A CLUSTER OF FEVER AND HYPOTENSION ON A SURGICAL INTENSIVE-CARE UNIT RELATED TO THE CONTAMINATION OF PLASMA EXPANDERS BY CELL-WALL PRODUCTSOF BACILLUS-STEAROTHERMOPHILUS

OBJECTIVE: To evaluate an outbreak of fever and hypotension after card iac surgical procedures and the role of polygeline, a plasma expander. DESIGN: Unmatched case-control study. SETTING: A six-bed cardiac surg ery intensive care unit (SICU) of the Hospital Clinic of Barcelona (Sp ain), a 940-bed public teaching hospital. PATIENTS: Eight cases and 25 control patients admitted to the SICU over a 4-week epidemic period. MAIN OUTCOME MEASURES: Development of hypotension (systolic blood pres sure less than or equal to 90 mm Hg or a drop of 40 mm Hg from baselin e systolic blood pressure) and fever (axillary temperature >38.5 degre es C) within 24 hours of a cardiac surgical procedure. RESULTS: The si ngle risk factor significantly different between cases and controls wa s the total volume of polygeline used throughout the surgical procedur e for extracorporeal circulation: a median of 1,250 mL (mean, 1,312.5 +/- 842.5 mL) in cases versus 500 mL (mean, 566.0 +/- 159.9 mL) in con trols (P=.0029). By multiple logistic regression analysis, polygeline use was the single risk factor significantly related to the outcome (o dds ratio, 8.75; CI95, 1.36 to 56.2; P=.01). Neither blood cultures fr om patients nor cultures of the polygeline used yielded growth of any microorganism. Stopping use of the implicated polygeline lot controlle d the outbreak. CONCLUSIONS: Use of polygeline was associated with an outbreak of fever and hypotension in a SICU. Information from the manu facturer indicated the likelihood of contamination of the product with Bacillus stearothermophilus components. The manufacturer has since ch anged the production and control processes, and no further adverse eve nts have been seen (Infect Control Hosp Epidemiol 1995;16:335-339).