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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 ,
Isabel Hernández-Ramos ,
Juan M. Muñoz-Barrett ,
Enrique Vargas-Salado ,
Francisco J. Guerrero-Martínez ,
Humberto Medina-Valdovinos ,
Jesus Hernández-Hernández  and
Samuel Ponce-de-León-Rosales
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
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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
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 5 , May 1996 , pp. 276 - 280
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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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;131:267–272.CrossRefGoogle Scholar
2. Band, JD, Maki, DG. Safety of changing intravenous delivery systems at longer than 24-hour intervals. Ann Intern Med 1979;91:173–178.CrossRefGoogle ScholarPubMed
3. Maki, DG, Goldmann, DA, Rhame, FS. Infection control in intravenous therapy. Ann Intern Med 1973;79:867–887.CrossRefGoogle ScholarPubMed
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;77:881–890.CrossRefGoogle 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;2:486–497.CrossRefGoogle ScholarPubMed
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; 1989:161–177.Google Scholar
7. Goldmann, DA, Pier, GB. Pathogenesis of infections related to intravascular catheterization. Clin Microbiol Rev 1993;6:176–192.CrossRefGoogle ScholarPubMed
8. Raad, II, Bodey, GP. Infectious complications of indwelling vascular catheters. Clin Infect Dis 1992;15:197–210.CrossRefGoogle ScholarPubMed
9. Mosca, R, Curtas, S, Forbes, B, Meguid, MM. The benefits of isolator cultures in the management of suspected catheter sepsis. Surgery 1987;102:718–723.Google ScholarPubMed
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;64:1747–1752.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
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;46:295–300.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;42:306–309.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;48:538–543.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;39:806–811.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;10:14–20.CrossRefGoogle Scholar
16. Pérez, A. Hemocultivos: experiencia del Hospital Infantil de México (1990-1991). Enferm Infecc Microbiol Clin 1992;12:188–191.Google Scholar
17. Martin, MA, Pfaller, MA, Wenzel, RP. Coagulase-negative staphylococcal bacteremia. Ann Intern Med 1989;110:9–16.CrossRefGoogle ScholarPubMed
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;144:324–329.Google ScholarPubMed
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;15:141–147.CrossRefGoogle ScholarPubMed
20. Kirchhoff, LV, Sheagren, JN. Epidemiology and clinical significance of blood cultures positive for coagulase-negative Staphylococcus . Infect Control 1985;5:479–486.CrossRefGoogle 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;89:696–700.CrossRefGoogle ScholarPubMed
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; 1991:360–383.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;258:1777–1781.CrossRefGoogle ScholarPubMed
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;251:2112–2115.CrossRefGoogle ScholarPubMed
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;265:981–986.CrossRefGoogle Scholar
26. Ponce de León, RS. Reflexiones sobre la calidad de la atención médica en México. Rev Invest Clin 1992;44:445–446.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;28:29–36.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;31:481–492.Google Scholar