Skip to main content Accessibility help
×
Home
Hostname: page-component-768dbb666b-jrcft Total loading time: 0.326 Render date: 2023-02-07T04:23:31.706Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Pediatric Primary Gram-Negative Nosocomial Bacteremia: A Possible Relationship With Infusate Contamination

Published online by Cambridge University Press:  02 January 2015

Alejandro E. Macías-Hernández*
Affiliation:
Facultad de Medicina de León, Universidad de Guanajuato
Isabel Hernández-Ramos
Affiliation:
Hospital General Regional de León, León, Guanajuato
Juan M. Muñoz-Barrett
Affiliation:
Facultad de Medicina de León, Universidad de Guanajuato
Enrique Vargas-Salado
Affiliation:
Facultad de Medicina de León, Universidad de Guanajuato
Francisco J. Guerrero-Martínez
Affiliation:
Hospital General Regional de León, León, Guanajuato
Humberto Medina-Valdovinos
Affiliation:
Facultad de Medicina de León, Universidad de Guanajuato
Jesus Hernández-Hernández
Affiliation:
Hospital General Regional de León, León, Guanajuato
Samuel Ponce-de-León-Rosales
Affiliation:
Instituto Nacional de la Nutrición “Salvador Zubirán”, México City, México
*
Facultad de Medicina de León, 20 de Enero 929, León, Guanajuato 37320, México

Abstract

Objective: To evaluate the potential contribution of “extrinsic” contamination of intravenous fluids in hospital bacteremia and infection.

Design: Prospective cross-sectional survey of infusate contamination, December 1992 to December 1993.

Setting: A pediatric department (1,500 admissions per year) in a general, urban teaching hospital, serving low-income patients.

Samples and Patients: Infusate samples (0.5 to 1.0 mL) from the injection port used by the staff were taken for cultures from all febrile or septic patients in hospital wards. At least four samples were taken each day; if no febrile or septic patients were available, other patients were sampled at convenience.

Results: A 6.8% positive culture rate (87 contaminates in 1,277 infusates) was obtained, without significant differences among the wards. Gram-negative organisms were recovered from 56 samples (62.9%), mainly of the tribe Klebsielleae (56.1%). Coagulase-negative staphylococci were isolated in 30 samples (33.7%). There was no significant difference between the febrile-septic group and the asymptomatic group in the rate of infusate contamination (P=.59). In eight patients, the same organisms were recovered from infusate and blood culture. The overall bacteremia rate was 2.5 per 100 discharges.

