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Salvage of Long-Term Central Venous Catheters During an Outbreak of Pseudomonas putida and Stenotrophomonas maltophilia Infections Associated With Contaminated Heparin Catheter-Lock Solution

Published online by Cambridge University Press:  02 January 2015

M. Beatriz Souza Dias ,
Alina Bernardes Habert ,
Vera Borrasca ,
Valeska Stempliuk ,
Aina Ciolli ,
M. Rita E. Araújo ,
Silvia F. Costa  and
Anna S. Levin
M. Beatriz Souza Dias
Affiliation:
Infection Control Department, Hospital Sírio Libanês, University of São Paulo, Brazil
Alina Bernardes Habert
Affiliation:
Infection Control Department and LIM 54, Hospital das Clínicas, University of São Paulo, Brazil Department of Infectious Diseases, University of São Paulo, Brazil
Vera Borrasca
Affiliation:
Infection Control Department, Hospital Sírio Libanês, University of São Paulo, Brazil
Aina Ciolli
Affiliation:
Infection Control Department, Hospital Sírio Libanês, University of São Paulo, Brazil
M. Rita E. Araújo
Affiliation:
Infection Control Department, Hospital Sírio Libanês, University of São Paulo, Brazil
Silvia F. Costa
Affiliation:
Infection Control Department and LIM 54, Hospital das Clínicas, University of São Paulo, Brazil Department of Infectious Diseases, University of São Paulo, Brazil
Anna S. Levin*
Affiliation:
Infection Control Department, Hospital Sírio Libanês, University of São Paulo, Brazil
*
Rua Banibas, 618, São Paulo-SP 05460-010, Brazil (gcih@hcnet.usp.br)
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Abstract

Objective.

To describe the management of patients with long-term central venous catheters (CVCs) during an outbreak of infection due to Pseudomonas putida and Stenotrophomonas maltophilia associated with contaminated heparin catheter-lock solution.

Design.

Descriptive study.

Setting.

Private, 250-bed tertiary-care hospital.

Methods.

In March 2003, we identified 2 febrile cancer patients with P. putida bacteremia. Over 2 days, 7 cases of bacteremia were identified; lots of syringes prefilled with heparin catheter-lock solution, supplied by a compounding pharmacy, were recalled and samples were cultured. More cases of bacteremia appeared during the following days, and any patient who had had a catheter lock infused with the suspect solution was asked to provide blood samples for culture, even if the patient was asymptomatic. Isolates that were recovered from culture were typed by pulsed-field gel electrophoresis. Antimicrobial salvage treatment of long-term CVCs was attempted.

Results.

A total of 154 patients had had their catheter lock infused with solution from the lots that were suspected of being contaminated. Only 48 of these patients had CVCs. By day 7 of the outbreak, 18 of these patients had become symptomatic. Twenty-six of the remaining 30 asymptomatic patients then also provided blood samples for culture, 10 of whom developed fever shortly after samples were collected. Thirty-two patients were identified who had P. putida bacteremia; 9 also had infection due to S. maltophilia. Samples from 1 of the 3 lots of prefilled syringes in use at the time of the outbreak also grew P. putida on culture. Molecular typing identified 3 different clones of P. putida from patients and heparin catheter-lock solution, and 1 clone of S. maltophilia. A total of 27 patients received antimicrobial therapy regimens, some of which included decontamination of the catheter lock with anti-infective lock solution. Of 27 patients, 19 (70%) retained their long-term CVC during the 6-month follow-up period.

Conclusions.

To our knowledge, this is one of the largest prospective experiences in the management of bloodstream infection associated with long-term CVCs. The infections were caused by gram-negative bacilli and were managed without catheter removal, with a high response rate. We emphasize the risks of using intravenous formulations of medications supplied by compounding pharmacies that produce large quantities of drugs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 2 , February 2008 , pp. 125 - 130
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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