedure. Moreover, in contrast to most cases described in the literature, no surgery was performed.
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Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:608-626. [PMID: 29671025 DOI: 10.1007/s00103-018-2718-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Serratia marcescens Infections in Neonatal Intensive Care Units (NICUs). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040610. [PMID: 30791509 PMCID: PMC6406414 DOI: 10.3390/ijerph16040610] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 01/21/2023]
Abstract
Serratia marcescens belongs to the family Enterobacteriaceae, which is commonly found in water, soil, animals, insects, plants. Although S. marcescens displays relatively low virulence, it causes nosocomial infections and outbreaks in severely immunocompromised or critically ill patients, particularly in settings such as intensive care units (ICUs), especially neonatal units (NICUs). This microorganism gives rise to a wide range of clinical manifestations in newborns: from asymptomatic colonization to keratitis, conjunctivitis, urinary tract infections, pneumonia, surgical wound infections, sepsis, bloodstream infection and meningitis. The most frequent site of infection is the bloodstream, followed by the respiratory apparatus and the gastrointestinal tract. Strains of S. marcescens involved in epidemic events have frequently proved to be multi-resistant. Indeed, this species displays intrinsic resistance to several classes of antibiotics. Often, the specific source of the infection cannot be identified. However, the contaminated hands of healthcare workers are believed to be a major vehicle of its transmission. In neonatal intensive care units, colonized or infected newborns are the main potential source of S. marcescens, particularly in the respiratory apparatus, but also in the gastrointestinal tract. The early identification of colonized or infected patients and the prompt implementation of infection control measures, particularly rigorous hand hygiene and contact precautions, are essential in order to curb the spread of infection.
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Infection prevention in the operating room anesthesia work area. Infect Control Hosp Epidemiol 2018; 40:1-17. [DOI: 10.1017/ice.2018.303] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Lucarelli C, Di Domenico EG, Toma L, Bracco D, Prignano G, Fortunati M, Pelagalli L, Ensoli F, Pezzotti P, García-Fernández A, Pantosti A, Ingrosso L. Ralstonia mannitolilytica infections in an oncologic day ward: description of a cluster among high-risk patients. Antimicrob Resist Infect Control 2017; 6:20. [PMID: 28191308 PMCID: PMC5297155 DOI: 10.1186/s13756-017-0178-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ralstonia spp, an environmental microorganism, has been occasionally associated with healthcare infections. The aim of this study was to investigate an outbreak caused by Ralstonia mannitolilytica in oncology patients. METHODS Case definition: Oncology outpatients attending a day ward, with positive blood and/or central venous catheter (CVC) culture for Ralstonia spp from September 2013 - June 2014. We analysed medical records, procedures and environmental samples. R. mannitolilytica was identified by 16S rRNA sequencing, and typed by Pulsed Field Gel Electrophoresis (PFGE); resistance to carbapenemes was investigated by phenotypic and molecular methods. RESULTS The patients (N = 22) had different malignancies and received different therapy; all had a CVC and 16 patients presented chills and/or fever. R. mannitolilytica was isolated from both blood and CVC (n = 12) or only blood (n = 6) or CVC tips (n = 4). The isolates had indistinguishable PFGE profile, and showed resistance to carbapenems. All the isolates were negative for carbapenemase genes while phenotypic tests suggests the presence of an AmpC β-lactamase activity,responsible for carbapenem resistance. All patients had had CVC flushed with saline to keep the venous access pervious or before receiving chemotherapy at various times before the onset of symptoms. After the first four cases occurred, the multi-dose saline bottles used for CVC flushing were replaced with single-dose vials; environmental samples were negative for R. mannitolilytica. CONCLUSIONS Although the source of R. mannitolilytica remains unidentified, CVC flushing with contaminated saline solution seems to be the most likely origin of R. mannitolilytica CVC colonization and subsequent infections. In order to prevent similar outbreaks we recommend removal of any CVC that is no longer necessary and the use of single-dose solutions for any parenteral treatment of oncology patients.