Conclusions: Compared to previous reports, higher infusate contamination rates and different organisms (mainly gram-negative) were observed. In hospitals of underdeveloped countries, nosocomial infection control frequently is disregarded. Infusate contamination may be common and could lead to gram-negative bacteremia. In such settings, it seems advisable to perform surveillance studies to identify infusate contamination, because a single infusate contamination could be a signal for an epidemic.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Maki, DG, Martin, WT. Nationwide epidemic of septicemia caused by contaminated infusion products: IV growth of microbial pathogens in fluids for intravenous infusion. J Infect Dis 1975;131:267272.Google Scholar
2.Band, JD, Maki, DG. Safety of changing intravenous delivery systems at longer than 24-hour intervals. Ann Intern Med 1979;91:173178.Google Scholar
3.Maki, DG, Goldmann, DA, Rhame, FS. Infection control in intravenous therapy. Ann Intern Med 1973;79:867887.Google Scholar
4.Felts, SK, Schaffner, W, Melly, MA, Koeing, MG. Sepsis caused by contaminated intravenous fluids: epidemiologic, clinical, and laboratory observations in one hospital. Ann Intern Med 1972;77:881890.Google Scholar
5.Mackel, DC, Maki, DG, Anderson, RL, Rhame, FS, Bennett, JV. Nationwide epidemic of septicemia caused by contaminated intravenous products: mechanisms of intrinsic contamination. J Clin Microbiol 1975;2:486497.Google Scholar
6.Maki, DG. Pathogenesis, prevention, and management of infections due to intravascular devices used for infusion therapy. In: Bisno, AL, Waldvogel, FA, eds. Infections Associated With Indwelling Medical Devices. Washington, DC: American Society for Microbiology; 1989:161177.Google Scholar
7.Goldmann, DA, Pier, GB. Pathogenesis of infections related to intravascular catheterization. Clin Microbiol Rev 1993;6:176192.Google Scholar
8.Raad, II, Bodey, GP. Infectious complications of indwelling vascular catheters. Clin Infect Dis 1992;15:197210.Google Scholar
9.Mosca, R, Curtas, S, Forbes, B, Meguid, MM. The benefits of isolator cultures in the management of suspected catheter sepsis. Surgery 1987;102:718723.Google Scholar
10.Kappers-Klunne, MC, Degener, JE, Stijnen, T, Abes, J. Complications from long-term indwelling central venous catheters in hematologic patients with special reference to infection. Cancer 1989;64:17471752.Google Scholar
11.Macías, AE, Ortega, P, Muñoz, J, et al.Bacteriemia nosocomial pediátrica. Utilidad potencial del cultivo de los líquidos de infusión. Rev Invest Clin 1994;46:295300.Google Scholar
12.Vargas-Origel, A, Escobedo-Chávez, E, Mercado-Arellano, A. Epidemiología de las bacteriemias en una unidad de cuidado intensivo neonatal. Bol Med Hosp Infant Mex 1985;42:306309.Google Scholar
13.Zaidi-Jacobson, M, Ponce de León-Rosales, S, Vázquez Narvaez, G, Chable-Mendoza, C. Estudio prospectivo de infecciones nosocomiales en una unidad de pediatría. Bol Med Hosp Infant Mex 1991;48:538543.Google Scholar
14.Larracilla-Alegre, J, Vargas de la Rosa, R, Peñaloza-Santillán, J, García-Melgar, M, Dillman, C. Septicemias Nosocomiales. Bol Med Hosp Infant Mex 1982;39:806811.Google Scholar
15.Zaidi, M, Sifuentes, J, Bobadilla, M, Moncada, D, Ponce de León, S. Epidemic of Serratia marcescens. Bacteremia and meningitis in a neonatal unit in Mexico City. Infect Control Hosp Epidemiol 1989;10:1420.Google Scholar
16.Pérez, A. Hemocultivos: experiencia del Hospital Infantil de México (1990-1991). Enferm Infecc Microbiol Clin 1992;12:188191.Google Scholar
17.Martin, MA, Pfaller, MA, Wenzel, RP. Coagulase-negative staphylococcal bacteremia. Ann Intern Med 1989;110:916.Google Scholar
18.Freeman, J, Epstein, MF, Smith, NE, Platt, R, Sidebottom, DG, Goldmann, DA. Extra hospital stay and antibiotic usage with nosocomial coagulase-negative staphylococcal bacteremia in two neonatal intensive care unit populations. Am J Dis Child 1990;144:324329.Google Scholar
19.Donowitz, LG, Haley, CE, Gregory, WW, Wenzel, RP. Neonatal intensive care unit bacteremia: emergence of gram-positive bacteria as major pathogens. Am J Infect Control 1987;15:141147.Google Scholar
20.Kirchhoff, LV, Sheagren, JN. Epidemiology and clinical significance of blood cultures positive for coagulase-negative Staphylococcus. Infect Control 1985;5:479486.Google Scholar
21.Low, DE, Schmidt, BK, Kirpalani, HM, et al.An endemic strain of Staphylococcus haemolyticus colonizing and causing bacteremia in neonatal intensive care unit patients. Pediatrics 1992;89:696700.Google Scholar
22.Farmer, JJ, Kelly, MT. Enterobacteriaceae. In: Balows, A, Hausler, WJ, Herrmann, KL, Isenberg, HD, Shadomy, HJ, eds. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology; 1991:360383.Google Scholar
23.Maki, DG, Botticelli, JT, LeRoy, ML, Thielke, TS. Prospective study of replacing administration sets for intravenous therapy at 48- vs 72-hour intervals. JAMA 1987;258:17771781.Google Scholar
24.Gorbea, HF, Snydman, DR, Delaney, A, Stockman, J, Martin, WJ. Intravenous tubing with burettes can be safely changed at 48-hour intervals. JAMA 1984;251:21122115.Google Scholar
25.Maki, DG, Klein, BS, McCormick, RD, et al.Nosocomial Pseudomonas picketti bacteremias traced to narcotic tampering: a case for selective drug screening of health care personnel. JAMA 1991;265:981986.Google Scholar
26.Ponce de León, RS. Reflexiones sobre la calidad de la atención médica en México. Rev Invest Clin 1992;44:445446.Google Scholar
27.Ponce de León, RS (1), Ponce de León, RS (2), Ruiz Palacios, G, Gutiérrez, R. Infecciones nosocomiales: características del problema en el Instituto Nacional de la Nutrición “Salvador Zubirán” y en México. Salud Publica Mex 1986;28:2936.Google Scholar
28.García-García, ML, Gómez-Morales, E, Sánchez-García, G. Validación de un programa de vigilancia de infecciones nosocomiales. Salud Publica Mex 1989;31:481492.Google Scholar
7
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Pediatric Primary Gram-Negative Nosocomial Bacteremia: A Possible Relationship With Infusate Contamination
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Pediatric Primary Gram-Negative Nosocomial Bacteremia: A Possible Relationship With Infusate Contamination
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Pediatric Primary Gram-Negative Nosocomial Bacteremia: A Possible Relationship With Infusate Contamination
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *