Serratia marcescens bacteremia traced to an infused narcotic

Belinda E. Ostrowsky, Cynthia Whitener, Helen K. Bredenberg, Loretta A. Carson, Stacey Holt, Lori Hutwagner, Matthew J. Arduino, William R. Jarvis

Research output: Contribution to journalArticle

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Abstract

Background: From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak. Methods: A case was defined as the occurrence of S. marcescens bacteremia in any patient in the surgical intensive care unit during the period of the epidemic. To identify risk factors, we compared patients with S. marcescens bacteremia with randomly selected controls. Isolates from patients and from medications were evaluated by pulsed-field gel electrophoresis. The hair of one employee was tested for fentanyl. Results: Twenty-six patients with S. marcescens bacteremia were identified; eight (31 percent) had polymicrobial bacteremia, and seven of these had Enterobacter cloacae and S. marcescens in the same culture. According to univariate analysis, patients with S. marcescens bacteremia stayed in the surgical intensive care unit longer than controls (13.5 vs. 4.0 days, P<0.001), were more likely to have received fentanyl in the surgical intensive care unit (odds ratio, 31; P<0.001), and were more likely to have been exposed to two particular respiratory therapists (odds ratios, 13.1 and 5.1; P<0.001 for both comparisons). In a multivariate analysis, receipt of fentanyl and exposure to the two respiratory therapists (adjusted odds ratio for one therapist, 6.7; P= 0.002; adjusted odds ratio for the other therapist, 9.5; P=0.02) remained significant. One respiratory therapist had been reported for tampering with fentanyl; his hair sample tested positive for fentanyl. Cultures of fentanyl infusions from two case patients yielded S. marcescens and E. cloacae. The isolates from the case patients and from the fentanyl infusions had similar patterns on pulsed-field gel electrophoresis. After removal of the implicated respiratory therapist, no further cases occurred. Conclusions: An outbreak of S. marcescens and E. cloacae bacteremia in a surgical intensive care unit was traced to extrinsic contamination of the parenteral narcotic fentanyl by a health care worker. Our findings underscore the risk of complications in patients that is associated with illicit narcotic use by health care workers.

Original languageEnglish (US)
Pages (from-to)1529-1537
Number of pages9
JournalNew England Journal of Medicine
Volume346
Issue number20
DOIs
StatePublished - May 16 2002
Externally publishedYes

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Serratia marcescens
Narcotics
Bacteremia
Fentanyl
Critical Care
Intensive Care Units
Enterobacter cloacae
Odds Ratio
Pulsed Field Gel Electrophoresis
Hair
Disease Outbreaks
Delivery of Health Care
Multivariate Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ostrowsky, B. E., Whitener, C., Bredenberg, H. K., Carson, L. A., Holt, S., Hutwagner, L., ... Jarvis, W. R. (2002). Serratia marcescens bacteremia traced to an infused narcotic. New England Journal of Medicine, 346(20), 1529-1537. https://doi.org/10.1056/NEJMoa012370

Serratia marcescens bacteremia traced to an infused narcotic. / Ostrowsky, Belinda E.; Whitener, Cynthia; Bredenberg, Helen K.; Carson, Loretta A.; Holt, Stacey; Hutwagner, Lori; Arduino, Matthew J.; Jarvis, William R.

In: New England Journal of Medicine, Vol. 346, No. 20, 16.05.2002, p. 1529-1537.