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Affiliation(s)
- Claudia Lucarelli
- Istituto Superiore di Sanità Viale Regina Elena, 299 00161 Rome, Italy
- European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
| | - Enea Gino Di Domenico
- Istituto Nazionale Tumori Regina Elena, Istituto Dermatologico San Gallicano, Rome, Italy
| | - Luigi Toma
- Istituto Nazionale Tumori Regina Elena, Istituto Dermatologico San Gallicano, Rome, Italy
| | - Domenico Bracco
- Istituto Nazionale Tumori Regina Elena, Istituto Dermatologico San Gallicano, Rome, Italy
| | - Grazia Prignano
- Istituto Nazionale Tumori Regina Elena, Istituto Dermatologico San Gallicano, Rome, Italy
| | - Maria Fortunati
- Istituto Nazionale Tumori Regina Elena, Istituto Dermatologico San Gallicano, Rome, Italy
| | - Lorella Pelagalli
- Istituto Nazionale Tumori Regina Elena, Istituto Dermatologico San Gallicano, Rome, Italy
| | - Fabrizio Ensoli
- Istituto Nazionale Tumori Regina Elena, Istituto Dermatologico San Gallicano, Rome, Italy
| | - Patrizio Pezzotti
- Istituto Superiore di Sanità Viale Regina Elena, 299 00161 Rome, Italy
| | | | - Annalisa Pantosti
- Istituto Superiore di Sanità Viale Regina Elena, 299 00161 Rome, Italy
| | - Loredana Ingrosso
- Istituto Superiore di Sanità Viale Regina Elena, 299 00161 Rome, Italy
- European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:171-206. [DOI: 10.1007/s00103-016-2487-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Wiersma P, Schillie S, Keyserling H, Watson JR, De A, Banerjee SN, Drenzek CL, Arnold KE, Shivers C, Kendrick L, Ryan LG, Jensen B, Noble-Wang J, Srinivasan A. Catheter-Related Polymicrobial Bloodstream Infections among Pediatric Bone Marrow Transplant Outpatients—Atlanta, Georgia, 2007. Infect Control Hosp Epidemiol 2015; 31:522-7. [DOI: 10.1086/651668] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective.To identify risk factors for polymicrobial bloodstream infections (BSIs) in pediatric bone marrow transplant (BMT) outpatients attending a newly constructed clinic affiliated with a children's hospital.Methods.All 30 outpatients treated at a new BMT clinic during September 10-21, 2007, were enrolled in a cohort study. The investigation included interviews, medical records review, observations, and bacterial culture and molecular typing of patient and environmental isolates. Data were analyzed using exact conditional logistic regression.Results.Thirteen patients experienced BSIs caused by 16 different, predominantly gram-negative organisms. Presence of a tunneled catheter (odds ratio [OR], 19.9 [95% confidence interval {CI}, 2.4-∞), catheter access (OR, 13.7 [95% CI, 1.8-∞]), and flushing of a catheter with predrawn saline (OR, 12.9 [95% CI, 1.0-766.0]) were independently associated with BSI. The odds of experiencing a BSI increased by a factor of 16.8 with each additional injection of predrawn saline (95% CI, 1.8-827.0). Although no environmental source of pathogens was identified, interviews revealed breaches in recommended infection prevention practice and medication handling. Saline flush solutions were predrawn, and multiple doses were obtained from single-dose preservative-free vials to avoid delays in patient care.Conclusion.We speculate that infection prevention challenges in the new clinic, combined with successive needle punctures of vials, facilitated extrinsic contamination and transmission of healthcare-associated pathogens. We recommend that preservative-free single-use vials not be punctured more than once. Use of single-use prefilled saline syringes might prevent multiuse of single-use saline vials. Storage of saline outside a medication supply system might be advisable. Before opening new clinic facilities, hospitals should consider conducting a mock patient flow exercise to identify infection control challenges.
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Poon YC, Kuo HK. Endogenous Serratia marcescens endophthalmitis associated with Port-a-Cath in an oncology patient: A case report and review of the literature. Taiwan J Ophthalmol 2013. [DOI: 10.1016/j.tjo.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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[Endemic and epidemic. Investigation of a nosocomial outbreak]. Enferm Infecc Microbiol Clin 2012; 31:181-6. [PMID: 23218740 DOI: 10.1016/j.eimc.2012.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 10/23/2012] [Indexed: 11/22/2022]
Abstract
The majority of healthcare associated infections are endemic, but outbreaks or epidemic infections also occur. The most frequent nosocomial endemic infections are catheter associated bacteremia, ventilator-associated pneumonia, surgical site infections and urinary catheter associated infections. These are conditions with a significant healthcare burden. Infection control measures are the mainstay for reducing their frequency and health impact. Other nosocomial infections occur in epidemic outbreaks, with potential and various negative consequences. A well conducted outbreak investigation can achieve good control at an early stage of the development of an outbreak. This research is divided into several stages that facilitate monitoring the development of the work in an orderly and efficiently manner. It also includes some guidelines for writing reports and scientific papers concerning outbreaks.
