PYROGENIC REACTIONS IN PATIENTS UNDERGOING CARDIAC-CATHETERIZATION ASSOCIATED WITH CONTAMINATED GLASS MEDICINE CUPS

Pyrogenic reactions are potentially life-threatening complications cau sed by bacterial endotoxin, After two cardiac catheterization patients developed rigors the same day, the procedures were halted and a case control study was conducted. To identify case patients (persons with r igors less than or equal to 3 hr after catheterization during Septembe r 25-November 9, 1995), we reviewed medical records of all cardiac cat heterization patients who had a blood culture or received intravenous meperidine. Twelve case patients and 40 randomly selected control pati ents were identified. No specific catheter was associated with case pa tients, but exposure to intracoronary-nitroglycerin (NTG) was (odds ra tio = 12.0; 95% confidence interval 2.2, 75.6). NTG or indocyanine gre en dye was poured into glass medicine cups previously washed in an enz yme cleaner and then sterilized. The cleaner, used for an entire day, had elevated levels of gram-negative bacteria (>10(4) colony forming u nits/mL) and endotoxin (434 endotoxin units [EU]/mL]); the reprocessed cups had no live bacteria but had elevated endotoxin levels (median 2 ,250 EU). Exposure to contaminated glass medicine cups probably result ed in pyrogenic reactions and contributed to death in two critically i ll patients. (C) 1997 Wiley-Liss, Inc.