Volume 15, Number 1—January 2009
CME ACTIVITY - Research
Sphingomonas paucimobilis Bloodstream Infections Associated with Contaminated Intravenous Fentanyl1
|Patient no./ age, y/gender||Hospital unit (US state)||Clinical diagnosis||Date(s) of fentanyl administration†||Date(s) of infection||Treatment||Outcome||PFGE strain‡|
|1/65/M||Medicine (MD)||Osteomyelitis; MRSA wound infection||NA||Nov 14||ADT, central line removed and replaced||Survived||Unique|
|2/64/M||NCCU (MD)||Subarachnoid hemorrhage||Oct 29–31, Nov 2–3, Nov 11–22||Nov 14, Nov 18||ADT, central line removed and replaced||Survived||A|
|3/46/F||NCCU (MD)||Subarachnoid hemorrhage||Nov 10–11 Nov 16–18||Nov 11 Nov 17 Nov 19||ADT, central line removed and replaced||Survived||A|
|4/69/F||NCCU (MD)||Subarachnoid hemorrhage||Nov 18||Nov 18||ADT, central line removed and replaced||Survived||A|
|5/38/F||MICU (MD)||Group A streptococcal sepsis||Nov 16||Nov 16||ADT§||Died||A|
|6/38/M||Oncology (MD)||Head and neck tumor||Nov 20, Nov 26||Nov 20, Nov 23||ADT, implanted medication port removed and replaced||Survived||A|
|7/38/M||SICU (CA)||Temporal lobe hemorrhage||Oct 29||Oct 29||ADT||Survived||NA¶|
|8/59/M||SICU (CA)||Entero-cutaneous fistula; aorto-bifemoral bypass surgery||Nov 8||Nov 8||ADT||Survived||NA¶|
*All infections (except in patient 1) developed after administration of intravenous fentanyl compounded at an out-of-state pharmacy; MD, Maryland; CA, California; NCCU, neurologic critical care unit; MICU, medical intensive care unit; SICU, surgical intensive care unit; NA, not applicable; ADT, antimicrobial drug therapy; MRSA, methicillin-resistant Staphylococcus aureus; PFGE, pulsed-field gel electrophoresis.
†Intravenous fentanyl in 0.9% sodium chloride solution from a 250-mL (10 mcg/mL) bag prepared at compounding pharmacy A.
‡Strain A is the outbreak strain that was indistinguishable by PFGE from the fentanyl isolates.
§The patient died of Group A streptococcal sepsis before the blood culture results for S. paucimobilis became available.
¶Isolates from patients 7 and 8 in the California hospital were not available for strain typing.
1Data presented in part at the 18th Annual Meeting of the Society for Healthcare Epidemiology of America; Orlando, Florida; April 6, 2008 (abstract 478).