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Hadano Y, Kamiya T, Uenishi N. A fatal case of infective endocarditis caused by an unusual suspect: Serratia marcescens. Intern Med 2012; 51:1425-8. [PMID: 22687855 DOI: 10.2169/internalmedicine.51.6648] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Serratia marcescens has been reported to cause infective endocarditis among intravenous drug users, but it is extremely rare in non-intravenous drug users in Japan. In this article, we report an 85-year-old woman with diabetes mellitus who presented with low-grade fever and general fatigue. She was administered intravenous prednisolone under a diagnosis of right Bell's palsy before this admission. Blood cultures revealed positive Serratia marcescens, which was complicated by multiple cerebral infarctions after admission. Transthoracic echocardiography on day 5 revealed vegetation on the mitral valve, which was diagnosed as infective endocarditis. An operation could not be performed because of the presence of multiple cerebral infarctions. She died on day 65 because of uncontrolled heart failure.
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Affiliation(s)
- Yoshiro Hadano
- Department of General Internal Medicine, Rakuwakai Otowa Hospital, Japan.
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Madani T, Alsaedi S, James L, Eldeek B, Jiman-Fatani A, Alawi M, Marwan D, Cudal M, Macapagal M, Bahlas R, Farouq M. Serratia marcescens-contaminated baby shampoo causing an outbreak among newborns at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. J Hosp Infect 2011; 78:16-9. [DOI: 10.1016/j.jhin.2010.12.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 12/31/2010] [Indexed: 12/27/2022]
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An Outbreak of Klebsiella pneumoniae and Enterobacter aerogenes Bacteremia After Interventional Pain Management Procedures, New York City, 2008. Reg Anesth Pain Med 2010; 35:496-9. [DOI: 10.1097/aap.0b013e3181fa1163] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim JH, Choi WH, Yun SW, Chae SA, Yoo BH. An outbreak of serratia marcescens sepsis in a pediatric ward. Clin Pediatr (Phila) 2010; 49:1000-2. [PMID: 20118080 DOI: 10.1177/0009922809351238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, Raad II, Rijnders BJA, Sherertz RJ, Warren DK. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49:1-45. [PMID: 19489710 DOI: 10.1086/599376] [Citation(s) in RCA: 2273] [Impact Index Per Article: 151.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Abstract
These updated guidelines replace the previous management guidelines published in 2001. The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them.
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Affiliation(s)
- Leonard A Mermel
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Lin SY, Lay PC, Hughes LF, Bass R. The safety of multi-dose vials in allergy immunotherapy. Otolaryngol Head Neck Surg 2008; 139:195-7. [PMID: 18656714 DOI: 10.1016/j.otohns.2008.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 04/29/2008] [Accepted: 05/06/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To prospectively evaluate the risks of vial contamination after routine clinical use of multiple-dose vials for immunotherapy. STUDY DESIGN Prospective observational study of immunotherapy vial cultures from June 2007 to January 2008. SETTING Tertiary care outpatient otolaryngology clinic. RESULTS Over an 8-month period, 136 consecutive vials were cultured for aerobic and anaerobic bacteria at the 3-month expiration date after regular use in an outpatient allergy clinic and dispensation of multiple doses of injection immunotherapy from each vial. All vials had negative cultures. CONCLUSION Immunotherapy vials are at low risk to undergo contamination in routine use. Important factors include aseptic technique, bacteriostatic agents, and expiration dating.
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Affiliation(s)
- Sandra Y Lin
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Outbreak of Serratia marcescens bloodstream and central nervous system infections after interventional pain management procedures. Clin J Pain 2008; 24:374-80. [PMID: 18496300 DOI: 10.1097/ajp.0b013e31816157db] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the cause of an outbreak of Serratia marcescens infections in patients after interventional pain management procedures at an outpatient pain clinic. METHODS We conducted a case-control study and collected clinical and environmental samples. RESULTS We identified 5 culture-confirmed case-patients and 2 presumptive case-patients who had no bacteria recovered from cultures. The 7 case-patients were compared with 28 controls who underwent procedures at the same clinic but did not develop symptoms of infection. All confirmed case-patients had S. marcescens bloodstream infections; 2 had concurrent S. marcescens central nervous system infections. Case-patients were more likely than controls to have procedures that used contrast solution or entered the epidural or intervertebral disc space (P< or =0.01 for each). All S. marcescens clinical isolates were indistinguishable by pulsed-field gel electrophoresis. We did not isolate S. marcescens from medications or environmental samples; however, S. marcescens was shown to survive and grow in contrast solution that was experimentally contaminated for up to 30 days. Single-dose vials of medication, including contrast solution, were used for multiple procedures; multiple medications were accessed with a common needle and syringe. DISCUSSION The findings of this investigation suggest contamination of a common medication, likely contrast solution, as the source of the outbreak. Practices, such as reusing single-dose medication vials and using a common needle and syringe to access multiple medications, could have led to contamination and propagation of S. marcescens and should be avoided in interventional pain management procedures.
