POSTOPERATIVE INFECTIONS TRACED TO CONTAMINATION OF AN INTRAVENOUS ANESTHETIC, PROPOFOL

Background. Between June 1990 and February 1993, the Centers for Disea se Control and Prevention conducted investigations at seven hospitals because of unusual outbreaks of bloodstream infections, surgical-site infections, and acute febrile episodes after surgical procedures. Meth ods. We conducted case-control or cohort studies, or both, to identify risk factors. A case patient was defined as any patient who had an or ganism-specific infection or acute febrile episode after a surgical pr ocedure during the study period in that hospital. The investigations a lso included reviews of procedures, cultures, and microbiologic studie s of infecting, contaminating, and colonizing strains. Results. Sixty- two case patients were identified, 49 (79 percent) of whom underwent s urgery during an epidemic period. Postoperative complications were mor e frequent during the epidemic period than before it. Only exposure to propofol, a lipid-based anesthetic agent, was significantly associate d with the postoperative complications at all seven hospitals. In six of the outbreaks, an etiologic agent (Staphylococcus aureus, Candida a lbicans, Moraxella osloensis, Enterobacter agglomerans, or Serratia ma rcescens) was identified, and the same strains were isolated from the case patients. Although cultures of unopened containers of propofol we re negative, at two hospitals cultures of propofol from syringes curre ntly in use were positive. At one hospital, the recovered organism was identical to the organism isolated from the case patients. Interviews with and observation of anesthesiology personnel documented a wide va riety of lapses in aseptic techniques. Conclusions. With the increasin g use of lipid-based medications, which support rapid bacterial growth at room temperature, strict aseptic techniques are essential during t he handling of these agents to prevent extrinsic contamination and dan gerous infectious complications.