Volume 22, Number 6—June 2016
CME ACTIVITY - Synopsis
Infectious Disease Risk Associated with Contaminated Propofol Anesthesia, 1989–20141
, Jimmy J. Arevalo, Kevin Escandón-Vargas, Daniel Soltanifar, and Marek A. Mirski
Table 1
Summary data of iatragenic disease outbreaks associated with contaminated propofol reported worldwide, 1989–2014*
| Location† | No. outbreaks | Duration, d‡ | Year§ | Type of infection | Type of surgery | Microorganism¶ | No. cases | No. (%) deaths | Ref. |
|---|---|---|---|---|---|---|---|---|---|
| California, USA |
1 |
8 |
1990 |
SSI |
ND |
Staphylococcus aureus |
5 |
ND |
(6) |
| Illinois, USA |
1 |
5 |
1990 |
BSI, endophthalmitis |
Endarterectomy, arthroscopy, dilation and curettage |
Candida albicans |
4 |
0 |
(6) |
| Maine, USA |
1 |
2 |
1990 |
BSI |
ND |
Moraxella osloensis |
2 |
0 |
(6) |
| Michigan, USA |
1 |
14 |
1990 |
BSI, SSI |
Orthopedics, gynecology, biopsy |
S. aureus |
13 |
ND |
(6) |
| Houston, Texas, USA |
1 |
65 |
1990 |
BSI, SSI, endophthalmitis |
ND |
S. aureus |
16 |
2 (12.5) |
(2) |
| United States |
1 |
11 |
1990 |
BSI |
General, urology, gynecology |
Enterobacter agglomerans |
4 |
0 |
(2) |
| United States |
1 |
16 |
1992 |
BSI, SSI |
Orthopedics |
Serratia marcescens |
6 |
0 |
(2) |
| United States |
1 |
7 |
1992 |
ND |
Gynecology |
ND |
4 |
0 |
(2) |
| Paris, France |
1 |
0.33 |
1994 |
BSI |
ND |
Klebsiella pneumoniae |
4 |
0 |
(10) |
| Atlanta, Georgia, USA |
1 |
1 |
1997 |
BSI |
Electroconvulsive therapy |
S. aureus |
5 |
1 (20) |
(8) |
| Reggio Emilia, Italy |
1 |
1 |
2001 |
Hepatitis C |
Gynecology |
HCV |
5 |
0 |
(11) |
| Toronto, Ontario, Canada |
1 |
ND |
2001 |
BSI, SSI |
Orthopedics, gastrointestinal, vascular, neurosurgery, pulmonary |
S. marcescens |
7 |
2 (28.6) |
(4) |
| Berlin, Germany |
1 |
ND |
2002 |
BSI |
ND |
E. cloacae |
4 |
2 (50) |
(3) |
| Melbourne, Victoria, Australia |
2 |
2 |
2003 |
Hepatitis C |
Arthroscopy |
HCV |
6 |
ND |
(9) |
| Las Vegas, Nevada, USA |
1 |
2 |
2008 |
Hepatitis C |
Endoscopy |
HCV |
9# |
1 (11.1) |
(13) |
| Alicante, Spain |
1 |
ND |
2010 |
Systemic candidiasis, endophthalmitis |
Endoscopy |
C. albicans |
27 |
0 |
(14) |
| New York, USA |
1 |
2 |
2010 |
Hepatitis C and B |
Endoscopy |
HCV, HBV |
12 |
ND |
(12) |
| Rotterdam, the Netherlands |
1 |
2 |
2010 |
BSI, SIRS |
Orthopedics, gynecology |
K. pneumoniae, S. marcescens |
7 |
2 (28.6) |
(15) |
| Hsinchu, Taiwan |
1 |
1 |
2013 |
Endotoxemia |
Endoscopy, colonoscopy |
ND |
4 |
0 |
(16) |
| Total | 20 | 144 | 10 (9.3)** |
*Outbreak, >2 cases; ND, not described in publication; BSI, bloodstream infection; SSI, surgical site infection; HCV, hepatitis C virus; HBV, hepatitis B virus; ref., reference; SIRS, systemic inflammatory response syndrome.
†Location where the outbreak emerged.
‡Duration of the outbreak.
§Year of publication.
¶Causative microorganism implicated in outbreak.
#Results of HCV tests of 60,000 persons (who underwent procedures requiring anesthesia at the same clinic from March 1, 2004 through January 11, 2008) are pending. The health department identified an additional 106 infections that could have been linked to the multi-dose vials of propofol. (http://www.cdc.gov/hepatitis/Outbreaks/HealthcareHepOutbreakTable.htm).
**Death rate was estimated taking into account only the published outbreaks with mortality data reported (n = 108).
1Part of this work was presented at the XXXI Colombian Congress of Anesthesiology and Critical Care, Cali, Columbia, July 2015.