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Yu WL, Ko WC, Cheng KC, Chen HE, Lee CC, Chuang YC. Institutional spread of clonally related Serratia marcescens isolates with a novel AmpC cephalosporinase (S4): a 4-year experience in Taiwan. Diagn Microbiol Infect Dis 2008; 61:460-7. [PMID: 18455901 DOI: 10.1016/j.diagmicrobio.2008.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 02/28/2008] [Accepted: 03/11/2008] [Indexed: 10/22/2022]
Abstract
Resistance of Serratia marcescens, a nosocomial pathogen of Enterobacteriaceae, to the extended-spectrum beta-lactams is usually mediated by an overproduced AmpC cephalosporinase. We aimed to characterize the molecular epidemiology and AmpC of S. marcescens isolates recovered from 1 medical center in southern Taiwan. AmpC-encoding genes for SRT families were investigated by polymerase chain reaction and DNA sequencing. From August 1999 through July 2003, 69 nonrepetitive bloodstream isolates were enrolled. Excluding 11 isolates, which also produced an extended-spectrum beta-lactamase, 58 isolates carried an AmpC-encoding gene, including a novel S4 gene with 98% identity to SRT-1 gene (n = 50), SRT-2 gene (n = 3), SST-1 gene (n = 1), and others (n = 4). Isolates with S4 exhibited a phenotype of resistance to cefotaxime (CTX) but not ceftazidime. Genotype analysis by pulsed-field gel electrophoresis revealed that 45 (90%) of the isolates carrying S4 gene belonged to 2 major epidemic clones, including types A (n = 28) and B (n = 17). In conclusion, the AmpC-like S4 beta-lactamase may confer CTX resistance of the S. marcescens population. Strains carrying the S4 gene with prolonged dissemination were closely related.
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Affiliation(s)
- Wen-Liang Yu
- Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan 71004, Taiwan
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Laupland KB, Parkins MD, Gregson DB, Church DL, Ross T, Pitout JDD. Population-based laboratory surveillance for Serratia species isolates in a large Canadian health region. Eur J Clin Microbiol Infect Dis 2007; 27:89-95. [PMID: 17960436 DOI: 10.1007/s10096-007-0400-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 09/22/2007] [Indexed: 12/29/2022]
Abstract
A population-based laboratory surveillance was conducted during a six-year period to define the incidence, demographic risk factors for acquisition, and anti-microbial susceptibilities of Serratia species isolates. A total of 715 incident Serratia species isolates were identified for an annual incidence of 10.8 per 100,000 residents; bacteremic disease occurred in 0.9 per 100,000 residents annually. The incidence increased with advancing age and males were at the highest risk. Ninety-two percent of the isolates were Serratia marcescens, and the majority (65%) of incident Serratia species isolates were of community onset. Ninety-five percent of isolates were susceptible to ciprofloxacin, 98% to gentamicin, 98% to trimethoprim/sulfamethoxazole, and >99% to imipenem. No yearly increase in resistance was observed. Serratia species isolation is most commonly of community onset and older patients and males are at increased risk. Despite reports of increasing resistance among Serratia species, the incidence in our region remains at a low stable rate.
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Affiliation(s)
- K B Laupland
- Department of Medicine, University of Calgary and Calgary Health Region, Calgary, AB, Canada.
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Wick JY, Zanni GR. Proper use of multidose vials. THE CONSULTANT PHARMACIST : THE JOURNAL OF THE AMERICAN SOCIETY OF CONSULTANT PHARMACISTS 2006; 21:1005-8. [PMID: 17243851 DOI: 10.4140/tcp.n.2006.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PROBLEM Every month when we inspect our facilities we find multidose vials (MDVs) used or stored inappropriately. It's frustrating to toss costly drugs and biologics into the trash. What can we do to heighten awareness of proper MDV handling? SOLUTION Staff probably know the proper procedures for safe use of MDVs, but job stress, time constraints, and poor staffing levels can underlie a medication giver's decision to skip or omit steps in the process. Hurried or careless staff may have inadequate handwashing hygiene, reuse a single-use needle or syringe, or fail to decontaminate the vial's stopper. Potential contamination is an out-of-sight, out-of-mind problem. To ensure better policy adherence, it helps to reinforce staff's understanding of the repercussion of increased infections when shortcuts are taken.
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Affiliation(s)
- Jeannette Y Wick
- National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
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Affiliation(s)
- Susan Paparella
- Consulting Services, Institute for Safe Medication Practices, Huntingdon Valley, PA, USA.
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Nelson DB, Muscarella LF. Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy. World J Gastroenterol 2006; 12:3953-64. [PMID: 16810740 PMCID: PMC4087702 DOI: 10.3748/wjg.v12.i25.3953] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The purpose of this article is to review the evidence regarding transmission of infection during gastrointestinal endoscopy, factors important in endoscope reprocessing and infection control, areas to focus on to improve compliance, and recent developments and advances in the field.
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