ENTEROBACTER-CLOACAE AND PSEUDOMONAS-AERUGINOSA POLYMICROBIAL BLOOD-STREAM INFECTIONS TRACED TO EXTRINSIC CONTAMINATION OF A DEXTROSE MULTIDOSE VIAL

Objective: To identify risk factors for polymicrobial bloodstream infe ctions (BSIs) in neonatal intensive care unit (NICU) patients during a n outbreak of BSIs. Design: During an outbreak of BSIs, we conducted a retrospective cohort study, assessed NICU infection control practices and patient exposure to NICU healthcare workers (HCWs), and obtained cultures of the environment and HCW hands. Patients: During the period May 3 to 7, 1996, 5 infants contracted BSIs caused by both Enterobact er cloacae and Pseudomonas aeruginosa, and one infant contracted a BSI caused by E cloacae only. For each pathogen, all isolates were identi cal on DNA typing Results: Infants exposed to the following were more likely than nonexposed infants to have BSI: umbilical venous catheters (6/14 vs 0/7, P =.05), total parenteral nutrition given simultaneousl y with a dextrose/electrolyte solution (6/12 vs 0/9, P =.02), or one H CW (5/7 vs 1/13, P =.007). Neither environmental nor HCW hand cultures yielded the outbreak pathogens. Quality control cultures of intraveno us solution bags were negative. Conclusions: We speculate that a dextr ose multidose vial became contaminated during manipulation or needle p uncture and that successive use of this contaminated vial for multiple patients may have been responsible for BSIs. Aseptic techniques must be employed when multidose vial medications are used. Single-dose vial s should be used for parenteral additives whenever possible to reduce the risk of extrinsic contamination and subsequent transmission of nos ocomial pathogens.