Research output: Contribution to journalArticle

Ostrowsky, BE, Whitener, C, Bredenberg, HK, Carson, LA, Holt, S, Hutwagner, L, Arduino, MJ & Jarvis, WR 2002, 'Serratia marcescens bacteremia traced to an infused narcotic', New England Journal of Medicine, vol. 346, no. 20, pp. 1529-1537. https://doi.org/10.1056/NEJMoa012370
Ostrowsky BE, Whitener C, Bredenberg HK, Carson LA, Holt S, Hutwagner L et al. Serratia marcescens bacteremia traced to an infused narcotic. New England Journal of Medicine. 2002 May 16;346(20):1529-1537. https://doi.org/10.1056/NEJMoa012370
Ostrowsky, Belinda E. ; Whitener, Cynthia ; Bredenberg, Helen K. ; Carson, Loretta A. ; Holt, Stacey ; Hutwagner, Lori ; Arduino, Matthew J. ; Jarvis, William R. / Serratia marcescens bacteremia traced to an infused narcotic. In: New England Journal of Medicine. 2002 ; Vol. 346, No. 20. pp. 1529-1537.
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abstract = "Background: From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak. Methods: A case was defined as the occurrence of S. marcescens bacteremia in any patient in the surgical intensive care unit during the period of the epidemic. To identify risk factors, we compared patients with S. marcescens bacteremia with randomly selected controls. Isolates from patients and from medications were evaluated by pulsed-field gel electrophoresis. The hair of one employee was tested for fentanyl. Results: Twenty-six patients with S. marcescens bacteremia were identified; eight (31 percent) had polymicrobial bacteremia, and seven of these had Enterobacter cloacae and S. marcescens in the same culture. According to univariate analysis, patients with S. marcescens bacteremia stayed in the surgical intensive care unit longer than controls (13.5 vs. 4.0 days, P<0.001), were more likely to have received fentanyl in the surgical intensive care unit (odds ratio, 31; P<0.001), and were more likely to have been exposed to two particular respiratory therapists (odds ratios, 13.1 and 5.1; P<0.001 for both comparisons). In a multivariate analysis, receipt of fentanyl and exposure to the two respiratory therapists (adjusted odds ratio for one therapist, 6.7; P= 0.002; adjusted odds ratio for the other therapist, 9.5; P=0.02) remained significant. One respiratory therapist had been reported for tampering with fentanyl; his hair sample tested positive for fentanyl. Cultures of fentanyl infusions from two case patients yielded S. marcescens and E. cloacae. The isolates from the case patients and from the fentanyl infusions had similar patterns on pulsed-field gel electrophoresis. After removal of the implicated respiratory therapist, no further cases occurred. Conclusions: An outbreak of S. marcescens and E. cloacae bacteremia in a surgical intensive care unit was traced to extrinsic contamination of the parenteral narcotic fentanyl by a health care worker. Our findings underscore the risk of complications in patients that is associated with illicit narcotic use by health care workers.",
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AU - Ostrowsky, Belinda E.

AU - Whitener, Cynthia

AU - Bredenberg, Helen K.

AU - Carson, Loretta A.

AU - Holt, Stacey

AU - Hutwagner, Lori

AU - Arduino, Matthew J.

AU - Jarvis, William R.

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N2 - Background: From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak. Methods: A case was defined as the occurrence of S. marcescens bacteremia in any patient in the surgical intensive care unit during the period of the epidemic. To identify risk factors, we compared patients with S. marcescens bacteremia with randomly selected controls. Isolates from patients and from medications were evaluated by pulsed-field gel electrophoresis. The hair of one employee was tested for fentanyl. Results: Twenty-six patients with S. marcescens bacteremia were identified; eight (31 percent) had polymicrobial bacteremia, and seven of these had Enterobacter cloacae and S. marcescens in the same culture. According to univariate analysis, patients with S. marcescens bacteremia stayed in the surgical intensive care unit longer than controls (13.5 vs. 4.0 days, P<0.001), were more likely to have received fentanyl in the surgical intensive care unit (odds ratio, 31; P<0.001), and were more likely to have been exposed to two particular respiratory therapists (odds ratios, 13.1 and 5.1; P<0.001 for both comparisons). In a multivariate analysis, receipt of fentanyl and exposure to the two respiratory therapists (adjusted odds ratio for one therapist, 6.7; P= 0.002; adjusted odds ratio for the other therapist, 9.5; P=0.02) remained significant. One respiratory therapist had been reported for tampering with fentanyl; his hair sample tested positive for fentanyl. Cultures of fentanyl infusions from two case patients yielded S. marcescens and E. cloacae. The isolates from the case patients and from the fentanyl infusions had similar patterns on pulsed-field gel electrophoresis. After removal of the implicated respiratory therapist, no further cases occurred. Conclusions: An outbreak of S. marcescens and E. cloacae bacteremia in a surgical intensive care unit was traced to extrinsic contamination of the parenteral narcotic fentanyl by a health care worker. Our findings underscore the risk of complications in patients that is associated with illicit narcotic use by health care workers.

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