Salvage of long-term central venous catheters during an outbreak of Pseudomonas putida and Stenotrophomonas maltophilia infections associated with contaminated heparin catheter-lock solution


Autoria(s): DIAS, M. Beatriz Souza; HABERT, Alina Bernardes; BORRASCA, Vera; STEMPLIUK, Valeska; CIOLLI, Aina; ARAUJO, M. Rita E.; COSTA, Silvia F.; LEVIN, Anna S.
Contribuinte(s)

UNIVERSIDADE DE SÃO PAULO

Data(s)

19/10/2012

19/10/2012

2008

Resumo

objective. To describe the management of patients with long-term central venous catheters (CVCs) during an outbreak of infection due to Pseudomonas putida and Stenotrophomonas maltophilia associated with contaminated heparin catheter-lock solution. design. Descriptive study. setting. Private, 250-bed tertiary-care hospital. methods. In March 2003, we identified 2 febrile cancer patients with P. putida bacteremia. Over 2 days, 7 cases of bacteremia were identified; lots of syringes prefilled with heparin catheter-lock solution, supplied by a compounding pharmacy, were recalled and samples were cultured. More cases of bacteremia appeared during the following days, and any patient who had had a catheter lock infused with the suspect solution was asked to provide blood samples for culture, even if the patient was asymptomatic. Isolates that were recovered from culture were typed by pulsed-field gel electrophoresis. Antimicrobial salvage treatment of long-term CVCs was attempted. results. A total of 154 patients had had their catheter lock infused with solution from the lots that were suspected of being contaminated. Only 48 of these patients had CVCs. By day 7 of the outbreak, 18 of these patients had become symptomatic. Twenty-six of the remaining 30 asymptomatic patients then also provided blood samples for culture, 10 of whom developed fever shortly after samples were collected. Thirty-two patients were identified who had P. putida bacteremia; 9 also had infection due to S. maltophilia. Samples from 1 of the 3 lots of prefilled syringes in use at the time of the outbreak also grew P. putida on culture. Molecular typing identified 3 different clones of P. putida from patients and heparin catheter-lock solution, and 1 clone of S. maltophilia. A total of 27 patients received antimicrobial therapy regimens, some of which included decontamination of the catheter lock with anti- infective lock solution. Of 27 patients, 19 (70%) retained their long-term CVC during the 6-month follow-up period. conclusions. To our knowledge, this is one of the largest prospective experiences in the management of bloodstream infection associated with long-term CVCs. The infections were caused by gram-negative bacilli and were managed without catheter removal, with a high response rate. We emphasize the risks of using intravenous formulations of medications supplied by compounding pharmacies that produce large quantities of drugs.

Identificador

INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, v.29, n.2, p.125-130, 2008

0899-823X

http://producao.usp.br/handle/BDPI/22178

10.1086/526440

http://dx.doi.org/10.1086/526440

Idioma(s)

eng

Publicador

UNIV CHICAGO PRESS

Relação

Infection Control and Hospital Epidemiology

Direitos

restrictedAccess

Copyright UNIV CHICAGO PRESS

Palavras-Chave #FIELD GEL-ELECTROPHORESIS #INTENSIVE-CARE-UNIT #VASCULAR ACCESS #TAP WATER #BACTEREMIA #AERUGINOSA #COLONIZATION #WARD #DNA #Public, Environmental & Occupational Health #Infectious Diseases
Tipo

article

original article

publishedVersion